Usefulness of late coronary thrombolysis (recombinant tissue-type plasminogen activator) in preserving left ventricular function in acute myocardial infarction.

This study assesses whether administration of recombinant tissue-type plasminogen activator (rt-PA) up to 8 hours after onset of symptoms of acute myocardial infarction (AMI) may result in a significant improvement in left ventricular function. Sixty patients were classified into 3 groups: group A (n = 21) received rt-PA within 4 hours from symptom onset; the remaining 39 patients, admitted between 4 and 8 hours, were randomized into 2 groups--group B (n = 19) received rt-PA, and group C (n = 21) was treated with conventional therapy. Coronary and left ventricular angiograms were recorded 8 to 10 days after rt-PA administration. The patency rate of the infarct-related artery was 76% in group A, and 63 and 35% in group B and C, respectively. The Thrombolysis in Myocardial Infarction trial perfusion grade was higher in group A and B than in group C (A vs C: p less than 0.005; B vs C: p less than 0.01). Left ventricular ejection fraction was significantly higher in group A (60.2 +/- 10%) and B (54.7 +/- 12%) compared with group C (44.2 +/- 12%) (A vs C: p less than 0.01; B vs C: p less than 0.05). Regional wall motion of the entire ischemic zone was better in group A and B than in group C (A vs C: p less than 0.001; B vs C: p less than 0.01). In contrast, the kinesis of the central ischemic zone was significantly better in group A than in both group B and C (A vs B: p less than 0.05; A vs C: p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
AuthorsB Villari, F Piscione, D Bonaduce, P Golino, T Lanzillo, M Condorelli, M Chiariello
JournalThe American journal of cardiology (Am J Cardiol) Vol. 66 Issue 19 Pg. 1281-6 (Dec 1 1990) ISSN: 0002-9149 [Print] UNITED STATES
PMID2123072 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Recombinant Proteins
  • Tissue Plasminogen Activator
  • Coronary Angiography
  • Hemodynamics (drug effects)
  • Humans
  • Middle Aged
  • Myocardial Infarction (drug therapy, physiopathology)
  • Recombinant Proteins (therapeutic use)
  • Stroke Volume (drug effects)
  • Thrombolytic Therapy
  • Tissue Plasminogen Activator (therapeutic use)
  • Vascular Patency (drug effects)
  • Ventricular Function, Left (drug effects, physiology)

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