Infarktgrößenbegrenzung durch nicht-chirurgische Rekanalisation der Koronararterien

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Abstract
The occluded coronary vessel was recanalized in 18 patients with cardiac infarction (investigation group) within 8.2 .+-. 6.9 h after onset of complaints by intracoronary streptokinase infusion. Ejection fraction increased from 51.4 .+-. 9.8% before reperfusion to 55.9 .+-. 9% immediately after the end of streptokinase infusion (P < 0.01). The akinetic segment decreased from 10.2 .+-. 6.1 to 7.1 .+-. 4.9 cm (P < 0.025). During chronic infarction stage and after bypass operation no further significant changes were observed. Conservatively treated patients [18] (control group K) were comparable to the investigated group as regards coronary involvement and left ventricular function measurements during the acute stage. A control angiogram during the chronic infarction stage showd persistent occlusion in 9 of these patients (Kl) and spontaneous recanalization of infarcted vessels in the remaining 9 (K2). During the chronic stage the investigation group showed a significantly higher ejection fraction (57 .+-. 13%) and a shorter akinetic segment (4.5 .+-. 6 cm) than group K1 (ejection fraction 43.4 .+-. 7.6%, P < 0.05; akinetic segment 9.8 .+-. 5.5 cm, P < 0.025). Loss or R potentials in the ECG was less pronounced in the investigation group than in both control groups. In 10 patients of the investigation group, in whom a bypass operation was performed, intraoperative inspection showed that the recanalized coronary vessel perfused healthy myocardium. Infarction size apparently could be limited by non-surgical coronary artery reperfusion.