ABSTRACT
Primary angioplasty is considered the best reperiusion therapy in the treatment of ST-segment elevation myocardial infarction (STEMI). However, thrombolysis is the reperiusion method most commonly used, due to its wide availability, reduced costs and ease of administration. Aim: To compare inhospital mortality in STEMI patients according to reperiusion therapy. Material and Methods: Patients admitted to Chilean hospitals participating in the GEMI network, from 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperiusion procedure. Inhospital mortality according to gender, was analized in each group, using a logistic regression method, to assess risk factors associated with mortality. Results: We included 3,255 patients. Global mortality was 9.9 percent (7.5 percent in men and 16.7 percent in women, p <0.001). Mortality in patients treated with thrombolytics, was 10.2 percent (7.6 percent in men and 18.7 percent in women, p <0.01). The figure for patients treated with primary angioplasty, was 4.7 percent (2.5 percent in men and 13 percent in women, p <0.01), and in patients without reperiusion, was 11.6 percent (9.8 percent in men and in 15.4 percent women, p <0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty, compared with no reperiusion, was associated with a reduced mortality only in men. The use oí thrombolytics in women was associated with a higher mortality. Conclusions: Primary angioplasty was the reperiusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women.
Subject(s)
Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary/mortality , Hospital Mortality , Myocardial Infarction/mortality , Thrombolytic Therapy/mortality , Fibrinolytic Agents/therapeutic use , Logistic Models , Myocardial Infarction/therapy , Risk Factors , Sex Factors , Streptokinase/therapeutic use , Tissue Plasminogen Activator/therapeutic use , Treatment OutcomeABSTRACT
Objective To evaluate the myocardial protective effect of pretreatment with pinacidil, a potassium channel opener, on myocardium perfused intermittently with normothermic or hypothermic high potassium crystalloid cardioplegie solution during cardiopulmonary bypass ( CPB) . Methods Eighteen dogs of both sexes weighing 10-15 kg were intubated and mechanically ventilated after induction of anesthesia. Femoral artery and vein were cannulated for direct MAP and CVP monitoring. Swan-ganz catheter was placed via right internal jugular vein. The animals were randomly divided into 3 groups: group A (hypothermic CPB) in which heart was perfused with 4℃ St Thomas solution 10 ml?kg-1 in 2 min and 30 min later perfused again with half of the initial volume(5 ml? kg-1); in group B (normotherinic CPB) and group C (hypothermic CPB) heart was pretreated with oxygenated pinacidil solution (0.083 mg?kg-1 37℃) before cardioplegia. The heart was subjected to 60 min global ischemia followed by 30 min reperfusion. The hemodynamic changes were measured before aortic cross-clamping and 15 and 30 min after release of aortic cross-clamping. Myocardial tissue was obtained from apex of left ventricle for determination of myocardial adenine nucleotide content 5 min after CPB was initiated, 30 and 60 min after aortic cross-clamping and 20 min after reperfusion. Results During reperfusion the hemodynamic function and myocardial ATP content recovered significantly better in group C than those in group A and B ( P