CLINICAL AND ANGIOGRAPHIC FEATURES OF PATIENTS WITH AN OCCLUDED VERSUS A PATENT INFARCT VESSEL AFTER INTRAVENOUS STREPTOKINASE FOR ACUTE MYOCARDIAL-INFARCTION

Despite early treatment with thrombolytic agents for acute myocardial infarction, a significant portion of patients fail to achieve a patent infarct artery. To study the various factors related to achieving pat ency in the infarct vessel, 201 patients who received streptokinase wi thin six hours of symptoms were studied. All patients underwent cardia c catheterization during the same hospitalization at 5.40+/-3.26 days after admission. Forty five (22.4%) patients were found to have an occ luded infarct artery (group 1) and 156 (77.6%) had a patent infarct ve ssel (group 2). There was no difference in the time from onset of symp toms to receiving streptokinase between the two groups. The two groups were similar to each other with regard to age, gender, history of myo cardial infarction or angina, and major risk factors for coronary dise ase. Coagulation parameters before and after streptokinase therapy, re flecting the lytic state, were similar in both groups. The left ventri cular end diastolic pressure was significantly higher and the left ven tricular ejection fraction was significantly lower in group 1 than in group 2. These observations suggest that despite early initiation of t hrombolytic therapy in patients with acute myocardial infarction, a si gnificant portion of patients fail to achieve a patent infarct artery. This failure cannot be explained by the observed clinical parameters or the lytic state after streptokinase.