[Non-invasive evaluation of coronary reperfusion. Analysis of the ST segment before and after thrombolysis in acute myocardial infarct]. / Valutazione non invasiva della riperfusione coronarica. Analisi del tratto ST prima e dopo trombolisi durante infarto miocardico acuto.

BACKGROUND: The aim of this study was to determine the role of the ST segment elevation resolution > 50% between the ECG before and 2 hours after thrombolytic therapy as a predictor of acute myocardial infarction (AMI)-related artery patency, assessed by a coronary angiography performed 1 month after AMI. MATERIALS AND METHODS: This study enrolled 95 patients, 75 men and 20 women, 58 years mean aged, admitted to the coronary care unit with diagnosis of AMI. Patients were treated with thrombolysis within 6 hours from the onset of chest pain, according to the GUSTO trial. RESULTS: The findings showed a significant prevalence of ST segment elevation resolution > 50% in inferior AMI (p < 0.01). It has been observed that the ST segment resolution is correlated with lower (p < 0.01) and earlier (p < 0.05) peak in serum creatinekinase (CK) and CK MB release and with less damage of left ventricular ejection fraction assessed by ventriculography (p < 0.01). All these findings indicated a lower extensive myocardial damage. Patients with ST segment resolution presented a prevalence of one or two-coronary vessel disease, with an infarct-related vessel narrowing like that observed in the other patients without ST resolution. Nevertheless a TIMI grade 2 or 3 flow was observed more frequently, but not significantly, in the subjects with ST resolution; a significant prevalence was limited to TIMI 3 grade flow (p < 0.05). In the present study ST segment elevation resolution > 50% represented a highly sensitive and a poor specific predictor of vessel patency in inferior AMI, but with a poor sensitivity and specificity in anterior AMI. CONCLUSIONS: Personal experience suggested that the thrombolytic therapy has a less favourable effect on the artery patency assessed 1 month after AMI, rather than in the acute phase as reported in previous studies. Dynamic changes of flow or a following worsening in atherosclerotic plaque could be probably responsible of reocclusion of an initially reperfused coronary artery.

[Female gender and acute myocardial infarction: what role does it play in the early and late prognosis]. / Sesso femminile ed infarto miocardico acuto: quale ruolo nella prognosi a breve e medio termine?

The primary purpose of this study is to examine the influence of the female gender on the early and 1-year post-discharge prognosis after acute myocardial infarction (AMI). Moreover, the therapeutic approaches are compared between the two sexes during the early phase of AMI. We performed a retrospective cohort study of 341 patients, 219 men and 122 women, consecutively admitted to the coronary care unit with AMI. Among the baseline characteristics, the age greater than 70 years, the systemic hypertension and the diabetes mellitus are more represented in women; on the contrary cigarette smoking is prevalent in the male gender. The analysis of laboratory and clinical parameters does not show any statistic differences between the two sexes, except the ejection fraction and the coronary reperfusion. The first turns out to be lower in the females and the second one is more often observed in the males. As for the intra-hospital complications, the cardiogenic shock is prevalent in the female gender, the early mortality gets to 26% in women and 11% in men (p < 0.01). The late mortality during the follow-up does not present any difference between the two sexes. From our data, we conclude that transmural AMI, cardiogenic shock, ventricular fibrillation and 2-3 degree atrio-ventricular blocks are significantly bound to a higher early mortality in women. In them the atrial fibrillation is the only predictor of 1-year mortality. Finally, thrombolysis, beta-blockers and significantly aspirin and heparin (p < 0.05), are less used in the female patients, while diuretics and digoxin are more employed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of age on early and late mortality after an acute myocardial infarct]. / Influenza dell'età sulla mortalità precoce e tardiva dopo infarto miocardico acuto.

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.