Acute coronary artery obstruction in XXXX : overview of thrombolytic therapy.

@entity1 @entity1188 @entity27216 @entity583 @entity67 @entity1455 @entity204
Pump failure, ranging from @entity67 to acute @entity1455 , is now the leading cause of @entity204 . Efforts at temporary mechanical or pharmacologic support of the heart have been largely unsuccessful so that attention is now directed toward prevention of @entity67 and limitation of @entity583 size or even outright prevention of @entity1188 itself. In particular, attention has been refocused on earlier reperfusion efforts with streptokinase. The effect of thrombolysis in acute @entity583 on enzymatic @entity1188 size, left ventricular function and early mortality was studied in subsets of @entity1 in a randomized trial (Netherlands Interuniversity Cardiology Institute). Early thrombolytic therapy with intracoronary streptokinase (152 @entity1 ) or with intracoronary streptokinase preceded by intravenous streptokinase (117 @entity1 ) was compared with conventional treatment (264 @entity1 ). All 533 @entity1 were admitted to the coronary care unit within 4 hours after onset of symptoms indicative of acute @entity583 . Of the @entity1 eligible for this detailed analysis, 245 were allocated to thrombolytic therapy and 243 to conventional treatment. Early angiography was preformed in 212 of the 245 @entity1 allocated to thrombolytic therapy. Patency of the @entity1188 was achieved in 181 @entity1 (85%). Enzymatic @entity1188 size, measured from cumulative @entity27216 dehydrogenase release, was smaller in @entity1 allocated to thrombolytic therapy (median 760 versus 1,179 U/liter in control subjects, p = 0.0001). Left ventricular ejection fraction measured by radionuclide angiography before discharge was higher after thrombolytic therapy (median 50% versus 43% in control subjects, p = 0.0001). Twelve month mortality was lower in @entity1 allocated to thrombolytic therapy (8% versus 16% in the control group, p less than 0.01). In multivariate regression analysis @entity1188 size limitation, improvement of left ventricular ejection fraction and 3 month mortality were predicted by sigma ST, time from onset of symptoms to admission and Killip class at admission. Thrombolysis was most useful in @entity1 admitted within 2 hours after onset of symptoms and in @entity1 with a sigma ST segment of 1.2 mV or more. On the other hand, no beneficial effects of streptokinase on enzymatic @entity1188 size, left ventricular function or mortality were observed in the subset of @entity1 with sigma ST less than 1.2 mV, admitted 2 to 4 hours after onset of symptoms.
