title: Applicability of percutaneous transluminal coronary angioplasty to patients with recombinant tissue plasminogen activator mediated thrombolysis.
abstract: To test the utility and safety of percutaneous transluminal coronary angioplasty (PTCA) after recombinant tissue plasminogen activator (t-PA), we performed the procedure in all suitable candidates with acute myocardial infarction (MI) who had successful t-PA mediated coronary thrombolysis. Twenty consecutive patients with MI received t-PA after coronary angiographic conformation of total occlusion. Successful recanalization with t-PA was achieved in 13 patients, leaving a residual obstruction of 84 +/- 6% in the nine patients for whom PTCA was attempted at a mean of 21.6 h. Success was achieved in seven patients, leading to a residual lesion of 29 +/- 7%. In the two patients for whom PTCA was unsuccessful, total reocclusion occurred prior to the attempt despite therapy with heparin, aspirin, dipyridamole, and nifedipine. All PTCA procedures were uncomplicated. Serial two-dimensional echocardiography at 10 days, compared to admission, demonstrated infarct zone wall motion index improvement in the patients with successful PTCA (group A, 0.83 +/- 0.36 to 1.46 +/- 0.49) as compared to the 13 patients without thrombolysis or successful PTCA (group B, 0.61 +/- 0.26 to 0.66 +/- 0.39), (P less than 0.05). One patient of group A sustained a massive stroke at 2 weeks after hospital discharge. In the remaining six patients, follow-up exercise testing and/or coronary arteriography demonstrated a negative treadmill test and/or patent infarct vessel, respectively. After successful PTCA, no patient had clinical signs of reocclusion, reinfarction, postinfarction angina, or congestive heart failure. At 9.4 +/- 2 months, all six patients are asymptomatic and have returned to work. Thus, sequential PTCA after t-PA can be performed safely and successfully in patients with MI and this approach may be associated with improved regional function and a favorable post-MI course.
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: J E
authors.initials: JE
authors.lastname: Eha
authors.forename: K P
authors.initials: KP
authors.lastname: Brin
authors.forename: E P
authors.initials: EP
authors.lastname: Shapiro
authors.forename: J L
authors.initials: JL
authors.lastname: Weiss
authors.forename: M B
authors.initials: MB
authors.lastname: Riegel
authors.forename: S O
authors.initials: SO
authors.lastname: Gottlieb
authors.forename: J A
authors.initials: JA
authors.lastname: Brinker
mesh_terms: D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000628:therapy*; D004452:Echocardiography; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator