K. Nagao et al., THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - EFFECTS, PROBLEMS AND STRATEGIES, Japanese Circulation Journal, 58(12), 1994, pp. 885-893
The effects and problems of coronary thrombolysis (CT) were investigat
ed in 652 patients with initial acute myocardial infraction (AMI). Nos
ocomial mortality obtained by matching factors which determined progno
sis was significantly lower in patients treated by CT (8.3%) than in t
hose who did not undergo CT (18.1%). Regardless of whether the treatme
nt was intracoronary arterial (ICT) or intravenous (IVCT), the primary
cause of the decreased mortality was reperfusion of the coronary arte
ry responsible for infarction (mortality 6.1% in the reperfused group
vs 21.50/0 in the ineffective group). CT therapy improved left ventric
ular ejection fraction (LVEF), the nosocomial mortality rate, and regi
onal wall motion at the site of infarction in cases that were reperfus
ed less than 3 h, 3-6 h, and even 6 or more hours after the therapy. T
he long-term prognosis was significantly better in the reperfused grou
p than in the ineffective group for 5 years and 7 months after therapy
. However, CT was accompanied by both (1) poor prognosis in the ineffe
ctive group; and (2) unfavorable effects on the prognosis and on the d
aily life of patients with severe stenosis even after treatment. Accor
dingly, supplemental ICT and rescue PTCA (strategy (A)) were performed
to treat the first problem, and deferred PTCA (strategy (B)) was cond
ucted to treat the second problem in 80 patients with initial AMI. As
a result, strategy (A) increased the coronary reperfusion rate to 94.3
%, and strategies (A) and (B) together decreased the nosocomial mortal
ity rate of 8.5% to 3.8%, and reduced the risk of death by 55.3%.