| Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. | |
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MedLine Citation:
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PMID: 2937825 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The effect of thrombolysis in acute myocardial infarction on infarct size, left ventricular function, clinical course and patient survival was studied in a randomized trial comparing thrombolysis (269 patients) with conventional treatment (264 control patients). All 533 patients were admitted to the coronary care unit within 4 hours after the onset of symptoms related to the infarction. Baseline characteristics were similar in both groups. Informed consent was requested only of patients allocated to thrombolysis; no angiography was performed in 35. The infarct-related artery was patent in 65 patients and occluded in 169. Recanalization was achieved in 133 patients. The median time to angiographic documentation of vessel patency was 200 minutes after the onset of symptoms. The clinical course in the coronary care unit was more favorable after thrombolysis. Infarct size, estimated from myocardial enzyme release, was 30% lower after thrombolysis. In patients admitted within 1 hour after the onset of symptoms the reduction of infarct size was 51%, in those admitted between 1 and 2 hours it was 31% and in those admitted later than 2 hours it was 13%. Left ventricular function measured by radionuclide angiography before hospital discharge was better after thrombolysis (ejection fraction 48 +/- 15%) than in control patients (44 +/- 15%). Similar improvement was observed in patients with a first infarct only (thrombolysis 50 +/- 14%, control subjects 46 +/- 15%), in patients with anterior infarction (thrombolysis 44 +/- 16%, control subjects 35 +/- 14%) and in those with inferior infarction (thrombolysis 52 +/- 12%, control subjects 49 +/- 12%). Similar results were obtained by contrast angiography. Mortality was lower after thrombolysis. After 28 days 16 patients allocated to thrombolysis and 31 control patients had died. One year survival rates were 91 and 84%, respectively. On the other hand, nonfatal reinfarction occurred more frequently after thrombolysis (36 patients) than in control subjects (16 patients). Early thrombolysis by intracoronary streptokinase leads to a smaller infarct size estimated by enzyme release, preserves left ventricular function at the second week and leads to improved 1 year survival. |
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Authors:
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M L Simoons; P W Serruys; M van den Brand; J Res; F W Verheugt; X H Krauss; W J Remme; F Bär; C de Zwaan; A van der Laarse |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 7 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1986 Apr |
Date Detail:
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Created Date: 1986-04-25 Completed Date: 1986-04-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 717-28 Citation Subset: AIM; IM |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Balloon Clinical Trials as Topic Coronary Vessels / radionuclide imaging Female Humans Hydroxybutyrate Dehydrogenase / blood Infusions, Intra-Arterial L-Lactate Dehydrogenase / blood Male Middle Aged Myocardial Infarction / mortality, physiopathology, therapy* Random Allocation Streptokinase / administration & dosage, therapeutic use* Stroke Volume |
| Chemical | |
Reg. No./Substance:
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EC 1.1.1.-/2-hydroxybutyrate dehydrogenase; EC 1.1.1.27/L-Lactate Dehydrogenase; EC 1.1.1.30/Hydroxybutyrate Dehydrogenase; EC 3.4.-/Streptokinase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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