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Importance of myocardial infarct artery patency on the prevalence of ventricular arrhythmia and late potentials after thrombolysis in acute myocardial infarction

  • Frank V. Aguirre
    Correspondence
    Address for reprints: Frank V. Aguirre, MD, Cardiac Catheterization Laboratory, St. Louis University Medical Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, Missouri 63110.
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Morton J. Kern
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Judith Hsia
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Harvey Serota
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Denise Janosik
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Terry Greenwalt
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Allan M. Ross
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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  • Bernard R. Chaitman
    Affiliations
    From the Cardiology Division, St. Louis University Medical Center, St. Louis, Missouri USA

    From the Cardiology Division, George Washington University, Washington, D.C. USA
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      Abstract

      Sustained infarct artery patency is an important determinant of survival in patients with acute myocardial infarction. We studied 61 patients with acute myocardial infarction who received intravenous recombinant tissue-type plasminogen activator, aspirin or heparin within 6 hours of symptom onset, to determine if infarct artery patency after intravenous thrombolytic therapy influences myocardial electrical stability as measured by the prevalence of spontaneous ventricular ectopy or late potential activity. Infarct artery patency was determined by angiographic evaluation 2.5 ± 3 days after infarction. Forty-eight patients (79%) had a patent infarct-related artery and 13 (21%) patients had an occluded vessel. The mean number of ventricular premature complexes (VPCs)/hour (p < 0.01) and the prevalence of late potentials (54 vs 19%; p < 0.03) were significantly higher in patients with an occluded versus patent-infarct related vessel. Although VPC frequency and late potentials were not influenced by the time to thrombolytic treatment, patients with a patent infarct-related artery had a lower prevalence of late potentials regardless of whether treatment was initiated ≤2 hours (25% patent vs 50% occluded; p = not significant) or 2 to 6 hours (16% patent vs 55% occluded; p > 0.03) after symptom onset.
      Thus, successful thrombolysis decreases the frequency of ventricular ectopic activity and late potentials in the early postinfarction phase. The reduction in both markers of electrical instability may help explain why the prognosis after successful thrombolysis is improved after acute myocardial infarction.
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