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[Intracoronary streptokinase in acute myocardial infarct. Experience with 461 patients]
Insights
This study investigated thrombolytic therapy for acute myocardial infarction. Early reperfusion with streptokinase, particularly via percutaneous transluminal coronary angioplasty (PTCA) or bypass surgery, significantly reduced mortality compared to conservative treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Acute myocardial infarction (AMI) involves thrombus formation causing coronary artery occlusion.
- Timely reperfusion is critical for salvaging myocardium and improving outcomes in AMI patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of selective intracoronary streptokinase infusion for thrombolysis in patients with AMI.
- To compare mortality rates across different treatment strategies including PTCA, bypass surgery, and conservative management.
Main Methods:
- Coronary angiography was performed on 461 AMI patients between March 1980 and July 1984.
- Selective intracoronary streptokinase infusion was used to lyse partially or completely obstructing thrombi.
- Treatment groups included high-grade stenosis without occlusion (Group A), successful reperfusion (Group B), and failed reperfusion (Group C).
- Subsequent treatments involved PTCA, bypass surgery, or conservative management based on vessel disease and occlusion time.
Main Results:
- Successful reperfusion was achieved in 86% of patients with complete occlusion.
- 30-day mortality was 14% in failed reperfusion (Group C), 7.8% in conservative treatment (Groups A & B), and 3.1% after successful PTCA.
- The lowest mortality (2.6%) was observed in patients with short occlusion times undergoing early bypass operations.
- One-year mortality rates were 21.2% for conservative treatment, 9.3% for PTCA, and 6.4% for bypass surgery.
Conclusions:
- Intracoronary streptokinase infusion is effective in achieving reperfusion in AMI.
- Early revascularization through PTCA or bypass surgery significantly improves short-term and long-term survival rates in AMI patients.
- Cardiogenic shock remains a primary cause of mortality, highlighting the importance of rapid and successful reperfusion.
Abstract:
Between March 1980 and July 1984, coronary angiography was performed on 461 consecutive patients (no age limit) with acute myocardial infarction, and the partially or completely obstructing thrombus lysed by selective intracoronary infusion of streptokinase. At the time of first coronary angiography 96 patients (21%) had a high degree of stenosis but no total occlusion of the infarct vessel (group A). In 365 patients (79%) there was complete occlusion which in 315 patients (86%) was removed successfully after an occlusion period of 213 +/- 87 minutes (group B). In 50 patients (14%) (group C) attempts at reperfusion failed. In 129 of 163 patients (79.1%) with one-vessel disease, PTCA (percutaneous transluminal coronary angioplasty) was successful. Patients with multiple-vessel disease and an occlusion time of less than four hours, on the other hand, were treated surgically within the first ten days (78 patients). In the remaining 254 patients conservative treatment was practised. Within the first 30 days there were seven deaths (14%) in group C, while among group A and B patients, under conservative treatment, 16 died (7.8%). After successful PTCA four patients (3.1%) died. The lowest mortality was among patients with a short occlusion time and early bypass operation (2.6%). The most frequent cause of death was cardiogenic shock (20 of 29 patients), more rarely ventricular fibrillation (3) or other causes (4). Ventricular rupture occurred in three patients, one of whom was saved by pericardial tap. One year later the mortality among the conservative group was 21.2%, after successful PTCA or bypass operation 9.3% and 6.4%, respectively.