Effective thrombolytic therapy with transluminal coronary angioplasty to prevent the evolution of acute myocardial infarction at the very early stage Kazuyuki Sakata 1 , Tsuneo Hoshino 1 , Syoichi Yokoyama 1 , Shinichi Takayama 1 , Norico Mori 1 , Mitugu Kida 1 , Hiroshi Yoshida 1 , Isoroku Kato 1 , Tsuneo Kaburagi 1 1Department of Cardiology, Shizuoka General Hospital pp.103-109
Published Date 1986/1/15
DOI https://doi.org/10.11477/mf.1404204811
  • Abstract
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A 44-year-old man was admitted with a 1-hour history of severe chest pain. The admission ECG showed slight ST-segment elevation and peaked T-waves in leads V1-V4. Intravenous infusion of Uro-kinase (UK: 36×104 IU) was performed immedi-ately after admission and in 30 minutes his chest pain was almost disappeared. A coronary angiogram (CAG) shortly after that showed a 90% stenosis (AHA classification) in the proximal portion of left anterior descending coronary artery (LAD). Be-cause severe coronary stenosis was present also after intracoronary infusion of UK (24×104 IU), trans-luminal angioplasty (PTCA) was performed. Coro-nary stenosis was improved from 90 to 25%. Thirty minutes after PTCA the second attack with promi-nent ST-segment elevation in V1-V5 occurred. CAG showed complete occlusion at the same site of LAD. Recanalization with residual 50% stenosis was ob-tained after intracoronary UK (60×104 IU). But 15 minutes later we experienced the second reocclusion of the LAD and performed intracoronary UK (72 ×104 IU) and repeat PTCA. Again complete oc-clusion of the LAD was improved to less than 25% stenosis. After that he was free from recurrent at-tacks. The restudy 1 month later revealed complete patency of the LAD and normal wall motion of the left ventricle. Neither definite perfusion defect in Tl-201 scintigraphy nor development of abnormal Q waves were observed. This case suggests that sequen-tial thrombolytic therapy and PTCA performed at the early stage of acute myocardial infarction is effective to prevent the evolution of infarction.

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