The Effect of Thrombolysis on the Status of Infarct-Related Coronary Artery and Left Ventricular Function in Acute Myocardial Infarction

ABSTRACT

BACKGROUND: Patency of the infarct-related coronary artery may influence LV remodeling, provide a more stable electrophysiologic milieu and improves the outcome of patient with acute myocardioal infarction. The result from clinical trials have confirmed that early reperfusion in humans induced by a thrombolytic agent is associated with limitation of infarct size, preservation of ventricular function, and improved survival. The purpose of this study was evaluate the effect of thrombolytic therapy on the severity of the residual stenosis, antegrade flow of infarct-related coronary artery after acute myocardial infarction, and investigate left ventricular function and regianal wall motion abnormality depending on the thrombolytic therapy. METHODS: A retrosperctive study was performed in 166 patients with acute myocardial infarction with underwent coronary angiography within 8 days after acute attack from Oct. 1990 to Sep. 1994. Patients were grouped as thrombolysis group(n=64) who had undertaken urokinase infusion therapy within 6 hours of symptom onset and conservatively treated group(n=102) who had not received thrombolytic trerapy. At 8+/-7days, cardiac catheterization was performed. Status of the infarct related artery was assessed by resiudal % diameter stenosis, TIMI and collateral trading. Left ventricular function and wall motion were analyzed. RESULTS: 1) The was no statistical differenccs in age, sex and risk factors(diabetes, hypertension, smoking and hypercholesterolemia)between two groups. 2) The peak serum CK level was higher(2719+/-2333 vs 1951+/-2064 IU/L) and time to peak CK enzyme level was shorter(19+/-13 vs 32+/-24 hr) in thrombolysis group than conservatively treated group. 3) There was lower incidence of total occlusion(12.5% vs 30.4%), residual % diameter stenosis of infarct-related artery(67+/-34% vs 80+/-27%) and better antegrade flow(TIMI grade 0-1, 12.5% vs 32.4%) in thrombolysis group than conservatively treated group(p0.05). CONCLUSION: Thrombolytic therapy in acute myocardial infarction resulted in dquisition of early infarct-related arterial patency, effectiove antegrade flow and reduced incidence of totoal occlusion of infarct-related artery. Left ventricular ejection fraciton, regional wall motion score was not affected by thrombolytioc therapy in inhospital period.