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Thrombolytic therapy for acute myocardial infarction-effects, problems and strategies
K Nagao1, K Kanmatsuse, N Kajiwara
1Department of Cardiology, Surugadai Nihon Unversity Hospital, Tokyo, Japan.
Insights
Coronary thrombolysis (CT) significantly reduces mortality in acute myocardial infarction (AMI) patients by restoring blood flow. Further strategies like percutaneous coronary angioplasty (PTCA) improve outcomes in cases with ineffective thrombolysis.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) poses significant mortality risks.
- Coronary thrombolysis (CT) is a critical treatment for AMI.
- Evaluating CT's effectiveness and associated problems is essential for optimizing patient care.
Purpose of the Study:
- To investigate the effects and problems of coronary thrombolysis (CT) in patients with acute myocardial infarction (AMI).
- To assess the impact of CT on mortality, left ventricular ejection fraction (LVEF), and long-term prognosis.
- To evaluate the efficacy of supplemental intracoronary arterial thrombolysis (ICT) and rescue percutaneous coronary angioplasty (PTCA) in improving outcomes.
Main Methods:
- Retrospective analysis of 652 patients with initial AMI.
- Comparison of outcomes between patients treated with CT and those not treated.
- Implementation of strategies including supplemental ICT and deferred PTCA in a subset of 80 patients.
Main Results:
- CT significantly lowered nosocomial mortality (8.3% vs 18.1%).
- Successful coronary artery reperfusion was the primary driver of decreased mortality (6.1% vs 21.5% in ineffective group).
- Combined strategies (A and B) reduced nosocomial mortality from 8.5% to 3.8%, decreasing death risk by 55.3%.
Conclusions:
- Coronary thrombolysis is effective in reducing mortality and improving cardiac function in AMI patients.
- Successful reperfusion is key to favorable outcomes, even when delayed.
- Adjunctive strategies like PTCA significantly enhance reperfusion rates and reduce mortality in complex cases.
Abstract:
The effects and problems of coronary thrombolysis (CT) were investigated in 652 patients with initial acute myocardial infraction (AMI). Nosocomial mortality obtained by matching factors which determined prognosis was significantly lower in patients treated by CT (8.3%) than in those who did not undergo CT (18.1%). Regardless of whether the treatment was intracoronary arterial (ICT) or intravenous (IVCT), the primary cause of the decreased mortality was reperfusion of the coronary artery responsible for infarction (mortality 6.1% in the reperfused group vs 21.5% in the ineffective group). CT therapy improved left ventricular ejection fraction (LVEF), the nosocomial mortality rate, and regional wall motion at the site of infarction in cases that were reperfused less than 3 h, 3-6 h, and even 6 or more hours after the therapy. The long-term prognosis was significantly better in the reperfused group than in the ineffective group for 5 years and 7 months after therapy. However, CT was accompanied by both (1) poor prognosis in the ineffective group; and (2) unfavorable effects on the prognosis and on the daily life of patients with severe stenosis even after treatment. Accordingly, supplemental ICT and rescue PTCA (strategy (A)) were performed to treat the first problem, and deferred PTCA (strategy (B)) was conducted to treat the second problem in 80 patients with initial AMI. As a result, strategy (A) increased the coronary reperfusion rate to 94.3%, and strategies (A) and (B) together decreased the nosocomial mortality rate of 8.5% to 3.8%, and reduced the risk of death by 55.3%.