| Abstract: | Between 1986 and 1988, 239 consecutive patients with acute myocardialinfarction received thrombolytic therapy up to 285 minutes afteronset of symptoms; in 39 (17 with anterior infarction, 21 inferior,one lateral infarction) recombinant tissue plasminogen activatoror anistreplase was administered a mean of 51 minutes (range20–60 minutes) after the onset of symptoms. The patencyrates (26 of 30; 87 per cent), rapid ST segment resolution (36of 38; 95 per cent) and QRS score of  3 (28 of 38; 74 per cent)were statistically significantly higher for those seen and treatedin the first hour in comparison with those seen and treatedlater. For those treated within the first hour mean peak creatine kinasewas 1264 U/I for those with TIMI grade 2 or 3 (partial or completeperfusion) compared with 3005 U/I for those with TIMI grade0 or 1 (no perfusion or penetration without perfusion) (p=0.02):mean peak creatine kinase-MB for those with TIMI grade 2 or3 perfusion was 115 U/I compared with 312 U/I for those withTIMI grade 0 or 1 (p=0.01). Four of the 39 patients developedventricular fibrillation following thrombolytic therapy, threewithin 24 hours of infarction and one following reinfarctionon day 15. There were no significant bleeding complications.One patient died. Thrombolytic therapy within 1 hour of the onset of symptomsled to a very high angiographic patency rate, rapid ST segmentresolution with preservation of left ventricular function. Thistherapy is without significant complications. |
