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[Intracoronary lysis of acute myocardial infarct]
Insights
Intracoronary streptokinase effectively achieved thrombolysis in 83% of acute myocardial infarction patients with thrombotic occlusion. However, significant residual stenosis and reocclusion remained concerns post-treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombolytic Therapy
Background:
- Acute myocardial infarction (AMI) necessitates rapid reperfusion to salvage myocardial tissue.
- Thrombotic occlusion of coronary arteries is a primary cause of AMI.
- Early intervention aims to restore blood flow and improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of intracoronary streptokinase administration in patients with acute myocardial infarction.
- To assess thrombolysis rates, residual stenosis, and early clinical outcomes following treatment.
- To investigate the incidence of reinfarction, need for bypass surgery, and reocclusion.
Main Methods:
- Twenty-one patients with AMI and pain duration < 3 hours were included.
- Coronary angiography was performed to identify vessel occlusion or stenosis.
- Intracoronary streptokinase was administered at a rate of 2000-4000 U/min.
- Angiographic and clinical follow-up was conducted.
Main Results:
- Thrombolysis was achieved in 15 of 18 patients (83%) with thrombotic occlusion.
- Significant residual stenosis (≥80%) was observed in most patients post-thrombolysis.
- Two patients died from pump failure; two experienced reinfarction; four required bypass surgery.
- Reocclusion occurred in 3 cases by the fourth week, with 2 associated with reinfarction.
- Mean ejection fraction remained stable in patients with persistent recanalization.
Conclusions:
- Intracoronary streptokinase is effective in achieving thrombolysis in a high percentage of selected AMI patients.
- Significant residual stenosis and the risk of reocclusion are important considerations.
- Further management strategies, including bypass surgery, may be necessary for optimal outcomes.
Abstract:
A report is presented on 21 patients admitted with acute myocardial infarction in whose pain duration had not exceeded three hours. The coronary angiogram revealed occlusion of the supply-vessel to the infarcted area in 18 patients and only subtotal stenosis in the 3 remaining cases. Intracoronary administration of streptokinase (2000 to 4000 U/min) achieved thrombolysis in 15 out of 18 patients (83%) with thrombotic occlusion. All patients with exception of 2 patients revealed after thrombolysis a greater than or equal to 80% remaining stenosis. 2 patients without successful recanalisation died due to pump failure on the first or fourth day, respectively, following myocardial infarction. Reinfarction occurred in 2 patients out of successful treated cases, 4 patients required aortocoronary bypass-surgery for impending reinfarction or unstable angina pectoris. Angiographic control in the fourth week following myocardial infarction demonstrated reocclusion of the corresponding vessel in 3 cases, 2 of whose had a reinfarction. There was no change in the mean ejection fraction in the patients with persistent recanalisation between the acute and the chronic stage of infarction.