Bedside intracoronary thrombolysis in the coronary care unit

Using a mobile X-ray unit in the coronary care unit (CCU), intracoronary streptokinase (IC STK) administration was performed in 20 patients with acute myocardial infarction who arrived 2 to 5 hours after onset of symptoms. IC STK was infused at a rate of 4000 U/min. Of 20 patients, 17 had complete and 3 subtotal occlusion of the infarct-related artery. The IC STK infusion resulted within 15 to 80 min in reperfusion in 12 of 17 patients with occluded artery (70%). One patient died, 4 patients underwent early bypass grafting, in one PTCA was attempted and in one a femoral A-V fistula caused by the procedure required surgical revision. IC STK infusion is much more economical if performed in the CCU and the 24-hour coverage can be provided by an experienced invasive cardiologist on call service.