Late thrombolysis followed by antithrombotic treatment in acute myocardial infarction: effect of therapy evaluated with thallium-201 SPECT.
Perfusion abnormalities and infarct size evaluated by thallium-201 SPECT after late thrombolysis followed by anti-thrombotic treatment in acute myocardial infarction were studied in 111 patients. Patients were prospectively randomized to a treatment group (n = 54) receiving streptokinase initiated 12-49 h after onset of symptoms, followed by heparin for at least 5 days and warfarin and dipyridamole for at least 3 months, or to a control group (n = 57) treated routinely without any of these drugs. Thallium-201 scintigraphy was performed within 3 months of follow-up in 40 (74%) of the patients in the treatment group and 46 (81%) in the control group. During a symptom-limited bicycle test the isotope was injected at peak exercise. SPECT was acquired 10 min later (exercise SPECT) and after 3 h (redistribution SPECT). A computerized quantitative analysis was performed. Defects were defined as regions with activity below 40% of the maximum. In the exercise SPECT defects were significantly smaller in the treatment group than among control patients (9 +/- 12% vs 15 +/- 15% of the left ventricle; P < 0.05). The difference was more apparent in patients with Q-wave than in those with non-Q-wave infarctions and the entire difference was accounted for by patients without a previous history of infarct or angina pectoris. There was no statistically significant difference in defect size in the redistribution SPECT (5 +/- 10% vs 9 +/- 11%, ns).(ABSTRACT TRUNCATED AT 250 WORDS)
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Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
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Holmgren
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Rydén
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D000368:Aged; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D004176:Dipyridamole / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D013300:Streptokinase / Q000008:administration & dosage*; D015996:Survival Rate; D013794:Thallium Radioisotopes; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology; D014859:Warfarin / Q000008:administration & dosage*
D013794:Thallium Radioisotopes; D014859:Warfarin; D004176:Dipyridamole; D006493:Heparin; D013300:Streptokinase