[Selective thrombolysis in acute myocardial infarction: evaluation of functional result by metabolic studies and perfusion imaging (author's transl)].

The effects of selective thrombolysis with intra-coronary streptokinase in regard to myocardial protection are still debated. In 25 patients with acute myocardial infarction we evaluated regional metabolism with 123 radio-iodinated heptadecanoic acid and segmental 201 thallium scintigraphy in the distribution of the recanalized coronary vessel. Lysis was successful in 11/16 occlusions of LAD-, 4/7 RCA- and 1/2 CX-vessels. In this group (A) the average defect size on TI-scintigrams was 19 +/- 6% 24 hours after the intervention, whereas unsuccessful recanalisation (group B) resulted in a defect size of 38 +/- 7% (p less than 0.01). There was good concordance between thallium defect size and fatty acid metabolism in group B. However, in group A 6 of 11 patients showed significantly smaller fatty aid accumulation than the thallium defect size reflected. These data suggest that successful reperfusion does result in protection of myocardium in the majority of infarct patients reflected in the smaller TI infarct size. Successful reperfusion, however, does not always immediately restore metabolic dysfunction. This discrepancy will have to be analyzed by further follow-up studies of these patients.