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European Heart Journal 1992 13(4):484-490;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

H. MICKLEY, P. PLESS, J. R. NIELSEN, J. BERNING and M. MØLLER

Department of Cardiology, Odense University Hospital 5000 Odense C, Denmark

Received 4 February 1991; revised 3 June 1991; .

Correspondence Hans Mickley. MD. Department of Cardiology. Odense University Hospital, 5000 Odense C. Denmark

Abstract

In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only the last 35 patients included received thrombolytic therapy. As thrombolysis was not available in our Department at the start of the study, the first 39 patients included were conservatively treated (controls). No significant differences in baseline clinical characteristics were found between the two groups.

In-hospital atrial fibrillation and digoxin therapy was more prevalent in controls (P <0.05). During exercise, thrombolvsed patients reached a higher maximal work capacity compared with controls; 160 ± 41 vs 139 ± 34 W (P <0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144 min in controls (P <0.05). Thrombolysed patients reached a higher heart rate during transient ischaemic episodes: 114±17 vs 93± 11 b.min–1 in controls (P<0.001).

In conclusion, thrombolytic therapy administered for a first AMI significantly reduces the burden of transient myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study.

Key Words: Ambulatory electrocardiographic monitoring • transient myocardial ischaemia • exercise testing • ST segment depression • acute myocardial infarction


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