[Significance of coronary perfusion for therapeutic success in myocardial infarct].
Survival in acute myocardial infarction is dependent on several parameters. Some of them act by limiting the infarct size, others improve the prognosis independent of the final infarct size. Determinants of infarct size are time of vessel occlusion, degree of collaterals and area at risk. The latter two determinants do not offer a therapeutic approach in acute myocardial infarction. The most important therapeutic intervention remains the restoration of blood flow in the area at risk by either thrombolysis or PTCA. Reperfusion within 60 to 120 minutes significantly reduces mortality and infarct size. Within this time frame, changes in left ventricular function correlate with the survival rate. If reperfusion occurs later, the correlation between changes in left ventricular function and survival is poor or absent in some studies, despite a persistent survival benefit. After 4 bis 6 hours reperfusion is no longer able to limit infarct size significantly. However, this time frame is variable since there are wide variations in the degree of collaterals. With increasing occlusion time of the infarct related coronary artery, mechanisms independent of the limitation of infarct size will determine the prognosis. Late reperfusion has a beneficial effect on survival and on left ventricular function in certain cases. Left ventricular re-modeling and the incidence of severe ventricular arrhythmias can be reduced by delayed reperfusion. Reactivation of hibernating myocardium following reperfusion therapy may improve global left ventricular function. We analysed the importance of the infarct artery perfusion grade (TIMI flow) in 156 consecutive patients treated with infarct-PTCA. The most frequent indications for infarct-PTCA were failed thrombolysis and cardiogenic shock (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)
II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
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Spiecker
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Erbel
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Janssen
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Meyer
D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D015912:Thrombolytic Therapy
Bedeutung der Koronarperfusion für den Therapieerfolg beim akuten Myokardinfarkt.