Percutaneous transluminal coronary angioplasty after thrombolytic therapy: A prospective controlled randomized trial

Abstract

In 162 patients with acute transmural myocardial infarction, combined intravenous and intracoronary thrombolytic therapy with streptokinase was initiated. In vessels that remained occluded, mechanical recanalization was performed with a 3F recanalization catheter (group I, n = 79) or a 4F Grüntzig balloon catheter (group II, n = 83). After reperfusion, intracoronary streptokinase was administered superselectively. After termination of streptokinase infusion, angioplasty was performed only in patients in group II. There was no difference between the groups in relation to sex, age, infarct location, creatine kinase levels and time between onset of symptoms and start of treatment. Initial coronary angiography showed an open vessel in 27 (34%) of 79 patients in group I and 21 (25%) of 83 patients in group II. The final reperfusion rate was 90% (71 of 79) in group I and 86% (71 of 83) in group II. Angioplasty was attempted in 69 of the 71 patients in group II with a success rate of 65% and an occlusion rate of 3%. During the hospital stay, reocclusion occurred in 14 (20%) of 71 patients in group I. After thrombolytic therapy, coronary luminal narrowing in group I was 75 +/- 17% in patients without and 87 +/- 6% in patients with reocclusion (p less than 0.05). In group II, reocclusion was found in 10 (14%) of 71 patients. After angioplasty, the degree of coronary stenosis in group II was reduced from 82 +/- 12 to 51 +/- 30% (p less than 0.001). Reocclusion was found in 3 (7%) of the 45 patients with successful angioplasty and in 7 (32%) of the 22 patients with unsuccessful angioplasty (p less than 0.01). Improvement in regional left ventricular function was observed only in patients from group II with anterior myocardial infarction. In conclusion, by combined medical and mechanical recanalization, the rate of coronary reperfusion can be increased and infarct time shortened, providing the possibility of full revascularization by angioplasty, with improvement of regional wall motion and reduction of the rate of reocclusion.

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

“…They were still present 4 weeks after the acute event [235]. Reopening of the occluded coronary vessel by thromboembolytic therapy is successful in angioplasty improving ventricular function and/or survival [62,95,118,172,221]. But combined therapy failed to demonstrate superior results to thrombolytic therapy alone [208,224].…”

“…Direct balloon angioplasty has been introduced in addition to thrombolytic therapy [62], but also as stand-alone procedure [172]. However, the expected superior effect of angioplasty compared to thrombolysis could initially not be proven [208,224].…”

“…With mechanical reopening of the vessel, coronary emboli are observed in up to 11% of patients [62]. Even PTCA in the subacute setting can induce significant peripheral coronary embolization leading to myocardial re infarction despite an open vessel, with a distal occlusion due to dislodgement of plaque of thrombotic material [169].…”

Effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function in unstable angina pectoris

“…D, shadedzones represent the 10th to the 90th percentile area of CREF values in normal persons. On the x axis, the CREF values of the anterior and inferoposterior wall areas are displayed (%), while on they axis the segment numbers of the anterior wall (I-IO) and of the inferoposterior wall (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 'p <0.05; tp <O.OOl. CREF = contribution to regional ejection fraction (see Figure 1).…”

Management of Shock in Acute Myocardial Infarction: Changing Concepts; Past, Present and Future

“…In fact, reocclusion may occur more frequently after acute angioplasty, pos sibly because of a residual intracoronary thrombus [60,61]. It is clear that achieving early and persistent patency is essential for the maintenance of cell viability, and that a high-grade residual stenosis remaining after thrombolysis may result in continued de pression of left ventricular function.…”