Intermittent, dose-related fluctuations of pain and ST elevation during infusion of recombinant tissue plasminogen activator during acute myocardial infarction

Reocclusion of reperfused coronary arteries is a major setback that erodes the initial gain obtained by thrombolytic therapy in patients with acute myocardial infarction (AMI). 1 After thrombolysis with recombinant tissue-type plasminogen activator (rt-PA), early in-hospital reocclusion is observed in 20 to 45% of successfully treated patients. 2 Although maintenance infusion of rt-PA reduces the incidence of reocclusion during the in-hospital period, 3 very early reocclusions immediately after 4 or even during continuous rt-PA infusion can occur. 5,6 We describe 15 patients among 190 patients with AM1 treated with rt-PA in whom initial clinical signs of reperfusion were followed by clinical and electrocardiographic evidence of rt-PA dose-related reocclusion-reperfusion cycles.