[Mechanical reperfusion in acute myocardial infarction after failure of thrombolysis with intravenous streptokinase].

OBJECTIVE

to report the clinical evolution of four patients with acute myocardial infarction that were subjected to immediate coronary angioplasty due to the failure of reperfusion with streptokinase.

BACKGROUND

the limitations for the use of thrombolytic agents, an accepted treatment of acute myocardial infarction, or their uncertain results in selected groups of patients has prompted the search for mechanical revascularization infarction subjected to thrombolytic therapy with streptokinase (1.500.000 U i.v.) after administration of hydrocortisone (100 mg i.v.) and acetyl salicylic acid (500 mg od). After 60 min thrombolytic therapy and due to hemodynamic depression with requirement of inotropic agents or the absence of clinical signs of reperfusion, the patients were subjected to coronary angiography. In view of a total occlusion or severe stenosis of the artery responsible for the infarction, an immediate transluminal angiography was performed to improve coronary flow.

RESULTS

transluminal coronary angioplasty revascularized arteries with total occlusion or increased the lumen of those with severe residual stenosis. This was accompanied by reduction in pain and hemodynamic improvement. In one patient with complete AV block, conduction was improved and sinus rhythm was recovered. Echocardiographic controls showed preservation of ventricular function with persistence of segmental motility alterations.

CONCLUSIONS

transluminal coronary angioplasty can be a revascularization alternative in patients with acute myocardial infarction and failure of reperfusion with systemic streptokinase.