Reperfusion and Revascularization in Acute Myocardial Infarction

283 Pages·1988·9.068 MB·English

by  R. B. Jennings, K. A. Reimer, C. Steenbergen Jr. (auth.), Professor Dr. Dres. h. c. mult. Gotthard Schettler, Dr Robert B. Jennings, Dr. Elliot Rapaport, Dr. Nanette K. Wenger, Dr. Ralph Bernhardt (eds.)

Veroffentlichungen aus der
Geomedizinischen Forschungsstelle
(Leiter: Professor Dr. Dres. h. c. G. Schettler)
der Heidelberger Akademie der Wissenschaften
Supplement zu den Sitzungsberichten der
Mathematisch-naturwissenschaftlichen Klasse
Jahrgang 1988
International Society and Federation of Cardiology
Societe et Federation Internationale de Cardiologie
Sociedad y Federaci6n Internacional de Cardiologra
Proceedings of the Joint Meeting of the Heidelberger Akademie der Wis
senschaften and the International Society and Federation of Cardiology,
Scientific Board "Possibilities to Improve and Reconstruct Occluded Cor
onary Vessels", Heidelberg, 15-17 September 1987
G. Schettler R. B. Jennings E. Rapaport
N. K. Wenger R. Bernhardt (Eds.)
Rep erfu sion
and Revascularization
in Acute
Myocardial Infarction
With 66 Figures and 43 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Prof. Dr. Dr. h.c. multo Gotthard Schettler
Priisident der Heidelberger Akademie der Wissenschaften
Karlstrasse 4, 6900 Heidelberg, FRG
Dr Robert B. Jennings
Duke University Medical Center, Department of Pathology
P.O. Box 3712, Durham, NC 27710, USA
Dr. Elliot Rapaport
San Francisco General Hospital, R.5GI
1001 Potrero Street, San Francisco, CA 94110, USA
Dr. Nanette K. Wenger
Department of Medicine (Cardiology)
Emory University School of Medicine
69 Butler Street S.B., Atlanta, GA 30303, USA
Dr. Ralph Bernhardt
Heidelberger Akademie der Wissenschaften
Geomedizinische Forschungsstelle
Karlstrasse 4, 6900 Heidelberg, FRG
ISBN-13:978-3-642-83546-9 e-ISBN-13:978-3-642-83544-5
DOl: 10.1007/978-3-642-83544-5
Ubrary of Congress Cataloging-in-Publication Data
Reperfusion and revascularizatiou in acute myocardial infarction I [edited by] G_ Schettler, R.B.
Jeouings, E. Rapaport, N.K. Wenger, R. Bernhardt
p. cm. -(VerOffentlichungen aus der Geomedizinischen Forscbungsstelle derHeidelberger
Akademie der WlSsenscbaften) (Supplement zu den Sitzungsberichten der Mathematiscb-natur
wissenschaftlichen Klasse; Jabrg. 1988)
"Proceedings of the joint meeting of the Heidelberger Akademie der Wissenscbaften and
the International Society and Federatiou of Cardiology, Scientific Board ... Heidelberg,
15-17 September 1987" -T. p. verso.
ISBN-13:978-3-642-83546-9 (U.S.)
1. Heart - Infarction -Surgery -Congresses. 2. Myocardial revascularization -Congresses.
3. Heart - Infarction -Chemotherapy -Congresses. I. Schettler, Gottbard. II. Jeouings,
Robert B., 1926- . m. Rapaport, Elliot, 1924- . IV. Wenger, Nanette K. V. Bernhardt,
Ralph. VI. Heidelberger Akademie der Wissenschaften. VII. International Society and Federa
tion of Cardiology. Scientific Board. VIII. Series. IX. Series: Supplement zu den Sitzungs
berichten der Mathematisch-naturwissenschaftlichen KJasse; Jahrg. 1988.
[DNLM: 1. Coronary Circulation -cougresses. 2. Myocardial Infarctiou -surgery -con
gresses. 3. Myocardial Revascu\arization -cougresses. WG 300 R425 1987]
RD598.R461988 617'.412-dc 19 DNLMlDLC 88-24950
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Contents
Opening Address
G. Schettler ................................... XVII
Session I. Pathophysiology of Salvage of Ischemic
Myocardium by Reperfusion
Chairman: R. B. Jennings ....................... 1
Acute Regional Ischemia
R.B. Jennings, K.A. Reimer, andC. Steenbergen, Jr. 3
The Role of Free Radical Scavengers in Reperfusion
R. Ferrari, C. Ceconi, S. Curello, G. Ciampalini,
P. Berra, and O. Visioli. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Calcium and the Stunned Myocardium
J. K. Porterfield, H. Kusuoka, and E. Marban . . . . . . 23
The No-Reflow Phenomenon
C. E. Ganote and R. S. Vander Heide. . . . . . . . . . . . . . 41
Microcirculation in Myocardial Ischemia and
Reperfusion
H. Til/manns, H. Leinberger, F. -J. Neumann,
M. Steinhausen, N. Parekh, R. Zimmermann,
R. Dussel, and W. Kabler. . . . . . . . . . . . . . . . . . . . . . . . 46
Reperfusion Injury
K. A. Reimer and R. B. Jennings. . . . . . . . . . . . . . . . . . 52
Discussion: Session I - Pathophysiology of Salvage
of Ischemic Myocardium by Reperfusion . . . . . . . . . . . 56
Summary of Session I
R. B. Jenninas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
VI Contents
Session II. Thrombolysis in Acute Myocardial
Infarction
Chairman: M. Verstraete........................ 65
Thrombolysis in Acute Myocardial Infarction
M. Verstraete.................................. 67
Streptokinase in Acute Myocardial Infarction -
Benefits and Risks
H. Schmutzler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Results from ISAM and GISSI
R. Schr(jder ................................... 76
Prehospital Thrombolysis in Acute Myocardial
Infarction: The Jerusalem Experience
M. S. Gotsman, A. T. Weiss, D. Sapoznikov,
D. Applebaum, S. Rosenheck, C. Lotan, and
S. Welber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Extracorporal Plasma Therapy in the Treatment of
Severe Hyper-~-lipoproteinemia: The HELP System
D. Seidel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Very Early Urokinase Treatment in Acute Myocardial
Infarction
J. Scholer, D. G. Mathey, and W. Blei/eld ......... 100
Prourokinase in Acute Myocardial Infarction: Is It
Effective?
C. Bode, S. SchtJnermark, G. Schuler,
R. Zimmermann, H.-G. Simanek, F. Schwarz, and
W. Kabler. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Recombinant Tissue-Type Plasminogen Activator in
the Treatment of Myocardial Infarction
K. L. Neuhaus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Thrombolytic Agents in Early Myocardial Infarction
An Overview in 1987
P. G. Hugenholtz, M. L. Simoons, H. Suryapranata,
and F. Vermeer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Is There a Role for Thrombolysis in Non-Q-Wave
Myocardial Infarction and Unstable Angina Pectoris?
B. L. Zaret and H. J. Bigham, Jr. . . . . . . . . . . . . . . . . . 128
Anticoagulants After Thrombolysis
F. Markwardt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Contents VII
Drug Therapy in Coronary Heart Disease, Especially
in the Management of Chronic Myocardial Ischemia
P. Lichtlen .. . . ..... . ........ ....... . ....... . .. 144
Discussion: Session II - Thrombolysis in Acute
MyocardialInfarction. . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Session III. Percutaneous Transluminal Coronary
Angioplasty
Chairman: E. Rapaport . . . . . . . . . . . . . . . . . . . . . . . . . 153
Recommendations of the Joint International Society
and Federation of Cardiology/World Health
Organization Task Force on PTCA
E. Rapaport. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
The Changing Role of PTCA in Patients with Acute
Myocardial Infarction
B. Pitt, E. Topol, and W. O'Neill. . . . . . . . . . . . . . . . . 160
Thrombolytic Therapy and PTCA
R. Erbel, T. Pop, and J. Meyer................... 165
Percutaneous Transluminal Coronary Angioplasty in
Unstable Angina
F. Schwarz... ...................... ........... 174
Drug Treatment after PTCA
R. A. O'Rourke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Discussion: Session III - Percutaneous
Transluminal Coronary Angioplasty .............. 188
Summary of Session III
E. Rapaport...... ............................. 197
Session IV. Coronary Bypass Surgery
Chairman: E. Varnauskas ....................... 201
Coronary Artery Bypass Surgery - State of the Art
E. Varnauskas ......... ........................ 203
Coronary Bypass Surgery After Thrombolysis and
Balloon Dilatation
B. J. Messmer, R. Uebis, C. Minale, P. Bardos, and
S. Effert ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206
Discussion: Session IV - Coronary Bypass Surgery 215
VIII Contents
Session V. Rehabilitative Care After Myocardial
Revascularization
Chairman: N. K. Wenger . . . . . . . . . . . . . . . . . . . . . . .. 221
Long-Term Care and Surveillance of the Patient
Following Coronary Angioplasty or Coronary Bypass
Surgery
N. K. Wenger.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
The Role of Exercise Testing in Assessment of
Myocardial Revascularisation
J. P. Broustet, B. Mora, and H. Douard . . . . . . . . . . . 231
Physical Exercise in Comprehensive Care
J. J. Kellermann ............................... 236
Cost-Effectiveness of Noninvasive Surveillance
B. Boskis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Rehabilitative Care After Myocardial
Revascularization
H. Sanne. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 244
Return to Work After Coronary Artery Bypass
Surgery
P. J. Walter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Rehabilitation Systems in Different Areas of the
World
K. Konig . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Discussion: Session V - Rehabilitative Care After
Myocardial Revascularization . . . . . . . . . . . . . . . . . . .. 268
List of Authors
Applebaum, D.,
Department Medicine B, Hadassah University Hospital
P.O. Box 12000, 91120 Jerusalem, Israel
Bardos, P.,
Kardiologische Abteilung, U niversitatsklinikum
5100 Aachen, FRO
Berra, P.,
Cattedra di Cardiologia, Universita degli Study di Brescia
c/o Spedali Civili, P. Ie Spedali Civili 1, Brescia 25100
Italy
Bigham, H. J.
Section of Cardiology, Yale University School of Medicine
333 Cedar Street, 87 L.M.P., New Haven, CT 06519, USA
Bleifeld, W.
Abteilung Kardiologie, Medizinische Klinik
Universitats-Krankenhaus Eppendorf
Martinistr. 52, 2000 Hamburg 20, FRO
Boden, Ch.
Medizinische Klinik III
Bergheimerstr. 58, 6900 Heidelberg, FRO
Boskis, B.
Argentine Heart Foundation
Azcuenaga 980/86, Buenos Aires 1115, Argentina
Broustet, J. P.
Hopital Cardiologique du Haut Leveque
Avenue de Magellan, 33604 Pessac, France
Ceconi, C.
Cattedra di Cardiologia, Universita degli Study di Brescia
c/o Spedali Civili, P. Ie Spedali Civili 1, Brescia 25100
Italy
X List of Authors
Ciampalini, G.
Cattedra di Cardiologia, Universita degli Study di Brescia
c/o Spedali Civili, P. Ie Spedali Civili 1, Brescia 25100
Italy
Curello, S.
Cattedra di Cardiologia, Universita degli Study di Brescia
c/o Spedali Civili, P. Ie Spedali Civili 1, Brescia 25100
Italy
Douard, H.
Hopital Cardiologique du Haut Leveque
Avenue de Magellan, 33604 Pessac, France
Dussel, R.
Innere Medizin III, Kardiologie,
Bergheimerstr. 58, 6900 Heidelberg, FRG
Effert, S.
Kardiologische Abteilung, Universitatsklinikum
5100 Aachen, FRG
Erbel~ E.
Klinikum der Johannes Gutenberg-Universitat
II. Medizinische Klinik und Poliklinik
Langenbeckstr. 1,6500 Mainz, FRG
Ferrari, R.
Cattedra di Cardiologia, Universita degli Study di Brescia
c/o Spedali Civili, P. Ie Spedali Civili 1, Brescia 25100
Italy
Ganote, C. E.
Department of Pathology, Ward Memorial Building
303 East Chicago Avenue, Chicago, Illinois 60611, USA
Gotsman, M. S.
Department Medicine B, Hadassah University Hospital
P.O. Box 12000, 91120 Jerusalem, Israel
Hugenholtz, P. G.
Thoraxcenter BD 408, Erasmus University
P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
Jennings R. B.
Duke University Medical Center
Department of Pathology
P.O. Box 3712, Durham, North Carolina 27710, USA