Short and intermediate clinical outcome after late coronary stenting in myocardial infarction.

BACKGROUND: The open artery theory has been proposed that late reperfusion of an occluded coronary artery favorably affects clinical outcome. Myocardial reperfusion can be achieved in acute myocardial infarction (AMI) by coronary angioplasty. Coronary stenting improves initial success rate and reduces rate of restenosis. However, there are limited data regarding intermediate outcome of late angioplasty with stenting. METHOD: Between June 1998 and August 1999, one hundred and twenty-three patients with AMI, and forty-four patients (37 males, 7 females) underwent late coronary stenting. Mean age was 57 +/- 10 years. Echocardiography was performed before the procedure and at 6-months follow-up. RESULTS: There were 36 Q-MI and 8 non Q-MI. The infarct-related artery (IRA) was left anterior descending artery (LAD) 55 per cent, left circumflex artery (LCX) 15 per cent, and right coronary artery (RCA) 30 per cent. Coronary stenting was successfully performed in all patients. Pre- and post-procedural diameter stenosis were 90.5 +/- 8.9 per cent and 2.2 +/- 6.5 per cent. Stent indications were suboptimal results (68.2%), intimal dissection (20.4%), and acute closure (11.4%). Over all in-hospital mortality was 2.27 per cent from sudden cardiac death. Mean follow-up was 11.41 +/- 4.79 months. There were 1 MI (2.3%), 2 CHF (4.65%), 1 unstable angina pectoris (2.3%), 1 transient ischemic attack (TIA) (2.3%), and no cardiac death. LVEF showed improvement at 6-months follow-up (47.75 +/- 11.55% vs 54.89 +/- 14.76%, p value < 0.001) CONCLUSION: Late coronary stenting of the IRA of patients with AMI is feasible, with few complications. There was improved LVEF and intermediate clinical outcome.

Clinical manifestations and therapy of heat stroke: consumptive coagulopathy successfully treated by exchange transfusion and heparin.

This report of 8 cases (6 severe and 2 mild) heat stroke patients seen during the hot summer of 1987 at Pramongkutklao Hospital, Bangkok, represent the first report of this syndrome in Thailand. Severe cases presented with deep coma, shock, ARDS, DIC and other systemic complications. Two cases of mild heat stroke recovered completely with conventional treatment. Two of the 6 severe cases died with DIC, bleeding and acute renal failure. The other 4 surviving cases received early exchange transfusion and low dose heparin therapy. The clinical features of these 4 cases were as severe as those recorded for fatal heat stroke patients, including shock over 10 hours in 4, coma longer than 120 hours in 3, ARDS and DIC in 1. From these findings, early exchange transfusion plus low dose heparin should be considered as one effective treatment in severe fatal heat stroke patients.