THROMBOLYTIC THERAPY IN SELECTED PATIENTS WITH IMPENDING MYOCARDIAL REINFARCTION

Background: In selected patients with postinfarction angina and impend ing reinfarction, thrombolysis with recombinant tissue-type plasminoge n activator (rt-PA) or streptokinase is highly effective in avoiding a new myocardial infarction. Methods: To avoid major cardiac events, we treated 14 consecutive patients with thrombolytic therapy because of impending reinfarction with ECG ST-segment elevation. Thirteen patient s received rt-PA (100 mg over 3 hours), and one patient received strep tokinase (1.5 million IU over 1 hour). All patients had failed to resp ond to maximal medical therapy with intravenous nitrates, beta-blocker s, Ca-antagonists, heparin, and opiates. Results: In all patients, cli nical and ECG signs of acute ischemia resolved completely within 1 hou r after beginning thrombolysis, and no patient developed biochemical m arkers of myocardial infarction. Ten patients underwent coronary angio graphy: five had three-vessel disease, two had two-vessel disease, and three had one-vessel disease. The culprit lesion was located in the l eft anterior descending artery in eight cases and the right coronary a rtery in two. No patient showed intracoronary thrombus. Four patients underwent successful, semiurgent percutaneous transluminal coronary an gioplasty; three received an elective and two an urgent coronary arter y bypass graft. Conclusions: Thrombolysis (or repeated thrombolysis) i s effective in selected patients with clinical ECG signs of impending reinfarction. It can temporarily stabilize the condition of many patie nts, thus allowing safer mechanical revascularization to be performed.