Efficacy of two streptokinase formulations in acute myocardial infarction: a double-blind randomized clinical trial

We sought to evaluate the efficacy and safety of the different trade forms of streptokinase available in our country, namely Heberkinasa [Heberbiotec, Havana, Cuba] and Streptase [Aventis Behring GmbH, Marburg, Germany]. We conducted a double-blind randomized clinical trial to compare the two streptokinase formulations, i.e. Heberkinasa [HBK] or Streptase [STP], in patients with acute myocardial infarction who needed thrombolysis. Thrombolysis success was evaluated angiographically and/or clinically. Clinical follow-up was done 30 days after thrombolysis. We randomly allocated 221 patients with a mean age of 56.9 +/- 10.8 years [males: 88.2%] to HBK [n = 119] and STP [n=102] groups. Baseline clinical and demographic characteristics were similar between the two groups, and the two groups were not significantly different in terms of door-to-needle and pain-to-needle intervals. The rate of complications was not significantly different between the groups [44.1% [HBK] vs. 42% [STP]]. Angiography was done for 158 [71.5%] patients in the first 24 hours [9%] and in the first 72 hours [38.8%] after thrombolysis. Lesion morphology and lesion/patient ratio were not significantly different between the two groups [1.87[HBK] vs. 1.67[STP]]. The two groups were similar with respect to angiographic patency rate [67.5% [HBK] vs. 67.6% [STP]]. The study groups were also similar as regards clinical outcome and complications of both streptokinase formulations. The present study demonstrated that Heberkinasa is as effective and as safe as a standard streptokinase, namely Streptase, in a clinical setting

Moderate Mitral Regurgitation and Coronary Disease: Treatment with Coronary Bypass Alone?

In cases of moderate[2 or 3+ on a scale of 0 to 4+] nonorganic mitral regurgitation [MR] and coronary artery disease, operative strategy continues to be debated between coronary artery bypass grafting alone [CABG] or concomitant valve repair. To clarify the optimal management of these patients, we evaluated the mid-term results of isolated CABG in the study group. From March 2002 to February 2005, 40 consecutive patients [57.5% male, mean age: 62.45 +/- 8.7 years, mean ejection fraction: 44.15 +/- 12.6%, mean New York Heart Association class 2.5 +/- 0.78] with coronary artery disease and moderate MR without organic mitral valve disease [prolapse, rheumatism, etc.] underwent CABG alone. Thirty one [77.5%] patients had either postoperative or follow-up transthoracic echocardiography with mean follow up time of 10.82 +/- 8.12 months. Patient's pre and postoperative data were compared to evaluate the results of isolated CABG on moderate MR. MR was ischemic [with persistent wall motion abnormality] in 25 [62.5%] patients and functional [without persistent wall motion abnormality] in 15 [31.5%]. Considering postoperative and follow up transthoracic echocardiography, 54.8% had no or mild MR [29% MR 1+, 25.8% no MR] and 45.2% had moderate MR [16.1% MR 3+, 29% MR 2+]. ResoluItion of MR was significant [p<0.001], but it had no correlation with ischemic MR [p=0.46], preoperative ejection fraction [p=0.09], LV systolic [p=0.70] and diastolic dimensions [p=0.80]. Seven patients died, 2 in hospital and 5 later. Although for coronary artery disease accompanying moderate nonorganic MR, CABG alone reduces severlity of MR significantly, many patients are left with moderate MR. Preoperative diagnosis of moderate nonorganic MR may warrant concomitant mitral repair

Main Pulmonary Artery Hydatidosis with Seconday Involvement of the Lungs: a Shepherd Boy's Story

Cardiac hydatid cyst [CHC] is a rare disease that was endemic in some regions especially in sheep-raising areas. The most commonly accepted theory for the routes of heart involvement in hydatid cyst was infestation by the hexacanthus embryo through coronary arteries.Here, we describe a case with the primitive cardiac hydatid cyst located around the pulmonary valve [PV] and main pulmonary artery [mPA] extended to right and left pulmonary arteries and metastasized to both lungs. Could it be possible for the embryo to adhere PV and mPA directly

Predictors of Long-term Outcome in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a single center registry [THCR]

This study sought to access differences in long-term [9 months] outcomes between Acute Coronary Syndrome [ACS] patients who undergo early intervention compared to Percutaneous Coronary Intervention [PCI] in stable and refractory conditions. Data originated from Tehran Heart Center Registry- interventional cardiology [THCR-IC] and consisted of 1267 patients divided into two categories; 227 patients had features corresponding to acute coronary syndromes [17.9%] and 1040 patients suffered from stable angina [82.1%]. They were admitted between April 3, 2003 and April 25, 2004. The clinical success rate of PCI was higher in ACS [97% vs. 94%; P=0.037], while In-hospital complications was similar in both groups. During the follow-up period, clinical restenosis was not significantly different and the overall number of re-interventions caused by restenosis or progression was not more frequent in ACS patients. Also, 1.3% of ACS and 0.4% of SA patients died, but the difference was not statistically significant [P=0.16]. Finally, Major Adverse Cardiac Events [MACE] showed no significant difference [5.2% vs. 3.9%; P=0.42]. Multivariate analysis showed that female sex [OR=25.6; P=0.003] and previous history of PCI [OR=8.4; P=0.016] were the only strong independent risk factors for major adverse cardiac events. Analyzing ACS patient outcomes using Mantel-Hanzel analysis showed that the female sex was the only factor which strongly increased the incidence of MACE. Both ACS and SA patients who underwent coronary intervention had similar in-hospital and composite major adverse cardiac events, nevertheless female gender must be considered as an independent risk factor for major adverse cardiac events especially in patients with acute coronary syndrome who undergo PCI