Intracoronary thrombolytic therapy in acute myocardial infarction: A prospective, randomized, controlled trial

Raizner, Albert E.; Tortoledo, Francisco; Verani, Mario S.; Reet, Richard E. Van; Young, James B.; Rickman, Frank D.; Cashion, W.Richard; Samuels, David A.; Pratt, Craig M.; Attar, Mohammed; Rubin, Howard S.; Lewis, John M.; Klein, Milton S.; Roberts, Robert

doi:10.1016/0002-9149(85)90365-0

Cited by 86 publications

(8 citation statements)

References 16 publications

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“…Thrombolytic therapy appeared most effective in patients with a large infarction, including anterior infarction (10,14,16,25,27); in patients with heart failure (16) or low LVEF upon admission (21); and particularly in patients with a short treatment delay (10,(14)(15)(16)24). On the other hand, data from the ISIS-2 and ASSET trials suggest that patients with minor or nonspecific ECG abnormalities, and even patients with a suspected infarction and a normal ECG upon admission may benefit from thrombolytic therapy (25, 26), even though the placebo group mortality in the latter patients was low (3.9 and 3.0% respectively).…”

Section: Patient Selectionmentioning

confidence: 99%

Thrombolytic Therapy in Acute Myocardial Infarction

Simoons

1989

Annu. Rev. Med.

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Early thrombolytic therapy has been shown to reduce hospital mortality after myocardial infarction by 20-50%. This is achieved through reperfusion of the ischemic myocardium, which leads to limitation of infarct size by 15-30% and preservation of regional and global left ventricular function. Thrombolysis and reperfusion can be achieved by intravenous administration of streptokinase, urokinase, APSAC, or rt-PA, or by intracoronary administration of streptokinase or urokinase. Thrombolytic therapy is most effective in patients with extensive myocardial ischemia (large infarction) treated early after the onset of symptoms, but also patients with smaller infarcts may benefit from the therapy. It is uncertain whether treatment later than six hours after the onset of symptoms is beneficial, and if so, in which patients. Thrombolytic therapy leads to bleeding complications in a minority of patients. The risk of intracranial bleeding is approximately 0.5%. However, in several large trials the rate of cerebrovascular accidents (bleeding plus embolism) was not higher after thrombolytic therapy with streptokinase or rt-PA than after placebo. In order to prevent rethrombosis, additional treatment with acetyl salicylic acid and heparin is recommended. Nitrates and antiarrhythmic drugs are not recommended as routine practice. Immediate PTCA does not improve patient outcome. At present angiography and subsequent angioplasty or bypass surgery is recommended in patients with recurrent ischemia (spontaneous or upon exercise) after the infarct.

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Section: Patient Selectionmentioning

confidence: 99%

Thrombolytic Therapy in Acute Myocardial Infarction

Simoons

1989

Annu. Rev. Med.

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“…Numerous re ports exist which demonstrate the efficacy of streptokinase in both experimental animals [14,15] and in humans [16]. Animals with intact femoral arterial thrombus received Fig.…”

Section: Resultsmentioning

confidence: 99%

Biological and Thrombolytic Properties of Fibrolase -A New Fibrinolytic Protease from Snake Venom

Ahmed¹,

Gaddis²,

Tennant³

et al. 1990

Pathophysiol Haemos Thromb

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Fibrolase, a direct-acting fibrinolytic enzyme has been shown to cleave primarily the Aα and Bβ chains of human fibrin. We have previously reported that fibrolase also exhibits fibrinogenolytic activity and acts mainly as an α-chain fibrinogenase. In contrast to the action of streptokinase (plasminogen activator), fibrolase does not activate plasminogen. In vitro thrombolytic efficacy of fibrolase was determined by monitoring the release of radiolabel from iodinated fibrin and human blood clots. Fibrolase effectively digested the clots in a dose-dependent manner. The in vivo efficacy of fibrolase was evaluated in an animal model of arterial thrombosis. Fibrolase was found to be efficacious at dissolving femoral arterial clots following a single intravenous bolus administration. Time to reperfusion was dose dependent and similar to that observed with streptokinase. No adverse effects on blood pressure and heart rate were observed.

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“…In one study [9] comparing effects of intracoronary strepto kinase, NTG or streptokinase + NTG 6 ± 3 h after symptom onset, ejection fraction increased by 3.9 per centage points with combined therapy and the benefit was greater in patients with collateralized total occlusion. In all 6 reported studies that used adjunctive intravenous NTG and intracoronary streptokinase [6,7,10,12], LV function improved, suggesting that NTG might have contributed to functional recovery. Rcntrop et al [6.…”

Section: Other Studiesmentioning

confidence: 99%

“…12], intravenous NTG was given from the time of admission and contin ued during streptokinase infusion [11]. Raizner et al [10] found, on retrospective analysis, that radionuclide ejection fraction improved by 7 percentage points in the subgroup with successful rccanalization after intracoro nary' streptokinase and intravenous NTG. In our study, reperfusion alone also resulted in a late and similar mod est increase in ejection fraction by 7 percentage points blit adjunctive NTG resulted in a prompt increase by 13 points on day 1.…”

Section: Other Studiesmentioning

confidence: 99%

Prompt Improvement of Left Ventricular Function and Preservation of Topography with Combined Reperfusion and Intravenous Nitroglycerin in Acute Myocardial Infarction

Jugdutt

Schwarz-Michorowski²,

Tymchak³

et al. 1997

Cardiology

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Reperfusion alone during acute myocardial infarction (AMI) preserves left ventricular (LV) topography but causes ‘stunning’, with delayed or no recovery of function. To determine whether adjunctive intravenous nitroglycerin (NTG) accelerates functional recovery, we prospectively measured function and topography by repeated two-dimensional echocardiography between 1 day and 6 months in 5 groups of patients (n = 73) with a first AMI: placebo (group 1), NTG alone (group 2), NTG combined with successful reperfusion after 4 h (group 3) or failed reperfusion (group 4), and successful reperfusion alone (group 5). Asynergy decreased promptly (p < 0.001) and ejection fraction improved (p < 0.001) between day 1 and 6 months in groups 2 and 3 compared to baseline and groups 1, 4 and 5. Infarct expansion and thinning found in group 1 were prevented in groups 2, 3, 4 and 5. Diastolic volume increased in the anterior subgroup 1 but not 2, 3, 4 and 5. This is the first demonstration that reperfusion combined with adjunctive NTG produces earlier, greater and persistent recovery of LV function in addition to attenuation of remodeling in patients after AMI.

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Intracoronary thrombolytic therapy in acute myocardial infarction: A prospective, randomized, controlled trial

Cited by 86 publications

References 16 publications

Thrombolytic Therapy in Acute Myocardial Infarction

Thrombolytic Therapy in Acute Myocardial Infarction

Biological and Thrombolytic Properties of Fibrolase -A New Fibrinolytic Protease from Snake Venom

Prompt Improvement of Left Ventricular Function and Preservation of Topography with Combined Reperfusion and Intravenous Nitroglycerin in Acute Myocardial Infarction

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