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Despite early treatment with thrombolytic agents for acute myocardial infarction, a significant portion of patients fail to achieve a patent infarct artery. To study the various factors related to achieving patency in the infarct vessel, 201 patients who received streptokinase within six hours of symptoms were studied. All patients underwent cardiac catheterization during the same hospitalization at 5.40 +/- 3.26 days after admission. Forty-five (22.4%) patients were found to have an occluded infarct artery (group 1) and 156 (77.6%) had a patent infarct vessel (group 2). There was no difference in the time from onset of symptoms to receiving streptokinase between the two groups. The two groups were similar to each other with regard to age, gender, history of myocardial infarction or angina, and major risk factors for coronary disease. Coagulation parameters before and after streptokinase therapy, reflecting the lytic state, were similar in both groups. The left ventricular end diastolic pressure was significantly higher and the left ventricular ejection fraction was significantly lower in group 1 than in group 2. These observations suggest that despite early initiation of thrombolytic therapy in patients with acute myocardial infarction, a significant portion of patients fail to achieve a patent infarct artery. This failure cannot be explained by the observed clinical parameters or the lytic state after streptokinase.

The present study describes the indications and results of 636 Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures that were carried out in 596 patients. Of these, 366 (61.4 %) patients had Single Vessel Disease (SVD), 183 (30.7%) had Two Vessel Disease (2VD) and 47 (7.8%) had all Three Vessels Diseased (3VD). Dilatation of a single lesion was carried out in 564 (93.5%) patients. In another 41 (6.5%) patients, more than one vessel was dilated. The patients were predominantly male (562/596,93%) with a mean age of 46 (7.9 years. The indication for angiography was angina in 65.8% and for recent Acute Myocardial Infarction (AMI) in 34.2%. The number of procedures increased from 106 in 86-89 to 320 in 92-96 (an increase of 280%). PTCA was carried out in the same session as the angiography in 113/596 (19%). In the remaining 81%, PTCA was planned as an elective procedure with a similar success rate (85% and 87% respectively, p=N.S). Females and Qatari patients had the highest success rates (97.6% and 90.5%) respectively. The Left Anterior Descending (LAD) was the most frequently tackled vessel (53% of cases), Left Circumflex (LCX) in 20% and Right Coronary Artery (RCA) in 27%. For coronary stenoses, the overall success rate was 89%, being highest in the LAD (89.5%), lowest for LCX (82%) and moderate for RCA (88%). When faced with a total occlusion the overall success rate was 71% and was highest in RCA (84% success) and lowest in LCX (43%) and moderate in LAD (74%). Major complications were rare with only one mortality (1/596, 0.16%) and four emergency CABG is (4/596, 0.7%). Intracoronary stents were used as a bailout device in five patients and to obtain an optimal result in one patient. Stents were technically successful in all but one case.