Angiographic patency study of an albumin-free recombinant streptokinase formulation in acute myocardial infarction.

PURPOSE: Fibrinolytic therapy restores coronary patency and reduces mortality in patients with acute myocardial infarction. Albumin is present in most of the streptokinase formulation as a stabilizer but it is not known whether it plays a role in the product's efficacy and safety profiles. The aim of this study was to assess 90 minutes-coronary patency of a new albumin-free recombinant streptokinase (rSK) formulation. METHODS . Patients with ischemic chest pain and ST-segment elevation, less than 12 hours after symptoms onset, without contraindications for fibrinolytic therapy, were included to receive 1.5 x 10(6) IU of rSK in a one-hour intravenous infusion. Angiography was performed 90 minutes after and coronary patency was classified according to the TIMI flow scales. RESULTS: The study enrolled 25 patients, 59.4 +/- 9.2 years-old, 88% men and 92% white. The mean time interval between the symptoms onset and rSK infusion was 3.0 +/- 2.0 hours. Patency rate (TIMI 2-3) of the infarct-related vessel was 72% (18/25). Partial or complete ST-segment resolution was achieved in 17 patients (68%). Hypotension and nauseas were the most frequent adverse events. Haemorrhage or in-hospital deaths were not reported. CONCLUSIONS: This study suggests that intravenous albumin-free rSK is a safe and appropriate therapy to get early (90-minute) coronary patency in patients with acute myocardial infarction.

Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms.

BACKGROUND: Microvascular disease is proposed as a cause of segmental myocardial blood flow abnormalities and heterogeneous myocardial perfusion in cardiac syndrome X. OBJECTIVE: To assess if myocardial ischemia can be evidenced through both perfusion abnormalities and poststress left ventricular ejection fraction (LVEF) reduction by gated single photon emission tomography (SPECT) myocardial scintigraphy in women with syndrome X in a similar way to those with epicardial coronary lesions. METHODS: Three groups of postmenopausal women were studied: group I, 20 women with angina, perfusion defects, and normal coronary angiography; group II, 20 women with epicardial coronary lesions (> or =50% of coronary lumen reduction); group III, 15 volunteers without signs or symptoms of ischemia (control group). Each underwent technetium-99m ((99m)TC) methoxyisobutylisonitrile gated SPECT myocardial scintigraphy (protocol: exercise-stress-rest), brachial artery endothelial function measured by ultrasonography, and lipidogram. RESULTS: Groups I and III patients had a higher body mass index (BMI). There were more smokers in groups I and II. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides were higher in group II patients. The brachial artery vasodilator responsiveness after 5 minutes of ischemia was similarly lower in patients of groups I and II compared with those of group III (3% vs. 6.5%, respectively; p = 0.03 group III vs. group I and group II). Mean DeltaLVEF (LVEF poststress minus LVEF at rest) was -3.86%, -2.90%, and 4.18% in groups I, II, and III, respectively (p = NS between I and II, p = 0.005 between II and III, and p = 0.003 between I and III). In 43% of group I patients and in 10 of 18 group III patients with perfusion defects, there was a poststress LVEF reduction >5%. CONCLUSIONS: Stress-induced ischemia is associated with poststress LVEF reduction as a probable manifestation of myocardial stunning in postmenopausal women with typical angina and normal coronary angiography.

Angiographic patency study of an albumin-free recombinant streptokinase formulation in acute myocardial infarction

PURPOSE: Fibrinolytic therapy restores coronary patency and reduces mortality in patients with acute myocardial infarction. Albumin is present in most of the streptokinase formulation as a stabilizer but it is not known whether it plays a role in the product's efficacy and safety profiles. The aim of this study was to assess 90 minutes-coronary patency of a new albumin-free recombinant streptokinase (rSK) formulation. METHODS . Patients with ischemic chest pain and ST-segment elevation, less than 12 hours after symptoms onset, without contraindications for fibrinolytic therapy, were included to receive 1.5 x 106 IU of rSK in a one-hour intravenous infusion. Angiography was performed 90 minutes after and coronary patency was classified according to the TIMI flow scales. RESULTS. The study enrolled 25 patients, 59.4 ± 9.2 years-old, 88 percent men and 92 percent white. The mean time interval between the symptoms onset and rSK infusion was 3.0 ± 2.0 hours. Patency rate (TIMI 2-3) of the infarct-related vessel was 72 percent (18/25). Partial or complete ST-segment resolution was achieved in 17 patients (68 percent). Hypotension and nauseas were the most frequent adverse events. Haemorrhage or in-hospital deaths were not reported. CONCLUSIONS. This study suggests that intravenous albumin-free rSK is a safe and appropriate therapy to get early (90-minute) coronary patency in patients with acute myocardial infarction(AU)

PROPÓSITO: Terapia fibrinolítica restablece la permeabilidad coronaria y reduce la mortalidad en pacientes con infarto agudo de miocardio. Albúmina está presente en la mayoría de la estreptoquinasa como la formulación de un estabilizador, pero no se sabe si juega un papel en la eficacia del producto y los perfiles de seguridad. El objetivo de este estudio fue evaluar 90 minutos permeabilidad coronaria de un nuevo albúmina libre de la estreptoquinasa recombinante (RSK) formulación. MÉTODOS. Los pacientes con dolor torácico y elevación del segmento ST, a menos de 12 horas después de los síntomas de inicio, sin contraindicaciones para la terapia fibrinolítica, se incluyeron para recibir 1,5 x 106 UI de RSK en una hora en perfusión intravenosa. Angiografía se realizó 90 minutos después de permeabilidad coronaria y se clasifican de acuerdo con el flujo TIMI escalas. RESULTADOS. El estudio reclutó 25 pacientes, 59,4 ± 9,2 años, 88 por ciento hombres y 92 por ciento blanco. La media de intervalo de tiempo entre la aparición de los síntomas y RSK perfusión fue de 3,0 ± 2,0 horas. Tasa de permeabilidad (TIMI 2-3) de los buques relacionados con el infarto fue del 72 por ciento (18/25). Parcial o completa del segmento ST resolución se logró en 17 pacientes (68 por ciento). Hipotensión y náuseas fueron los acontecimientos adversos más frecuentes. Hemorragia en el hospital o no se informaron muertes. CONCLUSIONES. Este estudio sugiere que la albúmina intravenosa sin RSK es un tratamiento seguro y apropiado para obtener temprano (90 minutos) permeabilidad coronaria en pacientes con infarto agudo de miocardio