Systemic thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction.

Intravenous high-dose infusion of streptokinase in acute evolving myocardial infarction is a widely used therapeutic concept with clinically relevant recanalization rates and low complications. In our experience with 150 patients and acute myocardial infarction treated with intravenous streptokinase (1.5 Mio U), 107 (78 p. 100) of 137 patients demonstrated an antegrade perfused infarct artery. In a group of patients (n = 95), in whom early revascularization was performed, the incidence of reinfarction was reduced from 15 p. 100 to 7 p. 100; hospital mortality was not influenced (3.6 p. 100 vs 4.3 p. 100). PTCA was successful in 39 of 48 patients (81 p. 100). The incidence of angiographically determined restenosis amounted to 28 p. 100 (9/32). Patients after successful PTCA without restenosis demonstrated an improvement of left ventricular function in contrast to patients with restenosis or reocclusions. Thus, intravenous streptokinase followed by PTCA presents a clinically practicable and promising method for treatment of acute myocardial infarction.