Thrombolytic therapy within 2 hours yielded greater improvement in hypokinesis than later treatment (2.1 vs 0.7 SD/chord, p<0.001), as did minimum stenosis >0.4 mm vs ≤0.4 mm (1.0 vs 0.0, p<0.05).
Observational (n=47)
Do residual stenosis severity and timing of treatment affect the recovery of left ventricular function in patients with acute myocardial infarction treated with intracoronary streptokinase?
Early thrombolysis and adequate residual lumen diameter (>0.4 mm) are critical for salvaging myocardial function after acute myocardial infarction.
Absolute Event Rate: 2.1% vs 0.7%
p-value: p=<0.001
The coronary and ventricular angiograms of 47 patients with acute myocardial infarction in whom reperfusion was achieved by intracoronary streptokinase were quantitatively analyzed to determine the factors that affect recovery of regional left ventricular function after reperfusion. Hypokinesis in the infarct region was measured by the centerline method and expressed in terms of standard deviations (SDs) from normal. Severity of coronary artery stenosis was measured quantitatively. Hypokinesis showed more significant improvement after thrombolysis in patients with minimum stenosis diameter of greater than 0.4 mm than in those with severe residual stenosis, i.e., stenosis producing a minimum diameter of 0.4 mm or less (1.0 +/- 1.3 SD/chord, n = 31, vs 0.0 +/- 0.9 SD/chord, n = 7; p less than .05). Improvement in hypokinesis was greater in patients who received thrombolytic therapy within 2 hr than in those treated later (2.1 +/- 1.1, n = 8, vs 0.7 +/- 1.0 SD/chord, n = 28; p less than .001). These results indicate that angiographic reperfusion alone may not be sufficient: reperfusion must provide adequate flow and be achieved early to salvage myocardial function.
Sheehan et al. (Sat,) conducted a observational in Acute myocardial infarction (n=47). Intracoronary streptokinase vs. Delayed treatment (>2 hours) or severe residual stenosis (≤0.4 mm) was evaluated on Improvement in hypokinesis (SD/chord) (p=<0.001). Thrombolytic therapy within 2 hours yielded greater improvement in hypokinesis than later treatment (2.1 vs 0.7 SD/chord, p<0.001), as did minimum stenosis >0.4 mm vs ≤0.4 mm (1.0 vs 0.0, p<0.05).