[Ischemic reaction in coronary angioplasty (PTCA) as a prerequisite for improving left ventricular function following intravenous thrombolysis in acute myocardial infarct].
The incidence of ischemic ECG-changes and anginal symptoms during PTCA and the influence of PTCA on left ventricular function were studied in a consecutive series of 40 patients with recanalized infarct artery and significant (greater than 50%) single vessel disease. PTCA was performed within the first week (4.1 +/- 2.5 days) after intravenous streptokinase (1.5 Mio U i.v. over 60 min) in acute myocardial infarction (duration of pain less than four hours). The primary success rate of PTCA was 78% (31/40). In 25 of 31 (81%) successfully dilated patients, there were ischemic ECG-changes (ST-segment elevation greater than 0.1 mV), and in 14 patients anginal symptoms were observed during balloon inflation. Follow-up angiography after six months showed restenosis or reocclusion in 5/22 (23%) of the patients with an ischemic reaction, and in 3/6 (50%) without ischemic signs during PTCA. Only patients with an ischemic reaction and without restenosis demonstrated an increase in left ventricular ejection fraction (p less than 0.05) and regional wall motion in the infarct region (p less than 0.01), in contrast to patients with restenosis or without an ischemic reaction during angioplasty. Thus, after intravenous streptokinase an ischemic reaction can be detected in a high percentage (81%) as an indicator of salvaged myocardium. Significant improvement of left ventricular function was only demonstrable in patients with ischemic signs during PTCA without restenosis.
Leisch
F
F
1. Medizinische Abteilung (Kardiologie), Allgemeines Krankenhaus der Stadt Linz, Osterreich.
Schützenberger
W
W
Kerschner
K
K
Herbinger
W
W
D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D003326:Coronary Circulation; D004562:Electrocardiography; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D013300:Streptokinase / Q000008:administration & dosage*
D013300:Streptokinase
Ischämiereaktion bei der koronaren Angioplastie (PTCA) als Voraussetzung für Verbesserungen der linksventrikulären Funktion nach intravenöser Thrombolyse beim akuten Myokardinfarkt.