THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - EFFECTS, PROBLEMS AND STRATEGIES

Citation
K. Nagao et al., THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - EFFECTS, PROBLEMS AND STRATEGIES, Japanese Circulation Journal, 58(12), 1994, pp. 885-893
Citations number
18
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
00471828
Volume
58
Issue
12
Year of publication
1994
Pages
885 - 893
Database
ISI
SICI code
0047-1828(1994)58:12<885:TTFAM->2.0.ZU;2-Y
Abstract
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%.