Facts and Hopes in Thrombolysis in Acute Myocardial Infarction

ISBN-13: 9783662071762 / Angielski / Miękka / 2013 / 229 str.

S. Effert

Opis

It was a great pleasure for us to welcome so many experts from all over the world to our symposium in Aachen. We are also pleased - and you can attribute this to my own vanity - with the success and acceptance of the concept of myocardial reperfusion and revascularization - specifically selective intracoronary lysis followed either by PTCA or bypass surgery - which we have been pursuing since 1979. But after the dramatic immediate effects of the first attempts, which you have to experience yourself, we did not expect it to be any different. We decided against performing a randomized study in which every patient is catheterized, and thrombolytic therapy only given to some of the patients, for which we have been criticized at times. At the previous symposium in Aachen in 1983 on the topic of thrombolysis for acute myocardial infarction, in the final session several speakers were asked directly about this topic, and replied that if they were patients they would not want to be randomized into the placebo group. In the meantime positive results from large, randomized studies have been recorded, which are presented in this volume. I mention in particular the Western Washington Study from Dr. Kennedy and the Interuniversity Study in Holland. Aachen, a relatively small city with 250,000 inhabitants, provided the opportunity to treat a relatively large patient population with acute myocardial infarction.

Spis treści

The role of ATP depletion and accumulated metabolic products during myocardial ischemia.- Ultrastructural aspects of ischemia and reperfusion in canine and human hearts.- Pro-urokinase and tissue-type plasminogen activator.- Preliminary clinical results with pro-urokinase.- Anisoylated streptokinase plasminogen activator.- Antifibrin-urokinase complex.- GISSI — A randomized trial with intravenous streptokinase in acute myocardial infarction. Preliminary results.- ISAM — A randomized trial with intravenous streptokinase versus placebo.- Randomized trial with intracoronary streptokinase versus placebo (Western Washington).- Randomized trial with intracoronary streptokinase versus placebo (The Netherlands).- Randomised trial with intravenous acylated streptokinase (BRL 26921) versus streptokinase (preliminary data).- Short and long term results with intracoronary SK with regard to further treatment and age of patients — experiences in Aachen—.- ECG and ECG mapping in myocardial infarction: facilities and limitations for assessment of coronary reperfusion therapy.- Measurement of improvement of left ventricular function after reperfusion using left ventricular angiography.- Quantitative assessment of regional left ventricular motion after early thrombolysis using endocardial landmarks.- Positron emission tomography of the heart.- Planar and tomographic scintigraphic studies in connection with coronary thrombolysis.- Echocardiography in myocardial infarction.- How to estimate reocclusion risk?.- Indications for early PTCA after thrombolysis.- Panel Discussion.- Clinical experience with rt-PA in the Cooperative European Trials. 1. rt-PA versus placebo.- Clinical experience with rt-PA in the Cooperative European Trials. 2. rt-PA versus streptokinase.- Panel Discussion.- What have we learned during this symposium?.- What shall we recommend to the practising physican and the cardiologist in a general hospital?.- What should the health services and regulatory agencies take into account?.- rt-PA — does this now mean thrombolysis for everyone?.- What should be the future strategy?.- A short overview summarizing two important rt-PA studies from the United States.