Intracoronary thrombolytic treatment in myocardial infarction and unstable angina pectoris

The authors report on 18 patients with fresh transmural myocardial infarction (MI) and 5 patients with an abrupt change of stable into unstable angina pectoris (AP), in whom superselective intracoronary thrombolysis (SIT) was performed. All patients with unstable AP showed an improvement of subjective complaints and increased tolerance of exercise, even though a demonstrable angiographic effect of SIT was found only in 1 patient. Coronary occlusion disappeared in 13 patients with MI (72%). A significant improvement of local kinetic disturbances and of the global left ventricular function occurred in 50%, in-hospital death occurred only in the group in which recanalization did not succeed. Emphasis is placed on the necessity of checking the effect of SIT not only by documenting correction, of the coronary occlusion but also by evaluating the size of MI and the extent of disturbances of local and total left ventricular kinetics. The most accurate and practical method for this purpose is two-dimensional echocardiography. The authors developed their own echocardiographic indicators of the infarction focus--asynergy extent and asynergy index.