Prognostic significance of transient myocardial ischaemia in patients with stable chronic angina pectoris

Data on the prognostic value of transient myocardial ischemia in stable patients with coronary artery disease are as yet, very scarce. This study was designed to assess the prognostic significance of transient ischemic episodes [silent and symptomatic] during daily activities in patients with chronic stable angina. Seventy eight patients attending the cardiac out patient clinic were studied by exercise treadmill testing and 24-hours of ambulatory Holter monitoring and followed for prognostic purposes for up to 24 months [mean of 17 months]. Patients inclusion depend on the clinical diagnosis of stable coronary artery disease which necessitated out patient review and it was not dependent on objective evidence of reversible ischemia. Events recorded during the follow-up period included death, non-fatal myocardial infarction, unstable angina and requirements for revascularization. Twenty four patients [31%] had transient ischemic episodes during their daily activities and 45 [58%] patients had a positive exercise test for ischemia with 19 patients [24%] had evidence of ischemia on both investigations and 21 patients [27%] had no documented evidence of ischemia on either investigation. Thee were 16 patient events [20.5%] recorded over a mean of 17 months follow-up including one cardiac death [1.3, 4 non-fetal MI [5.1%], 4 admissions with unstable angina [5.1%] and 7 patients were referred for revascularisation because of symptoms. Of the 5 cases of cardiac death and non-fatal Ml only 2 had evidence of ischemia in both investigations and 2 had no ischemia on either Investigation. As a whole 6 of recorded events occurred in 19 patients [31%] with both investigations positive for ischemia, 6 in 21 patients [29%] with both in investigations negative and 4 in patients who had one test positive for ischemia. We could conclude that in an unselected group of patients with stable angina, 17 months outcome was favorable and over this time the results of ambulatory ST segment monitoring seemed to contribute little to the identification of patients liable to have non-fatal myocardial infarction or cardiac death

Nitroglycerin versus streptokinase in acute myocardial infarction, efficacy and one-year follow-up

We have compared the efficacy and long term prognosis of nitroglycerin [NG] and streptokinase [SK] in 67 patients with acute myocardial infarction [AMI]. The two groups were matched for age, sex, site of infarction and ischemic heart disease [I>H.D] risk factors. The two groups had been subjected to in-hospital non-invasive evaluation of reperfusion, echocardiography [ECHO-C.G] assessment of left ventricular [LV] function and 6 - 12 months follow-up. In comparison to NG-group [N = 25], the SK-group [n = 42] had shown significant higher reperfusion score; relief of chest pain in 48%, ST-segment regression in 60%, early peaking CPK in 52% and reperfusion arrhythmias in 33%; versus 60%, 12% and 0% respectively in NG-group. Again SK-group had shown significant less in-hospital mortality, and less incidence of severe LV failure. Lethal ventricular arrhythmias showed no significant difference. The in-hospital ECHO-C.G. parameters of LV function were significantly better in SK-group, particularly in the anterior MI subgroup yet these differences were not recorded on 6 and 12 months follow-up. Post infarction angina, reinfarction, heart failure and death at 6 and 12 months follow up period did not show significant differences. Although, the use of SK early in AMI had initial beneficial effect and is superior to NG, yet its long term efficacy in comparison to NG had been brought into question and further intervention may be needed in selected cases

In-hospital course of acute myocardial infarction among native residents in high altitude and sea level

85 patients with acute myocardial infraction [AMI] had been included in the present work to analyze the effect of high altitude [H.A.] on the in-hospital course of AMI. Native residents at [H.A.] presented the first group [G-1 n=39] and at sea level [S.L.] constituted the second group [G-2 n=46]. The study groups were comparable with regards site and size of AMI as determined by ECG and peak of cardiac enzymes. There was higher age presentation in the first group compared to the second group [mean 71.8 +/- 14.4 years versus 59.4 +/- 9.2, respectively, P <0.001]. Females were less affected in G-1 compared to G-2: 5 out of 39 [12.82%] versus 8 out of 46 [17.39%], respectively, in subgroup-C, two females out of 11 [18.18%] were affected in G-1-C versus 5 out of 11 [45.45%] in G-2-C. Total deaths were less in [H.A.] group in comparison to [S.L.] group 3 out 39 [7.69%] versus 7 out of 46 [15.2%], respectively. Subgroups showed parallel decline in mortality: one out of 11 [9.09%] in G-1-C versus 3 out of 11 [27.27%] in G-2-C. Total life threatening complications were less in G-1 in comparison to G-2 14 out of 39 [35.9%] versus 22 [47.8%], respectively. Total life threatening complications were less the G-1-C in comparison to subgroup-C 3 out of 11 [27.27%] versus 7 [63.63%], respectively. In conclusion, in-hospital course of AMI had less mortality and morbidity in high altitude group, moreover, AMI had presented later in life in this group and this protective effect could be a true consequence of high altitude effect