Beneficial effects of intracoronary thrombolysis up to eighteen hours after onset of pain in evolving myocardial infarction

Smalling, Richard W.; Fuentes, Francisco; Freund, G. C.; Reduto, Lawrence A.; Wanta-Matthews, Margaret; Gaeta, Jay M; Walker, William E.; Sterling, Rosalyn P.; Gould, K. Lance

doi:10.1016/0002-8703(82)90264-2

Cited by 51 publications

(13 citation statements)

References 17 publications

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“…In 10-31 % of patients with mycardial infarction, subtotal coronary stenosis has been demonstrated [5,6,9,12,13,26]. In our study, an open vessel was found in 26% with the first coronary arteriograms.…”

Section: Discussionsupporting

confidence: 56%

“…In the placebo-controlled study of Kjaha et a1 [ll] a slight but significant rise was observed in both patient groups. Smalling et a1 [9] also observed an increase in ejection fraction in patients with reperfusion and no improvement in those with no reperfusion. Sheehan et a1 [37] found an improvement of ejection fraction only in patients with streptokinase therapy and coronary bypass surgery, whereas ejection fraction decreased in those without surgery.…”

Section: Discussionmentioning

confidence: 89%

“…Two holes at the tip allowed pressure measurement and superselective infusion of streptokinase. Smalling et a1 [9] found no advantage in superselective lysis, which was also attempted by Ganz et a1 [31]. Further experience is necessary, however, in order to test whether superselective infusion of streptokinase is superior to selective infusion.…”

Section: Discussionmentioning

confidence: 97%

“…Intravenous (i.v.) [ 1-41 and/or selective intracoronary infusion of streptokinase [5][6][7][8][9][11][12][13][14][15][16] make reperfusion possible by lysis of coronary artery thrombus. The success rate for intravenous infusion of streptokinase ranges from 50% [4] to 67% [l] using acute coronary angiography and 96 % using indirect clinical criteria [ 101, and for intracoronary application from 60% [ll] to 86% [12].…”

mentioning

confidence: 99%

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Combined medical and mechanical recanalization in acute myocardial infarction

Erbel

Pop

Meinertz

et al. 1985

Cathet. Cardiovasc. Diagn.

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A technique of combined medical and mechanical recanalization was employed in 96 patients with acute transmural myocardial infarction. The mean time between onset of symptoms and admission to hospital was 170 +/- 65 min (X +/- SD). After 10 +/- 16 min, 250,000 U streptokinase was administered intravenously for 20 min. Intracoronary thrombolysis was commenced within 38 +/- 14 min. First coronary angiograms demonstrated reperfusion, an open vessel in 25/96 patients (26%). In 15/71 patients (21%) reperfusion occurred during thrombolysis therapy, before mechanical recanalization could be performed. Recanalization was achieved mechanically in 37/71 patients (52%) with occluded coronary vessels. In 8/71 patients (11%) mechanical recanalization failed but the vessel opened during thrombolysis. In 12/96 patients (12%), the coronary vessel remained occluded. Thus, reperfusion could be achieved in 88% of the patients. Reperfusion rate was 76% in the first 38 patients and 95% subsequently. After reperfusion, coronary thrombi were found in 25/96 patients (26%) but dissolved during thrombolysis in 16/25 patients (64%). Peripheral coronary embolism was observed in 3/25 patients (12%). For the whole group, reocclusion occurred in 8/84 patients (10%). By combined medical and mechanical recanalization, the recanalization rate could be increased with low reocclusion rate. Trends showed an improvement in regional and global left ventricular function in patients with anterior myocardial infarction.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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Combined medical and mechanical recanalization in acute myocardial infarction

Erbel

Pop

Meinertz

et al. 1985

Cathet. Cardiovasc. Diagn.

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“…For example, patients with subtotal occlusion were randomized in the study by Anderson et al34 but treated as a separate group in that by Leiboff et al 35 Administration of thrombolytic therapy under angiographic observation leads to selection of patients well enough to tolerate early cardiac catheterization. As a result, the potential benefit of thrombolytic therapy may be underestimated since (1) left ventricular function improves more after reperfusion in patients with severely depressed function early, as seen in previous reports38 50, 54 and in the present study, and (2) reperfusion reduces mortality most significantly in those with the most impaired hemodynamic state.55 Patient selection also occurs through refusal to undergo follow-up testing. Comparability of patients with and without follow-up tests of ventricular function has rarely been analyzed in previous reports, making it impossible to determine whether this can explain the differences in results.…”

Section: Discussionmentioning

confidence: 48%

The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial.

Sheehan¹,

Braunwald²,

Canner³

et al. 1987

Circulation

385

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In Phase I of the NHLBI trial of Thrombolysis in Myocardial Infarction (TIMI), 290 patients admitted within 7 hr after onset of acute infarction were randomly assigned to intravenous treatment with either streptokinase (SK) or recombinant tissue-type plasminogen activator (rt-PA). Left ventricular function was measured from contrast ventriculograms in 145 patients with both pretreatment and predischarge studies analyzable. Regional wall motion in the infarct site was measured by the centerline method and expressed in units of standard deviations (SDs) from the mean motion in 52 normal subjects. Patients treated with rt-PA (n = 77) achieved a significantly higher reperfusion rate after 90 min of treatment. Perfusion of the infarct-related artery improved from visual grade 0 or 1 (total occlusion or penetration without perfusion) to grade 2 or 3 (partial or full reperfusion) in 62% receiving rt-PA vs 31% receiving SK (n = 68) (p < .001). However, the ejection fraction did not change significantly from before treatment to before discharge in either treatment group (+0.7 6.7% vs + 1.0 8.3%, respectively). A small but significant increase in regional wall motion was observed in each of the two groups (+0.4 0.8 vs +0.3 0.8 SD/chord, respectively; each p < .001 compared with baseline). This was countered by declines in the hyperkinesis of the noninfarct region (-0. Analysis of the combined groups revealed that the ejection fraction increased only in patients who achieved reperfusion by 90 min after onset of therapy or who had subtotal occlusions initially. There was greater recovery of left ventricular function in patients who achieved reperfusion earlier vs later than 4 hr after symptom onset and in patients with vs without some collateral circulation to the infarctrelated artery. Circulation 75, No. 4, 817-829, 1987. SINCE the late 1960s, many trials of thrombolytic therapy with streptokinase or urokinase in patients with acute myocardial infarction have been performed. The results have varied widely, both in terms of the degree of reperfusion achieved and clinical benefit, evaluated from mortality, recurrent infarction, or funcFrom the TIMI Coordinating Center, Baltimore.

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Intravenous versus intracoronary streptokinase for acute transmural myocardial infarction

Blunda

Meister

Shechter

et al. 1984

Cathet. Cardiovasc. Diagn.

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In order to compare the thrombolytic efficacy of selective versus systemic administration of streptokinase, we gave this drug by either the intracoronary or intravenous routes to 25 patients during the first 6 hours of acute myocardial infarction. All patients had total occlusion of the infarct-related vessel, unresponsive to intracoronary nitroglycerin. Twelve patients received intravenous streptokinase and 13 received intracoronary administration of the drug. Angiograms were taken prior to and during streptokinase administration. Reopening was achieved in 11 of 13 intracoronary patients and 8 of 12 intravenous patients (P = Ns). Time to reopening was longer (54 minutes) in the intravenous patients than in the intracoronary patients (26 minutes) (P less than 0.05). In this study, intravenous streptokinase reopened infarct-related vessels nearly as often as intracoronary streptokinase, but it took longer. Given the limited access and time to prepare for intracoronary infusion and the ease of intravenous administration, further study of intravenous streptokinase is justified.

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Beneficial effects of intracoronary thrombolysis up to eighteen hours after onset of pain in evolving myocardial infarction

Cited by 51 publications

References 17 publications

Combined medical and mechanical recanalization in acute myocardial infarction

Combined medical and mechanical recanalization in acute myocardial infarction

The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial.

Intravenous versus intracoronary streptokinase for acute transmural myocardial infarction

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