Favorable Effects of Hyaluronidase on Electrocardiographic Evidence of Necrosis in Patients with Acute Myocardial Infarction

P. R. Maroko, L. D. Hillis, J. E. Muller, L. Tavazzi, G. R. Heyndrickx, M. Ray, M. Chiariello, A. Distante, J. Askenazi, J. Salerno, J. Carpentier, N. I. Reshetnaya, P. Radvany, P. Libby, D. S. Raabe, E. I. Chazov, P. Bobba, E. Braunwald

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Abstract

To evaluate hyaluronidase's effect in reducing post-infarction myocardial necrosis, we randomized 91 patients with anterior infarction to control (45) or to hyaluronidase-treatment (46) groups. A 35-lead precordial electrocardiogram was recorded on admission and seven days later. Hyaluronidase was administered intravenously after the first electrocardiogram and every six hours for 48 hours. QRS-complex changes were analyzed to assess the drug's effect. Precordial sites with ST-segment elevation (≥0.15 mV) on the initial electrocardiogram that retained an R wave were considered vulnerable for the development of electrocardiographic signs of necrosis. The sum of R-wave voltages of vulnerable sites fell more in the control group than in the hyaluronidase group (70.9±3.6 per cent [±1 S.E.M.] vs. 54.2±5.0 per cent P<0.01). Q waves appeared in 59.3±4.9 per cent of the vulnerable sites in control versus 46.4±4.9 per cent in hyaluronidase-treated patients (P<0.05). Thus, hyaluronidase reduced the frequency of electrocardiographic signs of myocardial necrosis. (N Engl J Med 296:898–903, 1977) Death of hospitalized patients with acute myocardial infarction has two principal causes: primary arrhythmias and failure of the cardiac pump. Death secondary to disturbances in rhythm has been markedly reduced through the use of modern monitoring technics and by the application of antiarrhythmic drugs as well as other therapeutic measures, whereas the mortality due to pump failure has shown little change in recent years and remains unacceptably high. The classic approach to the treatment of pump failure is to attempt to improve the associated adverse hemodynamic indexes by pharmacologic or mechanical means. An alternative approach to the treatment of acute.

Original languageEnglish (US)
Pages (from-to)898-903
Number of pages6
JournalNew England Journal of Medicine
Volume296
Issue number16
DOIs
StatePublished - Apr 21 1977

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Maroko, P. R., Hillis, L. D., Muller, J. E., Tavazzi, L., Heyndrickx, G. R., Ray, M., Chiariello, M., Distante, A., Askenazi, J., Salerno, J., Carpentier, J., Reshetnaya, N. I., Radvany, P., Libby, P., Raabe, D. S., Chazov, E. I., Bobba, P., & Braunwald, E. (1977). Favorable Effects of Hyaluronidase on Electrocardiographic Evidence of Necrosis in Patients with Acute Myocardial Infarction. New England Journal of Medicine, 296(16), 898-903. https://doi.org/10.1056/NEJM197704212961603