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| Publications [#198018] of Daniel B. Mark
Papers Published
- RS Stack, CM O'Connor, DB Mark, T Hinohara, HR Phillips, MM Lee, NM Ramirez, WG O'Callaghan, CA Simonton, EB Carlson, Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase.,
Circulation, vol. 77 no. 1
(January, 1988),
pp. 151-61, ISSN 0009-7322
(last updated on 2011/11/29)
Abstract:
Two hundred and sixteen patients with acute myocardial infarction were treated with immediate infusion of high-dose (1.5 million units) intravenous streptokinase followed by emergency coronary angioplasty. The infarct lesion was crossed and dilated in 99% and persistent coronary perfusion after the procedure was achieved in 90% (including 3% with significant residual stenosis). Total in-hospital mortality was 12%. Multivariable analysis showed a higher hospital mortality with cardiogenic shock (41% vs 5% without shock), older age, lower left ventricular ejection fraction, and female sex. Final patency of the infarct-related vessel was determined by follow-up in-hospital cardiac catheterization. Coronary reocclusion occurred in 11% (symptomatic in 7%, treated with emergency angioplasty or bypass surgery; silent in 4%, treated medically). Of the surviving patients with successful initial establishment of infarct vessel patency, 94% were discharged from the hospital with an open infarct artery or a bypass graft to the infarct vessel. There was significant improvement in both ejection fraction (44% to 49%; p less than .0001) and regional wall motion in the infarct zone (-3.0 SD to -2.4 SD; p less than .0001) among patients with persistent coronary perfusion and insignificant residual stenosis at the time of the follow-up cardiac catheterization. Thus, a treatment strategy for acute myocardial infarction that includes immediate administration of streptokinase followed by emergency coronary angioplasty, and coronary bypass surgery when necessary, results in a high rate of early and sustained patency of the infarct-related vessel.
Keywords:
Angioplasty, Balloon* • Coronary Artery Bypass • Coronary Circulation* • Emergencies • Female • Follow-Up Studies • Humans • Male • Middle Aged • Myocardial Infarction • Statistics as Topic • Streptokinase • Time Factors • physiopathology • therapeutic use* • therapy*
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