PTCA-INDUCED MYOCARDIAL-ISCHEMIA FOR DETECTION OF SALVAGED MYOCARDIUMAFTER THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

In 43 patients (ages 55.8 +/- 9.0 years) with myocardial infarction tr eated with thrombolytic therapy presenting with one-vessel coronary ar tery disease, the monitoring-ECGs during PTCA (17.0 +/- 12.7 days afte r infarct) were analyzed. Patients with ST-segment deviations greater than or equal to 0.1 mV (group A, n = 33) were compared with those < 0 .1 mV (group B, n = 10). To answer the question, if these ischemic sig ns might be interpreted as salvaged myocardium, parameters of infarct size were evaluated. The maximal CK-activity in group A was 867 +/- 56 7 IU/1, in group B 1452 +/- 992 IU/1 (p < 0.05), whereas the maximal G OT-activity was 113 +/- 69 IU/1 and 174 +/- 102 UI/1 (p < 0.05). The n umber of pathologic segments of the ventriculographies in the acute ph ase were 9 +/- 2 and 14 +/- 3 (p < 0.05), shortly after PTCA, 12 +/- 2 and 16 +/- 2 (p = 0.06), and after 6 months, 11 +/- 4 and 13 +/- 1 (N .S.). At the same time points EDV was analyzed in both groups and reve aled the following: 103 +/- 20 ml, 98 +/- 21 ml, 104 +/- 23 ml and 103 +/- 25 ml (N.S.), 101 +/- 21 ml (N.S.), 116 +/- 46 ml (N.S.). ESV was 39 +/- 11 ml, 42 +/- 9 ml, 41 +/- 15 ml and 43 +/- 8 ml (N.S.), 49 +/ - 7 ml (p < 0.05), 52 +/- 21 ml (N.S.) and EF 62 +/- 8%, 58 +/- 9%, 60 +/- 11% and 54 +/- 9% (p < 0.05), 50 +/- 12% (N.S.), 56 +/- 46% (N.S. ). Successful reperfusion and salvaged myocardium can be detected by s imply monitoring the ECG during PTCA without any additional instrument al or time-consuming effort. These ECG signs should result in special attention to the postinfarct treatment. This is done to insure that th e acutely salvaged myocardium continues to be adequately perfused.