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Intracoronary thrombolysis and coronary angioplasty for evolving myocardial infarction.

At present experience in South Africa with coronary reperfusion during the acute phase of myocardial infarction is limited. Acute reperfusion of an infarct-related coronary artery was attempted in 55 patients using intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA). Intracoronary streptokinase infusion had reopened 25 to 40 totally occluded lesions but usually a residual severe stenosis remained. PTCA was subsequently attempted in 36 severely stenotic coronary arteries and 19 totally occluded coronary arteries. PTCA was successful in 48 of the 55 cases (87%). After 1 week vessel patency was present in 36 of the 39 patients who had early coronary artery re-assessment. Late restenosis occurred in 4 out of 14 cases. There were no procedure-related deaths. Normal global as well as regional left ventricular function was present in 15 cases after 1 week. Emergency PTCA alone or in combination with intracoronary thrombolytic therapy is efficacious in achieving coronary reperfusion. On follow-up, left ventricular function appeared to be well preserved in 27% of patients with patent infarct-related arteries.