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Biomedical subjects

D G Mathey

Publications and source records attributed to D G Mathey.

At least 73 records · Page 4Linked to original sources
PubMed1985

Usefulness of coronary artery bypass graft surgery or percutaneous transluminal angioplasty after thrombolytic therapy.

Intracoronary streptokinase (STK) was given to 52 patients and 2 million U of intravenous urokinase was given to 15 patients with acute myocardial infarction less than 3 hr from onset of symptoms. Wall motion in the infarct region improved in 20 patients receiving STK alone (-2.5 +/- 1 to 2.1 +/- 1.1 SD/chord) and in 22 patients receiving STK and undergoing coronary bypass surgery within 24 hr (-2.5 +/- 1 to -1.5 +/- 1.0 SD/chord). Wall motion was unchanged in 10 patients not successfully reperfused with STK (-2.9 +/- 0.7 to -3.1 +/- 0.7 SD/chord). Regional wall motion improved at least 1.0 SD/chord in 71% of 14 patients treated within 2 hr of onset of symptoms, but in only 29% of 34 treated after 2 hr. Mean coronary artery stenosis after thrombolysis was 77 +/- 9%. Rethrombosis was associated with a stenotic cross-sectional area of less than 0.4 mm2. Ventricular function did not improve, with a residual stenosis of 0.4 mm or less in diameter. The Western Washington randomized trial reported a 1 year mortality of 2.5% in 80 successfully reperfused patients, but a mortality of 23% in 13 in whom reperfusion was partial and of 14.6% in 41 in whom reperfusion failed. The improved survival with successful reperfusion and improved ventricular performance with early and more complete reperfusion has stimulated interest in the need for angioplasty and coronary artery bypass grafting after thrombolytic therapy.

Angioplasty, Balloon↗
PubMed1985

[Ineffective use of lidocaine in preventing reperfusion arrhythmias in patients with acute myocardial infarct].

To study the efficacy of prophylactic lidocaine treatment on the genesis of ventricular tachyarrhythmias following recanalization of an occluded coronary artery, 49 patients with an acute myocardial infarction were studied. All patients underwent intracoronary thrombolysis. Patients were admitted within 3 hours of the onset of symptoms and were randomized into two groups: 23 patients received an intravenous infusion of lidocaine (2 mg/min), following an initial bolus of 200 mg, and the remaining 26 patients received no lidocaine. Reperfusion arrhythmias were documented in 16 of 20 successfully recanalized patients who received lidocaine and in 15 of 21 successfully recanalized patients without lidocaine treatment. There were no statistically significant differences between the two patient groups in the frequency of occurrence of ventricular tachycardias or ventricular fibrillation. Independent of lidocaine treatment, two types of ventricular tachycardia could be distinguished: the most frequent type 1 met the electrocardiographic criteria of tachycardia caused by enhanced automaticity, whereas the characteristics of the less frequent type 2 tachycardia suggested reentry or triggered activity as the underlying mechanism. Only type 2 ventricular tachycardias were accompanied by haemodynamic deterioration. Our results show that lidocaine, in the dosage given here, does not influence incidence or mechanisms of reperfusion tachyarrhythmias.

Angioplasty, Balloon↗
PubMed1984

Assessment of myocardial necrosis immediately after intracoronary thrombolysis by intracoronary injection of technetium-99m pyrophosphate.

To assess myocardial necrosis immediately after intracoronary thrombolysis, thallium-201 (TL-201) and technetium-99m pyrophosphate (Tc-99m PYP) were injected simultaneously into the coronary artery in 25 patients with acute transmural myocardial infarction. In 17 of the 25 patients, the occluded coronary artery was reopened. Minutes after the intracoronary injection of Tc-99m PYP into the reopened coronary artery a localized accumulation was seen within the area of the Tl-201 defect in all patients. Control intravenous scintigraphy, which was performed in 8 of these 17 patients 1-6 days later, and in 2 patients 18 and 42 days after infarction, revealed a Tc-99m PYP spot similar to that of the acute intracoronary Tc-99m PYP scintigram in all 10 patients. In the 8 of the 25 patients, in whom intracoronary thrombolysis failed, no localized Tc-99m PYP accumulation was seen after injection into the infarct vessel. In 5 of these patients, a control intravenous scintigram, performed 1-8 days later, resulted in a Tc-99m PYP spot in the area of the Tl-201 defect. We conclude that, in the presence of therapeutic or spontaneous reperfusion, Tc-99m PYP scintigraphy may provide a useful method of assessing myocardial necrosis during the early stage of an acute myocardial infarction.

Adult↗
PubMed1984

[Long-term drug treatment of chronic heart failure].

After reversible causes have been excluded and precipitating factors eliminated therapy of chronic heart failure is performed to achieve the following goals: A reduction of cardiac work by physical restriction; the increased risk of thromboembolic complications should be met by special physical exercises, elastic stockings and a low-dose heparin therapy in hospitalized patients. To improve the contractility of the heart muscle by digitalis. The efficacy of digitalis has been demonstrated by a double-blind study. It cannot be excluded, however, that digitalis therapy may be associated with an increased mortality in patients with coronary artery disease and complex ventricular arrhythmias. To eliminate symptoms of congestion. To reduce pre- and afterload by vasodilators. The application of vasodilators has become an established therapy in patients who do not respond to conventional therapy with digitalis and diuretics. By activation of the adrenergic nervous system and the renin-angiotensin system-an initially useful compensatory mechanism to sustain blood pressure and stroke volume-peripheral vascular resistance and end-diastolic volume increase in patients with chronic heart failure. Both factors contribute to an increase in afterload, thereby further diminishing left ventricular function. In this situation vasodilators are particularly effective. According to their main mode of action they alter venous capacity and/or systemic vascular resistance to a different degree. Knowledge of their effects is necessary for a successful application in individual patients.

Adrenergic beta-Antagonists↗
PubMed1983

Effect of interventions in salvaging left ventricular function in acute myocardial infarction: a study of intracoronary streptokinase.

The ability of intracoronary streptokinase (STK) infused early in acute myocardial infarction (MI) to salvage left ventricular (LV) function was studied in 52 patients who underwent contrast angiography immediately after STK and 6 +/- 7 weeks later. Ten nonrevascularized patients had no lysis or reocclusion. Of 42 patients with thrombolysis, 22 with optimal reperfusion underwent coronary artery bypass grafting (CABG) to prevent rethrombosis (STK + CABG group) and 20 did not (STK group). Motion was measured at 100 chords around the left ventricle and expressed in standard deviations (SD) from the normal mean. Hypokinesia was computed as the mean motion of chords in the infarct artery territory and hyperkinesia on the opposite wall was similarly computed. Hypokinesia improved greater than or equal to 1 SD/chord in 9 STK + CABG patients (41%), 8 STK patients (30%) (p = not significant versus STK + CABG) and 0 nonrevascularized patients. However, the ejection fraction did not change because it was normal in acute MI despite severe hypokinesia due to hyperkinesia on the opposite wall, and a subsequent decrease in hyperkinesia masked significant improvement in hypokinesia. It is concluded that regional wall motion must be measured to adequately assess the effect of therapeutic interventions on LV function. Early thrombolysis in acute MI results in improved LV function. The main benefit of CABG is to prevent rethrombosis.

Adult↗
PubMed1983

Indication for early aorto-coronary bypass surgery after successful intracoronary lysis.

Intracoronary lysis (ICL) was carried out in 108 patients with acute coronary artery thrombosis. In 79 subjects, recanalization of the occluded vessel was achieved, while 29 patients were unresponsive to the method. Thirty patients required early aorto-coronary bypass (ACB) surgery after successful ICL, while 49 patients with successful lysis were treated medically as well as the 29 patients with unsuccessful lysis. Mortality was 20% among the patients unresponsive to ICL, 12% among the 49 patients with successful lysis treated on a medical regimen thereafter, and 3.3% among the 30 patients undergoing early surgery after successful lysis. Early aorto-coronary surgery, however, was felt to be indicated only when the myocardium supplied by the occluded vessel was still viable. Beside LV angiography and ECG studies, intracoronary Thallium-scintigraphy was most helpful in assessing the viability of the heart muscle.

Coronary Artery Bypass↗
PubMed1982

Acute coronary artery occlusion during percutaneous transluminal coronary angioplasty: reopening by intracoronary streptokinase before emergency coronary artery surgery to prevent myocardial infarction.

Percutaneous transluminal coronary angioplasty (PTCA) was complicated by acute coronary artery occlusion associated with ST elevation and severe chest pain in three patients. Within 10 minutes, the occluded artery was reopened by an intracoronary (i.c.) infusion of streptokinase, resulting in the disappearance of chest pain and normalization of ST segments. To keep the artery patent, i.c. streptokinase had to be continued until emergency bypass surgery was performed. In two patients, no myocardial infarction occurred, as shown by a normal postoperative left ventricular angiogram. ECG and thallium-201 scintigram. In the other patient, who was admitted with an inferior infarction and underwent PTCA after i.c. lysis, no infarct extension was observed. These results show that i.c. streptokinase rapidly opens an acute coronary artery occlusion complicating PTCA, preventing myocardial infarction.

Adult↗
PubMed1982

[Recanalization by intracoronary infusion of streptokinase in acute myocardial infarction. Hospital course in 204 patients (author's transl)].

A multicenter study evaluated the early management and subsequent hospital course of 204 patients with acute myocardial infarction who were receiving intracoronary infusions of streptokinase (STK). The in-hospital mortality in 37 patients with thrombotic occlusion of the infarct-related vessel, in whom recanalization could not be achieved, was 24%. However, the cardiac mortality in 129 patients who were successfully treated by percutaneous transluminal coronary recanalization (PTCR) was only 5.4%. Cardiac deaths (5 patients) and nonfatal reinfarctions (20 patients) occurred in the early period in the cardiac care unit (CCU) in 21% of the latter group and, despite anticoagulation measures, could not be consistently prevented. Hemorrhagic complications, necessitating blood transfusion, occurred in 15 (7.4%) of the total 204 patients in the group, usually in the acute CCU stage, and were positively related to decline of fibrinogen serum concentrations below 100 mg/dl and to use of the Judkins technique. The later course of most of the patients on the general ward was uneventful until hospital discharge. Thus there were only 2 more cardiac deaths, and of 64 successfully treated STK-PTCR patients who left the CCU without clinical indications of reinfarction and agreed to repeat coronary angiography before hospital discharge, the infarct-related vessel was patent in 59 patients and reoccluded in only 5 (7.8%).

Aged↗
PubMed1981

Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: postprocedure management and hospital course in 204 patients.

A multicenter study evaluated the early management and subsequent hospital course of 204 patients with acute myocardial infarction who were receiving intracoronary infusions of streptokinase (STK). The in-hospital mortality in 37 patients with thrombotic occlusion of the infarct-related vessel, in whom recanalization could not be achieved, was 24%. However the cardiac mortality in 129 patients who were successfully treated by percutaneous transluminal coronary recanalization (PTCR) was only 5.4%. Cardiac deaths (five patients) and nonfatal reinfarctions (20 patients) occurred in the early period in the cardiac care unit (CCU) in 21% of the latter group and, despite anticoagulation measures, could not be consistently prevented. Hemorrhagic complications, necessitating blood transfusion, occurred in 15 (7.4%) of the total 204 patients in the group, usually in the acute CCU stage, and were positively related to decline of fibrinogen serum concentrations below 100 mg/dl and to use of the Judkins technique. The later course of most of the patients on the general ward was uneventful until hospital discharge. Thus there were only two more cardiac deaths, and of 64 successfully treated STK-PTCR patients who left the CCU without clinical indications of reinfarction and agreed to repeat coronary angiography before hospital discharge, the infarct-related vessel was patient in 59 patients and reoccluded in only five (7.8%).

Angiography↗
PubMed1981

Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function.

In 48 patients with acute myocardial infarction (AMI) the acutely thrombus-occluded coronary artery was successfully recanalized nonsurgically via catheter with intracoronary streptokinase (SK) infusion after a mean occlusion time of 3.1 +/- 1.6 hours. In all cases residual high-grade fixed atherosclerotic stenosis remained after percutaneous transluminal coronary recanalization (PTCR). Subsequent aortocoronary bypass surgery (ACBS) circumventing the stenotic coronary artery was performed during the acute stage of myocardial infarction (within 10 days of AMI onset) in 34 patients and electively (longer than 10 days after AMI onset) in 14 patients. No patient died from early PTCR or from ACBS intervention. There were two late post-ACBS arrhythmogenic deaths, two patients suffered nonfatal reinfarction post ACBS several months after hospital discharge, only two had occasional post-ACBS angina pectoris, and one patient had post-ACBS mild heart failure. The remaining 41 post-ACBS patients were completely asymptomatic throughout long-term follow-up evaluation. In the left ventricular (LV) segment supplied by the initially occluded coronary artery, which was recanalized early by means of SK therapy and subsequently grafted, wall motion improved significantly from the acute to the postoperative stage in patients who underwent early surgery (from 13.6% +/- 1.9% to 40.3% +/- 2.7%, p less than 0.001) and in the electively operated group (from 18.0% +/- 7.1% to 48.2% +/- 6.3%, p less than 0.001). Ischemic wall motion was improved irrespective of whether or not the bypass graft circumventing the residual stenosis of the infarct vessel remained patent. Wall motion of nonischemic segments remained essentially unchanged. In the patients who underwent surgery in the early stage, the closure rate of the bypass graft to the infarct-related vessel was 17%, and in the electively operated group no graft was found to be occluded. In conclusion, coronary artery recanalization, achieved by means of early SK-PTCR therapy with subsequent ACBS, can be performed safely in patients with AMI, and the result will be marked improvement in LV segmental wall motion and global function, diminished reinfarction rate, and reduced incidence of angina pectoris, all benefits that are consistently maintained during long-term evaluation.

Angioplasty, Balloon↗