We performed continuous electrocardiographic ST-segment monitoring and serial coronary arteriography in 45 consecutive patients presenting in the early stages of acute myocardial infarction. During cardiac catheterization, 28 episodes of arteriographically confirmed coronary reopening and subsequent reocclusion were observed in 16 patients before (3 episodes) and during (25 episodes) continuous intracoronary infusion of streptokinase. In addition, ST-segment monitoring demonstrated 12 episodes of spontaneous transient return of the ST segment to the base line in eight patients between the time of admission and the performance of coronary arteriography. During arteriographically documented reocclusion, intracoronary isosorbide dinitrate (2 mg) reestablished the patency of the coronary artery within one to two minutes in 14 of 28 episodes that occurred in 11 of 16 patients. After streptokinase infusion, intracoronary administration of isosorbide dinitrate was followed by dilatation of the infarct-related stenosis from a mean value (+/- SD) of 1.12 +/- 0.3 mm (58.1 +/- 12.1 percent) to 1.33 +/- 0.4 mm (51.6 +/- 12.9 percent; P = 0.004). Spontaneous intermittent coronary recanalization and reocclusion resulting from a variable combination of thrombosis and vasoconstriction are frequent during the early phase of acute myocardial infarction. We propose that the combination of intracoronary streptokinase and isosorbide dinitrate may increase the rate of stable coronary recanalization.
Source Information
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London.
This article has been cited by other articles:
Johanson, P., Fu, Y., Goodman, S. G., Dellborg, M., Armstrong, P. W., Krucoff, M. W., Wallentin, L., Wagner, G. S.
(2005). A dynamic model forecasting myocardial infarct size before, during, and after reperfusion therapy: an ASSENT-2 ECG/VCG substudy. Eur Heart J
26: 1726-1733
[Abstract][Full Text]
Steffel, J., Akhmedov, A., Greutert, H., Luscher, T. F., Tanner, F. C.
(2005). Histamine Induces Tissue Factor Expression: Implications for Acute Coronary Syndromes. Circulation
112: 341-349
[Abstract][Full Text]
Ibanez, B, Navarro, F, Cordoba, M, M-Alberca, P, Farre, J
(2005). Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma?. Heart
91: 102-104
[Full Text]
Krucoff, M. W., Johanson, P., Baeza, R., Crater, S. W., Dellborg, M.
(2004). Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction: Assessing the Dynamics of Epicardial and Myocardial Reperfusion. Circulation
110: e533-e539
[Full Text]
Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., Macfarlane, P. W., Sommargren, C., Swiryn, S., Van Hare, G. F.
(2004). Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation
110: 2721-2746
[Abstract][Full Text]
Tomoda, H., Aoki, N.
(2004). Coronary Blood Flow in Evolving Myocardial Infarction Preceded by Preinfarction Angina: A Critical Reevaluation of Preconditioning Effects in Clinical Cases. ANGIOLOGY
55: 9-15
[Abstract]
Lee, S., Otsuji, Y., Minagoe, S., Hamasaki, S., Toyonaga, K., Negishi, M., Tsurugida, M., Toda, H., Tei, C.
(2003). Noninvasive Evaluation of Coronary Reperfusion by Transthoracic Doppler Echocardiography in Patients With Anterior Acute Myocardial Infarction Before Coronary Intervention. Circulation
108: 2763-2768
[Abstract][Full Text]
Lamfers, E J P, Hooghoudt, T E H, Hertzberger, D P, Schut, A, Stolwijk, P W J, Verheugt, F W A
(2003). Abortion of acute ST segment elevation myocardial infarction after reperfusion: incidence, patients' characteristics, and prognosis. Heart
89: 496-501
[Abstract][Full Text]
Johanson, P., Jernberg, T., Gunnarsson, G., Lindahl, B., Wallentin, L., Dellborg, M.
(2003). Prognostic value of ST-segment resolution--when and what to measure. Eur Heart J
24: 337-345
[Abstract][Full Text]
Drew, B. J.
(2002). Celebrating the 100th Birthday of the Electrocardiogram: Lessons Learned From Research in Cardiac Monitoring. Am J Crit Care
11: 378-386
[Abstract][Full Text]
Libby, P., Ridker, P. M., Maseri, A.
(2002). Inflammation and Atherosclerosis. Circulation
105: 1135-1143
[Abstract][Full Text]
Wong, C.-K., French, J.K., Andrews, J., Frey, M.J., Adgey, A.A.J., Aylward, P.E., White, H.D.
(2002). Usefulness of the presenting electrocardiogram in predicting myocardial salvage with thrombolytic therapy in patients with a first acute myocardial infarction. Eur Heart J
23: 399-404
[Abstract][Full Text]
Maseri, A., Cianflone, D.
(2002). Inflammation in acute coronary syndromes. Eur Heart J Suppl
4: B8-B13
[Abstract]
Hatada, K., Sugiura, T., Kamihata, H., Nakamura, S., Takahashi, N., Yuasa, F., Iwasaka, T.
(2001). Clinical Significance of Coronary Flow to the Infarct Zone Before Successful Primary Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction. Chest
120: 1959-1963
[Abstract][Full Text]
Fu, Y., Goodman, S., Chang, W.-C., Van de Werf, F., Granger, C. B., Armstrong, P. W.
(2001). Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis: Insights From the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Trial. Circulation
104: 2653-2659
[Abstract][Full Text]
Tomoda, H., Aoki, N.
(2001). Pathophysiology of Early Coronary Angioplasty with Stenting on Non-Q-Wave vs Q-Wave Myocardial Infarction. ANGIOLOGY
52: 671-679
[Abstract]
Andrews, J., Straznicky, I. T., French, J. K., Green, C. L., Maas, A. C. P., Lund, M., Krucoff, M. W., White, H. D.
(2000). ST-Segment Recovery Adds to the Assessment of TIMI 2 and 3 Flow in Predicting Infarct Wall Motion After Thrombolytic Therapy. Circulation
101: 2138-2143
[Abstract][Full Text]
Pristipino, C., Beltrame, J. F., Finocchiaro, M. L., Hattori, R., Fujita, M., Mongiardo, R., Cianflone, D., Sanna, T., Sasayama, S., Maseri, A.
(2000). Major Racial Differences in Coronary Constrictor Response Between Japanese and Caucasians With Recent Myocardial Infarction. Circulation
101: 1102-1108
[Abstract][Full Text]
Laine, P., Kaartinen, M., Penttila, A., Panula, P., Paavonen, T., Kovanen, P. T.
(1999). Association Between Myocardial Infarction and the Mast Cells in the Adventitia of the Infarct-Related Coronary Artery. Circulation
99: 361-369
[Abstract][Full Text]
Bhagat, K.
(1998). Endothelial function and myocardial infarction. Cardiovasc Res
39: 312-317
[Full Text]
White, H. D., Van de Werf, F. J. J.
(1998). Thrombolysis for Acute Myocardial Infarction. Circulation
97: 1632-1646
[Abstract][Full Text]
White, H. D., Aylward, P. E., Frey, M. J., Adgey, A. A. J., Nair, R., Hillis, W. S., Shalev, Y., Brown, M. A., French, J. K., Collins, R., Maraganore, J., Adelman, B.
(1997). Randomized, Double-blind Comparison of Hirulog Versus Heparin in Patients Receiving Streptokinase and Aspirin for Acute Myocardial Infarction (HERO). Circulation
96: 2155-2161
[Abstract][Full Text]
Di Carli, M. F., Tobes, M. C., Mangner, T., Levine, A. B., Muzik, O., Chakroborty, P., Levine, T. B.
(1997). Effects of Cardiac Sympathetic Innervation on Coronary Blood Flow. NEJM
336: 1208-1216
[Abstract][Full Text]
Hebert, D., Xiang, J.-X., Lam, J. Y.T.
(1997). Persistent Inhibition of Platelets During Continuous Nitroglycerin Therapy Despite Hemodynamic Tolerance. Circulation
95: 1308-1313
[Abstract][Full Text]
Cobbaert, C., Hermens, W. Th., Kint, P. P., Klootwijk, P. J., Van de Werf, F., Simoons, M. L.
(1997). Thrombolysis-induced coronary reperfusion causes acute and massive interstitial release of cardiac muscle cell proteins. Cardiovasc Res
33: 147-155
[Abstract][Full Text]
Haider, A. W., Andreotti, F., Thompson, G. R., Kluft, C., Maseri, A., Davies, G. J.
(1996). Serum Lipoprotein(a) Level Is Related to Thrombin Generation and Spontaneous Intermittent Coronary Occlusion in Patients With Acute Myocardial Infarction. Circulation
94: 2072-2076
[Abstract][Full Text]
Andreotti, F., Pasceri, V., Hackett, D. R., Davies, G. J., Haider, A. W., Maseri, A.
(1996). Preinfarction Angina as a Predictor of More Rapid Coronary Thrombolysis in Patients with Acute Myocardial Infarction. NEJM
334: 7-12
[Abstract][Full Text]
Langford, E.J., Wainwright, R.J., Martin, J.F.
(1996). Platelet Activation in Acute Myocardial Infarction and Unstable Angina Is Inhibited by Nitric Oxide Donors. Arterioscler. Thromb. Vasc. Bio.
16: 51-55
[Abstract][Full Text]
Arstall, M. A., Yang, J., Stafford, I., Betts, W. H., Horowitz, J. D.
(1995). N-Acetylcysteine in Combination With Nitroglycerin and Streptokinase for the Treatment of Evolving Acute Myocardial Infarction : Safety and Biochemical Effects. Circulation
92: 2855-2862
[Abstract][Full Text]
Laperche, T., Steg, P. G., Dehoux, M., Benessiano, J., Grollier, G., Aliot, E., Mossard, J.-M., Aubry, P., Coisne, D., Hanssen, M., Iliou, M.-C.
(1995). A Study of Biochemical Markers of Reperfusion Early After Thrombolysis for Acute Myocardial Infarction. Circulation
92: 2079-2086
[Abstract][Full Text]
Yao, S.-K., Akhtar, S., Scott-Burden, T., Ober, J. C., Golino, P., Buja, L. M., Casscells, W., Willerson, J. T.
(1995). Endogenous and Exogenous Nitric Oxide Protect Against Intracoronary Thrombosis and Reocclusion After Thrombolysis. Circulation
92: 1005-1010
[Abstract][Full Text]
Uren, N. G., Crake, T., Lefroy, D. C., de Silva, R., Davies, G. J., Maseri, A.
(1994). Reduced Coronary Vasodilator Function in Infarcted and Normal Myocardium after Myocardial Infarction. NEJM
331: 222-227
[Abstract][Full Text]
Krichbaum, D. W., Trivedi, D. A.
(1990). Thrombolytic Therapy in Acute Myocardial Infarction. Journal of Pharmacy Practice
3: 332-348
(1987). THROMBOSIS AND CORONARY ARTERY SPASM MAY CAUSE MYOCARDIAL INFARCTION. JWatch General
1987: 7-7
[Full Text]
Previous
