[Thrombolysis: Bucarest registry]. / La thrombolyse. Registre roumain de Bucarest.

The end-point of this retrospective study was to evaluate the standard of care in terms of in-hospital morbidity and mortality for patients with acute myocardial infarction (AMI) treated by thrombolysis within the first 12 hours from the start of the symptoms in five cardiology centers from Bucarest for a period of 5 years (2000-2004). This retrospective registry on a central database included 1814 patients (73.63% men, mean age 59.9 +/- 11.8 years), presented in an average time of 211.63 minutes from pain start. The most frequently used fibrinolitic was streptokinase (66.21%), administered most often in 30 minutes and for a subgroup in 20 minutes--accelerated regimen, with a good efficiency for the reperfusion of the culprit vessel evaluated non-invasively (clinical, electrical and biological methods). The global in-hospital mortality was 11.1%. The only predictors of in-hospital mortality were female gender and advanced age (>75 years) [p < 0.05]. The rate of haemorrhagic complications was not different from the one described by other clinical studies. The treatment by anticoagulants, antiaplatelets agents like aspirin, ACE inhibitors and statins were significant determinants of in-hospital survival. In the subgroup followed-up for 1 year (315 patients), the most frequent complication was the heart failure. In conclusion, in Bucarest, where availability of primary angioplasty in AMI was limited, thrombolysis with streptokinase was still very much used, with acceptable low in-hospital mortality and relatively high rate of artery reperfusion appreciated by non-invasive methods.

Correlated biochemical modifications of plasma lipoproteins in coronary heart disease: an accelerating pathologic factor.

We investigated the presence of biochemically modified plasma lipoproteins as pathologic factor for coronary heart disease in 15 patients with angina pectoris (CHD-P) vs 20 normal subjects (N). Decreased HDL were the most significant pathological feature present in P over 66 years old, while, P under 66 had, in addition to low HDL-Cholesterol (HDL-C), high levels of plasma cholesterol (C), LDL-Cholesterol (LDL-C), and lipid peroxides (TBARS), together with the presence of desialylated LDL and VLDL. We demonstrated by statistic analysis that these risk factors are correlated: high plasma C with a more pronounced imbalance between LDL and HDL, which, in turn, is associated with high TBARS levels, and also with circulating desialylated VLDL; high plasma TBARS values with desialylated LDL. We detected an increased level of autoantibodies towards autologous LDL and VLDL, in P vs N. The level of autoantibodies anti-LDL correlated with LDL-C level and with LDL desialylation, thus modified circulating LDL being most probably atherogenic. Circulating anti-LDL autoantibodies together with the low level of HDL might contribute to acceleration and aggravation of the atherosclerotic process.

[Sudden death in acute myocardial infarct in hospitalized patients: a clinical and anatomicopathological study over a 10.5-year period]. / Moartea subita în faza acuta a infarctului de miocard la bolnavi spitalizati: studiu clinic si anatomopatologic pe o perioada de 10.5 ani.

The paper reports on the study of 1457 patients with acute myocardial infarct (Ami) admitted in the word of the cardiac intensive care of the clinic for 10.5 years. The general mortality was of 21.2% and the sudden death (defined as such when appeared suddenly within less than 1 hour from the onset of the acute symptoms, but after 24 hours from the onset of AMI in a patient apparently equilibrated) appeared in 114 patients who were examined postmortem (43.3% of the total of the deaths). The main causes of the SD was rupture of the myocardium (28.8% of the general mortality), primary ventricular fibrillation (22.0%) and thromboembolic phenomena (17.8%). The sudden death by rupture of the myocardium appeared in a first AMI, usually large and was not helped by the anticoagulant treatment or by other therapy. Primary ventricular fibrillation appeared during the first week from the onset and was favoured by the ventricular hyperexcitability and active myocardial ischemia (which were not specific). Xyline (only more than 2 mg/min) and amiodarone gave a good protection. The sudden death by systemic thromboembolization appeared almost only in the antero-lateral myocardial infarcts, 5-8 days after the onset. The appearance of a small flow syndrome "sine materia" with or without association of some recurrent arrhythmias was suggested. Efficient anticoagulation prevented systemic thromboembolization and, to a smaller extent to pulmonary thromboembolization.

[The etiological spectrum of mitral insufficiency: a 10-year retrospective study]. / Spectrul etiologic al insuficientei mitrale: studiu retrospectiv pe 10 ani.

The incidence, etiology and data on the severity and therapeutic implications of the mitral insufficiency were investigated in the patients admitted in the clinic during 10 years. The diagnosis was based mainly on clinical and echocardiography mode M data. 595 patients suffering from mitral insufficiency (below 2% of the total of the patients admitted) were recorded. In 65% of the cases mitral insufficiency had a rheumatic etiology (the majority associated polyvalvulopathies), in 14.8% an ischaemic origin, and in 10.9% an organic-functional one (the left ventricle was dilated). The primary prolapse of the mitral valve appeared in 6.9% of the cases (the low incidence was explained by the severe criteria applied in positive diagnosis). 4 cases of rupture of the subvalvular apparatus are described in the patients suffering from prolapse. All of them had a sudden onset, by severe cardiac insufficiency without a clear cause, appeared under conditions of seemingly complete health. Intense therapy followed by valvular prosthesis, resulted in a spectacular recovery of the heart function.