Reperfusion with streptokinase of an occluded right coronary artery: Effects on early and late right and left ventricular ejection fraction

The effect of coronary artery recanalization on early and late right and left ventricular function was studied in patients with an acute inferior wall myocardial infarction caused by an occlusion of the right coronary artery. Fifty-four out of 138 patients, with chest pain lasting less than 4 hours, with ST elevations diagnostic for acute myocardial infarction not responding to medical treatment, and without contraindication for thrombolytic therapy, had an occluded right coronary artery. In 26 of these 54 patients, the occlusion was located proximal to the first right ventricular branch. Fourteen of them were treated conventionally (group A) and 12 with intracoronary streptokinase (group B). In 28 patients, the occlusion was distal to the first right ventricular branch. Fifteen were treated conventionally (group C) and 13 with intracoronary streptokinase (group D). In all patients, coronary angiograms were made 2 to 3 weeks after acute myocardial infarction. A nuclear angiogram was made the second day after admission and 3 months later to determine right and left ventricular ejection fraction. Values of radionuclide left and right ventricular ejection fraction (RVEF) between acute study (< 48 hours after acute myocardial infarction [AMI] and late study (3 months after AMI) showed no significant improvement in the four groups of patients studied. Group A patients (patients with total occlusion of the right coronary artery treated conventionally) had a significantly lower RVEF acutely and at late study as compared to the other three groups. We conclude that patients with a proximally occluded right coronary artery treated with intracoronary streptokinase had a significantly better RVEF acutely and at 3 months follow-up compared to a conventionally treated group. There was no difference in the left ventricular ejection fraction between the groups.