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Introducción y Objetivos La coronariografía invasiva (CI) es el patrón estándar para el estudio de las coronarias con un bajo índice de complicaciones. La tomografía computarizada multicorte (TCMC) permite el estudio mínimamente invasivo del árbol coronario. El objetivo del presente trabajo estuvo dirigido a determinar la precisión de la TCMC para detectar estenosis coronaria significativa (ECS) según puntaje de calcio y frecuencia cardíaca. Material y métodos Se estudiaron 62 pacientes, 50 del sexo masculino, a los que se les realizó primero la coronariografía por TCMC y luego la CI, con una media de 45 días, previo consentimiento informado. Se determinaron la sensibilidad (S), la especificidad (E), el valor predictivo positivo (VPP), el valor predictivo negativo (VPN) y la precisión predictiva (PP) por paciente y arterias según puntaje de calcio y frecuencia cardíaca. Resultados La S, la E, el VPP, el VPN y la PP por arterias fueron, respectivamente, con puntaje de calcio menor o igual a 400 UA del 98%, 98%, 89%, 99% y 98% y con puntaje mayor de 400 UA, del 75%, 50%, 75%, 50% y 67%. En los 54 pacientes con frecuencia cardíaca menor o igual a 65 latidos por minuto, la S, la E, el VPP, el VPN y la PP fueron del 100%, 96%, 96%, 100% y 98,1% y en los 8 pacientes con frecuencia cardíaca mayor de 65 latidos por minuto fueron del 50%, 66,7%, 33%, 80% y 62,5%, respectivamente. Conclusiones El puntaje de calcio por encima de 400 UA por paciente y arterias, como también la frecuencia cardíaca mayor de 65 latidos por minuto, disminuyen la precisión diagnóstica de ECS a través de la TCMC.
Introduction and Objectives Invasive coronariography (IC) is the gold standard for the study of coronary arteries with a low percentage of complications. Multislice computerized tomography (MSCT) allows the minimally invasive study of the coronary tree. The objective of the present study was aimed at determining the accuracy of MSCT in the detection of significant coronary stenosis (SCS) by calcium score and heart rate. Material and Methods The 62 patients enrolled in the study (50 males) underwent a coronariography with MSCT, and later the IC, with a mean of 45 days, after signature of an informed consent. Sensitivity (Se) was assessed, as well as specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) per patient and arteries, according to calcium score and heart rate. Results Se, Sp, PPV, NPV and PA per arteries, with a calcium score lower or equal to 400 AU were, respectively 98%, 98%, 89%, 99% and 98%, and with a score higher than 400 AU, of 75%, 50%, 75%, 50% and 67%. In 54 patients with heart rate lower or equal to 65 beats per minute, Se, Sp, PPV, NPV and PA were 100%, 96%, 96%, 100% and 98,1% and in the 8 patients with heart rate higher than 65 beats per minute were 50%, 66.7%, 33%, 80% and 62.5%, respectively. Conclusions Calcium score above 400 AU per patient and arteries, as well as the heart rate over 65 beats per minute, decrease the diagnostic accuracy of SCS by means of MSCT.
RESUMEN
PURPOSE: Fibrinolytic therapy restores coronary patency and reduces mortality in patients with acute myocardial infarction. Albumin is present in most of the streptokinase formulation as a stabilizer but it is not known whether it plays a role in the product's efficacy and safety profiles. The aim of this study was to assess 90 minutes-coronary patency of a new albumin-free recombinant streptokinase (rSK) formulation. METHODS . Patients with ischemic chest pain and ST-segment elevation, less than 12 hours after symptoms onset, without contraindications for fibrinolytic therapy, were included to receive 1.5 x 10(6) IU of rSK in a one-hour intravenous infusion. Angiography was performed 90 minutes after and coronary patency was classified according to the TIMI flow scales. RESULTS: The study enrolled 25 patients, 59.4 +/- 9.2 years-old, 88% men and 92% white. The mean time interval between the symptoms onset and rSK infusion was 3.0 +/- 2.0 hours. Patency rate (TIMI 2-3) of the infarct-related vessel was 72% (18/25). Partial or complete ST-segment resolution was achieved in 17 patients (68%). Hypotension and nauseas were the most frequent adverse events. Haemorrhage or in-hospital deaths were not reported. CONCLUSIONS: This study suggests that intravenous albumin-free rSK is a safe and appropriate therapy to get early (90-minute) coronary patency in patients with acute myocardial infarction.
