Anticoagulant Treatment in Acute Coronary Occlusion with "So-Called" Ischemic Pattern

¹ The Edward B. Robinette Foundation, Medical Clinic, Hospital of the University of Pennsylvania.

1. During the past five years, approximately 200 cases were observed whose clinical history strongly suggested myocardial infarction, but the electrocardiogram showed T wave changes only and, in a few instances T wave changes and minor RS-T segment deviation. In 22 of these patients, after an interval of a day to several weeks, the initial bout of pain was followed by a second, with the development of the typical infarction pattern in the electrocardiogram.

2. Ten of the cases received no anticoagulant treatment—seven because hospitalization was refused, two because their condition was not considered serious enough, and one because of a history of duodenal ulcer. Eight other cases developed the infarction pattern in the electrocardiogram before anticoagulants could be started or given in sufficient amounts. There were five (28 per cent) deaths in this group.

3. The majority of the approximately 200 cases were hospitalized and given anticoagulant treatment. Four of them developed the pattern of myocardial infarction in the electrocardiogram. Two (50 per cent) of these four died.

4. An extension of the myocardial lesion may occur in spite of anticoagulants; but it is our impression that this took place in our subjects most often when anticoagulants were withheld or not given in sufficient amounts.

5. It is not possible to predict accurately the future course of patients who have suffered an acute coronary occlusion and in whom the electrocardiogram may or may not show the typical infarction pattern.