Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1984 Sep;11(3):260–267.

Determinants of Infarct Size in Patients Successfully Treated by Intracoronary Thombolysis

Wolfgang G Schmidt 1, Wolfgang Merx 1, Rainer V Essen 1, Rainer Uebis 1, Sven Effert 1, Renate Schmidt-Wenz 1
PMCID: PMC341722  PMID: 15227059

Abstract

In 125 patients successfully treated by intracoronary thrombolysis, data were analyzed to determine the amount of regional wall motion impairment. In 85 patients with complete occlusion of the affected vessel and successful recanalization, ventriculographic study could be performed immediately after recanalization of the vessel and repeated 3 days thereafter. Unexpectedly, no correlation could be seen between the amount of wall motion impairment and the time interval of coronary vessel occlusion. For assessment of other influencing factors two subgroups were analyzed, one with large infarction despite short occlusion time and the other with small infarction despite long occlusion time. The significant differences between these two groups was in regard to the occluded coronary vessels: In the first group, most patients had anterior infarctions caused by left anterior descending (LAD) occlusion, whereas in the second group, there were no LAD occlusions at all. According to the data that we compiled, the location of the occluded coronary vessel was the most important factor in determining infarct size.

Taking this into account, recovery of the impaired wall motion up to the third day after infarction was separately analyzed in LAD occlusion or inferior infarction and was found to be more pronounced in the first. Immediate recovery after recanalization however, which could be analyzed in 40 patients who had angiographic studies before recanalization as well as afterwards, was more pronounced in inferior infarction.

Full text

PDF
260

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Costantino C., Corday E., Lang T. W., Meerbaum S., Brasch J., Kaplan L., Rubins S., Gold H., Osher J. Revascularization after 3 hours of coronary arterial occlusion: effects on regional cardiac metabolic function and infarct size. Am J Cardiol. 1975 Sep;36(3):368–384. doi: 10.1016/0002-9149(75)90492-0. [DOI] [PubMed] [Google Scholar]
  2. Ginks W. R., Sybers H. D., Maroko P. R., Covell J. W., Sobel B. E., Ross J., Jr Coronary artery reperfusion. II. Reduction of myocardial infarct size at 1 week after the coronary occlusion. J Clin Invest. 1972 Oct;51(10):2717–2723. doi: 10.1172/JCI107091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Hooghoudt T. E., Serruys P. W., Reiber J. H., Slager C. J., van den Brand M., Hugenholtz P. G. The effect of recanalization of the occluded coronary artery in acute myocardial infarction on left ventricular function. Eur Heart J. 1982 Oct;3(5):416–421. doi: 10.1093/oxfordjournals.eurheartj.a061327. [DOI] [PubMed] [Google Scholar]
  4. Markis J. E., Malagold M., Parker J. A., Silverman K. J., Barry W. H., Als A. V., Paulin S., Grossman W., Braunwald E. Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction. N Engl J Med. 1981 Oct 1;305(14):777–782. doi: 10.1056/NEJM198110013051401. [DOI] [PubMed] [Google Scholar]
  5. Maroko P. R., Libby P., Ginks W. R., Bloor C. M., Shell W. E., Sobel B. E., Ross J., Jr Coronary artery reperfusion. I. Early effects on local myocardial function and the extent of myocardial necrosis. J Clin Invest. 1972 Oct;51(10):2710–2716. doi: 10.1172/JCI107090. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Matsuzaki M., Gallagher K. P., Kemper W. S., White F., Ross J., Jr Sustained regional dysfunction produced by prolonged coronary stenosis: gradual recovery after reperfusion. Circulation. 1983 Jul;68(1):170–182. doi: 10.1161/01.cir.68.1.170. [DOI] [PubMed] [Google Scholar]
  7. O'Brien C. M., Carroll M., O'Rourke P. T., Rhodes E. L., Gago O., Kirsh M. M., Morris J. D., Sloan H. E. The reversibility of acute ischemic injury to the myocardium by restoration of coronary flow. J Thorac Cardiovasc Surg. 1972 Dec;64(6):840–846. [PubMed] [Google Scholar]
  8. Puri P. S. Contractile and biochemical effects of coronary reperfusion after extended periods of coronary occlusion. Am J Cardiol. 1975 Aug;36(2):244–251. doi: 10.1016/0002-9149(75)90533-0. [DOI] [PubMed] [Google Scholar]
  9. Ramanathan K. B., Raina S., Banka V. S., Bodenheimer M. M., Helfant R. H. Effects of reperfusion on the regional contraction of ischemic and nonischemic myocardium following partial coronary obstruction. Circulation. 1978 Jan;57(1):47–52. doi: 10.1161/01.cir.57.1.47. [DOI] [PubMed] [Google Scholar]
  10. Rentrop P., Blanke H., Karsch K. R., Rutsch W., Schartl M., Merx W., Dörr R., Mathey D., Kuck K. Changes in left ventricular function after intracoronary streptokinase infusion in clinically evolving myocardial infarction. Am Heart J. 1981 Dec;102(6 Pt 2):1188–1193. doi: 10.1016/0002-8703(81)90651-7. [DOI] [PubMed] [Google Scholar]
  11. Rutsch W., Schartl M., Mathey D., Kuck K., Merx W., Dörr R., Rentrop P., Blanke H. Percutaneous transluminal coronary recanalization: procedure, results, and acute complications. Am Heart J. 1981 Dec;102(6 Pt 2):1178–1181. doi: 10.1016/0002-8703(81)90649-9. [DOI] [PubMed] [Google Scholar]
  12. Schwarz F., Schuler G., Katus H., Hofmann M., Manthey J., Tillmanns H., Mehmel H. C., Kübler W. Intracoronary thrombolysis in acute myocardial infarction: duration of ischemia as a major determinant of late results after recanalization. Am J Cardiol. 1982 Nov;50(5):933–937. doi: 10.1016/0002-9149(82)90398-8. [DOI] [PubMed] [Google Scholar]
  13. Smalling R. W., Fuentes F., Freund G. C., Reduto L. A., Wanta-Matthews M., Gaeta J. M., Walker W., Sterling R., Gould K. L. Beneficial effects of intracoronary thrombolysis up to eighteen hours after onset of pain in evolving myocardial infarction. Am Heart J. 1982 Oct;104(4 Pt 2):912–920. doi: 10.1016/0002-8703(82)90264-2. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES