Evaluation of the effect of thrombolytic treatment on infarct size and left ventricular function by enzymatic, scintigraphic, and angiographic methods. The European Cooperative Study Group for Recombinant Tissue Type Plasminogen Activator.
In a double-blind trial of the European Cooperative Study Group, 721 patients with acute myocardial infarction of less than 5 hours' duration were given either 100 mg recombinant tissue-type plasminogen activator (rt-PA) intravenously over 3 hours or an equivalent placebo infusion. In a subset of 312 patients, infarct size was assessed by the cumulative myocardial release of alpha-hydroxybutyrate dehydrogenase (HBDH) during the first 72 hours and by planar thallium scintigraphy (index of hypoperfusion) performed 10 to 22 days after the acute event. Left ventricular ejection fraction (LVEF) was determined by contrast and nuclear angiography. The median values of HBDH during the first 72 hours were 20% lower and the median values of thallium-201 28% smaller in the rt-PA group in comparison with controls. A significant but limited improvement of angiographic LVEF (2 absolute percentage points) was also shown in the patients treated with rt-PA. A moderate but statistically significant linear association between both measurements of infarct size and LVEF was found.
Mortelmans
L
L
Department of Epidemiology, University of Leuven, Belgium.
Vanhaecke
J
J
Lesaffre
E
E
Arnold
A
A
Urbain
J L
JL
Hermens
W
W
De Roo
M
M
De Geest
H
H
Verstraete
M
M
Van de Werf
F
F
D000328:Adult; D000368:Aged; D000792:Angiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D006884:Hydroxybutyrate Dehydrogenase / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000201:enzymology / Q000473:pathology*; D011877:Radionuclide Imaging; D013318:Stroke Volume; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; C035749:2-hydroxybutyrate dehydrogenase; D006884:Hydroxybutyrate Dehydrogenase; D010959:Tissue Plasminogen Activator