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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Published on: August 18, 2016

Coronary angiography during acute myocardial infarction: a search for spasm

R C Leinbach, H K Gold

    American Heart Journal
    |April 1, 1982
    PubMed

    Insights

    Early left anterior descending (LAD) obstruction in myocardial infarction is often caused by coronary thrombosis. Intracoronary nitroglycerin and streptokinase show potential in restoring blood flow, suggesting thrombosis as the primary occlusive process.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Vascular Medicine

    Background:

    • Transmural anterior myocardial infarction indicates severe coronary artery blockage.
    • Understanding the early mechanism of obstruction is crucial for timely intervention.

    Purpose of the Study:

    • To investigate the mechanism of left anterior descending (LAD) artery obstruction in acute myocardial infarction.
    • To evaluate the efficacy of nitroglycerin and streptokinase in managing LAD obstruction.

    Main Methods:

    • Studied 30 patients with transmural anterior myocardial infarction.
    • Administered nitroglycerin via sublingual, intravenous, and intracoronary routes.
    • Performed coronary angiography within 6 hours of symptom onset.

    Main Results:

    • Sublingual nitroglycerin reduced ST elevation in 2 patients; intravenous nitroglycerin had no effect.
    • Intracoronary nitroglycerin improved LAD flow in one patient.
    • Seventeen patients showed filling defects suggestive of intracoronary thrombus; streptokinase was effective in 80% of treated cases.

    Conclusions:

    • Coronary thrombosis appears to be the dominant occlusive process early in myocardial infarction.
    • Intracoronary thrombolysis with streptokinase may be effective in selected cases.
    • Further investigation into the role of thrombosis and its treatment is warranted.

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