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European Heart Journal 1988 9(8):828-835;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Improvement of myocardial perfusion after thrombolysis assessed by thallium-201 exercise scintigraphy

E. E. VAN DER WALL, J.C.J. RES, R. VAN DEN POL, F. VERMEER, A. VAN DER LAARSE, S. BRAAT, P. FIORETTI, X. H. KRAUSS, F. W. A. VERHEUGHT and M. L. SIMOONS

Working Group on Thrombolytic Therapy in Acute Myocardial Infraction of the Netherlands Interuniversity Institute of Cardiology

Received 18 January 1988; .

E. E. van der Wall, M.D., Dept. of Cardiology, Building 1, C5-P025, Academic Hospital Leiden, Rijnsburgerweg 10, 2333 AA Leiden. The Netherlands

Abstract

The effects of recanalization by early intracoronary streptokinase in acute myocardial infarction on myocardial perfusion were studied in a subset of 236 out of 533 patients enrolled in a prospective multicentre trial, randomly allocated to either conventional treatment or to thrombolysis. Maximal symptom-limited thallium-201 stress testing was performed nine to 14 (median 12) weeks after the acute event in 236 patients with a first myocardial infarction, of whom 108 patients were allocated to conventional treatment and 128 patients to thromolysis. Three-view thallium exercise and redistribution scintigrams were divided into eight segments. The number of normal thallium segments at redistribution was 5.3±1.6 (mean±SD) in the control group and 5.8±1.6 in the thrombolysis group (P <0.01), indicating increased myocardial perfusion after early thrombolytic treatment. This beneficial effect was particularly evident in patients with a first anterior infraction with 4.8±1.6 normal thallium segments in the control group and 5.9±1.6 normal segments in the thrombolysis group (P <0.001). There was no difference in residual ischaemia during exercise between the control and the thrombolysis group either in the patients with anterior or in those with inferior infarction.

It is concluded that early thrombolysis within 4 h after onset of symptoms, in some of the patients followed by angioplasty or coronary artery bypass surgery, leads to sustained improvement of myocardial perfusion at rest without excessive ischaemia during exercise, particularly in patients with acute anterior infarction.

Key Words: Recanalization • streptokinase • thallium-201 exercise scintigraphy • myocardial infarction.


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