[Prediction and prevention of reocclusion after coronary thrombolysis for acute myocardial infarction based on analysis of the coronary morphology with angiography].
Morphology of the affected coronary artery in acute myocardial infarction was qualitatively analyzed to predict the incidence of reocclusion after intracoronary thrombolysis. In 274 patients with 75% or more residual stenosis after successful thrombolysis, the morphology of the stenosis underlying the acute thrombus was graded as 75% or more (type A, n = 195), or less than 75% (type B, n = 79). Eighty-one patients with type A stenosis and 39 of 79 patients with type B stenosis were treated with immediate PTCA following thrombolysis. In 154 patients treated without PTCA, the severity of type A stenosis on chronic angiography remained unchanged after thrombolysis (87 +/- 7%-->86 +/- 14%); whereas, regression of the stenosis was noted in patients with type B stenosis (85 +/- 6%-->53 +/- 32%, p < 0.001). After thrombolysis, reocclusion occurred in 31 of 117 patients with type A stenosis, but in only 2 of 40 patients with type B stenosis (26.5% vs 5.0%, p < 0.02). Reocclusion was prevented by PTCA in patients with type A stenosis (26.5% vs 8.6%, p < 0.01), but not in patients with type B stenosis (5.0% vs 10.3%, p = ns). Qualitative analysis of coronary morphology after thrombolysis can facilitate the prediction of the occurrence of reocclusion and may provide a framework for selection of therapy.
Ishihara
M
M
Department of Cardiology, Hiroshima City Hospital.
Sato
H
H
Tateishi
H
H
Uchida
T
T
Dote
K
K
D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D012008:Recurrence; D015912:Thrombolytic Therapy