Effect of Intracoronary Thrombolytic Therapy on Left Ventricular Function and Mortality in Patients with Acute Myocardial Infarction: Preliminary Results of the Thoraxcenter Randomised Trial

To answer the question whether intracoronary thrombolysis in patients with acute myocardial infarction is beneficial, a randomised trial was started in June 1981 at the Thoraxcenter: so far, 167 patients admitted less than 4 h after onset of symptoms have been enrolled. This interim report describes the effects of reperfusion versus conventional treatment on early and late mortality as well as on global and regional left ventricular function assessed from contrast angiography 2 weeks after the acute phase. In the conventionally treated group (N = 82), 8 patients died in hospital and 7 after discharge {median follow-up 13 months). In the group assigned to thrombolysis (N = 85), 6 patients died in hospital and 4 after discharge. In contrast to this nonsignificant difference in mortality, the haemodynamic data showed a preservation of global left ventricular function after thrombolysis, even when the results were presented on an 'intention to treat' basis. The left ventricular ejection fraction was 56 ± 10% (mean ± SD) in the thrombolysis group versus 44 ± 14% in the conventionally treated group (P10−5). This preservation of left ventricular function was observed both in patients with anterior and in those with inferior infarction. Thombolysis by the intracoronary route has the potential for myocardial salvage; however, the expected benefit on early and late mortality has not yet been demonstrated and this will require the inclusion of a larger number of patients.