Intracoronary thrombolysis in acute myocardial infarction: clinical course following successful myocardial reperfusion.

We reviewed the clinical course of 73 patients who had attempted intracoronary thrombolysis, with emphasis on follow-up. Fifty-nine patients (81%) had coronary reflow sufficient to control pain and injury current: 52 received thrombolysis alone and seven had thrombolysis combined with acute coronary angioplasty. Recurrent ischemic events in hospital were frequent and occurred in 17 patients (29%). These included silent reocclusion (four patients), recurrent angina (eight patients), and recurrent infarction in the same myocardial zone (five patients). Late ischemic events occurred in 11 patients (19%) and included silent reocclusion (two patients) and angina (nine patients). Although acute coronary angioplasty resulted in a high rate of successful myocardial reperfusion, long-term vessel patency was infrequent. The results of coronary bypass surgery, performed in hospital for severe residual coronary stenosis and angina and later for recurrent angina, were uniformly good. At follow-up of 6 to 36 months (mean 18.5 +/- 8.1), total mortality was five patients (8%). Only 16 reperfused patients (27%) were alive and well without recurrent ischemia or interventions. We conclude that reopening an acutely occluded coronary artery by thrombolysis and/or angioplasty can be performed in the majority of patients but must be regarded as initial therapy in view of the high incidence of recurrent ischemic events. Reperfused patients with stable myocardial blood supply post infarction have low long-term mortality.