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The effect of thrombolysis in acute myocardial infarction on infarct size, left ventricular function, clinical course and patient survival was studied in a randomized trial comparing thrombolysis (269 patients) with conventional treatment (264 control patients). All 533 patients were admitted to the coronary care unit within 4 hours after the onset of symptoms related to the infarction. Baseline characteristics were similar in both groups. Informed consent was requested only of patients allocated to thrombolysis; no angiography was performed in 35. The infarct-related artery was patent in 65 patients and occluded in 169. Recanalization was achieved in 133 patients. The median time to angiographic documentation of vessel patency was 200 minutes after the onset of symptoms. The clinical course in the coronary care unit was more favorable after thrombolysis. Infarct size, estimated from myocardial enzyme release, was 30% lower after thrombolysis. In patients admitted within 1 hour after the onset of symptoms the reduction of infarct size was 51%, in those admitted between 1 and 2 hours it was 31% and in those admitted later than 2 hours it was 13%. Left ventricular function measured by radionuclide angiography before hospital discharge was better after thrombolysis (ejection fraction 48 +/- 15%) than in control patients (44 +/- 15%). Similar improvement was observed in patients with a first infarct only (thrombolysis 50 +/- 14%, control subjects 46 +/- 15%), in patients with anterior infarction (thrombolysis 44 +/- 16%, control subjects 35 +/- 14%) and in those with inferior infarction (thrombolysis 52 +/- 12%, control subjects 49 +/- 12%). Similar results were obtained by contrast angiography. Mortality was lower after thrombolysis. After 28 days 16 patients allocated to thrombolysis and 31 control patients had died. One year survival rates were 91 and 84%, respectively. On the other hand, nonfatal reinfarction occurred more frequently after thrombolysis (36 patients) than in control subjects (16 patients). Early thrombolysis by intracoronary streptokinase leads to a smaller infarct size estimated by enzyme release, preserves left ventricular function at the second week and leads to improved 1 year survival.
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
August 1988,
Journal of the Indian Medical Association,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
January 1977,
Advances in internal medicine,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
January 1985,
Annales de cardiologie et d'angeiologie,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
January 2015,
Heart (British Cardiac Society),
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
July 1989,
The American journal of cardiology,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
May 1994,
Deutsche medizinische Wochenschrift (1946),
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
June 1996,
Der Internist,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
January 1986,
Archivos del Instituto de Cardiologia de Mexico,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
February 1989,
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology,
M L Simoons, and
P W Serruys, and
M van den Brand, and
J Res, and
F W Verheugt, and
X H Krauss, and
W J Remme, and
F Bär, and
C de Zwaan, and
A van der Laarse
January 1995,
Orvosi hetilap,
