[Comparative effects of intracoronary fibrinolysis and conventional treatment of myocardial infarction].

57 patients with a complete coronary thrombosis were treated by intracoronary fibrinolysis during the first 6 hours of inaugural myocardial infarction. The artery was revascularised in 37 cases (65 p. 100). Eleven patients had isolated stenosis of the left anterior descending artery and 16 patients isolated stenosis of the right coronary artery. These patients were compared with 27 other patients admitted between the 6th and 18th hours of primary myocardial infarction treated conventionally, in whom coronary angiography performed between the 14th and 21st day after infarction showed isolated left anterior descending disease in 14 cases (9 thromboses and 5 stenoses) and isolated right coronary disease in 13 cases (7 thromboses and 6 stenoses). The haemodynamic data and heart rates were identical in both groups during control coronary angiography between the 14th and the 21st days. Global left ventricular function and regional wall motion were studied by 30 degrees right anterior oblique ventriculography using the Stanford method before fibrinolysis in the first group and at the end of the 3rd week in both groups. In LAD, repermeabilisation by fibrinolysis, significant improvements were observed in ejection fraction (EF p. 100 = 42 +/- 9 vs 50.6 +/- 14 p. 100, p less than 0.05); fractional shortening of the hypokinetic segment (FS p. 100 = 4.5 +/- 4.6 vs 12.4 +/- 8.8 p. 100, p less than 0.001), and in the number of hypokinetic or akinetic segments (6.0 +/- 1.1 vs 4.2 +/- 2.1, p less than 0.05). Segmental and global left ventricular function was much poorer in the group treated conventionally at the 21st day (EF p. 100 = 44 +/- 11 p. 100, p less than 0.05; FS p.t100 = 5.8 +/- 9.7 p.t100, p less than 0.05; number of diseased segments: 6.0 +/- 1.4, p less than 0.01). On the other hand, the improvement was less marked in patients with inferior wall infarction; the results in the two groups were comparable.