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The Influence of Infarction Site and Size on the Ventricular Response to Coronary Thrombolysis
Gerald C. Timmis, MD;
Douglas C. Westveer, MD;
Andrew M. Hauser, MD;
James R. Stewart, MD;
Vellappillil Gangadharan, MD;
Renato G. Ramos, MD;
Seymour Gordon, MD
Arch Intern Med. 1985;145(12):2188-2193.
Abstract
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• To test the hypothesis that myocardial infarction (MI) size rather than location determines the ventricular response to reperfusion, we studied 69 patients receiving intracoronary streptokinase within five hours of chest pain onset who displayed sustained reperfusion at 8.4±3.4 (SD) days. Twenty reperfusion failures served as controls. There were 31 patients with anterior MIs, 18 of which were estimated to be large based on an ejection fraction (EF) at reperfusion of less than 50%; 14 of 38 patients with inferior MIs also had large MIs. The EF increased at follow-up by 6.4%±2.6% in patients with large anterior MIs and by 8.2%±2.5% in those with large inferior MIs; in contrast, it increased by only 1.8%±2.6% in patients with small anterior MIs and significantly decreased by 5.8%±1.9% in patients with small inferior MIs. Six controls with large MIs (four anterior) displayed no change in EF; in 14 with small MIs (ten inferior), it fell slightly. There were no significant group differences in the number of diseased vessels, residual stenosis, or collaterals. It is concluded that MI size, not site, largely determines the ventricular functional response to early reperfusion; thus, patients with inferior MIs cannot be disqualified on this basis alone for thrombolytic therapy.
(Arch Intern Med 1985;145:2188-2193)
Author Affiliations
From the Division of Cardiovascular Diseases (Drs Timmis and Gordon), the Cardiac Laboratories (Dr Timmis), the Electrophysiology Laboratory (Drs Westveer and Stewart), the Noninvasive Laboratory (Dr Hauser), the Coronary Care Unit (Dr Gangadharan), and the Cardiac Catheterization Laboratory (Dr Ramos), William Beaumont Hospital, Royal Oak, Mich; and the Department of Health Sciences, Oakland University, Rochester, Mich (Drs Timmis and Gordon).
Footnotes
Accepted for publication Feb 13, 1985.
Reprint requests to Division of Cardiovascular Diseases, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48072 (Dr Timmis).
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ABSTRACT
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