Document Detail

Thrombolysis-induced coronary reperfusion causes acute and massive interstitial release of cardiac muscle cell proteins.
MedLine Citation:
PMID:  9059538     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Reperfusion of the infarct-related artery in patients with acute myocardial infarction limits infarct size, but also causes accelerated release into plasma of cardiac tissue proteins. The latter effect could reflect either enhanced protein washout from the heart or abrupt disruption of myocyte membranes. The present study indicates that the latter mechanism prevails. METHODS: In 26 patients, patency of the infarct-related artery was determined by coronary angiography 90 min and 5-7 days after thrombolytic treatment. Continuous electrocardiography was performed during the first 24 h after admission. Cumulative release of myoglobin (Mb) and creatine kinase (CK) into plasma was calculated from frequently sampled plasma concentrations. RESULTS: In patients with a patent infarct-related artery after 90 min, onset of a rapid (> 50%) decrease in ST-vector magnitude coincided with an equally rapid increase in QRS-vector magnitude, and with a sudden onset of release into plasma of Mb as well as CK. In these patients, a maximal initial release rate was observed and cumulative release conformed closely to a simple model for sudden interstitial liberation of proteins. In contrast, protein release started more gradually and could not be fitted to this model, in patients with persistent occlusion of the infarct-related artery at 90 min and absence of ST-vector normalisation. CONCLUSIONS: Previous studies have demonstrated significant myocardial salvage by timely reperfusion therapy. Nevertheless, this study indicates that the moment of recanalisation of the infarct-related artery coincides with sudden and massive disruption of myocyte membranes. Attenuation of this effect, if possible, could further improve the benefits of reperfusion therapy.
C Cobbaert; W T Hermens; P P Kint; P J Klootwijk; F Van de Werf; M L Simoons
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular research     Volume:  33     ISSN:  0008-6363     ISO Abbreviation:  Cardiovasc. Res.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-03-28     Completed Date:  1997-03-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0077427     Medline TA:  Cardiovasc Res     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  147-55     Citation Subset:  IM    
Thorax Center, University Hospital Rotterdam, Netherlands.
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MeSH Terms
Aged, 80 and over
Coronary Angiography
Creatine Kinase / blood*
Electrocardiography, Ambulatory*
Middle Aged
Myocardial Infarction / blood,  drug therapy*,  physiopathology
Myocardial Reperfusion Injury / blood
Myoglobin / blood*
Regression Analysis
Thrombolytic Therapy*
Time Factors
Reg. No./Substance:
0/Myoglobin; EC Kinase

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

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