[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.

[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.

[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.

[Study of the effect of the restoration of coronary blood flow on left-ventricular contractility in patients with acute myocardial infarction based on the data of computerized two-dimensional echocardiography]. / Vliianie vosstanovleniia koronarnogo krovotoka na sokratitel'nuiu funktsiiu levogo zheludochka u bol'nykh ostrym infarktom miokarda po dannym komp'iuternoi dvukhmernoi ékhokardiografii.

Total and local left-ventricular contractility was assessed by computerized two-dimensional echocardiography in 52 patients with acute myocardial infarction. Three groups of patients were identified: those with recovered coronary flow (group 1), reperfusion failure (group 2) and the lack of occlusion at first coronarography (group 3). Patients from group 3 showed the most intact left-ventricular myocardial contractility and the most favorable clinical course of the disease, while second-group patients had particularly impaired left-ventricular contractility. In the first group, the size of the asynergic area diminished by day 28 of the disease to a greater extent, as compared to the second group. Therefore, coronary reperfusion within the first 6 hours after the attack shows correlation to a smaller asynergic zone and a more favorable clinical course of the disease.

[Blood coagulation shifts in patients with myocardial infarction treated with streptokinase]. / Gemokoagulologicheskie sdvigi u bol'nykh infarktom miokarda na fone terapii streptokinazoi.

Variation in major coagulation parameters was assessed in 87 patients with acute myocardial infarction, treated with streptokinase and/or heparin under angiographic control. Streptokinase treatment was associated with a drop in plasma fibrinogen, plasminogen and alpha 2-antiplasmin, and an increase in serum fibrin/fibrinogen degradation products. The magnitude of coagulation shifts was greater in case of intravenous streptokinase infusion (1,000,000 units over 60 min), as compared to intracoronary streptokinase administration in lower doses (120,000-180,000 units over 60-90 min). In all patients with regained coronary flow, fibrinogen, plasminogen and alpha 2-antiplasmin levels began to decline significantly earlier and/or became normal significantly later, as compared to patients with persisting coronary occlusion. The rates and severity of hemorrhagic complications were basically similar in intravenous and intracoronary routes of administration, in spite of different doses and magnitude of coagulation shifts.

[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.

[Coronary thrombolysis after intracoronary and intravenous administration of streptokinase to myocardial infarct patients]. / Koronarnyi trombolizis pri vnutrikoronarnom i vnutrivennom vvedenii streptokinazy u bol'nykh infarktom miokarda.

Coronary thrombolysis by intracoronary and intravenous streptokinase (SK) is reported in myocardial infarction patients. Forty-two patients were examined within the first 6 hours of infarction: they were subjected to coronary-angiography on admission and 24 hours later, and their plasma fibrinogen levels were measured repeatedly for 2 days. SK administration was intracoronary in 24 patients and intravenous in 18. Rapid intravenous SK injection was not inferior to intracoronary administration in terms of efficiency. Although coronary reperfusion takes a somewhat longer time in cases of intravenous SK treatment, its technical simplicity and relative safety, as well as the fact that it can be started early suggest that it is a promising method of treatment for 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.