Comparison of effects of thrombolytic therapy followed by elective coronary intervention and direct coronary intervention in acute myocardial infarction: Usefulness of dobutamine stress echocardiography

K. Hasegawa, M. Iwase, H. Matsuyama, M. Kimura, S. Koie, C. Kato, H. Yamamoto, A. Hatada, J. Ishii, M. Nomura, Y. Watanabe, H. Hishida

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Abstract

The effects of intravenous administration of tissue plasminogen activator (t-PA) followed by elective percutaneous transluminal coronary angioplasty (PTCA) were compared to those of direct PTCA (d-PTCA) in patients with acute myocardial infarction using dobutamine stress echocardiography 1 week and 1 month after the acute episode. There were 12 patients in the t-PA group and nine patients in the d-PTCA group. Dobutamine was infused at incremental doses (5 μg/kg/min for each 5 min step). Wall motion changes were classified during infusion into four patterns, improvement, biphasic, worsening and no change. One week after the acute episode, seven of 12 patients in the t-PA group showed biphasic the pattern and five showed the improvement pattern. The biphasic pattern was observed in three patients in the d-PTCA group, worsening in one and improvement in five. One month later, the biphasic pattern in five patients in the t-PA group changed to the improvement pattern. No patients in the d-PTCA group showed changes in the wall motion pattern. There was no difference between the two groups in the frequency of the change of wall motion patterns I week and I month after infarction, but the improvement pattern was significantly increased from five to 10 patients in the t-PA group after 1 month (p<0.05). The sensitivity, specificity and accuracy of the biphasic pattern in the t-PA group for indicating remnant coronary stenosis were 78%, 100% and 83%, respectively. Evaluation of wall motion pattern by dobutamine stress echocardiography is useful for assessment of reperfusion therapy for acute myocardial infarction. The administration of t-PA followed by elective PTCA has similar efficacy to d-PTCA.

Original languageEnglish
Pages (from-to)313-320
Number of pages8
JournalJournal of cardiology
Volume30
Issue number6
Publication statusPublished - 01-12-1997

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Hasegawa, K., Iwase, M., Matsuyama, H., Kimura, M., Koie, S., Kato, C., Yamamoto, H., Hatada, A., Ishii, J., Nomura, M., Watanabe, Y., & Hishida, H. (1997). Comparison of effects of thrombolytic therapy followed by elective coronary intervention and direct coronary intervention in acute myocardial infarction: Usefulness of dobutamine stress echocardiography. Journal of cardiology, 30(6), 313-320.