Early intervention in acute myocardial infarction: Significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

Hylton I. Miller, Yaron Almagor, Gad Keren, Joseph Chernilas, Arie Roth, Yemima Eschar, Itzhak Shapira, Boris Shargorodsky, Dora Berenfeld, Shlomo Laniado

Research output: Contribution to journalArticlepeer-review

Abstract

Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 ± 289 mU/nil in group I, and 1,614 ± 709 mU/ml in group II (p < 0.05). The mean initial left ventricular ejection fraction was 47 ± 11% in group 1 and 37 ± 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 ± 9% in group I (p < 0.05) and to 40 ± 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect.

Original languageEnglish
Pages (from-to)608-614
Number of pages7
JournalJournal of the American College of Cardiology
Volume9
Issue number3
DOIs
StatePublished - 1987

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