Myocardial metabolism during intracoronary thrombolysis. Two illustrative cases

Arterial and coronary sinus difference for potassium, lactate, glucose, free fatty acids and creatine kinase was measured every 5 minutes in two patients undergoing successful intracoronary thrombolysis of left anterior descending occlusion. In the first patient, reperfusion, 160 minutes after the onset of pain, was followed by a transient and limited release of creatine kinase in the coronary sinus, improvement in the electrocardiogram and restitution of left ventricular contraction. In the second patient, reperfusion 365 minutes after the onset of pain, was also accompanied by a limited release of creatine kinase. Reocclusion of the left anterior descending coronary artery, however, necessitated further thrombolysis which led to a massive release of creatine kinase and permanent loss of wall-motion. It is suggested that, in this case, reperfusion damage had occurred. The arteriovenous differences showed a wash-out of potassium and lactate during reperfusion in each case. The interpretation of the entire sequence of arteriovenous changes, however, could be shown to depend critically on the state of regional perfusion.