Importance of follow-up medical and surgical approaches to prevent reinfarction, reocclusion, and recurrent angina following intracoronary thrombolysis with streptokinase in acute myocardial infarction.

Thirty-four patients with acute myocardial infarction (mean age 55 years) who received intracoronary streptokinase for coronary thrombosis were followed for a mean of 9.4 months (longest 25 months) following the procedure of percutaneous transluminal coronary recanalization (PTCR). Twelve patients had undergone coronary artery bypass graft surgery (CABG), one had percutaneous transluminal coronary angioplasty (PTCA), and 21 received medical therapy. Among patients having CABG and PTCA, nearly 70% no longer had chest pain or reinfarction, and 62% were in New York functional class I status; there were no deaths, and there was only one reinfarction, in a patient who had graft closure. In contrast, 43% of medically treated patients had chest pain or reinfarction or had died on follow-up; only 32% of survivors were in class I functional status. Further, 71% of medically treated patients who were receiving warfarin had no chest pain and on reinfarction, whereas the majority (56%) of patients who did not receive either warfarin or antiplatelet agents either had chest pain or reinfarction or died. The importance of CABG/PTCA and anticoagulant therapy is stressed to prevent recurrent ischemia, reinfarction, and reocclusion following successful reperfusion by means of PTCR in acute myocardial infarction.