[A trial of the use of a new thrombolytic preparation--recombinant tissue-type plasminogen activator--in myocardial infarct patients]. / Opyt ispol'zovaniia novogo tromboliticheskogo preparata--rekombinantnogo tkanevogo aktivatora plazminogena--u bol'nykh infarktom miokarda.

Search for more effective and safe drugs has recently led to the design of second-generation thrombolytic enzymes one of which is recombinant tissue plasminogen activator. A total of 80 patients including 41 who received tissue plasminogen activator (TPA) (Group 1), 39 on streptokinase (SK) (Group 2) were examined. By the 90th minute of thrombolytic infusion, coronary blood flow was recovered in 27 (66%) patients from Group 1 and 19 (49%) from Group 2 (p = 0.12). A decrease in fibrinogen concentration by less than 1 g/l was seen in 7 (18.4%) patients from Group 1 and in 29 (82.9%) patients from Group 2 (p = 0.00005). The levels of fibrinogen and plasminogen during 36 hours of initiation of thrombolytic infusion were statistically significantly lower in Group 2. The incidence of hemorrhages was the same in the two groups and equal to 26.8 and 28.0% in Groups 1 and 2, respectively. All the patients had no hemorrhages requiring transfusion of blood and its substitutes, as well as no cerebral circulatory disorders in the first week of the disease.

[Effects of restoration of coronary circulation on the function of the left ventricle in patients with acute myocardial infarction (a follow-up after 1 year)]. / Vliianie vosstanovleniia koronarnogo krovotoka na funktsiiu levogo zheludochka u bol'nykh ostrym infarktom miokarda (nabliudenie v techenie 1 goda).

Values of overall and local left ventricular function were studied in 89 patients in the acute period and 1 year following myocardial infarction. Three patient groups were identified: (1) 26 patients with coronary artery patency recorded by the first coronary angiography; (2) 20 with coronary blood flow recovery made by thrombolytic therapy; and (3) 40 with coronary occlusion. There was a significant improvement of left ventricular function in the patients from Group 1 during their hospital treatment and 1 year after.

[Possibilities of the use of 99mTc pyrophospate myocardial scintigraphy in the early period of myocardial infarct in the evaluation of the effectiveness of thrombolytic therapy]. / Vozmozhnosti primeneniia stsintigrafii miokarda s 99mTc-pirofosfatom v rannie sroki infarkta miokarda dlia otsenki éffektivnosti tromboliticheskoi terapii.

In early (mean time, 6.9 +/- 0.2 hours following the onset of an anginal episode), 99mTc pyrophosphate myocardial scintigraphy was performed in 28 patients who received thrombolytic therapy under angiographic monitoring. The sensitivity and specificity of an early administration of pyrophosphate into the myocardium as a noninvasive marker of successful coronary reperfusion was 95.7% and 100%, respectively.

[Thrombolytic treatment of myocardial infarction at the prehospital and hospital stage]. / Tromboliticheskaia terapiia pri infarkte miokarda na dogospital'nom i statsionarnom étapakh.

Thrombolytic therapy was performed in 59 patients within the first hours of myocardial infarction. Twenty three patients (Group 1) were given streptokinase (SK) by an emergency team, 36 patients (Group 2) received SK following coronary angiography. In Group 1, SK was initiated earlier (p less than 0.001) than in Group 2. In Group 1 there was no coronary artery occlusion in the appropriate site of myocardial infarction in 86% of the patients. In Group 2, coronary occlusion was detected in 88% reperfusion, in 50% of the cases. Severe overall and regional left ventricular contractility abnormalities were found within the first month of the disease. The incidence of complications is the same in the two groups. High efficiency and relatively safe of thrombolytic therapy in the prehospital period makes this method particularly promising for practical medicine.

[An evaluation of left ventricular myocardial function by x-ray and electrocardiographic data in patients with postinfarct cardiosclerosis]. / Otsenka funktsional'nogo sostoianiia miokarda levogo zheludochka po rentgenologicheskim i élektrokardiograficheskim dannym u bol'nykh s postinfarktnym kardiosklerozom.

To determine the diagnostic significance of x-ray criteria for assessing heart function in patients with postinfarction cardiosclerosis, the coronary-ventricular and electrocardiographic findings were compared with x-ray data in patients of 2 age groups. Group I was made up of patients aged 22 to 39 years, group II of patients aged 60 to 69 years. An attempt was made to base the use of the x-ray method during follow-up of patients suffering from coronary disease. With lesions of the coronary arteries being the same, the functional alterations in the left ventricle were more pronounced in younger patients than in elderly ones. The presence of a sufficiently close correlation between the end systolic volume and the relative heart volume makes it possible to employ this x-ray indicator as a noninvasive criterion for assessing left ventricular function during follow-up of patients with coronary disease.

[What we found one year after conducting thrombolytic therapy with myocardial infarct patients]. / Chto my nashli cherez god posle provedeniia tromboliticheskoi terapii u bol'nykh infarktom miokarda.

As many as 135 patients with myocardial infarction were under observation for a year. All the patients had received thrombolytic therapy 3.9 +/- 0.2 h on the average after the onset of an anginal attack. The patients with the recovered coronary blood flow (group I) manifested a more frequent occurrence of angina pectoris (38%) and repeated myocardial infarctions (8%) as compared to those with persisting occlusion of the coronary artery (group 2)--12 and 1.6% respectively. According to the coronary angiography, group I patients with angina pectoris showed high values of the degree of residual stenosis; the development of reocclusion characterized by the asymptomatic course at the long-term period. Group I patients were noted to have a decrease in the hospital lethality and lethality during the first year.

[Electrocardiographic signs of coronary reperfusion in patients with myocardial infarct]. / Elektrokardiograficheskie priznaki koronarnoi reperfuzii u bol'nykh infarktom miokarda.

ST changes were assessed in records from electrocardiographic leads I, II, III, V as well as monitoring leads in 109 patients with myocardial infarction on thrombolytic and/or heparin treatment conducted under angiographic control. In patients with coronary reperfusion, achieved by thrombolytic treatment within 8 hours of the onset of infarction, ST displacement diminished more than twofold by the third hour of treatment in records from leads I, II, III and V, there was a rapid ST fall in monitoring leads that started within 90 min after the onset of thrombolytic therapy and went on for not more than 60 min at a maximum rate; ST reached its baseline (mean ST level over the last 6 hours of 24-hour monitoring) in records from the monitoring leads within 7 hours after the onset of thrombolytic therapy. These signs of coronary reperfusion are suggestive of the recovery of coronary flow by means of thrombolytic therapy within 8 hours of the onset of myocardial infarction.

[Reperfusion arrhythmia as a sign of restoration of coronary circulation in patients with myocardial infarction]. / Reperfuzionnye aritmii kak priznak vosstanovleniia koronarnogo krovotoka u bol'nykh infarktom miokarda.

Heart rhythm and conduction disturbances during the first day of myocardial infarction were analysed using Holter monitoring in 63 patients who were treated with thrombolytics or heparin under angiographic control. Patients with coronary reperfusion, developed as a result of thrombolytic therapy during the first 8 hours of the disease, exhibited higher frequency of ventricular ectopic complexes which was maximum during the first 30 minutes of coronary reperfusion. During this time interval various rhythm disturbances (including ventricular fibrillation in 11% of cases) were observed. If more than 75% of all the ventricular ectopic complexes during the two-hour period from the beginning of treatment occur from the 40th till the 90th minute, it strongly suggests the onset of thrombolytically induced coronary reperfusion in the first 8 hours of the disease.

[Dynamic characteristics of the electrocardiographic and biochemical indices in myocardial infarct patients undergoing thrombolytic therapy]. / Osobennosti dinamiki nekotorykh élektrokardiograficheskikh i biokhimicheskikh pokazatelei u bol'nykh s infarktom miokarda pri tromboliticheskoi terapii.

The authors assessed the time course of the S-T segment in 12 standard and monitor ECG leads and the time course of MB CPK fraction activity and Mg blood concentration in 34 patients with acute myocardial infarction. After the detection of thrombotic occlusion of the coronary artery they received thrombolytic therapy with angiographic control. Seventeen patients with recovered coronary blood flow demonstrated a considerable decrease in the index of total shift of the S-T segment in leads I, II, III (in inferior MI) and in V1-V6 (in anterior MI) by the 3rd hour of treatment, a decrease in the S-T segment over 50% by the 3rd hour in one of 12 standard leads, a rise of a segment in which basal S-T was maximum, a rapid time course of the S-T segment in monitor ECG leads and early peaks of MB CPK activity and Mg blood concentration. The results obtained, an analysis of the time course of the S-T segment, and assessment of the time of attainment of maximum MB CPK activity and Mg blood concentration make it possible to judge, with a high degree of probability, of the occurrence of coronary reperfusion in MI patients.