Reocclusion three months after successful thrombolytic treatment of acute myocardial infarction with anisoylated plasminogen streptokinase activating complex

Abstract

Thirty consecutive patients with acute myocardial infarction (AMI) were treated with anisoylated plasminogen streptokinase activating complex (APSAC) within 4 hours after onset of symptoms. After 1.5 and 48 hours, patency of the infarct-related vessel and the quantitative degree of residual diameter stenosis were studied by selective coronary angiography. Ventriculograms were made to determine the global left ventricular ejection fraction. Patients showing patency at 48 hours were reevaluated anglographically after 3 months. At 1.5 and 48 hours after APSAC administration patent vessels were demonstrated in 6S and 69% of patients, respectively. Mean residual stenosis decreased significantly from 56 ± 11% at 1.5 hours to 46 ± 13% at 48 hours (p <0.01). Patients not responding to thrombolytic therapy showed significant deterioration of the left ventricular function during the first 48 hours after AMI. Side effects were minor and mainly associated with invasive procedures. Despite adequate oral anticoagulation, angiographically documented Roccusion at 3 months amounted to 28%. Reocclusion, however, was neither associated with clinically documented reinfarction, nor with a decrease in the left ventricular ejection fraction. Our study shows that APSAC is an effective thrombolytic agent in AMI but that late Roccusion may occur. Oral anticoagulants appear to be less effective in the prevention of reocclusion in the treatment regimen after thrombolysis.