Systemic versus intracoronary thrombolysis in acute myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombolytic Therapy

Background:

• Complete coronary artery occlusion requires prompt restoration of blood flow to prevent myocardial damage.
• Thrombolytic therapy, using agents like streptokinase, is a key treatment strategy for acute myocardial infarction.
• Comparing intravenous and intracoronary administration routes is crucial for optimizing treatment efficacy.

Purpose of the Study:

• To review and compare the recanalization rates and thrombus lysis times of intravenous versus intracoronary streptokinase (SK) for occluded coronary arteries.
• To evaluate the utility of serum enzyme curves (MB-CK) in assessing coronary blood flow restoration.
• To determine the impact of early reperfusion on preserving jeopardized myocardium in acute myocardial infarction.

Main Methods:

• Review of published reports on streptokinase infusion for coronary artery occlusion.
• Analysis of recanalization rates and thrombus lysis times for both intravenous and intracoronary SK.
• Assessment of serial serum enzyme curves (MB-CK) to estimate coronary blood flow.
• Angiographic evaluation of left ventricular wall motion abnormalities in relation to treatment timing.

Main Results:

• Intravenous SK infusion achieved a 58% recanalization rate, compared to 77% for intracoronary SK.
• Thrombus lysis time was longer with intravenous SK compared to intracoronary administration.
• Thrombus age significantly influences lysis time.
• Early treatment (within 3 hours) with restored coronary blood flow preserved jeopardized myocardium, as indicated by improved left ventricular wall motion.

Conclusions:

• Intracoronary streptokinase demonstrates a higher recanalization rate than intravenous infusion for occluded coronary arteries.
• Early restoration of coronary blood flow, particularly within 3 hours of acute myocardial infarction, is critical for myocardial salvage.
• MB-CK enzyme curves provide valuable insights into the effectiveness of reperfusion therapy.