ABSTRACT
PURPOSE: The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization. PATIENTS AND METHODS: During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel. RESULTS: Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patients for GUSTO were treated: (1) without any reperfusion therapy (n = 449), (2) by mechanical revascularization (n = 97), or (3) given 1.5 million units of streptokinase (n = 85) outside of the GUSTO protocol. The inhospital and 1-year post-discharge mortality rates were 6% and 2% in patients included in the GUSTO study; 6% and 5% in those mechanically reperfused; 15% and 10% in those treated with thromoblysis despite ineligibility for the GUSTO trial, and 15% and 13% among patients not treated with any reperfusion therapy. CONCLUSIONS: Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligible for thrombolysis according to the GUSTO criteria, but nevertheless treated with a thrombolytic agent were exposed to an increased risk.
Subject(s)
Myocardial Infarction/therapy , Actuarial Analysis , Aged , Female , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/mortality , Myocardial Revascularization , Prognosis , Survival Analysis , Thrombolytic Therapy , Treatment OutcomeABSTRACT
To compare the long-term prognosis of a group of patients treated by an early invasive approach after a non-Q-wave anterior wall acute myocardial infarction (AMI) with a similar group treated conservatively, data from 110 consecutive patients with non-Q-wave AMI were retrospectively obtained from 3 different hospitals: (1) a hospital with coronary angioplasty and coronary bypass facilities favoring on early invasive approach, (2) a hospital with a catheterization laboratory and no coronary angioplasty or coronary bypass facilities, and (3) a community hospital without a catheterization laboratory. Patients were divided according to the presence or absence of an early invasive approach: those who had undergone in-hospital catheterization and revascularization (n = 55) and those with a conservative approach (n = 55). The early invasive approach resulted in a significant decrease in major events. The rate of recurrent myocardial infarction was 29% in the conservative group versus 7.2% in the invasive group (p = 0.025). Survival rate curves at 3-year follow-up showed significant differences in mortality (p = 0.001), recurrent myocardial infarction (p = 0.002), recurrent angina pectoris (p = 0.001), and development of congestive heart failure (p = 0.05). Multivariate analysis disclosed the early invasive approach to be an independent predictor for decreasing the likelihood of recurrent infarction by 86% (odds ratio 0.14, confidence intervals 0.04 to 0.48, p = 0.0006), and for decreasing the likelihood of recurrent angina by 66% (odds ratio 0.34, confidence intervals 0.18 to 0.63, p < 0.005). The early invasive strategy may result in an improved outcome in the treatment of patients with non-Q-wave anterior wall AMI compared with patients treated conservatively.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Myocardial Infarction/therapy , Aged , Angina Pectoris/etiology , Confidence Intervals , Electrocardiography , Female , Follow-Up Studies , Heart Failure/etiology , Humans , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/mortality , Myocardial Infarction/surgery , Odds Ratio , Prognosis , Recurrence , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
Lack of postextrasystolic potentiation in a normal heart is described. The phenomenon might be attributed to calcium channel blocker treatment. We could not find a previous description of such a phenomenon in the English literature.
Subject(s)
Cardiac Complexes, Premature/physiopathology , Heart/physiopathology , Cardiac Catheterization , Female , Humans , Middle AgedABSTRACT
A one-month-old infant developed atypical ventricular tachycardia, complete right bundle branch black, and alternating 2:1 Osborn waves during spontaneous mild hypothermia; 10 h after rewarming, the electrocardiogram was normal.
Subject(s)
Hypothermia/complications , Muscle Hypotonia , Tachycardia/etiology , Bundle-Branch Block/etiology , Bundle-Branch Block/physiopathology , Electrocardiography , Humans , Infant, Newborn , Male , Muscle Hypotonia/complications , Tachycardia/physiopathologyABSTRACT
A patient with isolated right ventricular ischemia and infarction is presented. ST elevation in leads V1 to V4 mimicking anteroseptal myocardial infarction was recorded at admission and during episodes of chest pain later on. Noninvasive and invasive workup suggested isolated right ventricular infarction and ischemia due to an occluded small and nondominant right coronary artery.