[Pharmacologic myocardial revascularization in acute infarct. Experience with 52 cases]

Coronary thrombosis is frequently demonstrated in the early hours of acute myocardial infarction. Local infusion of thrombolytic agents has been proposed in order to dissolve intracoronary thrombi and to restore myocardial perfusion. We report our initial experience in 52 patients. Thirty-nine males and 13 females had a coronary angiogram performed within 5 hours from the beginning of persistent ischemic pain (mean 2h 34 min +/- 68 min; range 20 min--5h 30 min). In all an ST segment elevation was documented on an ECG recording. Coronary occlusion was found in 86.5% (45/52) of our cases. Flow restoration was obtained in 39 of 45 of patients (86.6%) within 45 +/- 28 min. The mean dose of streptokinase employed was 272,140 +/- 112,484 IU (range 120,000--400,000 IU). Myocardial reperfusion was accompanied by the reduction of ischemic pain and ST elevation. In 8 cases severe ventricular arrhythmias occurred. Serious haemorrhagic complications were observed only in one patient. Eight patients developed a new myocardial infarction within few days from the procedure and two died 2 hours and 6 days respectively after myocardial revascularization. Thirty-two of thirty-nine patients underwent a angiographic control study within 11-128 days and coronary patency was shown in 75% (24/32). Seven patients underwent a coronary artery bypass procedure. At surgical inspection no clear evidence of myocardial necrosis was observed. Coronary flow restoration is rapidly and safely obtained i acute myocardial infarction by means of intracoronary streptokinase infusion but the efficacy of the procedure in salvaging myocardium has not been demonstrated yet.