Heart 1999;81:128-133 ( February )

Angiographic frame counts 90 minutes after streptokinase predict left ventricular function at 48 hours following myocardial infarction

J K French,^a I T Straznicky,^a B J Webber,^a P E Aylward,^b M J Frey,^c A A J Adgey,^d B F Williams,^a S C McLaughlin,^a H D White^a, for the HERO-1 Investigators

^a Department of Cardiology, Green Lane Hospital, Private Bag 92189, Auckland 1030, New Zealand, ^b Flinders Cardiovascular Centre, Adelaide, South Australia, ^c Heart Center of Sarasota, Florida, USA, ^d Royal Victoria Hospital, Belfast, Northern Ireland, UK

Correspondence to: Dr French. email: johnf{at}ahsl.co.nz

Accepted for publication 31 July 1998

ObjectiveTo assess whether the 90 minute corrected thrombolysis in myocardial infarction frame count (CTFC) in the infarct related artery predicts left ventricular function at 48 hours in patients with myocardial infarction treated with aspirin, streptokinase, and either heparin or Hirulog.
Design and settingAnalysis of 251 patients with acute myocardial infarction enrolled in the international, multicentre Hirulog early reperfusion/occlusion (HERO-1) trial, who underwent both 90 minute coronary angiography and 48 hour left ventriculography.
Main outcome variablesThe CTFC was determined in the infarct related artery 90 minutes after starting intravenous streptokinase (1.5 × 10⁶ U over 30 to 60 minutes), and compared with indices of left ventricular function assessed by contrast ventriculography at 48 hours.
ResultsA CTFC of  27 frames (previously reported mean + 2 SD in coronary arteries of patients without acute infarction) occurred in 29% of infarct related arteries, and was associated with a lower infarct zone mean chord score (2.06 v 2.54, p = 0.01), a lower fraction of chords > 2 SD below normal (37% v 51%, p = 0.005), and trends towards higher left ventricular ejection fractions (60.9% v 58.2%, p = 0.11) and lower end systolic volumes (50.1 ml v 55.9 ml, p = 0.23). A CTFC of  40 at 90 minutes occurred in 50% of infarct related arteries, and was associated with a significantly lower mean chord score (2.20 v 2.60, p = 0.02), a smaller fraction of chords > 2 SD below normal (41% v 52%, p = 0.025), a smaller end systolic volume (49.1 ml v 59.3 ml, p = 0.02), and a higher left ventricular ejection fraction (60.4% v 56.5%, p = 0.03).
ConclusionsThe 90 minute CTFC predicts left ventricular function at 48 hours following streptokinase. The CTFC associated with better ventricular function may be higher than values determined from a non-infarct population.

Keywords: streptokinase; Hirulog; perfusion; ventricular function; frame count

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© 1999 by Heart
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