Angiographic and clinical outcomes in elderly subjects treated with percutaneous coronary intervention following fibrinolytic administration for ST-elevation myocardial infarction / 老年心脏病学杂志（英文版）

Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) patients. The association of patient age with angiographic characteristics of flow and perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) following the administration of fibrinolytic therapy has not been previously investigated. Objectives and Methods We examined the association between age (≥ 70 years or ＜ 70years)and clinical and angiographic outcomes in 1472 STEMI patients who underwent rescue/adjunctive PCI following fibrinolytic therapy in 7 TIMI trials. We hypothesized that elderly patients would have slower post-PCI epicardial flow and worsened outcomes compared to younger patients. Results The 218 patients aged ≥ 70 years (14.8%) had more comorbidities than younger patients. Although these patients had significant angiographic improvement in TIMI frame counts and rates of TIMI Grade 3 flow following rescue/adjunctive PCI, elderly patients had higher (slower)post-PCI TIMI frame counts compared to the younger cohort (25 vs 22 frames, P = 0.039), and less often achieved post-PCI TIMI Grade 3 flow (80.1 vs 86.4%, P = 0.017). The association between age ( ≥70 years) and slower post-PCI flow was independent of gender, time to treatment, left anterior descending (LAD) lesion location, and pulse and blood pressure on admission. Elderly patients also had 4-fold higher mortality at 30 days (12.0 vs 2.7%,P = 0. 001 ). Conclusions This study suggests one possible mechanism underlying worsened outcomes among elderly STEMI patients insofar as advanced chronological age was associated with higher TIMI frame counts and less frequent TIMI Grade 3 flow after rescue/adjunctive PCI.

Efeito do captopril na dilataçäo ventricular progressiva após infarto do miocárdio anterior / Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction

Realizamos estudo duplo-cego, comparativo com placebo para determinar se a dilataçäo ventricular continua durante a fase de convalescença após infarto do miocárdio e se a terapêutica com captopril altera esse processo. Cinqüenta e nove pacientes com primeiro infarto do miocárdio anterior e fraçäo de ejeçäo de 45 por cento ou menos se submeteram a cateterismo 11 e 31 dias depois do infarto, se näo estivessem em insuficiência cardiáca congestiva evidente. Foram entäo randomicamente alocados para placebo ou captopril e acompanhados por um ano. Repetiu-se a cateterizaçäo para avaliar as mudanças intervalares na funçäo hemodinâmica e volume ventricular esquerdo. Trinta e oito pacientes masculinos foram avaliados, a cada três meses, para prova de exercício máximo em esteira. Näo foram detectadas diferenças na situaçäo basal em relaçäo às variáveis clínicas, hemodinâmicas ou de ventriculografia quantitativa. Durante um ano de acompanhamento o volume distólico final do ventrículo esquerdo aumentou em média (ñ DP) de 21 ñ 8ml (P < 0,02) no grupo placebo, mas somente 10 ñ 6ml (P näo significante) no grupo captopril. A pressäo de enchimento ventricular esquerda permaneceu elevada com placebo mas diminuiu (P < 0,01) de 36 pacientes que era de alto risco para dilataçäo ventricular, por terem uma oclusäo persistente da artéria coronária anterior esquerda, captopril preveniu dilataçöes ventriculares futuras (P < 0,05). Pacientes que receberam captopril tambem tiveram aumento na capacidade de exercício (P < 0,05). Este estudo preliminar indica que após infarto anterior do miocárdio, a dilataçäo ventricular é progressiva e captopril pode atenuar esse processo, reduzir as pressöes de enchimento, e melhorar a tolerância ao exercício