Related Experiment Videos
Intracoronary thrombolysis and coronary angioplasty for evolving myocardial infarction
H D Theron1, J D Marx, P H Kleynhans
1Department of Cardiology, University Orange Free State, Bloemfontein.
Insights
Emergency percutaneous transluminal coronary angioplasty (PTCA) effectively restores blood flow in acute myocardial infarction. This study shows PTCA, with or without thrombolysis, is a safe and effective reperfusion strategy in South Africa.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Limited experience with coronary reperfusion in acute myocardial infarction (MI) in South Africa.
- Acute reperfusion is critical for improving outcomes in MI patients.
Purpose of the Study:
- To evaluate the efficacy and safety of intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) for acute coronary reperfusion in South Africa.
- To assess early and late outcomes, including vessel patency and left ventricular function.
Main Methods:
- Retrospective analysis of 55 patients undergoing acute reperfusion for MI.
- Interventions included intracoronary streptokinase and PTCA.
- Coronary angiography, vessel patency assessment, and left ventricular function evaluation were performed.
Main Results:
- PTCA was successful in 87% of cases (48/55).
- Early vessel patency was achieved in 36/39 patients at 1 week.
- No procedure-related deaths occurred; 27% of patients showed preserved left ventricular function at follow-up.
Conclusions:
- Emergency PTCA, alone or combined with thrombolysis, is an effective strategy for achieving coronary reperfusion in acute MI.
- The procedure demonstrates a favorable safety profile with no procedure-related deaths.
- Left ventricular function can be well-preserved in a significant proportion of patients with patent infarct-related arteries.
Abstract:
At present experience in South Africa with coronary reperfusion during the acute phase of myocardial infarction is limited. Acute reperfusion of an infarct-related coronary artery was attempted in 55 patients using intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA). Intracoronary streptokinase infusion had reopened 25 to 40 totally occluded lesions but usually a residual severe stenosis remained. PTCA was subsequently attempted in 36 severely stenotic coronary arteries and 19 totally occluded coronary arteries. PTCA was successful in 48 of the 55 cases (87%). After 1 week vessel patency was present in 36 of the 39 patients who had early coronary artery re-assessment. Late restenosis occurred in 4 out of 14 cases. There were no procedure-related deaths. Normal global as well as regional left ventricular function was present in 15 cases after 1 week. Emergency PTCA alone or in combination with intracoronary thrombolytic therapy is efficacious in achieving coronary reperfusion. On follow-up, left ventricular function appeared to be well preserved in 27% of patients with patent infarct-related arteries.