[Estimation of the length of coronary thrombi and prediction of the result of coronary thrombolytic therapy based on the angiographic findings].
The optimal approach for the treatment of occluded coronary arteries in patients with acute myocardial infarction is still controversial. This study correlated the results of coronary thrombolytic therapy and the clinical course with angiographic findings of infarct related coronary arteries in 111 patients with first attack of acute myocardial infarction and complete coronary occlusion (Thrombolysis in Myocardial Infarction Class 0) of the infarct-related arteries confirmed on coronary angiography followed by thrombolytic therapy within 12 hours after the onset of acute myocardial infarction. The length of the coronary thrombi (proximal thrombi) was estimated by comparing the initial angiographic finding with that obtained approximately 2 weeks later. The shape of the coronary occlusion was classified into two types: occlusion with obscurely stained edge or convex dye outline (type SC), and occlusion with acute cutoff edge or tapered edge (type AT). Although the recanalization rate of thrombolytic therapy was higher and the length of proximal thrombi was shorter in type AT than in type SC, the degree of residual stenosis was greater in the former. Pre- and post-infarction angina were more frequent in type AT. Type SC may indicate a low success rate for thrombolytic therapy and more complications for direct percutaneous transluminal coronary angioplasty (PTCA). However, although direct PTCA may be indicated because of the frequent presence of residual stenosis, the recanalization rate of thrombolytic therapy is high for type AT. The shape of the occlusion of the infarct related artery observed in the coronary angiogram is helpful to decide the optimal recanalization therapy in the acute phase of acute myocardial infarction.
Mochida
Y
Y
Critical Care and Emergency Medical Center, Yokohama City University School of Medicine.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D015912:Thrombolytic Therapy