Differential response of thrombolysis between left and right coronary system
- Thrombolysis is the specific treatment for acute myocardial infarction. ( Privileged few , get primary PCI))
- Failed thrombolysis occurs in significant number of patients ( 30-40%).
- Persistent ST elevation 120 minutes after thrombolysis is best indicator of failed thrombolysis.
- It has been a consistent observation failed thromolysis is more frequent in anterior or LAD myocardial infarction.
In a simple study we have documented patients with inferior MI rarely had persistent ST elevation and thrombolysis was successful in vast majority of patients ( Except in few patients associated lateral MI)
The mechanism of better thrombolysis in right coronary artery is simple.The success of thrombolysis , apart from early time window , is directly correlated with pressure head and the duration of contact between the thrombolytic agent and the thrombus. In right coronary circulation the blood flow is continuous , occurs both in systole and diastole that facilitates the maximum delivery of the thrombolytic agent . Further there is a favorable pressure gradient across RV myocardium as the transmural occluding pressure across RV is considerably less then LV myocardium.
This paper was presented in the “Annual cardiological society of India scientific sessions”
at Chennai, Tamil Nadu.India December 2000
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Dr.S.Venkatesan MD 