Myocardial Salvage after Intracoronary Thrombolysis with Streptokinase in Acute Myocardial Infarction Assessment by Intracoronary Thallium-201

• Published in: The New England journal of medicine Vol. 305; no. 14; pp. 777 - 782
• Main Authors: Markis, John E, Malagold, Michael, Parker, J. Anthony, Silverman, Kenneth J, Barry, William H, Als, Ann V, Paulin, Sven, Grossman, William, Braunwald, Eugene
• Format: Journal Article
• Language: English
• Published: Boston Massachusetts Medical Society 01.10.1981
• Subjects: Catheterization; Catheters; Clinical trials; Coronary artery; Coronary vessels; Electrocardiography; Heart attacks; Heart diseases; Intubation; Long-term effects; Myocardial infarction; Myocardium; Patients; Perfusion; Stents; Streptokinase; Thallium; Thallium-201; Thrombolysis; Veins & arteries
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198110013051401

Nine patients with acute myocardial infarction had cardiac catheterization and intracoronary infusions of streptokinase 2.3 to 4.3 hours (mean, 3.5) after the onset of symptoms. Occluded coronary arteries were opened within approximately 20 minutes in all patients, but reocclusion occurred in one patient. The immediate effect of thrombolysis on myocardial salvage was assessed with the intracoronary injection of thallium-201. Improved regional perfusion, indicating myocardial salvage after recanalization, was observed in seven of the nine patients. One patient, who had also sustained a nontransmural infarction one week before, had no change after thrombolysis. In the ninth patient, recanalization of a coronary artery was followed by reocclusion and worsening of the myocardial-perfusion defect. Intracoronary thallium-201 studies two weeks and three months after streptokinase infusion in two patients were unchanged in comparison with scintiscans performed 1.5 hours after thrombolysis. These short-term observations suggest that recanalization of obstructed coronary arteries after intracoronary thrombolysis can salvage jeopardized myocardium. However, evaluation of the long-term effects of this procedure on survival and myocardial function will require controlled clinical trials. (N Engl J Med. 1981; 305:777–82.) RECENTLY it has been shown that intracoronary infusion of streptokinase can restore the patency of an obstructed coronary artery during the early hours of myocardial infarction. 1 2 3 However, since it is recognized that the rapidity and extent of myocardial necrosis after coronary occlusion can vary widely and that reperfusion may actually promote injury under some circumstances, 4 it is not clear that restoration of coronary flow in this manner is beneficial. 5 Thallium-201 imaging after intravenous injection of the radionuclide has been shown to be a sensitive technique for the detection of acute myocardial infarction in the first six hours after the onset . . .