Summary
During the five-year period between March 1980 and February 1985 selective intracoronary
thrombolysis with streptokinase was performed in 469 patients with clinical and ECG
signs of acute transmural myocardial infarct. Coronary arteriography prior to thrombolysis
showed the infarct related vessel still or again patent in 21 % of the patients. Among
372 patients with complete occlusion streptokinase infusion was successful in 87%,
but failed in 13%. Due to the high risk of reocclusion, early bypass surgery was performed
in 69 patients (18.5 %) of the successfully reperfused group. Indication was based
primarily on an ischemic time interval of less than 4 hours between the acute onset
of clinical symptoms and reperfusion. Early mortality was 1.5 % in this surgically
treated group and actuarial survival was 92 % at 5 years with all but 3 patients in
functional class I or II. Marked but non-fatal early congestive heart failure was
more significant when patients underwent operation within the first 2 days after thrombolysis
than thereafter. Late recatheterization studies in 29 patients showed a slight but
statistically insignificantly higher occlusion rate for vein grafts to the infarct
vessel (14 %) than to concomitantly grafted arteries (6 %). No correlation was found
between the initial ischemic time interval and graft patency. Late left ventricular
function was excellent or minimally impaired in 52 % of these patients while 48 %
had significantly reduced LV function. Again, no correlation was found between the
ischemic time interval and late LV function. LV aneurysm, however, occurred only in
patients with an ischemia of more than 3 hours. Thrombolysis combined with early bypass
surgery represents the optimal therapy for acute myocardial infarct. In patients with
single vessel disease simultaneous or early PTCA may be an alternative to surgical
treatment.
Key words
Acute myocardial infarct - Early bypass surgery - Intracoronary thrombolysis
