title: The Mikamo lecture. Tomographic assessment of myocardial perfusion and metabolism in the evaluation of coronary thrombolysis.
abstract: Although coronary thrombolysis with fibrinolytic agents leads to restoration of patency of coronary arteries demonstratable angiographically, elucidation of the efficacy of the approach requires evaluation of its effect on the heart. Clot-selective fibrinolytic agents such as tissue-type plasminogen activator (t-PA) offer particular promise as therapeutic agents because they induce clot lysis without marked activation of the fibrinolytic system in the circulating blood and hence without marked fibrinogenolysis and predisposition to bleeding. Results of several large scale clinical trials demonstrate recanalization in approximately 75% of patients. Detection of recanalization may be achievable by analysis of plasma creatine kinase isoforms as a function of time, and in the research environment, with the use of positron emission tomography. This modality demonstrates restoration of regional perfusion and intermediary myocardial metabolism and provides an approach for calibration of conventional and more widely applicable diagnostic procedures such as scintigraphy.
mesh_terms: D000818:Animals; D010478:Chemotherapy, Cancer, Regional Perfusion; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014055:Tomography, Emission-Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator