Document Detail


Intermittent coronary occlusion in acute myocardial infarction. Value of combined thrombolytic and vasodilator therapy.
MedLine Citation:
PMID:  3657868     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We performed continuous electrocardiographic ST-segment monitoring and serial coronary arteriography in 45 consecutive patients presenting in the early stages of acute myocardial infarction. During cardiac catheterization, 28 episodes of arteriographically confirmed coronary reopening and subsequent reocclusion were observed in 16 patients before (3 episodes) and during (25 episodes) continuous intracoronary infusion of streptokinase. In addition, ST-segment monitoring demonstrated 12 episodes of spontaneous transient return of the ST segment to the base line in eight patients between the time of admission and the performance of coronary arteriography. During arteriographically documented reocclusion, intracoronary isosorbide dinitrate (2 mg) reestablished the patency of the coronary artery within one to two minutes in 14 of 28 episodes that occurred in 11 of 16 patients. After streptokinase infusion, intracoronary administration of isosorbide dinitrate was followed by dilatation of the infarct-related stenosis from a mean value (+/- SD) of 1.12 +/- 0.3 mm (58.1 +/- 12.1 percent) to 1.33 +/- 0.4 mm (51.6 +/- 12.9 percent; P = 0.004). Spontaneous intermittent coronary recanalization and reocclusion resulting from a variable combination of thrombosis and vasoconstriction are frequent during the early phase of acute myocardial infarction. We propose that the combination of intracoronary streptokinase and isosorbide dinitrate may increase the rate of stable coronary recanalization.
Authors:
D Hackett; G Davies; S Chierchia; A Maseri
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  317     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1987 Oct 
Date Detail:
Created Date:  1987-11-10     Completed Date:  1987-11-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1055-9     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiography
Collateral Circulation
Coronary Angiography
Coronary Disease / drug therapy*,  physiopathology
Electrocardiography
Female
Humans
Isosorbide Dinitrate / administration & dosage,  therapeutic use*
Male
Middle Aged
Monitoring, Physiologic
Myocardial Infarction / complications*,  physiopathology
Streptokinase / administration & dosage,  therapeutic use*
Chemical
Reg. No./Substance:
87-33-2/Isosorbide Dinitrate; EC 3.4.-/Streptokinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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