[Role of fibrin D-dimer in acute coronary syndrome. Prospective study of 22 cases]. / Intérêt des D-dimères dans les syndromes coronariens aigus. Etude prospective à propos de 22 cas.

Fibrin D-dimer are the consequence of an excess of fibrinolysis. The raise of their level in coronary heart disease seems to be helpful to enhance the diagnosis of coronary ischemia. Prospective study over 4 months, including 22 patients (16 male, 6 female) divided in 2 subgroups: Group I: 10 patients investigated for stable angina Group II: 12 patients investigated for ACS without ST elevation. All patients underwent fibrin D-dimer dosage and coronarography. Fibrin D-dimer levels were higher in group II (924.5 ng/ml vs 703.9 ng/ml; p < 0.0001). In group II, 6 patients had ST depression with a level of fibrin D-dimer 879.5 ng/ml vs 969.6 ng/ml in the other 6 patients. We found a positive correlation between level of fibrin D-dimer and complexity of coronary lesions (1007 ng/ml in type C vs 675 ng/ml in type A lesions; p < 0.0001). Fibrin D-dimer seems highly implicated in coronary disease and if these results are confirmed by larger studies their routine dosage will be helpful in ACS.

[GPIIB/IIIA blockade after high-risk angioplasty: new perspectives]. / Les anti-GPIIB/IIIA, de l'angioplastie a haut risque vers de nouvelles perspectives.

The treatment of acute coronary syndromes knows today revolution, with the clinical use of platelet glycoprotein IIb/IIIa inhibitors. The benefit of these agents as adjunctive treatment for percutaneous coronary intervention has been substantial and consistently proved among trials; however patients undergoing revascularization after drug discontinuation demonstrated a moderate event reduction. In this analysis, including the entire large-scale trial experience of intravenous glycoprotein IIb/IIIa inhibitors, we try to evaluate this therapeutic class in the high risk coronary intervention, in patients with acute coronary syndromes primarily medically managed, and in combination therapy with thrombolytics in the acute myocardial infarction. The purpose was to demonstrate the reduction of cardiac events after administration of this drug in the different indications and to precise their different adverse effects.

[Role of low-molecular-weight heparin in acute coronary syndromes]. / Place des héparines de bas poids moléculaire dans les syndromes coronariens aigus.

Looking to their efficiency in the treatment of venous thrombosis and the problems caused by non fractioned heparins (NFH) in the treatment of acute coronary syndromes, several studies were realised to prove the interests of fractioned heparins (FH) as good alternative therapeutics in acute coronary syndromes. A fist attempt, FRISC study, showed that dalteparin was superior to the placebo given in patients receiving aspirin (75 mg daily). In the FRIC study the pursuit of dalteparin between the sixth and the fortieth day, at a low dose, don't give benefits compared to aspirin given simply. Enoxaparin seems to be superior to the NFH in ESSENCE and TIMI IIB studies:--In ESSENCE study witch was included 3171 patients with unstable angina or non Q wave myocardial infarction and all patients received aspirin, enoxaparin compared to NFH reduced significantly the combined risk of death, myocardial infarction, recurrent ischemia and the need of revascularisation. These benefits persisted after a year of the study:--TIMI IIB study realised in 3910 patients confirmed the results of ESSENCE study. Furthermore, their proved efficiency in unstable angina and the non Q wave myocardial infarction, a recent study published this year (2002) concluded that the use of FH, in patients with myocardial infarction and receiving fibrinolytic treatment (streptokinase), was associated of a less frequent major adverse cardiac evenment (MACE) than in patients receiving NFH.