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European Heart Journal 1990 11(Supplement F):19-28; doi:10.1093/eurheartj/11.suppl_F.19
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Controversial indications

Rationale for thrombolysis: later than 4–6 h from symptom onset, and in patients with smaller myocardial infarctions

R. Schröder, T. Linderer, K.-L. Brüggemann, K.-L. Neuhaus, U. Tebbe, K. Wegscheider for the ISAM Study Group

ISAM Coordinating Center Berlin, West Germany

Address for reprints: Prof. Dr Rolf Schröder, Department of Cardiology and Pneumonology, Klinikum Steglitz, Free University Berlin, Hindenburgdamm 30. D-1000 Berlin 45, F.R.G.

To evaluate the effect of late reperfusion of an infarct-related coronary artery on left ventricular (LV) function in the month after myocardial infarction (MI), findings from 386 patients in the Intravenous Streptokinase in Acute Myocardial Infarction (ISAM) trial were studied. All patients had a late peaking in the creatine kinase-MB serum time-activity curve, suggesting absence of early reperfusion. Significantly better LV function associated with patency of the infarct artery at angiography 1 month after the acute event confirmed the beneficial effect of reperfurion even if achieved beyond the time window for myocardial salvage. Thrombolysis commenced later than 4–6 h after symptom onset will be of benefit as long at it reopens infarct arteries more often and earlier than occurs spontaneously or from anticoagulation.

The value of the size of the sum of ST-segment elevation ({Sigma} ST{uparrow}) on admission ECG was evaluated from the total ISAM study population. The relation between ({Sigma}ST{uparrow}) and final infarct size as well as mortality risk war highly significant. However, weak correlations largely limit the value of ({Sigma} ST{uparrow}) to predict the outcome in an individual patient. Thus, whatever the relative beneficial effect in patients with smaller or larger MI may be, it would be unwarranted to withhold thrombolytic therapy from patients with smaller ({Sigma} ST{uparrow}) on admission ECG.

Key Words: Acute MI • late reperfusion from thrombolysis • LV function • prediction of infarct size • small infarcts


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