Thrombolytic therapy in acute myocardial infarct. 1. Markers for evaluating effectiveness and thrombolytic substances
Kothe, K.
Zeitschrift für die Gesamte Innere Medizin und ihre Grenzgebiete 45(7): 177-183
1990
ISSN/ISBN: 0044-2542 PMID: 2198713 Document Number: 365632
By means of serial investigations of coronary angiographies and acute dissections in the acute myocardial infarction (AMI) in the vast majority of the patients fresh thrombi could be made evident as cause of the vascular occlusion. By lysins produced within the body parts of the thrombi can be lyzed (spontaneous lysis up to 20%). However, thrombolytically effective substances considerably increase the recanalization in the first hours after the beginning of the symptomatology. These substances with clinical significance are as follows: streptokinase (SK), urokinase, tissue plasminogen activator (TPA) and acylated streptokinase (APSAC). The broad application of the thrombolytic therapy (TT) is possible only by the intravenous, highly dosed short-term method and demands non-invasive parameters for the judgment of effectiveness [(ECG, ejection fraction globally (EFg), marker protein monitoring)]. Though the ECG allows only conditionedly quantitative statements concerning the size of the myocardial infarction, an estimation of the successful TT in sufficient early recanalization is possible by a dynamics of criterias of ECG and electrocardiographic signs are less distinctly expressed, respectively. The limitation of the size of the myocardial infarction by the successful reperfusion which finds its expression in the remaining left-ventricular function is the decisive link for the influence on the quality of the life and the prognosis of these patients. A dynamics of the ejection fraction globally in the effective thrombolytic therapy is to be expressed. For this purpose at least two single measurements (acute phase, control 1st and 2nd week) are necessary. A non-invasive monitoring of marker proteins (enzymes/isoenzymes: CK, CK-MB, LDH and myoglobin, respectively) is suitable for the recognition of the effective thrombolytic therapy.