Effects of thrombolytic regimen, early catheterization, and predischarge angiographic variables on six-week left ventricular function

      This paper is only available as a PDF. To read, Please Download here.


      The Thrombolysis and Angioplasty in Acute Myocardial Infarction phase 5 (TAMI-5) trial randomized patients to 1 of 3 thrombolytic regimens (alteplase, urokinase, or both), then further randomized them to acute or deferred catheterization. The group of patients randomized to acute catheterization had improved infarct zone but not global left ventricular function on predischarge left ventriculography. To better explore the late effects of these strategies on global and regional left ventricular function, a subset of patients (n = 296) were prospectively evaluated at 6 weeks by multiple uptake gated acquisition (MUGA) radionuclide ventriculography scan. Of these patients, 219 had interpretable studies with paired predischarge and late left ventriculographic data for comparison. At 6 weeks, choice of thrombolytic regimen had no impact on either global or infarct-zone left ventricular function. Further, catheterization strategy (acute vs deferred) did not influence global or infarct-zone function at 6 weeks. In patients randomized to acute catheterization, those undergoing rescue angioplasty had worse infarct-zone wall motion at 6 weeks than patients with a patent infarct vessel not requiring rescue angioplasty (p = 0.002). The early benefit on regional left ventricular function of triage to acute catheterization after thrombolysis for acute myocardial infarction did not persist at 6 weeks, which is most likely attributable to a high incidence of reocclusion. The worse infarctzone regional wall motion in patients undergoing rescue angioplasty in the acute-catheterization group likely reflects failed reperfusion and illustrates the difficulty in identifying and consequences of early thrombolytic failures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • AIMS Trial Study Group
        Effect of intravenous APSAC on mortality after acute myocardial infarction: preliminary report of a placebo-controlled trial.
        Lancet. 1988; 1: 545-549
        • Wilcox RG
        • von der Lippe G
        • Olsson CG
        • Jensen G
        • Skene AM
        • Hampton JR
        Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction.
        Lancet. 1988; 2: 525-530
        • ISAM Study Group
        A prospective trial of intravenous streptokinase in acute myocardial infarction: mortality, morbidity and infarct size at 21 days.
        N Engl J Med. 1986; 314: 465-471
        • Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico
        Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction.
        Lancet. 1986; 1: 397-402
        • Topol EJ
        • Califf RM
        • George BS
        • Kereiakes DJ
        • Abbottsmith CW
        • Candela RJ
        • Lee KL
        • Pitt B
        • Stack RS
        • O'Neill WW
        A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction.
        N Engl J Med. 1987; 317: 581-588
        • The TIMI Study Group
        Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) phase II trial.
        N Engl J Med. 1989; 320: 618-627
        • Califf RM
        • Harrelson-Woodlief L
        • Topol EJ
        Left ventricular ejection fraction may not be useful as an end point of thrombolytic therapy comparative trials.
        Circulation. 1990; 82: 1847-1853
        • Henzlova MJ
        • Bourge RC
        • Papapietro SE
        • Maske LE
        • Morgan TE
        • Tauxe EL
        • Rogers WJ
        Long-term effect of thrombolytic therapy on left ventricular ejection fraction after acute myocardial infarction.
        Am J Cardiol. 1991; 67: 1354-1359
        • Sutton JM
        • Topol EJ
        Left ventricular function assessment and acute myocardial infarction.
        Curr Opin Cardiol. 1992; 7: 1035-1045
        • Califf RM
        • Topol EJ
        • Stack RS
        • Ellis SG
        • George BS
        • Kereiakes DJ
        • Samaha JK
        • Worley SJ
        • Anderson JL
        • Harrelson-Woodlief L
        • The TAMI Study Group
        Evaluation of combination thrombolytic therapy and timing of cardiac catheterization in acute myocardial infarction.
        Circulation. 1991; 83: 1543-1556
        • Sheehan FH
        • Bolson EL
        • Dodge HT
        • Mathey DG
        • Schofer J
        • Woo HW
        Advantages and applications of the centerline method for characterizing regional ventricular function.
        Circulation. 1986; 74: 293-305
        • The GUSTO Angiographic Investigators
        The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction.
        N Engl J Med. 1993; 329: 1615-1622
        • Sheehan FH
        • Braunwald E
        • Canner P
        • Dodge HT
        • Gore J
        • Van Nette P
        • Passamani ER
        • Williams DO
        • Zaret B
        The effect of intravenous thrombolytic therapy of left ventricular function a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial.
        Circulation. 1987; 75: 817-829
        • White HD
        • French JK
        • Hamer AW
        • Brown MA
        • Williams BF
        • Ormiston JA
        • Cross DB
        Frequent reocclusion of patent infarct-related arteries between 4 weeks and 1 year: effects of antiplatelet therapy.
        J Am Coll Cardiol. 1995; 25: 218-223
        • Veen G
        • Meyer A
        • Verheugt FW
        • Werter CJ
        • de Swart H
        • Lie KI
        • van der Pol JM
        • Michels HR
        • Van Eenige MJ
        Culprit lesion morphology and stenosis severity in the prediction of reocclusion after coronary thrombolysis: angiographic results of the APRICOT study.
        J Am Coll Cardiol. 1993; 22: 1755-1762
        • Ohman EM
        • Califf RM
        • Topol EJ
        • Candela R
        • Abbottsmith C
        • Ellis S
        • Sigmon KN
        • Kereiakes D
        • George B
        • Stack RS for the TAMI Study Group
        Consequences of reocclusion after successful reperfusion therapy in acute myocardial infarction.
        Circulation. 1990; 82: 781-791
        • Lamas GA
        • Flaker GC
        • Mitchell G
        • Smith SC
        • Gersh BJ
        • Wun CC
        • Moye L
        • Rouleau JD
        • Pfeffer MA
        Effect of infarct artery patency on prognosis after acute myocardial infarction. The Survival and Ventricular Enlargement Investigators.
        Circulation. 1995; 92: 1101-1109