[Thrombolysis in acute transmural heart infarction: length of ischemia as a determinant of late results after 15 months].

In 28 patients the effect of coronary artery reperfusion in acute transmural myocardial infarction was evaluated by the clinical and hemodynamic results obtained after 15 months. Patients with successful reperfusion within 4 hours after onset of symptoms were assembled in group A1 (n = 11), patients with successful reperfusion after more than 4 hours in group A2 (n = 7). Group B consists of 10 patients with unsuccessful reperfusion. Left ventricular ejection fraction (radionuclide ventriculography) and the perfusion defect (thallium-201 scintigraphy) were measured acutely and after 15 months (at rest and during exercise). The coronary anatomy and the regional ejection fraction of infarct area were determined acutely and after 4 weeks by cineangiography. Serum creatine kinase activity was measured serially during the acute phase of the infarction. Before the acute intervention, the patients of the 3 groups were comparable with regard to killip class, location of infarction, number of previous infarctions, coronary anatomy, left ventricular ejection fraction, thallium-201 perfusion defect and base-line serum creatine kinase activity. During acute infarction peak creatine kinase activity tended to be lower in group A1 (1296 U/l) than in group A2 (2100 U/l, NS) and in group B (2240 U/l, NS). After 4 weeks regional ejection fraction of infarct area was higher in group A1 (36%) than in groups A2 (24%, NS) and B (20%, p less than 0.05). After 15 months the thallium-201 perfusion defect was smaller in group A1 (7%) than in groups A2 (28%, p less than 0.05) and B (34%, p less than 0.01). At the same time left ventricular ejection fraction was higher in group A1 (52%) than in groups A2 (34%, p less than 0.05) and B (35%, p less than 0.05). Fifteen months after acute infarction patients in group A1 tended to reach a higher workload during exercise (118 watts) compared with patients of groups A2 (82 watts, NS) and B (86 watts, NS).(ABSTRACT TRUNCATED AT 250 WORDS)