Infarct size, myocardial hemorrhage, and recovery of function after mechanical versus pharmacological reperfusion: Effects of lytic state and occlusion time

Sorin V. Pislaru, Laurentino Barrios, Tony Stassen, Lin Jun, Cristina D Pislaru, Frans Van De Werf

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Whether myocardial reperfusion obtained with thrombolysis or primary angioplasty is associated with a similar recovery of function and with the same risk of hemorrhagic infarction is unknown. We evaluated the effects of mechanical and pharmacological reperfusion (with or without a plasma lytic state) on infarct size, myocardial hemorrhage, and left ventricular (LV) function in a canine model. Methods and Results: Six groups of six dogs were subjected to balloon occlusion of the left anterior descending coronary artery (LAD) followed by 2 hours of reperfusion. The study had a two-by-three factorial design with two occlusion periods (90 and 240 minutes) and three different reperfusion strategies (placebo, 0.4 mg/kg recombinant tissue plasminogen activator, and 40 μg/kg recombinant staphylokinase). In a seventh control group, LAD occlusion was maintained without reperfusion. All dogs received aspirin and heparin. A systemic lytic state was present in staphylokinase-treated dogs. Planimetry of LV slices showed larger infarcts (percent of area at risk) and more hemorrhage (percent of IA) after 240 minutes of occlusion than after 90 minutes of occlusion (54 ± 17% versus 37 ± 18% and 52 ± 27% versus 29 ± 27%, respectively; P<.01 for both comparisons), with no significant difference among treatments. Hemorrhage was not observed in the control group without reperfusion. LV angiography showed no differences in global and regional LV function between mechanical and pharmacological reperfusion. Conclusions: In this experimental model, hemorrhagic infarctions of similar extent were observed after both pharmacological and mechanical reperfusion. The extent of hemorrhage was increased by the delay in reperfusion but not by the presence of a lytic state.

Original languageEnglish (US)
Pages (from-to)659-666
Number of pages8
JournalCirculation
Volume96
Issue number2
StatePublished - Jul 15 1997
Externally publishedYes

Fingerprint

Recovery of Function
Reperfusion
Myocardial Infarction
Pharmacology
Hemorrhage
Dogs
Left Ventricular Function
Infarction
Balloon Occlusion
Myocardial Reperfusion
Control Groups
Tissue Plasminogen Activator
Angioplasty
Aspirin
Heparin
Canidae
Coronary Vessels
Angiography
Theoretical Models
Placebos

Keywords

  • Angioplasty
  • Myocardial infarction
  • Reperfusion
  • Thrombolysis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Infarct size, myocardial hemorrhage, and recovery of function after mechanical versus pharmacological reperfusion : Effects of lytic state and occlusion time. / Pislaru, Sorin V.; Barrios, Laurentino; Stassen, Tony; Jun, Lin; Pislaru, Cristina D; Van De Werf, Frans.

In: Circulation, Vol. 96, No. 2, 15.07.1997, p. 659-666.

Research output: Contribution to journalArticle

Pislaru, Sorin V. ; Barrios, Laurentino ; Stassen, Tony ; Jun, Lin ; Pislaru, Cristina D ; Van De Werf, Frans. / Infarct size, myocardial hemorrhage, and recovery of function after mechanical versus pharmacological reperfusion : Effects of lytic state and occlusion time. In: Circulation. 1997 ; Vol. 96, No. 2. pp. 659-666.
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T2 - Effects of lytic state and occlusion time

AU - Pislaru, Sorin V.

AU - Barrios, Laurentino

AU - Stassen, Tony

AU - Jun, Lin

AU - Pislaru, Cristina D

AU - Van De Werf, Frans

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N2 - Background: Whether myocardial reperfusion obtained with thrombolysis or primary angioplasty is associated with a similar recovery of function and with the same risk of hemorrhagic infarction is unknown. We evaluated the effects of mechanical and pharmacological reperfusion (with or without a plasma lytic state) on infarct size, myocardial hemorrhage, and left ventricular (LV) function in a canine model. Methods and Results: Six groups of six dogs were subjected to balloon occlusion of the left anterior descending coronary artery (LAD) followed by 2 hours of reperfusion. The study had a two-by-three factorial design with two occlusion periods (90 and 240 minutes) and three different reperfusion strategies (placebo, 0.4 mg/kg recombinant tissue plasminogen activator, and 40 μg/kg recombinant staphylokinase). In a seventh control group, LAD occlusion was maintained without reperfusion. All dogs received aspirin and heparin. A systemic lytic state was present in staphylokinase-treated dogs. Planimetry of LV slices showed larger infarcts (percent of area at risk) and more hemorrhage (percent of IA) after 240 minutes of occlusion than after 90 minutes of occlusion (54 ± 17% versus 37 ± 18% and 52 ± 27% versus 29 ± 27%, respectively; P<.01 for both comparisons), with no significant difference among treatments. Hemorrhage was not observed in the control group without reperfusion. LV angiography showed no differences in global and regional LV function between mechanical and pharmacological reperfusion. Conclusions: In this experimental model, hemorrhagic infarctions of similar extent were observed after both pharmacological and mechanical reperfusion. The extent of hemorrhage was increased by the delay in reperfusion but not by the presence of a lytic state.

AB - Background: Whether myocardial reperfusion obtained with thrombolysis or primary angioplasty is associated with a similar recovery of function and with the same risk of hemorrhagic infarction is unknown. We evaluated the effects of mechanical and pharmacological reperfusion (with or without a plasma lytic state) on infarct size, myocardial hemorrhage, and left ventricular (LV) function in a canine model. Methods and Results: Six groups of six dogs were subjected to balloon occlusion of the left anterior descending coronary artery (LAD) followed by 2 hours of reperfusion. The study had a two-by-three factorial design with two occlusion periods (90 and 240 minutes) and three different reperfusion strategies (placebo, 0.4 mg/kg recombinant tissue plasminogen activator, and 40 μg/kg recombinant staphylokinase). In a seventh control group, LAD occlusion was maintained without reperfusion. All dogs received aspirin and heparin. A systemic lytic state was present in staphylokinase-treated dogs. Planimetry of LV slices showed larger infarcts (percent of area at risk) and more hemorrhage (percent of IA) after 240 minutes of occlusion than after 90 minutes of occlusion (54 ± 17% versus 37 ± 18% and 52 ± 27% versus 29 ± 27%, respectively; P<.01 for both comparisons), with no significant difference among treatments. Hemorrhage was not observed in the control group without reperfusion. LV angiography showed no differences in global and regional LV function between mechanical and pharmacological reperfusion. Conclusions: In this experimental model, hemorrhagic infarctions of similar extent were observed after both pharmacological and mechanical reperfusion. The extent of hemorrhage was increased by the delay in reperfusion but not by the presence of a lytic state.

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