[Comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in patients with acute ST elevation myocardial infarction].

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

[Changes in the binding properties of albumin in patients with myocardial infarction].

The purpose of the study was to measure the levels of albumin and to evaluate its binding properties in patients with acute large-focal myocardial infarction (AMI) hospitalized within the first 24 hours of AMI onset. Two groups were formed: group one--41AMI patients without cardiogenic shock (CS) and group two--15 patients with AMI complicated by true CS. Blood samples were taken from an ulnar vein on the first, second, third, fifth, seventh, and fourteenth day after AMI onset. The properties of binding albumin centers were determined using fluorescent method (K-35 probe). Total albumin concentration (TAC), effective albumin concentration (EAC), and albumin binding reserve (ABR) were determined. The results were presented as M +/- m. A significant increase in TAC on the fifth day (from 43 +/- 1 to 40 +/- 1 g/l) and EAC on the second, third, fifth, and seventh days (from 36 +/- 1 to 32 +/- 1 g/l with the minimal level on the fifth day), and in ABR on the second day (from 83.3 +/- 1.3 to 78.8 +/- 8%) were registered in group one. TAC returned to the normal level on the seventh day, EAC did not become normal until the fourteenth day, while ABR did not normalize within the period of two weeks. Eleven patients in group two died (hospital CS-associated mortality was 73.3%). TAC and EAC in discharged patients were 43.4 +/- 0.9 g/l and 35.8 +/- 0.8 g/l, respectively, while these parameters in the deceased were 35.5 +/- 1.7 g/l (p < 0.0001) and 27.3 +/- 1.7 g/l (p < 0.0001), respectively. CS developed in 70% of cases (seven out of ten patients) in whom TAC was less than 36 g/l vs. 17.4% of cases (eight out of 46) with a TAC of 36 g/l or more (p = 0.0013). When EAC was less than 30 g/l CS developed in 72.7% of cases (eight out eleven patients) vs. 15.6% of cases (seven out of 45) with an EAC of 30 g/l or more (p = 0.0003). Six out of ten patients (60%) with a TAC of less than 36 g/l died. Lethal outcome also occurred in five cases out of 46 or 10.9% with a TAL of 36 g/l or more (p = 0.0008). Seven out of eleven or 63.6% patients with an EAC of less than 30 g/l died. Four out of 45 patients (8.9%) with an EAC of 30 g/l or more died (p = 0.0001). Thus, the study found that a low (less than 36 g/l) TAC and EAC (less than 30 g/l) during the first 24 hours of AMI was associated with a significantly higher frequency of true CS and with a significantly higher hospital lethality. Determining albumin parameters during the first 24 hours of AMI will be useful in distinguishing a group of patients with a high risk of lethal outcome, which will make it possible to begin early aggressive therapy directed towards limiting myocardial necrosis.

[Effectiveness of external mechanical recanalization in the treatment of cardiogenic shock in patients with myocardial infarction].

Attempts of mechanical coronary artery recanalization (angioplasty) were undertaken in 52 patients with acute myocardial infarction and cardiogenic shock. In 28 patients (53.9%) recanalization was successful while in 24 it was not (in-hospital mortality 39.3 and 87.5%, respectively, p<0.001). Overall 11 and 21 patients died among those with (n=28) and without (n=24) successful recanalization, respectively. Among patients with successful recanalization survivors compared with nonsurvivors had shorter time from onset of myocardial infarction to recanalization (11.44+/-2.86 vs 16.8+/-3.4 hours, respectively). No serious complications occurred during invasive interventions.