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Intracoronary thrombolysis 3 to 13 days after acute myocardial infarction for postinfarction angina pectoris
Insights
Intracoronary streptokinase can successfully lyse old coronary thrombi in patients experiencing acute myocardial infarction (AMI) angina. This treatment restores blood flow, reduces angina episodes, and enables further interventions like angioplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombolysis
Background:
- Restoration of coronary blood flow after acute myocardial infarction (AMI) is crucial for managing ongoing ischemia.
- Older intracoronary thrombi present a challenge for recanalization therapies.
- Persistent angina post-AMI indicates ongoing myocardial ischemia and warrants therapeutic intervention.
Purpose of the Study:
- To assess the efficacy of intracoronary streptokinase in lysing "old" coronary thrombi.
- To determine if recanalization of occluded infarct arteries improves outcomes in patients with post-AMI angina.
- To evaluate the impact of thrombolysis on reducing angina episodes and facilitating subsequent interventions.
Main Methods:
- Eighteen patients with evolving AMI and persistent angina underwent treatment with intracoronary streptokinase 3-13 days after AMI onset.
- Successful recanalization was defined by the restoration of anterograde coronary flow.
- Angina episodes were compared before and after treatment in patients with successful versus unsuccessful recanalization.
Main Results:
- Successful arterial recanalization was achieved in 12 out of 18 patients (67%) approximately 7 days after AMI.
- In patients with successful reperfusion, the mean daily episodes of angina at rest significantly decreased (from 1.02 to 0.09).
- Patients without successful reperfusion showed no significant reduction in angina episodes (from 1.07 to 0.88), highlighting the benefit of restored flow (p=0.027).
Conclusions:
- Intracoronary streptokinase is effective in restoring flow through "old" coronary thrombi in the early post-AMI period.
- Successful thrombolysis can significantly decrease the frequency of angina episodes in patients with post-AMI ischemia.
- This approach enables percutaneous coronary intervention (PCI) in select patients, offering a potential therapeutic strategy for refractory angina after AMI.
Abstract:
The restoration of anterograde coronary flow long after coronary thrombosis may be of benefit to patients with continuing ischemia. To determine whether "old" intracoronary thrombi are susceptible to lysis with thrombolytic agents, 18 patients with angina at rest during evolving acute myocardial infarction (AMI) and total occlusion of the infarct vessel were treated with intracoronary streptokinase 3 to 13 days after onset of AMI. In 12 of the 18 patients (67%), successful recanalization of the artery was achieved 6.9 +/- 2.7 days after AMI. Thrombolysis was followed by coronary angioplasty in 2 patients. To evaluate the efficacy of this approach in reducing post-AMI ischemia, the number of episodes of angina at rest was compared in patients with successful and unsuccessful attempts at recanalization. Even in patients without angioplasty, the mean number of daily episodes decreased from 1.02 +/- 0.6 to 0.09 +/- 0.2 in patients in whom reperfusion was achieved, and from 1.07 +/- 0.8 to 0.88 +/- 0.8 in those in whom it was not (p = 0.027 for the difference between the groups). Thus, in patients with early post-AMI angina, intracoronary streptokinase can restore flow in the occluded artery, may decrease the frequency of angina, and allows angioplasty to be performed.