Coronary artery reperfusion in acute myocardial infarction: Beneficial effects of intracoronary streptokinase on left ventricular salvage and performance

Reduto, Lawrence A.; Freund, G. C.; Gaeta, Jay M; Smalling, Richard W.; Lewis, Brenda; Gould, K. Lance

doi:10.1016/0002-8703(81)90648-7

Cited by 141 publications

(25 citation statements)

References 19 publications

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“…There was no significant change in ejection fraction after cardiac catheterization, even in patients who had successful thrombolysis.9' 10 In the remaining patients, thallium images were obtained before coronary arteriography with the intravenous injection of 1.5 to 2 mCi of thallium 201, as described previously. 10 Thallium scintigraphy should not be immediately preceded by gated radionuclide ventriculography. We felt that thallium imaging would provide useful information on the success of reperfusion and would also aid in localization of the infarctrelated artery.…”

Section: Methodsmentioning

confidence: 99%

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

Smalling¹,

Fuentes²,

Matthews³

et al. 1983

Circulation

140

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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.

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Section: Methodsmentioning

confidence: 99%

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

Smalling¹,

Fuentes²,

Matthews³

et al. 1983

Circulation

140

View full text Add to dashboard Cite

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“…Improvement in ventricular function occurred gradually over the course of a few weeks. [81][82][83][84] One report 85 suggested that stunned myocardium could be recruited after thrombolytic therapy with small boluses of inotropes. These studies suggest that the ultimate return of cardiac function cannot be determined immediately after reperfusion.…”

Section: Myocardial Stunning In Humansmentioning

confidence: 99%

Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning

et al. 1998

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“…No reduction of cumulative release of cardiac enzymes has been observed after SK infusion, even when the intervention is timely, the infusion is intracoronary, recanalization is achieved, and cardiac function is improved. 243 Considered with radionuclide evaluations of ejection fractions in injured areas (which often indicate recovery of myocardial function 207 ) these findings suggest that thrombolysis cannot prevent irreversible myocardial damage but may limit the size of the infarcted area and improve collateral circulation, even when the restitution of patency of the obstructed vessel may be too late to be effective itself. Spontaneous reperfusion may occur as well, 2256 ' 257 although SK-induced recanalization appears to improve myocardial function more than spontaneous recanalization, perhaps because of the time of reopening of the vessel.…”

Section: Thrombolytic Therapymentioning

confidence: 99%