Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase.
- 1 January 1988
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 77 (1) , 151-161
- https://doi.org/10.1161/01.cir.77.1.151
Abstract
Two hundred and sixteen patients with acute myocardial infarction were treated with immediate infusion of high-dose (1.5 million units) intravenous streptokinase followed by emergency coronary angioplasty. The infarct lesion was crossed and dilated in 99% and persistent coronary perfusion after the procedure was achieved in 90% (including 3% with significant residual stenosis). Total in-hospital mortality was 12%. Multivariable analysis showed a higher hospital mortality with cardiogenic shock (41% vs 5% without shock), older age, lower left ventricular ejection fraction, and female sex. Final patency of the infarct-related vessel was determined by follow-up in-hospital cardiac catheterization. Coronary reocclusion occurred in 11% (symptomatic in 7%, treated with emergency angioplasty or bypass surgery; silent in 4%, treated medically). Of the surviving patients with successful initial establishment of infarct vessel patency, 94% were discharged from the hospital with an open infarct artery or a bypass graft to the infarct vessel. There was significant improvement in both ejection fraction (44% to 49%; p less than .0001) and regional wall motion in the infarct zone (-3.0 SD to -2.4 SD; p less than .0001) among patients with persistent coronary perfusion and insignificant residual stenosis at the time of the follow-up cardiac catheterization. Thus, a treatment strategy for acute myocardial infarction that includes immediate administration of streptokinase followed by emergency coronary angioplasty, and coronary bypass surgery when necessary, results in a high rate of early and sustained patency of the infarct-related vessel.This publication has 40 references indexed in Scilit:
- Coronary Angioscopy in Patients with Unstable Angina PectorisNew England Journal of Medicine, 1986
- A Prospective Trial of Intravenous Streptokinase in Acute Myocardial Infarction (I.S.A.M.)New England Journal of Medicine, 1986
- A Prospective Randomized Clinical Trial of Intracoronary Streptokinase versus Coronary Angioplasty for Acute Myocardial InfarctionNew England Journal of Medicine, 1986
- The Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial InfarctionNew England Journal of Medicine, 1985
- The Thrombolysis in Myocardial Infarction (TIMI) TrialNew England Journal of Medicine, 1985
- Combined intracoronary streptokinase infusion and coronary angioplasty during acute myocardial infarctionThe American Journal of Cardiology, 1984
- Percutaneous transluminal coronary angioplasty: Application for acute myocardial infarctionThe American Journal of Cardiology, 1984
- Percutaneous transluminal coronary angioplasty in acute myocardial infarctionAmerican Heart Journal, 1984
- Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial InfarctionNew England Journal of Medicine, 1983
- Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarctionPublished by Elsevier ,1983