Clinical course after attempted thrombolysis in myocardial infarction

Immediate results and follow-up are reported on 118 patients with a diagnosis of myocardial infarction who were included in studies on intracoronary thrombolysis at the Thoraxcenter. Pilot studies included 37 patients treated with streptokinase, nine with urokinase and six with nitroglycerine and nifedipine. First results of the present on-going randomized trial are described from 34 patients allocated to streptokinase therapy and 32 allocated to conventional therapy in the coronary care unit. Urokinase, nitroglycerine and nifedipine were not effective for recanalization. Streptokinase resulted in recanalization of 22 out of 29 occluded arteries in the pilot studies (71%), as well as 19 out of 23 occluded arteries in the randomized trial (83%). Five patients died during angiography and attempted recanalization. In the pilot studies, four patients died during follow-up. In none of these had recanalization been achieved. On the other hand, angina and reinfarction were observed more frequently in patients after successful recanalization. In the randomized trial no differences were observed in mortality, reinfarction rate, angina or results of predischarge stress testing between patients allocated to streptokinase treatment or controls. However, cardiac -failure during follow-up seemed to be more prominent in controls. These preliminary data indicate that the clinical course in patients after attempted thrombolysis is similar to the course of patients treated by conventional methods. Both should be monitored carefully for signs of cardiac failure and episodes of myocardial ischemia and appropriate measures, including surgery, should be considered if these appear. Further randomized trials are warranted to determine whether patients after thrombolytic therapy have a better survival and fewer complications than patients treated conventionally.