Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.

Abstract

One hundred eighty-eight patients with acute myocardial infarction were studied prospectively from August 1980 to September 1982. One hundred thirty-six of these patients were entered into a intracoronary streptokinase study after informed consent was obtained. The remaining 52 patients, who either met exclusion criteria for the study or refused to participate, served as a control group and were treated as those in the study group except that they did not undergo emergency cardiac catheterization. Left ventricular function was determined in both groups by gated radionuclide ejection fraction (EF) on admission to the hospital, at discharge, and 6 months after discharge. With successful reperfusion up to 18 hr after onset of chest pain, mean left ventricular function in the study group improved (EF 39 + 13% on admission and 46 + 12% at discharge; p < .001). Mean EF in control patients and those not achieving reperfusion did not change from admission to discharge. Mean EF at 6 month follow-up was not significantly different than at discharge in the study group or the control group. Total cardiac mortality in the control group was 19% compared with 10% in the study group (p = .06, NS). When patients admitted in pulmonary edema or shock (Killip class III or IV) were excluded from both groups, total cardiac mortality in the study group was significantly lower (4%) compared with in the control group (12.5%, p < .05). The administration of intracoronary streptokinase during evolving myocardial infarction up to 18 hr after onset of chest pain may result in decreased mortality and sustained improvement in left ventricular function. Circulation 68, No. 1, 131-138, 1983. STANDARD CURRENT THERAPY for acute myocardial infarction entails prevention or treatment of complications secondary to evolving myocardial necrosis. Mortality during the first 30 days after acute myocardial infarction has been reported to be between 16% and 30% in large series and no definite decrease in this rate was noted between 1960 and 1975.14 Although there is no universally accepted method for reducing myocardial damage, emergency aortocoronary bypass surgery has been reported to decrease mortalityl'6 in certain patients. Intracoronary streptokinase From the University of Texas Medical School at Houston.

Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction.

“…22 The magnitude of the increase was small compared with that seen in the first few weeks after infarction.…”

Early Thrombolytic Therapy Does Not Enhance the Recovery of the Right Ventricle in Patients with Acute Inferior Myocardial Infarction and Predominant Right Ventricular Involvement

“…Early lysis of the occluding thrombus in patients with evolving myocardial infarction results in improvement of left ventricular function [1][2][3][4] and reduction in mortality [5][6][7][8]. Numerous studies have stressed the relatively common occurrence of right ven tricular infarction (5-84%) in patients with acute inferior myocardial infarction as well as its pathophysiology [9][10][11][12][13][14], However, to date no study has provided long-term follow up data of the impact of thrombolysis and of coronary angioplasty on the clinical out come, survival, and right ventricular func tion in patients with inferior wall and pre dominant right ventricular infarction.…”

Quantitative analysis of contraction band and coagulation necrosis after ischemia and reperfusion in the porcine heart.

“…An increased rate of recanalization in the infarct-related coronary artery and a lower death rate at the acute stage have been reported with their use. [1][2][3][4][5] However, it has not been established whether coronary thrombolysis can reduce the size of the infarct. 8 The observed reduction in infarct size is markedly variable, even among patients in whom coronary thrombolysis is accomplished at the same time after the onset of acute myocardial infarction and in whom recanalization is of the same degree.…”