<原著>急性心筋梗塞における血栓溶解療法の左室局所壁運動に及ぼす影響

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This study was conducted to clarify whether coronary thrombolysis was useful to preserve left ventricular function in patients with acute myocardial infarction. A total of 56 patients who was admitted to Kinki University Hospital within 6 hours after the onset of myocardial infarction was enrolled in the present study. Among them, 8 patients received urokinase intravenously, 17 intracoronarily, 12 intravenously and subsequently intracoronarily, and the rest of 19 patients showed spontaneous recanalization of the infarct-related coronary artery at the initial coronary angiogram on admission. Left ventriculogram and coronary angiogram were performed on admission and were repeated approximately 3 months after the onset of myocardial infarction. Left ventriculogram was obtained in the right anterior oblique projection. Left ventricular global ejection fraction and regional ejection fraction were calculated to compare left ventricular function between the acute and the chronic phases following coronary thrombolysis. Among 29 patients whose infarct-related coronary arteries were totally occluded on admission, 21 patients (72.4%) showed the recanalization of coronary arteries following coronary thrombolysis (successful group) and 8 showed that the arteries remained occluded after the treatment (unsuccessful group). Global ejection fraction was 54±3% (±SE) on admission in the 8 unsuccessful patients, while it was significantly reduced to 46±5% 3 months later (p<0.001). In the 21 successful patients, however, this value was not reduced (52±2% both at the acute and the chronic phases). Among 9 infarcted regional areas in the unsuccessful group, regional ejection fraction was improved in 3 areas, unchanged in 3 and aggravated in 3 from the acute to the chronic phase. On the other hand, after successful coronary thrombolysis, 9 regional areas among the 16 infarcted areas were improved on the chronic phase. Improvement of regional ejection fraction was more prominent in the spontaneously recanalized group with 90% stenosis, 9 areas were improved among the 14 infarcted areas. Regional ejection fraction at the infarcted portion was reduced from 20±5 at the acute phase to 18±6% at the chronic phase in the 8 unsuccessful patients. In the 21 successful patients, however, it showed rather improvement from 22±2 to 27±2%. The value remained high both at the acute and the chronic phases in patients with the spontaneously recanalized group, 31±2 and 36±3%, respectively. The data obtained in the present study indicate that if the infarct related coronary artery still remains occluded after the treatment with urokinase, the regional ejection fraction once reduced by infarction is further reduced during convalescence, but that successful coronary thrombolysis could convert this aggravation into improvement. This result suggests that successful coronary thrombolysis is useful to preserve left ventricular function in patients with acute myocardial infarction.
近畿大学の論文
1987-09-25

<原著>急性心筋梗塞における血栓溶解療法の左室局所壁運動に及ぼす影響

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