PMID: 15227492Jan 1, 1991Paper

Deterioration in left ventricular performance during early coronary angioplasty after thrombolysis. Evidence for myocardial salvage

Texas Heart Institute Journal
M S NorellR Balcon

Abstract

To investigate the effects of controlled coronary artery reocclusion after successful thrombolysis, we studied 15 patients during early elective angioplasty of the patent infarct-related artery. Eight patients underwent left anterior descending artery dilation, and the other 7 had right coronary artery dilation. In 13 cases, ST-segment elevation developed during balloon occlusion. In all 15 cases, intravenous digital subtraction left ventriculography during balloon inflation showed that the ejection fraction decreased at least 5% (mean decrease, from 60% to 47%), despite preexisting Q waves overlying the infarct territory in 5 patients. Balloon inflation resulted in decreased apical segmental shortening in all 8 patients who underwent left anterior descending artery dilation; likewise, balloon inflation produced impairment of inferior-wall contraction in all 7 patients who had right coronary artery dilation. In this setting, a deterioration in left ventricular performance indicates that the restoration of coronary patency with thrombolysis has resulted in myocardial salvage. In patients with Q waves, such deterioration suggests that this electrocardiographic abnormality does not necessarily indicate a completed infarction.

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