[Thrombolytic therapy for acute myocardial infarction: circadian sensitivity]. / Tromboliticheskaia terapiia infarkta miokarda: sutochnaia chuvstvitel'nost'.

AIM: To identify additional factors which may influence the results of thrombolytic therapy (TT) with streptokinase in acute myocardial infarction (AMI). MATERIALS AND METHODS: 122 case histories of males treated with streptokinase for AMI were analyzed. The patients were subdivided into 3 groups according to TT effectiveness: effective (74 patients-60.7%, age 61.3 +/- 11.9 years, group 1); probably successful (13 patients-10.7%, age 68.9 +/- 9.3, group 2), unsuccessful (35 patients-28.6%, age 64.9 +/- 13.6, group 3). RESULTS: Between groups 1 and 3 there were no differences by age, AMI location, coronary risk factors (smoking, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary disease), previous MI, Q and non-Q-wave MI prevalence. Significant differences were, on the contrary, obtained for the Killip class (1.82 +/- 0.46 vs 2.26 +/- 0.74, p = 0.0001), fibrinogen level before TT (314.6 +/- 87.2 vs 215.5 +/- 121.9 mg%, p = 0.003), LVEF% (by echo) 24 hours after the treatment (41.9 +/- 6.3 vs 36.5 +/- 7.8, p = 0.0001), time delay of TT from AMI symptoms onset (2.45 +/- 1.14 vs 3.08 +/- 1.73 hours, p = 0.014). Circadian variation has been discovered for efficacy of streptokinase: in the evening (from 16 to 24 pm) the effectiveness of TT was highest--38.0% vs 14.7% (p = 0.005) and at night (from 24 pm to 08 am) the effect was the lowest--22.5% vs 41.2% (p = 0.024). Smoking was not an independent factor for TT success. CONCLUSION: Multiple regression analysis (step by step) has shown that the main independent determinants for TT success in males were: Killip class (p = 0.002), time delay of TT (p = 0.014), day time of TT beginning (p = 0.023) and MI location (p = 0.123). These findings may have several clinical implications, for example: dose adjustment of streptokinase for the time of day or preference for primary coronary angioplasty in the morning.

[Thrombolysis in myocardial infarction-outcome optimization methods]. / Tromboliticheskaia terapia infarcta miokarda-podkhody k optimizatsii.

Early reperfusion in acute myocardial infarction (AMI) has been shown to reduce the extent of myocardial necrosis and to improve short and long term prognosis. Gender, smoking, age and site of infarct location may be regarded as prognostic factors for the outcome of AMI and of thrombolytic therapy with streptokinase (STK). The aim of this study was to identify factors, which are related to the results of thrombolytic therapy by STK in AMI. 156 patients (122 males and 34 females) treated with STK were retrospectively analyzed: they were subdivided into 3 groups according to the presumed success of thrombolytic therapy based on the accepted clinical and angiographic TIMI flow criteria. Group 1 = successful (88 patients), group 2 = probably successful (20 patients) and group 3 = failed thrombolysis (48 patients). Multiple regression analysis showed that Killip class (p = 0.0005), time from pain onset to thrombolysis initiation (p = 0.02) and the time of the day in which thrombolysis began (p = 0.037) are independent major predictive factors for successful thrombolytic therapy by STK in AMI. Gender, age, smoking and some risk factors are not of similar predictive power. These results may guide us in the optimization of thrombolytic therapy by STK in AMI, different dose regimens for different times of day and probably preference for primary PTCA in the early morning hours.

[The clinical aspects of thrombolytic therapy with streptokinase in myocardial infarct]. / Klinicheskie aspekty tromboliticheskoi terapii streptokinazoi pri infarkte miokarda.

We analyzed retrospectively 130 case histories of patients treated with streptokinase for acute MI in our cardiological department. The patients were subdivided into three groups according to the expected success of thrombolysis: successful-50.8% (66 pts), probably successful-19.2% (25 pts) and unsuccessful-30% (39 pts). There was neither difference in age, sex, MI location, nor in risk factor prevalence between the groups. Two factors were found to have a significant impact on thrombolysis success: time lag between onset of pain and treatment (streptokinase) initiation (the shorter this period was the better were the results, p = 0.002) and the time of day when the treatment was initiated, i.e. a circadian influence. The response to the treatment was observed much more frequently during evening hours (55.6% versus 18.5%, p = 0.001). It is concluded that there are circadian variations in the response to streptokinase therapy which are related most probably to circadian variations in the fibrinolytic system activity.