Medical-mechanical treatment of myocardial infarction

Changes in Ventricular Function and Coronary Stenosis after Successful Intravenous Thrombolysis in Acute Myocardial Infarction

“…With larger infarcts, the decrease in ejection fraction and increase in EDV were associ ated with an important increase in ESV. Similar observations have been made by Serruys et al [33], Heinrich et al [34] and Erbel et al [17] using angiographic and echocardiographic methods and was found to be the major predictor of survival after AMI by White et al [35].…”

“…The stenosis, if mild, may improve as a con sequence of natural healing or further spon taneous fibrinolysis, but more severe lesions may progress and ultimately lead to com plete occlusion. Clinical or silent reocclusion has been observed in 10-20% of patients with successsful thrombolysis [15][16][17], Serruys et al [8] found that stenosis of more than 58% and Harrison et al [9] of more than 68 % of lumen diameter to be sig nificant and predicted further narrowing or late reocclusion. Similarly, Voringer et al [29] found reocclusion in 10 of 18 patients who had routine recatheterization.…”

“…Recent stud ies have shown that infarct size can be re duced if lytic therapy is administered promptly within 1.5-2 h of the onset of chest pain, the total duration of ischemia is less than 4 h and the artery is opened adequately and good blood flow re-established [2,6,7]. Few longitudinal studies have been under taken to determine the natural history of the coronary pathology or left ventricular func tion after successful lytic therapy [8][9][10][11][12][13][14], Im-portant residual stenosis, usually associated with residual thrombus, remains in 70% of patients, and reocclusion of the artery occurs in 20-30% of patients with successful reper fusion [10,[15][16][17]. Significant progression of the disease has been demonstrated in se quential angiographic studies [12].…”