Early Reperfusion Assessment and Repeated Thrombolysis in Acute Myocardial Infarction Estimated by Repeated Standard Electrocardiography

Abstract

Thrombolytic therapy with streptokinase (SK) in acute myocardial infarction (AMI) does not result in early reperfusion in approximately 25% of patients. We hypothesized that early repeated thrombolysis with rt-PA in patients with early failed reperfusion would result in myocardial reperfusion. Fifty-nine AMI patients with a symptom delay of <6 h, treated with SK were included. ECG was taken on admission and after 90 and 180 min. An ST recovery of ≥25% at 90 min was interpreted as successful reperfusion. Sixteen patients had failed reperfusion at 90 min and were randomized to repeated thrombolysis with rt-PA or placebo. At 180 min from SK start, ST recovery was higher in the placebo group than in the rt-PA group (71 vs. 40%, p = 0.05). No serious bleeding complications were observed. Due to the limited sample size it was not possible to draw prominent conclusions.

Rescue Angioplasty or Repeat Fibrinolysis After Failed Fibrinolytic Therapy for ST-Segment Myocardial Infarction

“…We excluded 2 randomized studies of rescue PCI because they were not restricted to STEMI patients who failed fibrinolytic therapy (24,25). We also excluded 1 trial of repeat fibrinolytic therapy, because it did not report any clinical end points (26). Therefore, our meta-analysis included 8 trials with 1,177 patients, of which there were 6 trials that randomized 908 patients to rescue PCI or conservative therapy and 3 trials that randomized 410 patients to repeat fibrinolysis or conservative therapy (13,14,19 -22,27,28).…”

Pro-fibrotic and apoptotic activities of circARAP1 in myocardial ischemia–reperfusion injury

“…Myocardial infarction (MI) causes high disability and mortality in patients with cardiovascular disease worldwide [ 1 ]. Timely and complete reperfusion (primary percutaneous coronary intervention and clinical thrombolysis) can decrease mortality from MI [ 2 , 3 ], reperfusion itself may lead to hypersensitivity irreversible myocardial injury and cardiac dysfunction, namely myocardial ischemia–reperfusion injury (MI/RI) [ 4 ]. MI/RI can lead to a series of adverse effects and damages, such as reinfarction, malignant arrhythmia and heart failure [ 5 ].…”

Non-coding RNAs modulate autophagy in myocardial ischemia-reperfusion injury: a systematic review

“…Relatively, it is reported that there will be almost 23.6 million people dying from CVD by 2030 [ 2 , 3 ]. More specifically, myocardial infarction (MI) is a primary component in CVD, which can be treated with timely and complete reperfusion with main percutaneous coronary intervention (PCI) and thrombolysis in clinic [ 4 , 5 ]. The rapid recovery of ischemic myocardial blood flow can prevent myocardial cell death, restrict infarct size, and decrease disability and death, which prominently improves the quality of life of patients with MI.…”