THE SEVERITY OF RESIDUAL CORONARY STENOSIS IMMEDIATELY AFTER THROMBOLYTIC THERAPY DOES NOT INFLUENCE THE SIZE OF LATER LEFT-VENTRICULAR ASYNERGIC AREA

To determine whether the severity of residual coronary artery stenosis immediately after thrombolytic therapy influences the size of later l eft ventricular (LV) asynergic area, we reviewed coronary angiograms ( CAGs) and left ventriculograms (LVGs) of 31 patients with acute myocar dial infarction (AMI). All patients received intracoronary urokinase t herapy within 6 h after onset of AMI due to total occlusion of the pro ximal left anterior descending coronary artery (LAD). A dose of 960,00 0 IU urokinase was infused into the ostium of the left coronary artery over 40 min. Patients in whom antegrade blood flow without delayed di stal filling was restored received rigorous anticoagulation. The patie nts were divided into three groups according to the severity of the co ronary lesion immediately after urokinase therapy: 9 patients with com plete occlusion in Group 1, 15 with > 90% stenosis in Group 2, and 7 w ith < 90% stenosis in Group 3. There were no significant differences i n the baseline clinical characteristics among the patients in the thre e groups. The LADs in Group 1 were also totally occluded 1 month after urokinase therapy, the treated vessels in both Groups 2 and 3 were st ill patent, and patients in Group 2 showed a further reduction in resi dual stenosis. When LV asynergic area, regional wall motion, and globa l ejection fraction (EF) were compared among the three groups, no sign ificant differences were demonstrated. In comparison with the data imm ediately after urokinase therapy, all parameters 1 month after therapy were significantly improved in both Groups 2 and 3. However, there wa s no significant difference in the improvement of these parameters bet ween Groups 2 and 3 despite significant differences in residual stenos is of the LADs immediately after urokinase therapy. We conclude that s everity of residual coronary stenosis immediately after thrombolytic t herapy does not influence the size of later LV asynergic area.