Interventions in the Acute Phase of Myocardial Infarction

308 Pages·1984·14.42 MB·English

by  Keith A. Reimer

INTERVENTIONS IN THE
ACUTE PHASE
OF MYOCARDIAL
INFARCTION
DEVELOPMENTS IN CARDIOVASCULAR MEDICINE
Lancee, C.T., ed.: Echocardiology, 1979. ISBN 90-247-2209-8.
Baan, J., Arntzenius, A.C., Yellin, E.L., eds.: Cardiac dynamics. 1980. ISBN 90-247-2212-8.
Thalen, H.J.T., Meere, C.C., eds.: Funadmentals of cardiac pacing. 1970. ISBN
90-247-2245-4.
Kulbertus, H.E., Wellens, H.J.J., eds.: Sudden death. 1980. ISBN 90-247-2290-X.
Dreifus, L.S., Brest, A.N., eds.: Clinical applications of cardiovascular drugs. 1980. ISBN
90-247-2295-0.
Spencer, M.P., Reid, J.M., eds.: Cerebrovascular evaluation with Doppler ultrasound. 1981.
ISBN 90-247-90-247-2348-1.
Zipes, D.P., Bailey, J.C., Elharrar, V., eds.: The slow inward current and cardiac
arrhythmias. 1980. ISBN 90-247-2380-9.
Kesteloot, H., Joossens, J.V., eds.: Epidemiology of arterial blood pressure. 1980. ISBN
90-247-2386-8.
Wackers, F.J.T., ed.: Thallium - 201 and technetium-99m-pyrophosphate myocardial
imaging in the coronary care unit. 1980. ISBN 90-247-2396-5.
Maseri, A., Marchesi, C., Chierchia, S., Trivella, M.G., eds.: Coronary care units. 1981.
ISBN 90-247-2456-2.
Morganroth, J., Moore, E.N., Dreifus, L.S., Michelson, E.L., eds.: The evaluation of new
antiarrhythmic drugs. 1981. ISBN 90-247-2474-0.
Alboni, P.: Intraventricular conduction disturbances. 1981. ISBN 90-247-2483-X.
Rijsterborgh, H., ed.: Echocardiology. 1981. ISBN 90-247-2491-0.
Wagner, G.S., ed.: Myocardial infarction. Measurement and intervention. 1982. ISBN
90-247-2513-5.
Meltzer, R.S., Roelandt, J., eds.: Contrast echocardiography. 1982. ISBN 90-247-2531-3.
Amery, A., Fagard, R., Lijnen, R., Staessen, J., eds.: Hypertensive cardiovascular disease;
pathophysiology and treatment. 1982. ISBN 90-247-2534-8.
Bouman, L.N., Jongsma, H.J., eds.: Cardiac rate and rhythm. 1982. ISBN 90-247-2626-3.
Morganroth, J., Moore, E.M., eds.: The evaluation of beta blockers and calcium antagonist
drugs. 1982. ISBN 90-247-2642-5.
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Roelandt, J., Hugenholtz, P.G., eds.: Long-term ambulatory electrocardiography. 1982.
ISBN 90-247-2664.,.8.
Adgey, A.A.J., ed.:Acute phase of ischemic-heart disease and myocardial infarction. 1982.
ISBN 90-247-2675-1.
Hanrath, P., Bleifeld, W., Souguet, eds.: Cardiovascular diagnosis by ultrasound,
ansesophageal, computerized, contrast, Doppler echocardiography. 1982.
ISBN 90-247-2692-1.
Roelandt, J., ed.: The practice of M -mode and two-dimensional echocardiography. 1982.
ISBN 90-247-2745-6.
Meyer, J., Schweizer, P., Erbel, R., eds.: Advances in non-invasive cardiology. ISBN
0-89838-576-8.
Perry, H.M., ed.: Life-long management of hypertension. ISBN 0-89838-572-2.
Jaffe, E.A., ed.: Biology of endothelial cells. ISBN 0-89838-587-3.
Surawicz, B., Reddy, C.P., Prystowsky, E.N., eds.: Tachycardiac. ISBN 0-89838-588-1.
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Sambhi, M.P., ed.: Fundamental fault in hypertension. ISBN 0-89838-638-1.
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muscle and vascular smooth muscle. ISBN 0-89838-655-1.
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ii
INTERVENTIONS IN THE
ACUTE PHASE OF
MYOCARDIAL
INFARCTION
Edited by
Joel Morganroth
E. Neil Moore
~
"
Martinus Nijhoff Publishing
A member of the Kluwer Academic Publishers Group
Boston/The Hague/DordrechtiLancaster
Distributors for North America:
Kluwer Academic Publishers
190 Old Derby Street
Hingham, MA 02043
Distributors Outside North America:
Kluwer Academic Publishers Group
Distribution Centre
P.O. Box 322
3300 AH Dordrecht
The Netherlands
Library of Congress Cataloging in Publication Data
Symposium on New Drugs and Devices (1983 : Philadelphia, Pa.)
Interventions in the acute phase of myocardial infarction.
(Developments in cardiovascular medicine)
Includes bibliographical references.
1. Heart - Infarction-Chemotherapy-Congresses. 2. Heart - Infarction-Treatment
Congresses. I. Morganroth, Joel. II. Moore, E. Neil. III. Title. IV. Series. [DNLM:
1. Myocardial Infarction-drug therapy-congresses. 2. Myocardial Infarction-therapy
congresses. WI DE997VME / WG 300 S98925i 1983]
RC685.I6S88 1983 616.1'237 84-7972
ISBN-13: 978-1-4613-3821-5 e-ISBN-13: 978-1-4613-3819-2
DOl: 10.1007/978-1-4613-3819-2
Copyright 1984 © by Martinus Nijhoff Publishing, Boston
Softcover reprint of the hardcover 1st edition 1984
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical, photocopy
ing, recording, or otherwise, without written permission of the publisher, Martinus
Nijhoff Publishing, 190 Old Derby Street, Hingham, Massachusetts 02043.
CONTENTS
Preface vii
Faculty ix
Models to Study Experimental Infarction
1
Experimental Models and Endpoints for Evaluating Interventions
in the Acute Phase of Myocardial Infarction - An Anatomic
Approach
Keith A. Reimer and Robert B. Jennings
2
Models to Study Experimental Infarction - Pharmacologic
Stewart J. Ehrreich 12
3
Pharmacokinetics of Anti-Arrhythmic Agents in Acute
Myocardial Infarction
Raymond L. Woosley, Irene Cerskus, and Dan M. Roden 20
Indices to Define Infarct Size
4
Limitations of Electrophysiologic Techniques in Defining
Myocardial Infarct Size
E. Neil Moore and Joseph F. Spear 37
5
Estimates of Injury after Infarction Evolving Spontaneously
or in Response to Coronary Thrombolysis
Burton Sobel 48
6
Measurement of Myocardial Infarct Size Using Nuclear
Cardiology Methods
James T. Willerson, Samuel E. Lewis, James R. Corbett,
Christopher L. Wolfe, Robert W. Parkey, and
L. Maximilian Buja 61
v
7
Echocardiographic Approaches to the Evaluation of Acute
Myocardial Infarction
Andrew J. Kemper and Alfred F. Parisi 76
8
Two Dimensional Echocardiography in Acute Myocardial
Infarction: Clinical Applications
Ioannis P. Panidis and Joel Morganroth 88
9
Panel on Indices to Define Infarct Size
Moderator: Joel Morganroth 104
Pharmaceutical Interventions to Reduce Infarct Size
10
The Case for Prophylactic Lidocaine in Acute
Myocardial Infarction
Donald C. Harrison 113
11
Infarct Size Reduction by Antiarrhythmic Prophylaxis - A
Contrary View
R.W.F. Campbell and P. Kertes 119
12
Pharmaceutical Interventions to Reduce Infarct Size -
Streptokinase
Peter Rentrop 129
13
Streptokinase in Acute Myocardial Infarction
Sidney Goldstein and Fareed Khaja 138
14
Vasodilators in Acute Myocardial Infarction
Jay N. Cohn 144
vi
15
Panel on Pharmaceutical Interventions to Reduce Infarct Size
Moderator: Jay N. Cohn 152
16
Early Intravenous Atenolol in Suspected Acute Myocardial
Infarction: Final Report of a Randomized Clinical Trial
S. Yusuf, D. Ramsdale, P. Sleight, P. Rossi, R. Peto,
M. Pearson, H. Sterry, L. Furse, R. Motwani, S. Parish,
R. Gray, D. Bennett, and C. Bray 168
17
Calcium Channel Blockers and Limitation of Myocardial
Infarction Size
Zoltan G. Turi 190
18
Steroid Treatment of Acute Myocardial Infarction: Some
Implications for Clinical Trials in General
P.L. Dem 198
19
Evaluation of Inotropic Therapy
Raymond Lipicky 201
20
Panel on Pharmaceutical Interventions to Reduce Infarct Size
Moderator: Joel Morganroth 205
Devices to Limit Infarct Size
21
Transluminal Coronary Angioplasty
S. Goldberg 228
22
Devices to Limit Infarct Size: Ventricular Assist Devices
Jack Kolff 256
vii
23
Internal Electrical Devices to Limit Infarct Size
Leonard N. Horowitz 270
24
Devices to Limit Infarct Size - FDA Evaluation
Glenn Rahmoeller 274
25
Panel on Devices to Limit Infarct Size
Moderator: Leonard N. Horowitz 282
Summary of Symposium on New Drugs and Devices
E. Neil Moore 291
Participant List 293
viii
PREFACE
In the 1980's a primary focus for intense cardiovascular research is in the
treatment of patients with acute myocardial infarction. Although the
prevalence of this syndrome has been decreasing in the United States, still
over 1.5 million patients develop myocardial infarction per year. There is
about a 20% chance of a North American male developing myocardial in
farction before the age of 65. The in-hospital mortality still remains at ap
proximately 10070-15070 and advances in pharmacologic and device therapy
have allowed for the intensification of research in the treatment of patients
with acute myocardial infarction.
The following manuscripts represent the collective efforts of academic in
vestigators in the United States and abroad as well as members of the phar
maceutical industry, and the Food and Drug Administration to address the
issues involved in interventions in the acute phase of myocardial infarction.
State-of-the-art papers addressing important topics are followed by discus
sion sections which have allowed participants to express their own viewpoints
leading to a consensus opinion. The first part of this Symposium addresses
the models of experimental myocardial infarction followed by the important
issue of how one defines myocardial infarction size. The latter is extremely
important to be certain that endpoints of therapeutic or device interventions
are objective and reproducible. A detailed description of the pharmacological
interventions to reduce myocardial infarction size as well as newer devices to
effect mechanical and electrical disorders provide an up-to-date summary of
current opinion.
While we do not anticipate that this Symposium could evolve unanimous
consensus opinions on many of the important issues raised, it is clear that im
portant research concerns have been identified and suggestions for their solu
tion have emerged.
We hope that this book will be helpful to those individuals who study the
acute phase of myocardial infarction and hope it has provided guidelines,
study design, and interpretation.
Joel Morganroth, M.D.
E. Neil Moore, D.V.M., Ph.D.
Philadelphia, Pennsylvania, U.S.A.
ix
SYMPOSIUM ON NEW
DRUGS AND DEVICES
October 6 and 7, 1983
FACULTY
Ronald W.F. Campbell, M.D. Raymond J. Lipicky, M.D.
Senior Lecturer and Consultant Acting Director, Division of Cardio
Cardiologist Renal Drug Products
Freeman Hospital, England Food and Drug Administration
Jay N. Cohn, M.D. Robert E. Keenan, M.D.
Professor of Medicine Vice-President, Medical Research
University of Minnesota A.H. Robins Company, Inc.
Philip Dem, M.D. Andrew Kemper, M.D.
Cardio-Renal Division Instructor in Medicine
Food and Drug Administration Howard Medical School
Stewart J. Ehrreich, Ph.D. Richard S. Kent, M.D.
Deputy Director, Division of Senior Clinical Research Scientist
Cardio-Renal Drug Products Burroughs Wellcome Co.
Food and Drug Administration
Harris Koffer, Pharm.D.
Herman Gold, M.D. Assistant Director
Associate Professor of Medicine Philadelphia Association for
Harvard Medical School Clinical Trials
Sidney Goldstein, M.D. Jacob Kolff, M.D.
Professor of Medicine Professor of Surgery
University of Michigan Temple University Hospital
Donald C. Harrison, M.D. Ezra Lamdin, M.D.
William G. Irwin Professor of Cardiology Stuart Pharmaceuticals
Stanford University School of Medicine
David P. Lauler, M.D.
Leonard N. Horowitz, M.D. Chairman, Department of Medicine
Associate Professor of Medicine Lawrence & Memorial Hospitals
Hahnemann University
Ralph Lazzara, M.D.
Jacob Kolff, M.D. Professor of Medicine
Professor of Surgery University of Oklahoma Health
Temple University School of Medicine Sciences Center
xi