Fibrinolytic therapy in CCU instead of emergency ward: how it affects door to needle time?

The door-to-needle-time [DNT] is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit [CCU]. A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. The mean time interval between arrival at the hospital and electrocardiogram [ECG] assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 +/- 53.00 min ranged 30-325 min that was significantly more than standard DNT [P<0.01]. Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital [P<0.01]. The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU

Evaluation of the relation between anterior mitral valve leaflet motion based on height-to-length ratio and the immediate outcome of percutaneous balloon mitral valvuloplasty

The purpose of this study was to investigate whether there is any relation between mitral leaflet motion based on height-to-length ratio of the anterior mitral valve leaflet doming in diastole and the immediate outcome of balloon mitral valvuloplasty,. The study population consisted of 49 patients [47 women, mean age: 43.7 +/- 13.35 years] with symptomatic rheumatic mitral stenosis who underwent balloon valvuloplasty. Complete transthoracic and transesophageal studies were performed in all the patients before valvuloplasty, and transthoracic study was repeated 24-48 hours after valvuloplasty. The severity of the restriction of the mitral valve leaflet motion was classified based on the heightto- length ratio of the anterior mitral valve leaflet doming. Mitral valve thickness, calcification, subvalvular thickening, and mobility were scored according to the Wilkins system. Optimal immediate outcome of balloon mitral valvuloplasty was defined as a valve area improvement of 50% or more or a final mitral valve area of >/= 1.5 cm[2] and mitral regurgitation Sellers' grade >/= 2. There was a significant relation between the total mitral valve score and its thickness with the optimal immediate post-balloon mitral valvuloplasty results [p value=0.03 and 0.04, respectively], but no relation was found between the Wilkins score and its components with the anterior mitral valve leaflet height-to-length ratio. There was no significant relationship between the amount of increase in the mitral valve area, decrease in trans-mitral pressure gradients, decrease in pulmonary artery pressure, and anterior mitral leaflet height-to-length ratio [all p values>0.05; all the correlation coefficients<0.2]. Our study showed that post-balloon mitral valvuloplasty results are mainly affected by valve thickness and the total Wilkins score. In addition, the severity of mitral leaflet motion restriction in terms of the height-to-length ratio of the anterior mitral valve leaflet has no significant relation with the immediate result of balloon mitral valvuloplasty

Evaluation of independent prognostic importance of hyperuricemia in hospital death after acute myocardial infarction

To evaluate the role of hyperuricemia [serum uric acid level greater than 7 mg/dl] as an independent short term [in hospital] prognostic factor after acute myocardial infarction [AMI]. Included in the study were 2218 patients who were hospitalized with well established AMI from June 1996 through to December 2002 in the Coronary Care Unit of Ekbatan General Hospital, Hamedan University of Medical Sciences, Iran. All patients with exclusive criteria, were omitted from study. Furthermore, frequency of hyperuricemia in patients [N=59] who expired after AMI was compared with patients [N=104] whom were discharged from the hospital after AMI. Frequency of hyperuricemia was measured according to the extension of myocardial necrosis [as the most important prognostic risk factor] based on serum creatine phosphokinase level greater or less than 2000 IU, which was 13.3% and 20.7% in the case group, and 9.5% and 9.7% in the controls, respectively. These findings indicate that hyperuricemia is not an independent prognostic risk factor in hospital death after AMI