Intracoronary infusion of streptokinase in patients with acute myocardial infarction: Effects of reperfusion on left ventricular performance

Reduto, Lawrence A.; Smalling, Rrichard W.; Freund, G. C.; Gould, K. Lance

doi:10.1016/0002-9149(81)90066-7

Cited by 194 publications

(32 citation statements)

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“…An increased rate of recanalization in the infarct-related coronary artery and a lower death rate at the acute stage have been reported with their use. [1][2][3][4][5] However, it has not been established whether coronary thrombolysis can reduce the size of the infarct. 8 The observed reduction in infarct size is markedly variable, even among patients in whom coronary thrombolysis is accomplished at the same time after the onset of acute myocardial infarction and in whom recanalization is of the same degree.…”

mentioning

confidence: 99%

Quantitative analysis of contraction band and coagulation necrosis after ischemia and reperfusion in the porcine heart.

Miyazaki¹,

Fujiwara²,

Onodera³

et al. 1987

Circulation

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To assess the importance of contraction band necrosis (CBN) in reperfusion, CBN, coagulation necrosis (CN), and infarct size, expressed as CBN + CN, were quantitatively analyzed in 25 porcine hearts without collateral circulation. The left anterior descending coronary artery was ligated for 20, 30, 60, and 120 min and then reperfused for 8 hr (groups 1 to 4, respectively). Five hearts were not reperfused (group 5). The areas of CBN and CN were traced at a magnification of X 100 under an inverted microscope and quantified with use of an image analyzer. There was no change in hemodynamics with either occlusion or reperfusion. Regional myocardial blood flow, measured by the generated hydrogen gas clearance method. decreased to almost zero after occlusion but recovered during reperfusion. Percent of risk area infarcted in groups 1 to 4 was 0 ± 0%, 1 1 + 7%, 80 ± 9%, and 96 ± 2%, respectively, and the percent of risk area infarcted in group 4 was the same as that in hearts subjected to permanent occlusion (95 ± 3%). The percent area of CBN was 100 ± 0% in group 2 68 ± 1 1% in group 3, 2 ± 1% in group 4, and 2 ± 2% in group 5. In group 3, the inner third of the ischemic left ventricular wall showed CN and the middle and outer third CBN. These findings show that in pig hearts without collateral circulation, the transmural infarct, two-thirds of which is occupied by CBN, is evident even when reperfusion is achieved after 1 hr occlusion. Therefore, protection against CBN might reduce infarct size after reperfusion.

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mentioning

confidence: 99%

Quantitative analysis of contraction band and coagulation necrosis after ischemia and reperfusion in the porcine heart.

Miyazaki¹,

Fujiwara²,

Onodera³

et al. 1987

Circulation

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“…Much of this interest stems from evidence indicating that infarct size is a major determinant of both early and late morbidity and mortality (16,17). Recent studies describing the efficacy of streptokinase for intracoronary thrombolysis have demonstrated that myocardial reperfusion is clinically feasible (1)(2)(3)(4)(5)(6). The ability to salvage significant amounts of jeopardized myocardium resulting in a re- This study was specifically designed to quantitatively analyze the function of the jeopardized myocardium over time.…”

Section: Discussionmentioning

confidence: 89%

“…Several recent studies have shown that coronary recanalization can be accomplished in patients with acute myocardial infarction using intracoronary streptokinase (1)(2)(3)(4)(5)(6). The ability to salvage significant amounts of jeopardized myocardium using this technique, however, has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

“…One study has shown improvement in thallium-201 uptake immediately following reperfusion, suggesting at least some cellular viability in the ischemic region (6). Other studies have concentrated on measuring changes in the overall ejection fraction (EF)' using either contrast ventriculography or nuclear angiography (1)(2)(3)(4). These reports have demonstrated only a modest improvement in the EF between acute and chronic studies in patients who were successfully recanalized.…”

Section: Introductionmentioning

confidence: 99%

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Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction.

Stack¹,

Phillips²,

Grierson³

et al. 1983

J. Clin. Invest.

222

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A B S T R A C T The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptomns. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16±11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b)

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“…Reduto et al showed that LV ejection fraction does not increase directly after reperfusion, but after discharge from the hospital in patients after intracoronary administration of streptokinase 95% CI [16]. Results obtained by other researchers [17] confirmed that regional LV function reliably increases not earlier than 10 days after successful thrombolytic treatment performed 5 h after the coronary artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the efficacy of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction based on the ECG analysis

Madżitow¹,

Alimow²

2011

pwki

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A b s t r a c tBackground: The method of recording ECG is of particular importance for the diagnosis of cardiac arrhythmias, and an analysis of ST-segment behaviour, providing valuable information for the assessment of coronary circulation and the prognosis of patients with acute coronary syndrome.Aim: The objective of our study was to evaluate the effectiveness of reperfusion therapy with primary revascularization of the coronary artery responsible for myocardial infarction (infarct-related artery, IRA) in patients with acute myocardial infarction (AMI) with persistent ST-segment elevation in intraoperative ECG monitoring.Material and methods: The study included 72 patients (64 -89% men) with anterior AMI who were hospitalized in order to perform primary angioplasty (primary PCI).Results: The average time from onset of pain to admission to hospital was 2.5 ±1.3 h. The average time from admission to start of treatment (pPCI) was 78.2 ±12.4 min. Effective treatment with primary PCI IRA stenting was performed in all 72 patients (100%) after initial recanalization and predilation. All patients achieved good angiographic results evaluated on the basis of the size of the residual stenosis (below 10%), while flow in the grade TIMI III was found in 62 (86.1%) treated patients. In 49 patients (68%) metal stents ("Chopin") were implanted, and in 23 (32%) other patients paclitaxel-eluting stents ("Luc-Chopin") (Balton, Warsaw, PL) were implanted. ECG recording including the nature and frequency of arrhythmia was initiated prior to PCI. The measurements of changes in ST-segment elevation in relation to the isoelectric line were evaluated in the lead that best maps the changes in recording. Analysis of ECG monitoring results showed the characteristic dynamics of reduction of the ST level. Index rate of ST-segment depression after PCI was 3070.3 ±946.6 μV/h. In all cases with PCI there was reported the occurrence of arrhythmias after the reperfusion. Ventricular extrasystole (ExV) occurred in 72 patients (100%), accelerated idioventricular rhythm in 13 (18.0%), ventricular tachycardia in 14 (19.4)%, and ventricular fibrillation in 2 (2.7%). Through correlation analysis a significant association was detected between indicators of the speed of ST-segment depression after reperfusion, and left ventricular ejection fraction (LVEF), calculated 7 days after PCI (r = 0.53366, p < 0.001).Conclusions: 1) ECG monitoring is a study method of high clinical value, to evaluate the efficacy of reperfusion therapy in patients with AMI. 2) A significant correlation was detected between the rate of ST-segment depression after reperfusion and LVEF measured after 7 days of ACS with ST-segment elevation. 3) Index of ST-segment depression after reperfusion is a good predictor of restoration of left ventricular systolic function. 4) Primary PCI with stenting is an effective method of IRA reperfusion treatment of patients with AMI.Key words: myocardial infraction, ST elevation, percutaneous transluminal coronary angioplasty, stenting, reperfusion, ...

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Intracoronary infusion of streptokinase in patients with acute myocardial infarction: Effects of reperfusion on left ventricular performance

Cited by 194 publications

References 21 publications

Quantitative analysis of contraction band and coagulation necrosis after ischemia and reperfusion in the porcine heart.

Quantitative analysis of contraction band and coagulation necrosis after ischemia and reperfusion in the porcine heart.

Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction.

Assessment of the efficacy of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction based on the ECG analysis

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