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Effects of Intracoronary Thrombolysis on Global Left Ventricular Function Assessed by an Automated Edge Detection Technique

Working Group on Thrombolytic Therapy in Acute Myocardial Infarction, Interuniversity Cardiology Institute, The Netherlands

Correspondence: For reprints contact: Ernst E. van der Wall, MD, Dept. of Cardiology, C5 P25 Gebouw 1, Academic Hospital Leiden, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.

ABSTRACT

Three hundred and two patients with acute myocardial infarction were enrolled in a randomized multicenter trial to compare conventional treatment with attempted recanalization by intracoronary streptokinase. In a subgroup of patients, the effects of thrombolysis on left ventricular function were evaluated within 48 hr, at 2 wk, and at 3 mo after admission. Global left ventricular ejection fraction (LVEF) was obtained by radionuclide angiography and analyzed with an automatic detection program. Paired data were determined in 160 patients (control 78, thrombolysis 82) within 48 hr and at 2 wk, and in 143 patients (control 71, thrombolysis 72) at 48 hr, 2 wk, and 3 mo. It was shown that LVEF significantly improved in the thrombolysis group as compared with controls both at 2 wk ( LVEF thrombolysis 3.9 ± 7.9%, p < 0.001 compared with LVEF control 0.6 ± 9.7%, p = N.S.) and at 3 mo ( LVEF thrombolysis 3.1 ± 12.4%, p < 0.05 compared with LVEF control 2.1 ± 12.2%, p = N.S.). When patients were divided according to infarct site, however, significant improvement at 3 mo was only observed in the patients with anterior infarction ( LVEF thrombolysis 5.5 ± 13.1%, p < 0.05 compared with LVEF control 3.3 ± 10.4%, p = N.S.). It was shown that acute intervention with intracoronary streptokinase has a potentially favorable and lasting effect on left ventricular function in patients with anterior myocardial infarction. This improvement might be related to the rather rapid administration of thrombolytic therapy with a median time of 4 hr after onset of symptoms.

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