Status of the myocardium and infarct-related coronary artery in 19 necropsy patients with acute recanalization using pharmacologic (streptokinase, r-tissue plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty) or combined types of reperfusion therapy
BF Waller,
DA Rothbaum,
CA Pinkerton,
MJ Cowley,
TJ Linnemeier,
C Orr,
M Irons,
RA Helmuth,
ER Wills,
and
C Aust
In acute myocardial infarction, myocardial salvage is dependent on rapid restoration of blood flow. Pharmacologic (streptokinase, recombinant tissue-type plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty, guide wire perforation) or combined forms of reperfusion therapy can accomplish this goal, but their effects on infarcted myocardium and vessel occlusion site have not been compared at necropsy. The heart of 19 necropsy patients who had received various forms of acute reperfusion therapy was studied: 14 had pharmacologic or combined forms of reperfusion therapy (13 streptokinase and 1 tissue-type plasminogen activator, including 4 with combined balloon angioplasty) and 5 had had purely mechanical (balloon angioplasty) reperfusion therapy. Reperfusion was initially clinically successful in all 19 patients with the average time from onset of symptoms to reperfusion being 3.7 hours. Necropsy observations separated the 19 patients into distinct subgroups based on changes in the myocardium and infarct-related coronary arteries. Of the 19 patients, 14 (74%) had hemorrhagic myocardial infarction and they all received pharmacologic or combined forms of reperfusion therapy. The remaining five patients (26%) had nonhemorrhagic (anemic) infarction and were treated with balloon angioplasty therapy alone. Increased luminal cross-sectional area was present in 8 of 9 patients with acute balloon angioplasty but severe coronary atherosclerotic plaque remained in 9 of 10 patients without acute balloon angioplasty. Severe hemorrhage surrounded angioplasty sites in all four patients who also received streptokinase or tissue-type plasminogen activator. Severe bleeding at the angioplasty site compromised the dilated coronary lumen in one patient. No patient with angioplasty alone had intraplaque bleeding. Thus, acute coronary balloon angioplasty reperfusion therapy alone appears to avoid the potentially adverse effects of myocardial and intraplaque hemorrhage while simultaneously increasing luminal cross-sectional area at the site of acute occlusion.
This article has been cited by other articles:

|
 |

|
 |
 
G. W. Stone
Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention
Circulation,
July 29, 2008;
118(5):
538 - 551.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. W. Stone
Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions
Circulation,
July 29, 2008;
118(5):
552 - 566.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H. Fonge, K. Vunckx, H. Wang, Y. Feng, L. Mortelmans, J. Nuyts, G. Bormans, A. Verbruggen, and Y. Ni
Non-invasive detection and quantification of acute myocardial infarction in rabbits using mono-[123I]iodohypericin {micro}SPECT
Eur. Heart J.,
January 2, 2008;
29(2):
260 - 269.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al.
Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Circulation,
May 15, 2007;
115(19):
2570 - 2589.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. C. Keeley and J. A. de Lemos
Free wall rupture in the elderly: deleterious effect of fibrinolytic therapy on the ageing heart
Eur. Heart J.,
September 1, 2005;
26(17):
1693 - 1694.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. T. Beranek, C. B. Granger, K. W. Mahaffey, W. D. Weaver, P. Theroux, J. S. Hochman, T. G. Filloon, T. G. Todaro, S. Rollins, C. F. Mojcik, et al.
Why Did the Anti-C5 Complement Antibody Pexelizumab Not Reduce Infarct Size but Influence Clinical Outcomes Positively When Applied as Adjunctive Therapy to Primary Percutaneous Coronary Intervention? * Response
Circulation,
April 27, 2004;
109(16):
e195 - e196.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. N. Nanas, E. Tsolakis, J. V. Terrovitis, A. Eleftheriou, S. G. Drakos, A. Dalianis, and C. E. Charitos
Moderate Systemic Hypotension During Reperfusion Reduces the Coronary Blood Flow and Increases the Size of Myocardial Infarction in Pigs
Chest,
April 1, 2004;
125(4):
1492 - 1499.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. Scheller, B. Hennen, B. Hammer, J. Walle, C. Hofer, V. Hilpert, H. Winter, G. Nickenig, M. Bohm, and SIAM III Study Group
Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction
J. Am. Coll. Cardiol.,
August 20, 2003;
42(4):
634 - 641.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. C. Becker, J. S. Hochman, C. P. Cannon, F. A. Spencer, S. P. Ball, M. J. Rizzo, E. M. Antman, and for the TIMI 9 Investigators
Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists: Observations from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction 9 Study
J. Am. Coll. Cardiol.,
February 1, 1999;
33(2):
479 - 487.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Asanuma, K. Tanabe, K. Ochiai, H. Yoshitomi, K. Nakamura, Y. Murakami, K. Sano, T. Shimada, R. Murakami, S. Morioka, et al.
Relationship Between Progressive Microvascular Damage and Intramyocardial Hemorrhage in Patients With Reperfused Anterior Myocardial Infarction : Myocardial Contrast Echocardiographic Study
Circulation,
July 15, 1997;
96(2):
448 - 453.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
S. V. Pislaru, L. Barrios, T. Stassen, L. Jun, C. Pislaru, and F. Van de Werf
Infarct Size, Myocardial Hemorrhage, and Recovery of Function After Mechanical Versus Pharmacological Reperfusion : Effects of Lytic State and Occlusion Time
Circulation,
July 15, 1997;
96(2):
659 - 666.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
D. O. Williams, E. Braunwald, B. Thompson, B. L. Sharaf, C. E. Buller, and G. L. Knatterud
Results of Percutaneous Transluminal Coronary Angioplasty in Unstable Angina and Non Q-Wave Myocardial Infarction: Observations from the TIMI IIIB Trial
Circulation,
December 1, 1996;
94(11):
2749 - 2755.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
A. S. Hall and S. G. Ball
Clinical Background to the Use of ACE Inhibitor Therapy after Myocardial Infarction
European Journal of Cardiovascular Prevention & Rehabilitation,
October 1, 1995;
2(5):
396 - 405.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
Y. Ohnishi, M. C. Butterfield, J. E. Saffitz, B. E. Sobel, P. B. Corr, and J. A. Goldstein
Deleterious Effects of a Systemic Lytic State on Reperfused Myocardium : Minimization of Reperfusion Injury and Enhanced Recovery of Myocardial Function by Direct Angioplasty
Circulation,
August 1, 1995;
92(3):
500 - 510.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
E. D Grech, M. J Jackson, and D. R Ramsdale
Reperfusion injury after acute myocardial infarction
BMJ,
February 25, 1995;
310(6978):
477 - 478.
[Full Text]
|
 |
|

|
 |

|
 |
 
M. H. Eckman, J. B. Wong, D. N. Salem, and S. G. Pauker
Direct Angioplasty for Acute Myocardial Infarction: A Review of Outcomes in Clinical Subsets
Ann Intern Med,
October 15, 1992;
117(8):
667 - 676.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
E. J. Topol
Coronary Angioplasty for Acute Myocardial Infarction
Ann Intern Med,
December 15, 1988;
109(12):
970 - 980.
[Abstract]
[PDF]
|
 |
|
|