[Reinfarction after initially successful thrombolysis in acute myocardial infarct].

UNLABELLED: In 24 of 77 patients (31%, group A), successfully treated by intracoronary streptokinase infusion in the acute stage of a transmural myocardial infarction, reocclusion of the infarct artery occurred within four weeks, in 15 patients with, in the remaining nine without re-infarction symptoms. The age of the patients, frequency of single, double or triple-vessel disease, number of anterior and posterior wall infarcts, creatine-kinase activity before and during treatment, and degree of stenosis at first contrast-medium injection were all comparable in the patients with or without re-occlusion (53 patients, group B). At the end of the acute treatment, in five patients of group A (21%) and in 17 of group B (32%) combined with balloon dilatation at the same time as the infusion, residual stenosis was significantly higher in group A than group B (75%) and 62%, respectively; P less than 0.001). No patient with a residual stenosis of less than 50% (18, of whom 12 had balloon dilatation) had a re-occlusion.

CONCLUSION

A residual stenosis of at least 50% after initially successful thrombolysis presents a marked re-infarction risk and should lead to a second intervention in such cases.