Thrombolysis and coronary occlusion: effects upon the non-infarct zone.

Abstract

Regional wall motion was examined by angiography after 3 weeks in 154 patients taking part in the Thrombolysis in Coronary Occlusion (TICO) Trial. Coronary patency rate was greater after administration of recombinant tissue plasminogen activator, (rt-PA 62/77pts 81%) than after a placebo (P 49/77pts 64% P = 0.02), particularly for the left anterior descending artery compared with the right coronary artery (LAD 27/28 96% vs RCA 28/40 70% P = 0.006). Left ventricular ejection fraction (LVEF) was preserved after rt-PA (rt-PA 59 +/- 14% vs P 53 +/- 15% P = 0.01), predominantly because of more effective non-infarct zone contraction (rt-PA 0.52 +/- 1.16 SD/cord vs P 1.01 +/- 1.07 SD/cord P = 0.008). Infarct zone scores differed little (rt-PA 2.88 +/- 0.95 SD/cord vs P 3.16 +/- 1.11 SD/cord P = 0.09). Left ventricular ejection fraction and non-infarct zone function were best preserved after rt-PA compared with the placebo, particularly in patients with single vessel disease and in patients in whom the infarct-related artery was the left anterior descending vessel.