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European Heart Journal 1982 3(5):441-448;
Copyright © 1982 by the European Society of Cardiology.
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© 1982 by The European Society of Cardiology

Experience with intracoronary streptokinase in 36 patients with acute evolving myocardial infarction*

P. J. DE FEYTER, M. J. VAN EENIGE, J. P. JONG DE, E. E. WALL VAN DER, D. H. DIGHTON and J. P. ROOS

Department of Cardiology, Free University Hospital Amsterdam, The Netherlands

Received 16 October 1981; revised 19 January 1982; .

Requests for reprints to: Dr P. J. De Feyter, Department of Cardiology, Free University Hospital, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.

Abstract

Acute angiography was performed in 36 consecutive patients with evolving myocardial infarction admitted within 3 h after onset of symptoms. No fatal complication occurred. Angiography revealed a total occlusion in 32 patients (89%), a subtotal stenosis in three (8%), and a 90% stenosis in one patient (3%). Anterior infarction was exclusively related to left anterior descending, and inferior infarction to right coronary or circumflex obstruction. After identification of the ‘infarct-vessel’, nifedipine 10 mg was administered sublingually. In no patient was anterograde flow affected with this treatment.

In 35 patients an attempt to lyse clot was made with intracoronary streptokinase; an infusion of 2000–4000 U/min, preceded by a bolus of 10 000–20 000 U was infused into the ‘infarct-vessel’.

In 26 patients (74%) reperfusion was achieved, two combined with guidewire perforation. The mean duration of onset of symptoms to reperfusion was 3.6 h (range 1.8–5.6). The mean duration of lysis was 1.2 h (range 0.3–3), and the mean dosage of streptokinase was 200 000 U (50 000–400 000 U]. In 25 out of 26 patients (96%) a high degree of obstruction remained immediately after lysis and at repeat angiography 6–8 weeks after the acute event. Despite treatment with aspirin 200 mg daily and nifedipine 30 mg daily four re-occlusions occurred. Coronary bypass surgery was performed electively in five patients.

Thus, we conclude that in patients with evolving myocardial infarction, the infarct-vessel can be recanalized in 74% of patients by intracoronary streptokinase. The true benefit of this treatment must await a controlled study.

Key Words: Acute angiography • infarct size limitation • reperfusion • streptokinase


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