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Systemic thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction
F Leisch1, W Schützenberger, K Kerschner
1First Department of Internal Medicine (Cardiology), General Hospital, Linz, Austria.
Insights
Intravenous high-dose streptokinase effectively recanalized infarct arteries in acute myocardial infarction patients. Early revascularization with percutaneous transluminal coronary angioplasty (PTCA) reduced reinfarction rates, improving left ventricular function.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Intravenous streptokinase is a common treatment for acute myocardial infarction.
- It achieves clinically relevant recanalization rates with low complication incidence.
Purpose of the Study:
- To evaluate the efficacy of intravenous streptokinase followed by percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction.
- To assess the impact on reinfarction rates, hospital mortality, and left ventricular function.
Main Methods:
- 150 patients with acute myocardial infarction received intravenous streptokinase (1.5 million units).
- Early revascularization with PTCA was performed in 95 patients.
- Angiographic assessment of restenosis and left ventricular function was conducted.
Main Results:
- 78% of patients demonstrated an antegrade perfused infarct artery after streptokinase treatment.
- Early revascularization reduced reinfarction from 15% to 7%.
- PTCA success rate was 81%, with a 28% restenosis rate. Improved left ventricular function was observed in patients without restenosis.
Conclusions:
- Intravenous streptokinase followed by PTCA is a viable and promising treatment for acute myocardial infarction.
- This combined approach can reduce reinfarction and improve cardiac function.
Abstract:
Intravenous high-dose infusion of streptokinase in acute evolving myocardial infarction is a widely used therapeutic concept with clinically relevant recanalization rates and low complications. In our experience with 150 patients and acute myocardial infarction treated with intravenous streptokinase (1.5 Mio U), 107 (78 p. 100) of 137 patients demonstrated an antegrade perfused infarct artery. In a group of patients (n = 95), in whom early revascularization was performed, the incidence of reinfarction was reduced from 15 p. 100 to 7 p. 100; hospital mortality was not influenced (3.6 p. 100 vs 4.3 p. 100). PTCA was successful in 39 of 48 patients (81 p. 100). The incidence of angiographically determined restenosis amounted to 28 p. 100 (9/32). Patients after successful PTCA without restenosis demonstrated an improvement of left ventricular function in contrast to patients with restenosis or reocclusions. Thus, intravenous streptokinase followed by PTCA presents a clinically practicable and promising method for treatment of acute myocardial infarction.