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Combined intracoronary streptokinase infusion and coronary angioplasty during acute myocardial infarction

  • Herman K. Gold
    Correspondence
    Address for reprints: Herman K. Gold MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • Michael J. Cowley
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • Igor F. Palacios
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • George W. Vetrovec
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • Cary W. Akins
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • Peter C. Block
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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  • Robert C. Leinbach
    Affiliations
    From the Departments of Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    From the Department of Medicine, Medical College of Virginia, Richmond, Virginia USA
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      Abstract

      PTCA was performed in 28 patients with acute MI immediately after intracoronary streptokinase administration. Indications were failure to obtain reflow in 16 patients and high-grade residual stenosis in 12. PTCA was successful in 11 of 16 cases of streptokinase failure, increasing the overall reflow rate from 66% to 77%. PTCA reduced residual coronary stenosis by more than 20% in 9 of 12 cases in which streptokinase infusion was successful, with 1 acute reocclusion. The frequency of recurrent ischemic events in hospital was 76% in patients with a stenosis of 90% or greater after streptokinase infusion (no PTCA), 14% when residual stenosis was less than 90%, and 6% after successful PTCA. Late restenosis or reocclusion was documented in 5 of 11 PTCA cases (45%). Immediate PTCA after streptokinase administration produces increased clinical stability in hospital, but late restenosis is frequent.
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