Nine patients with acute myocardial infarction had cardiac catheterization and intracoronary infusions of streptokinase 2.3 to 4.3 hours (mean, 3.5) after the onset of symptoms. Occluded coronary arteries were opened within approximately 20 minutes in all patients, but reocclusion occurred in one patient. The immediate effect of thrombolysis on myocardial salvage was assessed with the intracoronary injection of thallium-201. Improved regional perfusion, indicating myocardial salvage after recanalization, was observed in seven of the nine patients. One patient, who had also sustained a nontransmural infarction one week before, had no change after thrombolysis. In the ninth patient, recanalization of a coronary artery was followed by reocclusion and worsening of the myocardial-perfusion defect. Intracoronary thallium-201 studies two weeks and three months after streptokinase infusion in two patients were unchanged in comparison with scintiscans performed 1.5 hours after thrombolysis. These short-term observations suggest that recanalization of obstructed coronary arteries after intracoronary thrombolysis can salvage jeopardized myocardium, However, evaluation of the long-term effects of this procedure on survival and myocardial function will require controlled clinical trials.
This article has been cited by other articles:
Braunwald, E.
(2009). Adventures in Cardiovascular Research. Circulation
120: 170-180
[Abstract][Full Text]
Kato, M., Dote, K., Sasaki, S., Takemoto, H., Habara, S., Hasegawa, D.
(2004). Intracoronary Verapamil Rapidly Terminates Reperfusion Tachyarrhythmias in Acute Myocardial Infarction. Chest
126: 702-708
[Abstract][Full Text]
Braunwald, E.
(2002). Personal reflections on efforts to reduce ischemic myocardial damage. Cardiovasc Res
56: 332-338
[Full Text]
Braunwald, E.
(2002). Reperfusion therapy for acute myocardial infarction: historical context and future promise. Eur Heart J Suppl
4: E10-E14
[Abstract]
Yoshida, Y., Hirai, M., Yamada, T., Tsuji, Y., Kondo, T., Inden, Y., Akahoshi, M., Murakami, Y., Tsuda, M., Tsuboi, N., Hirayama, H., Okamoto, M., Ito, T., Saito, H., Toyama, J.
(2000). Antiarrhythmic Efficacy of Dipyridamole in Treatment of Reperfusion Arrhythmias : Evidence for cAMP-Mediated Triggered Activity as a Mechanism Responsible for Reperfusion Arrhythmias. Circulation
101: 624-630
[Abstract][Full Text]
Christian, T. F., Clements, I. P., Behrenbeck, T., Huber, K. C., Chesebro, J. H., Gersh, B. J., Gibbons, R. J.
(1991). Limitations of the Electrocardiogram in Estimating Infarction Size after Acute Reperfusion Therapy for Myocardial Infarction. ANN INTERN MED
114: 264-270
[Abstract]
Zikria, B. A., Subbarao, C., Oz, M. C., Popilkis, S. J., Sachdev, R., Chauhan, P., Freeman, H. P., King, T. C.
(1990). Hydroxyethyl Starch Macromolecules Reduce Myocardial Reperfusion Injury. Arch Surg
125: 930-934
[Abstract]
Siegel, M. E., Chen, D. C. P., Lee, K., Rasmussen, D., Colletti, P., Thom, P., Rahimtoola, S.H.
(1989). Gated Intracoronary Thallium201 Scintigraphy: Feasibility and Potential Clinical Advantages. ANGIOLOGY
40: 513-520
[Abstract]
Levinger, S., Zauberman, H., Eldor, A., Zelikovitch, A., Rosenmann, E.
(1987). Prevention of Clot Formation in Cat Retinal Vein by Systemic and Subconjunctival Urokinase. Arch Ophthalmol
105: 554-558
[Abstract]
MARDER, V. J., ROTHBARD, R. L., FITZPATRICK, P. G., FRANCIS, C. W.
(1986). Rapid Lysis of Coronary Artery Thrombi with Anisoylated Plasminogen: Streptokinase Activator Complex: Treatment by Bolus Intravenous Injection. ANN INTERN MED
104: 304-310
[Abstract]
Wei, J. Y., Markis, J. E., Malagold, M., Grossman, W.
(1985). Time Course of Serum Cardiac Enzymes After Intracoronary Thrombolytic Therapy: Creatine Kinase, Creatine Kinase MB Isozyme, Lactate Dehydrogenase, and Serum Glutamic-Oxaloacetic Transaminase. Arch Intern Med
145: 1596-1600
[Abstract]
Goldberg, J. P., Contiguglia, S. R., Mishell, J. L., Klein, M. H.
(1985). Intravenous Streptokinase for Thrombolysis of Occluded Arteriovenous Access: Its Use in Patients Undergoing Hemodialysis. Arch Intern Med
145: 1405-1408
[Abstract]
vonRyll Gryska, P., Raker, E. J.
(1983). Post Embolectomy Thrombosis Treated with Intra-Arterial Streptokinase. ANGIOLOGY
34: 620-625
[Abstract]
Richardson, R. L. Jr, Gooch, J. B., Robbins, S. G. Jr, Garrett, H. E., Davis, J. T. Jr
(1983). Coronary Artery Bypass Grafts: Success After Selective Intracoronary Thrombolysis in Acute Myocardial Infarction. Arch Surg
118: 970-972
[Abstract]
Bergmann, SR, Fox, K., Ter-Pogossian, M., Sobel, B., Collen, D
(1983). Clot-selective coronary thrombolysis with tissue-type plasminogen activator. Science
220: 1181-1183
[Abstract]
Demeter, S. L., Fuenning, C.
(1983). Intra-Pulmonary Artery Streptokinase. ANGIOLOGY
34: 70-77
[Abstract]
RUDE, R. E., MULLER, J. E., EUGENE, B.
(1981). Efforts to Limit the Size of Myocardial Infarcts. ANN INTERN MED
95: 736-761
[Abstract]
