Late thrombolysis decreases the progression of myocardial necrosis Nitroglycerin augments streptokinase in collateralised occlusion

The time limit for benefit from thrombolysis in acute myocardial infarction is unclear. and efficacy may depend on initial angiographic status and be enhanced by adjuvant therapy. Therefore the effects of intracoronary streptokinase and/or nitroglycerin [glyceryl trinitrate] on left ventricular function. when given within 12 hours of onset of chest pain. were studied in a double-blind trial. Patients were randomised to streptokinase 2000 U/min (n = 97). nitroglycerin 0.Q1 mg/min (99). both (96). or a control group receiving conventional therapy without catheterisation (101). Patients also received anticoagulant therapy for 3 months.

Patients were treated from 1.8 to 13.6 (mean 6.3) hours after onset of symptoms. Only streptokinase-nitroglycerin recipients showed a significant improvement from preintervention in ejection fraction. In patients with collateralised total coronary occlusion, the streptokinase­nitroglycerin group showed significant improvements in ejection fraction compared with streptokinase-only and nitroglycerin-only groups. Patients in the streptokinase-nitroglycerin and streptokinase groups with collateral flow had greater ejection fraction improvements compared with those without collateral flow. Non­collateralised coronary occlusion was associated with a lack of improvement in ejection fraction, regardless of treatment. Subtotal occlusion was associated with improvement in ejection fraction in all treatment groups.

In conclusion, lale Ihrombolytlc therapy slows Ihe progression of myocardial necrosis In patlenls with collateral flow to an occluded coronary vessel, and Is augmenled by Inlracoronary nitroglycerin. Rentrop KP, Feit F. Sherman W, Stecy P. Hosat S, et aI. Late thrombolytic therapy preserves left ventricular function in pallents WIth collateralized total coronary occlusion: primary end point findings of the second Mount Sinai-New York University reperfusion trial. Journal of the American College of Cardiology 14: 58-64. July 1989 '222

14 INPHARMA'" 30 Sep 1989 0156-2703/89/0930-0014/0$01.00/0 © ADIS Press