Effects of tissue plasminogen activator therapy on the frequency of acute right ventricular myocardial infarction associated with acute left ventricular infarction

To assess the effects of reperfusion therapy on acute right ventricular myocardial infarction, we studied at necropsy the hearts from 51 patients who died after receiving intravenous recombinant tissue plasminogen activator for acute left ventricular myocardial infarction as part of the Thrombolysis...

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Veröffentlicht in:International journal of cardiology 1993-02, Vol.38 (2), p.151-158
Hauptverfasser: Kalan, Jay M., David Gertz, S., Kragel, Amy H., Berger, Peter B., Roberts, William C., Ryan, Thomas J.
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container_issue 2
container_start_page 151
container_title International journal of cardiology
container_volume 38
creator Kalan, Jay M.
David Gertz, S.
Kragel, Amy H.
Berger, Peter B.
Roberts, William C.
Ryan, Thomas J.
description To assess the effects of reperfusion therapy on acute right ventricular myocardial infarction, we studied at necropsy the hearts from 51 patients who died after receiving intravenous recombinant tissue plasminogen activator for acute left ventricular myocardial infarction as part of the Thrombolysis in Myocardial Infarction (TIMI) study. Right ventricular infarction occurred in none of 29 patients with infarction of the anterior wall of the left ventricle and in 8 of 22 patients (36%) with infarction of the posterior (inferior) wall of the left ventricle. Of the 22 patients with posterior wall infarction, the 8 patients with right ventricular infarction were compared to the 14 patients without right ventricular infarction. The patients with right ventricular infarction had a longer mean interval from tissue plasminogen activator infusion to peak creatine phosphokinase level (19 vs. 11 h, P < 0.03), a lower frequency of hemorrhagic necrosis (2 of 8 vs. 10 of 14, P < 0.04) and higher frequency of luminal thrombus in the infarct-related coronary artery (6 of 8 vs. 3 of 14, P = 0.054). Each of these findings is associated with the absence of coronary reperfusion. Thus, successful reperfusion following acute left ventricular myocardial infarction appears to be associated with a decreased frequency of concomitant right ventricular myocardial infarction.
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Right ventricular infarction occurred in none of 29 patients with infarction of the anterior wall of the left ventricle and in 8 of 22 patients (36%) with infarction of the posterior (inferior) wall of the left ventricle. Of the 22 patients with posterior wall infarction, the 8 patients with right ventricular infarction were compared to the 14 patients without right ventricular infarction. The patients with right ventricular infarction had a longer mean interval from tissue plasminogen activator infusion to peak creatine phosphokinase level (19 vs. 11 h, P &lt; 0.03), a lower frequency of hemorrhagic necrosis (2 of 8 vs. 10 of 14, P &lt; 0.04) and higher frequency of luminal thrombus in the infarct-related coronary artery (6 of 8 vs. 3 of 14, P = 0.054). Each of these findings is associated with the absence of coronary reperfusion. 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subjects Coronary artery disease
Creatine Kinase - blood
Female
Heart Ventricles
Humans
Infusions, Intravenous
Male
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - drug therapy
Myocardial Infarction - pathology
Myocardium - pathology
Necrosis
Reperfusion
Right ventricular infarction
Thrombolysis
Thrombolytic Therapy
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
title Effects of tissue plasminogen activator therapy on the frequency of acute right ventricular myocardial infarction associated with acute left ventricular infarction
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