Influence of baseline ejection fraction and success of thrombolysis on mortality and ventricular function after acute myocardial infarction.

The efficacy of streptokinase (STK) thrombolytic therapy was prospectively evaluated in 77 consecutive patients presenting within 9 hours of onset of acute myocardial infarction. Serial left ventricular (LV) ejection fraction (EF) was assessed by radionuclide ventriculography, initially (acute) and at 1 month (late). The role of initial LVEF was examined by comparing patients with an acute LVEF greater than or equal to 50% (type I) with those with LVEF less than 50% (type II). Sixty-five patients (84%) had total coronary occlusion and received STK. Initial successful reperfusion was achieved in 34 patients (52%), but repeat angiograms at 10 to 14 days revealed persistent patency in only 27 patients. Within the type I and type II classification, 2 patient subgroups were compared: Group A had successful and persistent thrombolysis and group B had initial failure of thrombolysis or in-hospital reocclusion. There was no significant change in global LVEF in any group from acute to 1 month follow-up: group IA--acute EF = 56 +/- 2% (mean +/- standard error of the mean), late EF = 55 +/- 2% (p = not significant [NS]); group IB--acute EF = 58 +/- 1%, late EF = 55 +/- 2% (NS); group IIA--acute EF = 35 +/- 2%, late EF = 4 +/- 4%, (NS); group II B--acute EF = 36 +/- 2%, late EF = 41 +/- 3% (NS). No patient with an acute EF greater than or equal to 50% died, i.e., group IA patients (n = 7) or group IB patients (n = 13).(ABSTRACT TRUNCATED AT 250 WORDS)