comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction

Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE [the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate. The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60% of the routine angiography group and 63% of the ischemia-guided group. The patients were followed for 8.8 +/- 2.8 months after the index event. The primary endpoint occurred in 6.9% of routine angiography patients and 10.9% of the control group [P= 0.4]. The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm [10.9% vs. 1.1, P:0.01],and mostly occurring before angiography. Routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study

[ effectiveness of stress inoculation group training on somatization and anxiety of the coronary heart disease patients]

The purpose of this study was to determine the effectiveness of stress inoculation training on the Somatization and Anxiety of coronary heart disease patients. Subjects were consisted of 40 patients with coronary heart disease, who were randomly selected from the hospitals Golestan, Mehr, naft and Tapesh Clinic of Ahwaz, through systematic sampling method. These patients were randomly assigned to experimental [N=20] and control [N=20] groups. There was 10 females and 10 males in each group. The experimental group received 8 weekly sessions of stress inoculation training that the control group did not received it. It was hypothesized that training would increase the general health of the training group as compared with the control group. The GHQ-28 was administered to both groups before and after training. The results of analysis of covariance showed that training significantly improved the general health in the experimental group as compared with the control group. Also, compared with the control groups, the experimental group showed significantly lower scores on the somatization Anxiety disorder and insomni. The result of research showed the stress inoculation training effected on the amount of general health, somatization and Anxiety disorder and insomnia in coronary heart disease and this method can be used with usual medicine care in improvement and rehabilitation in cardiovascular diseases

role of human platelet antigen 1 polymorphism in development of coronary artery stenosis in Iranian population

Aggregation is the final step in activation of platelets and is mediated by presentation of GPIIb/IIIa receptors on the platelet membrane that bands to fibrinogen and von Willebrand's factor. There are common mutations in GPIII structure that can change the behavior of the molecule and may change the pattern of interaction between platelets and injured endothelium, thus they can have prognostic impact in coronary artery disease [CAD] and acute coronary syndrome. In some large trials, persons homozygous for the PIA2 allele had a greater chance of coronary stenosis and myocardial infarction [MI] than heterozygotes or non-carriers, but other studies did not confirm this association. This is the first study of PIA polymorphism in Iran and is aimed to find a possible association of this mutation and CAD in the Iranian population. In this case-control study, we chose 200 patients who underwent diagnostic coronary angiography between 2005 and 2006 in Hamedan, Iran. In these patients HPIa genotype determination was done using PCR method. We found no significant association of coronary artery stenosis and PIA2A2 or P1A1A2 genotypes in our patients, p value > 0.05. However, there was a significant association between possession of P1A2 allele and occurrence of CAD in patients more than 50 years of age, p value 0.045. Variations in P1A phenotype do not seem to have an association with ischemic heart disease, but the P1A2 allele may have a role in the development of atherosclerosis and MI in persons more than 50 years of age

Anticoagulation with pregnancy in prosthetic valves: a review paper

Pregnancy in women with valvular heart diseases, having prosthetic cardiac valves and on anticoagulants pose a special problem. These women should, be aware of the extra risks of pregnancy to them and of the limited opportunity-to give birth to healthy children

Surgical management of heart valve disease in children

From 1-1.1984 to 31.12.1988, 1022 patients had heart valve operations at our institute 17% [170] out of these were 15 years or Younger in age. 59 patients had mitral stenosis [MS], 50 had mitral regurgitation [MR], 22 had both mitral stenosis and regurgitation [MS, MR], 22 had mitral and aortjc regurgitation [MR, AR] and 17 had aortic valve Stenosis or regurgitation [AS or AR]. 47 patients had closed mitral valvotomy [CMV], 35 and 15 and 19 had mitral, aortic and double valve replacement [MVR, AVE, DVR] respectively 42 patients Underwent mitral valve repair [MV repair] procedure Open Mitral Valvotomy [OMV], double valve repair [DV Repair]. Aortic valve repair and aortic valvotomy was carried out in another 12 patients Overall operative mortality [30 days] was 6.4% Assessment of disability after 3 months showed 80% of the patients were either asymptomatic or in NYHA class I and II. 65% of the patients had a valve Conserving operations [Group A] and 35% had the valve replaced [Group B]. After an average follow up of 39 months, Group A patients [n 111] had 3 operative deaths, no minor or major embolic episodes, no endocarditis, no permanent anticoagulants no bleeding and 3 re-Operations 10 had mild to moderate residual regurgitation 7 were lost to follow up and 1 late mortality. Group B patients [n 57] had 8 operative deaths, 4 minor and one major embolic episodic, 2 endocarditis 49 had permanent anticoagulants with 5 patients having bleeding, 2 peraprosthetic leaks, 3 late deaths and only 3 were lost to follow up. We Conclude that 17% of Our valve patients are 15 years or Younger in age. The best valve conserving operation in appropriate patients in CMV. Majority of the valves, Particularly mitrals, can be preserved by either CMV or open repairative procedures. Both early and late mortality morbidity and economics are very favorable in those who have their valves conserved at surgery it is strongly felt that in Developing Countries learning Practicing and improving valve Conserving techniques for young patients should be a major consideration for cardiac surgeons