Factors influencing probability of reperfusion with intracoronary ostial infusion of thrombolytic agent in patients with acute myocardial infarction.
A multivariate logistic regression equation was used to evaluate variables related to successful intracoronary thrombolytic therapy. One hundred seventeen patients with a totally occluded infarct-related artery were randomly given ostial infusions of urokinase or streptokinase in a blinded study. The opening rate was 57%. The agent used and time from onset of symptoms to beginning of treatment did not significantly influence opening rate (p greater than .25). The site of occlusion was a strong predictor of opening rate (p = .0004). The anterior descending coronary artery was successfully opened more frequently than the left circumflex or right coronary artery (p = .012). Presence of collaterals adversely affected the recanalization rate in all groups (p = .0004). These variables had an additive effect on the probability of opening. Patients with proximal anterior descending occlusion and no collaterals had a 90% recanalization rate, while those with distal occlusions in vessels other than the anterior descending and with collaterals had only a 24% chance for reperfusion. Thus location of occlusion and presence or absence of collaterals may strongly influence opening rates.
D000328:Adult; D000368:Aged; D003097:Collateral Circulation; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D011336:Probability; D012044:Regression Analysis; D013300:Streptokinase / Q000008:administration & dosage; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator