title: Deterioration in left ventricular performance during early coronary angioplasty after thrombolysis. Evidence for myocardial salvage.
abstract: To investigate the effects of controlled coronary artery reocclusion after successful thrombolysis, we studied 15 patients during early elective angioplasty of the patent infarct-related artery. Eight patients underwent left anterior descending artery dilation, and the other 7 had right coronary artery dilation. In 13 cases, ST-segment elevation developed during balloon occlusion. In all 15 cases, intravenous digital subtraction left ventriculography during balloon inflation showed that the ejection fraction decreased at least 5% (mean decrease, from 60% to 47%), despite preexisting Q waves overlying the infarct territory in 5 patients. Balloon inflation resulted in decreased apical segmental shortening in all 8 patients who underwent left anterior descending artery dilation; likewise, balloon inflation produced impairment of inferior-wall contraction in all 7 patients who had right coronary artery dilation. In this setting, a deterioration in left ventricular performance indicates that the restoration of coronary patency with thrombolysis has resulted in myocardial salvage. In patients with Q waves, such deterioration suggests that this electrocardiographic abnormality does not necessarily indicate a completed infarction.
authors.affiliation: Cardiac Department, London Chest Hospital, Bonner Road, London, United Kingdom.
authors.forename: M S
authors.initials: MS
authors.lastname: Norell
authors.forename: J P
authors.initials: JP
authors.lastname: Lyons
authors.forename: S A
authors.initials: SA
authors.lastname: Davies
authors.forename: A D
authors.initials: AD
authors.lastname: Timmis
authors.forename: R
authors.initials: R
authors.lastname: Balcon