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Intracoronary thrombolysis in evolving myocardial infarction. Sequential angiographic analysis of left ventricular
Insights
Early coronary recanalisation using streptokinase in acute myocardial infarction (AMI) improves heart function. Successful recanalisation preserved ejection fraction and improved regional wall motion, demonstrating partial myocardial salvage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Acute myocardial infarction (AMI) poses significant mortality risks.
- Early restoration of blood flow to the infarct-related artery is crucial for myocardial salvage.
- Streptokinase infusion offers a potential therapeutic option for coronary recanalisation.
Purpose of the Study:
- To evaluate the efficacy of local streptokinase infusion for coronary recanalisation in evolving AMI.
- To assess the impact of successful recanalisation on left ventricular function and myocardial salvage.
- To investigate the long-term effects of recanalisation on regional wall motion and ejection fraction.
Main Methods:
- Left ventricular angiography and coronary arteriography were performed in 80 patients with evolving AMI.
- Streptokinase infusion was administered an average of 3.6 hours after symptom onset.
- Sequential angiographic studies (21 days and 3 months) assessed infarct-related artery patency and left ventricular function (ejection fraction, regional wall motion).
Main Results:
- Successful recanalisation was achieved in 64% of patients.
- Patients with successful recanalisation (Group 1) showed preserved ejection fraction and improved regional wall motion at follow-up.
- Patients without successful recanalisation or with reocclusion (Group 2) experienced a significant decrease in ejection fraction and worsening regional wall motion.
- No serious procedure-related complications were noted.
Conclusions:
- Early coronary recanalisation with streptokinase in AMI results in partial myocardial salvage.
- Maintaining infarct-related artery patency is associated with improved left ventricular function and regional wall motion.
- Sequential angiographic assessment is valuable for evaluating the long-term impact of recanalisation therapies.
Abstract:
Since November 1979 left ventricular angiography and coronary arteriography have been performed in 80 patients with evolving acute myocardial infarction in order to attempt coronary recanalisation by local streptokinase infusion. The average delay between the onset of symptoms and streptokinase infusion was 3.6 hours. Thrombolysis was successful in 64% of cases. No serious complications related to the procedure were noted. Of the 12 patients in cardiogenic shock, recanalisation was achieved in only four, of whom two survived. To evaluate the left ventricular salvage resulting from early recanalisation the last 58 patients had a second left ventricular angiogram and further coronary arteriograms 21 +/- 10 days later and 16 patients had a third study three months later. From the left ventricular angiogram in the right anterior oblique projection the ejection fraction and two graphic variables of regional wall motion were computed quantifying the hypokinetic zone. Patients were divided into two groups, according to the patency of the infarct related artery at the second control: group 1 consisted of 28 patients with successful recanalisation confirmed, and group 2 of 30 patients in whom no recanalisation was achieved or secondary reocclusion had occurred. At the second study the ejection fraction was unchanged in group 1 but had significantly decreased in group 2. Regional wall motion improved in group 1 and worsened in group 2, more so in patients without recanalisation than in those in whom secondary reocclusion had occurred. The third study showed a further decrease in ejection fraction in group 2. A progressive decrease in percentage residual stenosis was observed in group 1. This sequential angiographic study confirms the partial myocardial salvage resulting from early coronary recanalisation during acute myocardial infarction.