Related Experiment Videos
[Late thrombolysis in acute myocardial infarct: short and long term effects on left ventricular function]
E Cordioli1, A Muscari, C Pizzi
1Istituto di Patologia Speciale Medica e Metodologia Clinica, Università degli Studi, Bologna.
Insights
Late administration of thrombolytic agents (rt-PA) for acute myocardial infarction, even after 6 hours, shows benefits. This treatment improved left ventricular function and reduced heart failure incidence in patients receiving rt-PA between 6 and 24 hours.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Intravenous thrombolysis is proven for acute myocardial infarction (AMI).
- Uncertainty exists regarding the optimal "temporal window" for thrombolytic administration.
- Late administration (≥6 hours) benefits require further investigation.
Purpose of the Study:
- To evaluate short- and long-term advantages of late thrombolytic agent (rt-PA) administration in AMI.
- To assess the impact on left ventricular function and clinical outcomes.
- To compare outcomes between treated and control groups based on administration time.
Main Methods:
- 100 first-episode AMI patients admitted within 24 hours were studied.
- 62 patients received rt-PA (44 within 6 hours, 18 between 6-24 hours).
- 38 control patients received no thrombolysis; serial ECGs and echocardiograms (ejection fraction, asynergy, ischemic area) were performed.
Main Results:
- No heart failure cases occurred in the rt-PA group (6-24 hours).
- Seven heart failure cases occurred in the control group (6-24 hours) (p=0.0068).
- Further analysis of left ventricular function and long-term outcomes is ongoing.
Conclusions:
- Late rt-PA administration (6-24 hours) in AMI appears to prevent early heart failure.
- This suggests a potential benefit of thrombolysis beyond the traditional "temporal window".
- Further research is warranted to confirm long-term efficacy and safety.
Abstract:
Although the efficacy of intravenous thrombolysis in the treatment of acute myocardial infarction has been widely proved, some uncertainty concerning the "temporal window" of administration still persists. The aim of the present investigation was to study whether the late administration of a thrombolytic agent (6 or more hours after the onset of symptoms of acute myocardial infarction) offers any short or long-term advantages with regards to left ventricular function and clinical outcome. We studied 100 consecutive patients at their first episode of myocardial infarction, admitted to Coronary Unit within 24 hours of the onset of symptoms. Of these patients, 62 were administered rt-PA (44 patients within the 6th hour, and 18 between the 6th and 24th hour after the onset of symptoms) and the 38 remaining patients, who did not receive the thrombolytic agent (due to concerns with respect to possible complications), constituted the control group (18 admitted within 6 hours and 20 between 6 and 24 hours). All patients underwent serial electrocardiograms, and echocardiograms upon admission and at discharge to assess the ejection fraction, the asynergy score and the percentage of ischemic area. Furthermore, the survivors were invited for a follow-up examination one year after their acute initial episode. Seven cases of heart failure occurred, before discharge, among the control patients admitted 6 to 24 hours after onset of symptoms, compared with no cases in the subgroup of patients treated with rt-PA during the same time period (p = 0.0068).(ABSTRACT TRUNCATED AT 250 WORDS)