Late thrombolytic therapy preserves left ventricular function in patients with collateralized total coronary occlusion: primary end point findings of the Second Mount Sinai-New York University Reperfusion Trial

Department of Medicine, Mount Sinai School of Medicine, New York, New York.

The change in left ventricular ejection fraction from preintervention to predischarge was prospectively assessed in 393 patients with acute myocardial infarction. Within 12 h of symptom onset (mean 6.3 +/- 2.7 h), patients were randomly assigned to a double-blind intracoronary infusion of streptokinase, nitroglycerin, both streptokinase and nitroglycerin or conventional therapy without acute cardiac catheterization. Treatment effects were also assessed in prospectively defined angiographic subsets. There was a significant interaction between streptokinase and nitroglycerin (p less than 0.01), resulting in an increase in ejection fraction of 3.9 percentage units in the combined treatment arm (p less than 0.001). Patients with collateral flow to a totally obstructed infarct-related artery showed a significant improvement over those without collateral flow in the streptokinase (5.4 +/- 2.5%) and streptokinase-nitroglycerin (10.6 +/- 2.7%) arms, but not in the nitroglycerin arm. Time to treatment did not influence the change in ejection fraction. In patients with initial subtotal occlusion, thrombolytic therapy was of no short-term benefit because ejection fraction increased by 6% in all three intervention arms. These findings indicate that relatively late thrombolytic therapy results in significant myocardial salvage in those patients with collateralized total coronary occlusion. This benefit is potentiated by concomitant nitroglycerin therapy.

This article has been cited by other articles:

				J. Mehilli, A. Kastrati, S. Schulz, S. Frungel, S. G. Nekolla, W. Moshage, F. Dotzer, K. Huber, J. Pache, J. Dirschinger, et al. Abciximab in Patients With Acute ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention After Clopidogrel Loading: A Randomized Double-Blind Trial Circulation, April 14, 2009; 119(14): 1933 - 1940. [Abstract] [Full Text] [PDF]

				C. Berry, K. P. Balachandran, P. L. L'Allier, J. Lesperance, R. Bonan, and K. G. Oldroyd Importance of collateral circulation in coronary heart disease Eur. Heart J., February 1, 2007; 28(3): 278 - 291. [Abstract] [Full Text] [PDF]

				A. Schomig, J. Mehilli, D. Antoniucci, G. Ndrepepa, C. Markwardt, F. Di Pede, S. G. Nekolla, K. Schlotterbeck, H. Schuhlen, J. Pache, et al. Mechanical Reperfusion in Patients With Acute Myocardial Infarction Presenting More Than 12 Hours From Symptom Onset: A Randomized Controlled Trial JAMA, June 15, 2005; 293(23): 2865 - 2872. [Abstract] [Full Text] [PDF]

				T. Kurotobi, H. Sato, K. Kinjo, D. Nakatani, H. Mizuno, M. Shimizu, K. Imai, A. Hirayama, K. Kodama, M. Hori, et al. Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction J. Am. Coll. Cardiol., July 7, 2004; 44(1): 28 - 34. [Abstract] [Full Text] [PDF]

				J. E. Madias, B. Shah, G. Chintalapally, G. Chalavarya, and N. E. Madias Admission Serum Potassium in Patients With Acute Myocardial Infarction : Its Correlates and Value as a Determinant of In-Hospital Outcome Chest, October 1, 2000; 118(4): 904 - 913. [Abstract] [Full Text] [PDF]

				K. P. Rentrop Thrombi in Acute Coronary Syndromes : Revisited and Revised Circulation, April 4, 2000; 101(13): 1619 - 1626. [Full Text] [PDF]

				N. P. R.o. Sand, M. Rehling, J. P. Bagger, L. Thuesen, C. Flo, and T. T. Nielsen Functional significance of recruitable collaterals during temporary coronary occlusion evaluated by 99mTc-sestamibi single-photon emission computerized tomography J. Am. Coll. Cardiol., March 1, 2000; 35(3): 624 - 632. [Abstract] [Full Text] [PDF]

				F Leclercq, P Messner-Pellenc, Q Descours, J-P Daures, J-L Pasquie, F-X Hager, J-M Davy, and R Grolleau-Raoux Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction Heart, July 1, 1999; 82(1): 62 - 67. [Abstract] [Full Text] [PDF]

				B. R. Brodie, T. D. Stuckey, T. C. Wall, G. Kissling, C. J. Hansen, D. B. Muncy, R. A. Weintraub, and T. A. Kelly Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1312 - 1319. [Abstract] [Full Text] [PDF]

				J. J. Piek, R. A. M. van Liebergen, K. T. Koch, R. J. de Winter, R. J. G. Peters, and G. K. David Pharmacological Modulation of the Human Collateral Vascular Resistance in Acute and Chronic Coronary Occlusion Assessed by Intracoronary Blood Flow Velocity Analysis in an Angioplasty Model Circulation, July 1, 1997; 96(1): 106 - 115. [Abstract] [Full Text]

				F. Ottani, M. Galvani, D. Ferrini, F. Sorbello, P. Limonetti, D. Pantoli, and F. Rusticali Prodromal Angina Limits Infarct Size : A Role for Ischemic Preconditioning Circulation, January 15, 1995; 91(2): 291 - 297. [Abstract] [Full Text]

				R. J. Krone The Role of Risk Stratification in the Early Management of a Myocardial Infarction Ann Intern Med, February 1, 1992; 116(3): 223 - 237. [Abstract] [PDF]

				J. J. Popma and E. J. Topol Adjuncts to Thrombolysis for Myocardial Reperfusion Ann Intern Med, July 1, 1991; 115(1): 34 - 44. [Abstract] [PDF]