caa a22 4500 477061885 CHVBK 20180405111403.0 cr unu---uuuuu 170330e19960901xx s 000 0 eng 10.1007/BF00181666 doi (NATIONALLICENCE)springer-10.1007/BF00181666 An angiographic study of intracoronary streptokinase versus intravenous tissue plasminogen activator after failed coronary thrombolysis with intravenous streptokinase [Elektronische Daten] [Freek Verheugt, Gerrit Veen, Carel de Cock, Albert Meijer] Objective: The medical treatment of failed intravenous streptokinase in patients with acute transmural myocardial infarction using angiographic endpoints. Design: Prospective open angiographic comparison of intracoronary streptokinase with intravenous tissue plasminogen activator. Setting: Single center study in a tertiary institution. Subjects: Eighty-five patients with acute myocardial infarction within 4 hours after symptom onset. Treatment regimens: The subjects received 1.5 million U intravenous streptokinase. Coronary angiography within 48 hours (median 19 hours) showed infarct-related vessel patency in 65 patients (76%). In the catheterization laboratory the 20 patients (24%) with failed intravenous streptokinase received repeat thrombolysis immediately after angiography. The first 10 patients with failed intravenous streptokinase received intracoronary streptokinase at a dose of 4000 U/min in the occluded infarctrelated artery for a maximum of 1 hour. The subsequent 10 patients received high-dose front-loaded intravenous tissue plasminogen activator (100 mg in 1 hour). Results: In none of the patients receiving repeat streptokinase was reperfusion obtained. In 6 of 10 (60%) of the patients receiving tissue plasminogen activator, reperfusion was seen within 60 minutes (p < 0.005 vs. intracoronary streptokinase). One patient (5%) died and two refused follow-up angiography. Seventeen (88%) patients underwent angiography 3 months later according to the protocol. Two patients showed a persistently reperfused infarct-related artery, three reoccluded, four spontaneously reperfused, and eight had a persistently occluded infarct-related artery. The left ventricular ejection fraction was slightly higher at 3 months, and there were no differences between the patients with open vessels (increase + 7.7 ± 5.8%) and those with persistently occluded vessels (increase +5.8 ± 6.8%) Conclusions: Repeat thrombolysis after failed intravenous streptokinase can be achieved with front-loaded intravenous tissue plasminogen activator but not with intracoronary streptokinase. Although patient numbers are small and repeat thrombolysis was performed rather late, this study leads the way to affordable optimization of thrombolysis, which needs large-scale testing. Kluwer Academic Publishers, 1996 intravenous streptokinase nationallicence failure nationallicence intracoronary streptokinase nationallicence tissue plasminogen activator nationallicence Verheugt Freek Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut Veen Gerrit Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut de Cock Carel Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut Meijer Albert Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/3(1996-09-01), 239-243 0929-5305 3:3<239 1996 3 11239 https://doi.org/10.1007/BF00181666 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00181666 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Verheugt Freek Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Veen Gerrit Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- de Cock Carel Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Meijer Albert Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/3(1996-09-01), 239-243 0929-5305 3:3<239 1996 3 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer