Confirmation that heparin is an alternative means of promoting early reperfusion.

BACKGROUND: New strategies to increase coronary patency rate before primary angioplasty are under discussion. We tested the hypothesis that use of a high dose of a standard heparin bolus could achieve an acceptable rate of re-opening occluded infarct-related arteries thus providing an alternative to chemical thrombolysis before admission of the patient to hospital, and a pretreatment for primary angioplasty. METHODS: Forty-eight patients who presented within 12 h of acute myocardial infarction with ST segment elevation were assigned randomly to groups to receive aspirin (200 mg orally) and high-dose standard heparin 300 U/kg as an intravenous bolus (n = 25), or aspirin and placebo bolus (n = 23). Thereafter, all patients underwent coronary arteriography to assess their suitability for primary angioplasty. RESULTS: The high-dose heparin group had greater patency rate (Thrombolysis in Myocardial Infarction grade 2 or 3 flow in the infarct-related artery) than the placebo group (52% compared with 13%, P = 0.006). Hemorrhages related to the puncture site that required blood transfusion occurred in two of 25 and in one of 23 patients in the high-dose heparin and placebo groups, respectively. CONCLUSION: Our study suggests that high-dose standard heparin does have a thrombolytic action when administered as an intravenous bolus.

[Difference of hospital mortality of acute myocardial infarction between men and women treated with primary angioplasty]. / Diferença de letalidade hospitalar do infarto agudo do miocárdio entre homens e mulheres submetidos a angioplastia primária.

PURPOSE: To compare the in-hospital case-fatality rate of men and women submitted to percutaneous transluminal coronary angioplasty (PTCA) as a strategy of reperfusion in acute myocardial infarction (MI). METHODS: A retrospective cohort study based on information abstracted from medical records of MI patients admitted to a hospital where PTCA is used as the preferred method for early myocardial reperfusion. A total of 83 patients, 35 (42%) women and 48 (58%) men, who met the criteria for early myocardial reperfusion was included in the analysis. RESULTS: The mean age of women was higher than that of men (66 +/- 10 vs 58 +/- 11 years; p < 0.001). The women also had a higher frequency of diabetes mellitus (37.1% vs 6.4%; p < 0.001). Despite these differences in age and in the frequency of diabetes mellitus, the percentage of patients in whom the PTCA was considered successful was similar between men (83.3%) and women (82.3%). The case-fatality rate was also similar between men and women; 14.6% and 14.3%, respectively. CONCLUSION: The possibility that the excess risk of death in women with MI may be reduced and even eliminated with the use of PTCA, supports to the need for the development of a clinical trial to assess this question.