[S-100B protein elevation in patients with the acute coronary syndrome after resuscitation is a predictor of adverse neurological prognosis]. / Elevace proteinu S-100B u pacientu s akutním koronárním syndromem po resuscitaci je prediktorem nepríznivé neurologické prognózy.

INTRODUCTION: The annual incidence of out-of-hospital cardiac arrest is around 90-190 cases per 100 000 inhabitants. The limiting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cells product, its glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation. METHODS: 24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 - good condition, CPC2 - moderate neurological disability, CPC3-5 - serious neurological impairment, coma or death. RESULTS: The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132-2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is < 0.23 pg/ml (specificity 93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is > 1.64 pg/ml (specificity 95%, sensitivity 83%). CONCLUSION: Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.

[Acute heart failure and early development of left ventricular dysfunction in patients with ST segment elevation acute myocardial infarction managed with primary percutaneous coronary intervention]. / Akutní srdecní selhání a casný rozvoj dysfunkce levé komory a patientu s akutním infarktem myokardu s elevacemi ST lécených primární perkutánní koronární intervencí.

BACKGROUND: Acute heart failure during ST elevation myocardial infarction (STEMI) makes worse prognosis. The aim of the work was to find independent factors with relationship to acute heart failure (AHF) and the early development of left ventricular dysfunction within the prospective followed patients with STEMI. METHODS: A total of 593 patients with STEMI treated by primary PCI (164 patients with AHF) were the study population. The activity of BNP and NT-ProBNP were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI. RESULTS: The patients with AHF had higher level of glycaemia, creatinine, uric acid, HDL-cholesterol, leukocytosis and natriuretic peptid. The total hospital mortality was 3.7%. 0.2% within the patients without AHF, 3.2%, 14.3%, resp. 63.6% within the patients with mild AHF, with pulmonary oedema, resp. with cardiogenic shock. The patients with AHF had lower ejection fraction (45.4 +/- 11.9% vs 53.0 +/- 10.3%). According to the multiple logistic regression we found higher glycaemia, age, heart rate, anterior wall MI, lower aortic pulse pressure and collaterals of infarct related artery as factors with independent relationship to AHF. Higher glycaemia, age, heart rate, anterior wall MI and lower aortic pulse pressure were found as independent factors with relationship to left ventricular dysfunction. According to ROC analysis possible cut off corresponding with AHF we suggested 29.5 mm Hg for LVEDP, 28.5 for dP/dt/P, 9.5 mmol/l for glycaemia, 50 mm Hg for aortic pulse pressure. CONCLUSIONS: Our results found the development of AHF in one third of patients with STEMI. AHF increases the risk of in-hospital mortality and the risk depends upon severity of failure. As the independent factors with relationship to development of AHF or left ventricular dysfunction we detected higher glycaemia, heart rate, anterior wall MI, age. Lower risk had patients with higher aortic pulse pressure.

Relationship between high aortic pulse pressure and extension of coronary atherosclerosis in males.

A high pulse pressure (PP) is a marker of increased artery stiffness and represents a well-established independent predictor for cardiovascular morbidity and mortality. The objective of the research was to determine whether invasively measured central aortic PP was related to the presence and severity of coronary artery disease. In total 1075 consecutive stable male patients undergoing diagnostic coronary angiography with a preserved left ventricular function were included. Diseased coronary vessel (DCV) was defined by the presence of >50 % stenosis. Men were divided into 3 groups according to the increased value of PP. The average PP in the tertiles was 47.8+/-7.1 vs. 67.0+/-4.9 vs. 91.3+/-12.8 mm Hg (p<0.01). The significant differences of DCV was found among tertiles (1.51+/-1.11 vs 1.80+/-1.04 vs. 1.99+/-0.98 DCV, p<0.01). Aortic PP together with age and hyperlipoproteinemia were found as factors with an independent relationship to DCV according to multivariate linear regression. In conclusions the increased value of aortic PP in the male population is independently connected with more severe atherosclerosis evaluated by the significant number of DCV.

Nuclear receptors gene polymorphisms and risk of restenosis and clinical events following coronary stenting.

INTRODUCTION: Hereditary factors connected with inflammation and fibroproliferation may play important role in restenotic process after coronary stenting. Peroxisome proliferator-activated receptors (PPAR) and retinoic X receptors (RXR) regulate the transcription of crucial genes involved in the glucose and lipid metabolism, inflammation and cell differentiation. METHODS: In our angiographic and clinical study we assessed the association of gene polymorphisms of L162V for PPAR-alpha, C161T for PPAR-gamma and A(39526)AA for RXR-alpha with the risk of restenosis and cardiac events after coronary stenting. Primary endpoint was diameter stenosis > or = 50% at follow-up angiography. Secondary endpoints were death, myocardial infarction and/or target lesion revascularisation at 12 months, and clinical restenosis. The results were adjusted for known predictors of restenosis. The genotypes were analysed by polymerase chains reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. RESULTS: Control angiography was performed in 477 of 565 patients (84.4%) with following restenosis rates in genotype subgroups: CC 29.0% vs GC/GG 22.6% (p = 0.33) in L162V, CC 29.9% vs TC/TT 24.6% (p = 0.24) in C161T and A/A 26.9% vs A/AA + AA/AA 35.0% (p = 0.14) in A(39526)AA polymorphisms. The T allele ofC161T polymorphism was associated with lower frequency of clinical restenosis (p = 0.015). CONCLUSION: We could not find an association of L162V PPAR-alpha, C161T PPAR-gamma and A(39526)AA RXR-alpha gene polymorphisms with angiographic in-stent restenosis or major cardiac events. However, we found the relationship between C161T PPAR-gamma polymorphism and clinical restenosis deserving further study.

[Acute embolization into the veins in the splanchnic bed--an overview of current methods of diagnosis and therapies]. / Akutní embolizace do tepen splanchnického reciste--prehled soucasných diagnostických prístupu a terapie.

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].

[Coronary artery disease with premature manifestation in young patients]. / Ischemická choroba srdecní s predcasnou manifestací u mladých pacientu.

INTRODUCTION: Coronary artery disease (CAD) affects in lower percentage even younger individuals. This paper describes group of young patients aged 40 years or less with premature manifestation of CAD, including analysis of risk factors, severity of coronary arteries affection, management and follow-up lasting up to 7 years. PATIENTS AND METHODS: There were 98 patients included retrospectively, in whom macroscopic affection of coronary arteries was diagnosed by coronary angiography within the years 2000-2007. 68 of the patients were indicated to coronary angiography urgently due to acute coronary syndrome (ACS), 44 of them due to acute myocardial infarction with ST elevations. The patients were called for further co-operation and 45 of them (45.9%) were re-examined completely and they will be observed prospectively. The results show overall good short-term prognosis of these patients and confirm importance of early invasive management and revascularisation. One-year mortality of the patients with ACS was 1.9%. 80% out of 45 completely re-examined patients have ejection fraction of left ventricle better than 50% and 84% ofthem is without any anginal symptoms. However, our results show inadequate secondary prevention in these patients. 15 patients (33%) still smoke, 20 (44%) is over-weighted. Only 22 patients (49%) had LDL-cholesterol level bellow 2.5 mmol/l and even only 15 patients (33%) had blood pressure below 130/80 mm Hg. CONCLUSIONS: Management of these basic risk factors should improve even the long-term prognosis of our patients.

[Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis]. / Embolizace vetví a. mesenterica superior jako komplikace direktní angioplastiky resená lokální trombolýzou.

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation ofa bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.

[Repolarization homogeneity in patients after acute myocardial infarction assessed from long-term 12-lead electrocardiographic recordings]. / Homogenita repolarizace u patientu po akutním infarktu myokardu hodnocená z dlouhodobých 12svodových elektrokardiografických záznamu.

BACKGROUND: Abnormal heterogeneity of myocardial electrophysiologic processes increases the risk of malignant arrhythmias. The aim of the studywas to assess changes ofrepolarization homogeneity in patients after acute myocardial infarction (MI) using morphological parameters obtained from long-term 12-lead electrocardiographic recordings. METHODS: In the group of 200 patients (45 females, 155 males) a long-term (10 minutes supine) 12-lead electrocardiographic recording (SEER MC, GE Medical) was performed 48-72 hours after acute myocardial infarction. The following parameters were calculated using experimental software: total cosine R to T (TCRT) and Twave residuum (TWR). The results were correlated with Q wave evolution and left ventricular ejection fraction (LVEF). RESULTS: Distinguishing the MI type (Q vs nonQ) the following values were obtained: TCRT: 0.17 +/- 0.61 vs 0.16 +/- 0.49, p = 0.52, absolute TWR: 21,200 +/- 21,700 vs 25,700 +/- 29,300, p = 0.3, relative TWR: 0.0012 +/- 0.0017 vs 0.0017 +/- 0.0026, p = 0.28. Stratification according to LVEF (< or = 40% vs > 40%) led to: TCRT: -0.03 +/- 0.66 vs 0.25 +/- 0.54, p = 0.01, absolute TWR: 29,700 +/- 32,400 vs 21,300 +/- 21,500, p = 0.14, relative TWR: 0.0021 +/- 0.0047 vs 0.0013 +/- 0.0021, p = 0.48. CONCLUSION: TCRT is a robust measurement of the spatial angle between the QRS complex and T wave loops which is related to LVEF. The results concerning TWR might indicate that this parameter is independent of LVEF, which needs to be confirmed in further analyses in a larger population.

[Factors related to NT-proBNP values in haemodynamically stable patients with normal systolic function of the left ventricle]. / Faktory se vztahem k hodnotám NT-proBNP u hemodynamicky stabilních pacientu s normální systolickou funkcí levé komory.

INTRODUCTION: Increased values ofnatriuretic peptides are considered prognostically significant in normal population with respect to mortality and the incidence of cardiovascular events, regardless of the left ventricular function. The objective of the study is to point out the factors related to NT-proBNP values in patients without the heart failure syndrome and with normal left ventricular systolic function. METHODS: The group consisted of 290 elective patients aged between 50 and 82, with the mean age of 62 years, of whom 47% were women. The enrolled patients were heamodynamically stable, without a history of MI, with a normal left ventricular systolic function and with the serum creatinine level < 150 micromol/l. On the same day, the following procedures were performed: left heart catheterisation, NT-proBNP sampling and echocardiographic examination. Diabetes mellitus, hypertension, coronary heart disease, body mass index, age, sex, left ventricular end-diastolic pressure and aortic pulse pressure were chosen as factors with possible impact on the level of NT-proBNP. We used echo parametres to assess the size of the left ventricle, the left ventricular mass index and the presence of left ventricular diastolic function. RESULTS: The median of NT-proBNP was 110 pg/ml (min. 11; max. 1,943 pg/ml), and higher values were recorded for 116 (i.e. 40%) of the total number of patients. Based on the above-referred factors, a significant relation was demonstrated between NT-proBNP and age (p < 0.01), sex (p < .01), BMI (p = 0.03), left ventricular size (p = 0.02), left ventricular mass index (p = 0.01), and aortic pulse pressure (p < 0.01). CONCLUSION: The study has shown that the level of NT-proBNP in patients does not solely depend on the haemodynamic status and left ventricular function, but is related to many other risk factors of cardiovascular mortality and morbidity.

[QT dynamicity in risk stratification in patients after myocardial infarction]. / QT dynamicita v rizikové stratifikaci u pacientu po infarktu myokardu.

BACKGROUND: Ventricular repolarization abnormalities are associated with increased risk of sudden cardiac death in patients after myocardial infarction. The aim of this study is to assess QT dynamicity - QT/RR relationship - in patients after myocardial infarction and its contribution to risk stratification of sudden cardiac death. METHODS: In a group of patients with diagnosis of acute myocardial infarction a long term ECG recording was performed 48-72 hours after myocardial infarction (MARS Unity Workstation, GE Medical Information Technologies). Patients with unstable circulation, artificial pulmonary ventilation, left bundle brach block, atrial fibrillation and paced rhythm were excluded. Analysis of QT dynamicity was performed by QT Guard software (GE Medical Information Technologies). QT/RR relationship is expressed by linear regression as QT = = aRR + b where "a" is termed "slope". RESULTS: Assessment of QT dynamicity was possible in 215 ECG recordings. In 6-month follow-up 2 patients died and another was successfully resuscitated for primary ventricular fibrillation. Six-month mortality resp. mortality + resuscitation was 0.9 %, resp. 1.4 %. Therefore statistical evaluation was not possible. In the 3 mentioned individuals the slope values were 0.333, 0.249 and 0.342. CONCLUSIONS: Mortality of up-to-date-treated patients after myocardial infarction is low. Therefore, in such patients it is not possible to assess QT dynamicity as a risk factor in midterm follow-up. Limitation of the method is the necessity of substantial selection of patients elegible for analysis and dependance on necessary equipment.

[Is the left ventricle enddiastolic pressure pathological in the older population?]. / Je zvýsený enddiastolický tlak v levé komore u populace starsího veku patologický?

INTRODUCTION: The percentage of older population has significantly increased in the recent decades. Morphologic and functional changes of the cardiovascular system go together with ageing. The aim of the study should show the correlation between the age and left ventricular enddiastolic pressure (LVDEP) value. METHODS: 106 patients of the age from 23 to 79 years without an organic heart disease and the history of hypertension underwent elective coronary angiography including left ventricle angiography between 1999 and 2002. LVEDP was obtained as an average value from 8 consecutive beats without extrasystoles. According to the relation between increased relative frequency of LVEDP and age patients were divided into two groups: 50 years and older (80 patients) and younger than 50 years (26 patients). RESULTS: An average LVEDP value in older population versus younger population was 12.1 +/- 5.0 mm Hg vs 8.9 +/- 3.4 mm Hg, p < 0.05. Increased LVEDP in yonger population was found in only 11.5 % vs 46.2 % in older group, p < 0.01 and the LVEDP was age dependent, p < 0.05. CONCLUSIONS: In compliance with about mentioned results we suppose that the age is a factor with impact to LVEDP value. LVEDP values > 12 mm Hg in older population may not be pathological and probably are due to the left ventricle diastolic dysfunction in consequence with ageing.

[ST-segment resolution as a simple tool for the assessment of successful primary coronary intervention at a microvascular level]. / Ustup ST elevací jako jednoduchý nástroj pro posouzení úspesnosti primární koronární intervence na mikrovaskuláirní úrovni.

BACKGROUND: The primary success of the coronary artery reperfusion by primary coronary intervention (PCI) is almost angiographically assessed by TIMI flow score. The perfusion at a microvascular level can be inadequate despite the restoring of normal flow in the epicardial coronary artery. One of the options of successful reperfusion at a microvascular level is the measurement of ST-segment resolution (STR) after primary PCI. AIM: The assessment of ST-segment resolution in patients indicated for primary PCI and the comparison with clinical data. METHODS: The authors studied 149 patients (68.5 % men) with ST elevation acute myocardial infarction treated by primary PCI. The ECG was taken at the time of arriving patient at coronary unit and compared with ECG early after primary PCI. Patients were divided into 3 groups according to the grade of STR: with complete (> or = 70%), partial (30-69%) and none (< 30%) STR. The lead with maximal changes (STEmax) and sum of ST elevation (STEsum) were assessed. RESULTS: 42 (28.2 %) patients had complete STR, 55 (36.9%) partial STR and 52 (34.9%) patients didn't achieve STR. STR was connected with better left ventricular ejection fraction, which was in group with complete STR 50% compared with 39.4% in group without STR (p < 0.0001). Patients with symptoms of heart failure on admission (Killip II-IV) had complete STR only in 4 cases (10%) compared with patients without heart failure (Killip I), where was complete STR in 38 (34.8%), (p = 0.003). There wasn't noted significant difference in STR at dependence on glycoprotein IIb/IIIa inhibitors administration. A normal or mildly slower coronary flow (TIMI 2, 3) was achieved in 146 patients (98%), 3 patients (2%) had inadequate coronary flow after primary PCI (TIMI 0, 1). CONCLUSIONS: The evaluation of early ECG changes is simple method for the assessment of primary PCI success at the microvascular level. Our outcomes confirm a differences in achievement of optimal epicardial coronary flow and a perfusion at microvascular level.

[Implantation of coronary stents in reperfusion therapy in acute myocardial infarct]. / Implantace koronárních stentu pri reperfuzní lécbe akutního infarktu myokardu.

BACKGROUND: Primary coronary angioplasty was accepted as a method of choice in the reperfusion treating strategy of the ST elevation acute myocardial infarction. Since 1995, when the very good results of the stent implantation in patients with acute myocardial infarction were published, there has been a general trend to more stenting also in the Czech Republic. AIM: The analysis of the effectivety and safety of the coronary stent implantation in acute myocardial infarction. METHODS: Prospective analysis of the patients with ST elevation acute myocardial infarction treated with primary coronary angioplasty with one coronary stent implantation at least in the period I/2000-XII/2000. RESULTS: In the above mentioned period the authors carried out the total of 116 primary coronary angioplasties in 116 patients with ST elevation acute myocardial infarction. Balloon angioplasty only was done in 27 patients (23.3%) only, at least one stent was implanted in 89 patients (76.7%). The average procedure time was 58 +/- 27.2 mins, fluoroscopy 10.6 +/- 6.6 mins, sciagraphy 1.8 +/- 0.7 mins. Primary angiographical result was optimal in 82 cases (92.2%) with achieving TIMI flow 3, in 5 cases (5.6%) there was slower perfusion of the infarcted artery observed with TIMI flow 2 and in 2 cases (2.2%) the authors were unsuccessful with final TIMI flow 0-1. Coronary stents were implanted in 13 cases (13.8%) without predilatation as so called "direct stenting", in 19 cases (20.2%) the planned or "elective" stenting was done, in 47 cases (50%) the suboptimal result after balloon angioplasty only was the reason for stent implantation and in 15 cases (16%) it was rescue "bail-out" stenting in complications of the balloon angioplasty only or if the result after balloon angioplasty was unsuccessful. Primary angiographical success of the stented lesion was 100% and in 14 cases (15.7%) the abciximab as a representative of IIb/IIIa platelet blockers was given. Periprocedural complications (up-to 24 hours after the procedure) in the stented group of patients occurred in 2 cases (2.2%), further serious in-hospital cardiovascular complications occurred in another 4 cases (4.4%). The total of 5 patients (5.5%) died in the hospital, out of which 4 patients (4.4%) died due to the primary cardiogennic shock and 1 patient (1.1%) admitted in pulmonary oedema died due to the heart failure progression. Excluding patients primary in cardiogennic shock the in-hospital mortality was 1.2% only. Hospital mortality in the group of patients treated with primary balloon angioplasty only was 3.7% (1 patient). CONCLUSION: At present the coronary artery stenting is safe and highly effective method in acute myocardial infarction treatment.

[Glycoprotein IIb/IIIa platelet blockers in acute myocardial infarct treated with primary coronary angioplasty]. / Gp IIb/IIIa blokátory desticek u akutního infarktu myokardu léceného primární koronární angioplastikou.

BACKGROUND: Primary coronary angioplasty is at present accepted as the most effective reperfusion treatment strategy of the ST elevation acute myocardial infarction. The optimum approach appears to be combination of the interventional technique (mechanical reperfusion) with aggressive pharmacological treatment aimed at the platelets. Intravenous blockers of the glycoprotein receptors IIb/IIIa together with acetylsalicylic acid have the additive antiaggregant effect and are used more frequently as adjunctive therapy by coronary interventions in patients with acute coronary syndromes and the acute myocardial infarction. AIM: The assessment of safety and effectiveness of the IIb/IIIa platelet blockers in patients indicated to primary coronary angioplasty. METHODS: Since 1st January 2000 to 30th June 2001 the authors carried out the total of 912 coronary angioplasties in their cathlab, from which in 195 cases (21.4%) the primary angioplasty in acute ST elevation myocardial infarction was conducted. IIb/IIIa blockers were administered in the total of 53 cases (5.1% from the whole amount of coronary angioplasties), in 30 cases (15.4% from the total of 195 patients) of the primary coronary angioplasties, unlike the elective procedures, where these agents were given only in 9 patients (1.5% from the overall number of 621 coronary angioplasties) (p < 0.001). The authors in their work analyse the group of patients treated with primary coronary angioplasty with adjuvant treatment of IIb/IIIa platelet blockers. RESULTS: In the stated period the IIb/IIIa platelet blockers were given to 30 patients at the age of 60.3 +/- 11.3 on average (70% were men). The most frequent risk factors were smoking, in 18 patients (60%), and hypertension, in 14 patients (40%). At least one coronary stent was implanted in 20 patients (66.7%). Abciximab was administered in 27 cases (90%) and eptifibatid in 5 cases (10%). Solely in 5 cases (16.7%) the agents were administered at least 10 minutes before the intervention and therefore preventively, and in 25 cases (83.3%) the administration was rescue. The reason for preventive administration was in 3 cases determination of the angiographically high-risk coronary artery disease and in 2 cases the thrombosis of another non-infarction related artery. The most frequent reason for the rescue use was in 6 cases (22.2%) slow-flow or no-reflow fenomena even after the mechanical obstacles and in 5 cases (18.5%) that were successfully treated with further dilatation, the acute in-stent thrombosis was observed. The infarct-related artery was most often the left anterior descending coronary artery, namely in 16 cases (54%). CONCLUSION: IIb/IIIa platelet blockers in primary coronary angioplasty administered either preventively or as rescue therapy are highly effective, relatively safe and improve the effectiveness of mechanical reperfusion. The total in-hospital mortality of this group of patients was 10%.