Circulation, Vol 77, 151-161, Copyright © 1988 by American Heart Association
RS Stack, CM O'Connor, DB Mark, T Hinohara, HR Phillips, MM Lee, NM Ramirez, WG O'Callaghan, CA Simonton and EB Carlson
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.
ARTICLES
Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase
Interventional Cardiac Catheterization Program, Duke University Medical Center, Durham, NC 27710.
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