Subject(s)
Humans , Male , Aged, 80 and over , Angioplasty, Balloon, Coronary/adverse effects , Wounds, Penetrating/etiology , Wounds, Penetrating/therapy , Stents/adverse effects , Coronary Vessels/injuries , Heart Injuries/etiology , Heart Injuries/therapy , Treatment Outcome , Cardiac Tamponade/etiology , Cardiac Tamponade/therapyABSTRACT
Background: The optimal dose of Streptokinase in the treatment of acute myocardial infarction is not well established. Apparently, the thrombolytic efficacy would not increase with doses over 750.000 units. Aim: To compare the effectiveness and safety of treatment with low doses of Streptokinase, ranging from 500.000 to 750.000 units, in patients with ST elevation acute myocardial infarction. Patients and methods: From September 1993 to September 1998, the GEMI register of patients with acute myocardial infarction, was carried out in 37 hospitals, incorporating 4,938 patients. Of these, 1,631 patients received streptokinase. According to the administered dose of Streptokinase, patients were divided in two groups: 1,465 patients who received 1.5 millions U in 60 minutes (classical therapy group), and 166 patients with ischemic chest discomfort and either ST-segment elevation or left bundle-branch block on the electrocardiogram, who received 500.000 to 750.000 U streptokinase administered in no more than 30 minutes, with heparin, within 0 to 6 hours of symptom onset. Successful reperfusion, mortality, complications, and hospital outcome was evaluated in both groups. Results: The low dose group of patients had a better reperfusion criteria profile. No differences between groups were observed in patient evolution, mortality, maximum Killip classification, post myocardial infarction heart failure, ischemic complications, arrhythmias or mechanical complications. Conclusions: These results suggest that streptokinase in low doses is at least as effective as classical therapy, in the treatment of ST elevation acute myocardial infarction.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Fibrinolytic Agents/administration & dosage , Myocardial Infarction/drug therapy , Streptokinase/administration & dosage , Thrombolytic Therapy , Chi-Square Distribution , Creatine Kinase/blood , Electrocardiography , Fibrinolytic Agents/adverse effects , Heparin/administration & dosage , Heparin/adverse effects , Myocardial Infarction/complications , Myocardial Reperfusion , Pain Measurement , Prospective Studies , Risk Factors , Streptokinase/adverse effects , Thrombolytic Therapy/adverse effects , Treatment OutcomeABSTRACT
Background:Coronary angioplasty was introduced in Chile in 1982, but only after the introduction of stents it became commonplace. However, the results of this procedure at the national level remain largely unknown. Aim: To assess the results and characteristics of coronary angioplasty and develop a national registry in Chile (RENAC). Patients and Methods: All centers performing angioplasty were invited to contribute prospectively with the clinical, angiographic, procedural characteristics and results of all consecutive coronary angioplasty procedures attempted between June 2001 and October 2002. Results: In 10 centers, 1768 lesions were treated in 1484 procedures (22.98 percent in women). Mean age was 60.8±11.3 years old. Diabetes was found in 21.8 percent, hypertension in 60.2 percent, dyslipidemia in 52.0 percent, active smoking in 40.0 percent, renal failure in 6.2 percent. Myocardial infarction was recent in 28.4 percent and acute in 19.7 percent. Forty eight percent of patients had unstable angina and 15.5 percent had stable angina. Fifty three percent of patients had single vessel disease and 71 percent, normal left ventricular eyection fraction. One vessel was treated in 90.6 percent of patients and 81.7 percent of lesions were treated with stents, 17.9 percent only with baloon and in 0.4 percent with atherectomy. Angiographic success was obtained in 95.2 percent. Clinical success was obtained in 92.2 percent, and 95.1 percent in patients without acute myocardial infarction. Overall inhospital death was 2.2 percent. In patients without myocardial infarction, the figure was 1.1 percent. Conclusions: Coronary angioplasty in Chile is performed mostly for the treatment of acute coronary syndromes. Stents are the most frequently used devices. The high success, low mortality and complications observed are comparable to North American registries (Rev Méd Chile 2004; 132: 913-22).
Subject(s)
Adult , Male , Humans , Female , Aged , Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Registries , Professional PracticeABSTRACT
Most reports concerning the use of streptokinase (SK) for thrombolysis in myocardial infarction (MI) have employed doses ovber 1 000 000 units. We evaluated the efficace of a dose of 500 000U in 40 patients with acute MI who received full heparin dose before, during and after SK. Thrombolytic effect, as measured by the protamine neutralized thrombin time was shown to be strong in 60% of cases, moderate in 17% and weak in 22%, and this was not modified by larger SK doses. A patent culprit artery ws demonstrated at coronary arteriography performed 3 days after SK in 90% of patients. Only one instance of severe bleeding was observed. Thus, a reduzed SK dose in association to heparine provides adequate lytic efect and artery patency rate in patients with MI