[Repeat thrombolysis in acute myocardial infarction].
During two years period (Jul. 97-Aug. 99) data of patients suffering from recurrent acute myocardial infarct within 6 days were compared by retrospective analysis. In this interval authors treated 58 patients with recurrent myocardial infarct. 22 patients were transmitted to a catheterisation lab, data of the other 36 patients were compared. There were two treatment groups: 18 patients received repeated thrombolysis (IT group), and 18 patients got conventional therapy (HT group). In the thrombolytic group 15 patients received streptokinase infusion again, and urokinase infusion was administred in 3 patients at second time. The patients were not transferred to a cath lab, because of their older ages (10 patients), or capacity problems (13 patients), or in absence of their signed consent (13 patients). Comparisons were made on the basis of non invasive diagnostic procedures (reperfusion signs suggested by ECGs and enzymatic changes, and left ventricular ejection fraction at discharge), bleeding rate, and frequency of recurring angina at the 3 months visit, and on the basis of mortality. Ejection fractions and reperfusion signs were better in the repeated thrombolytic group (time of maximal level ST elevation: IT 19.70 +/- 6.00 min, HT 23.17 +/- 5.15 min, p = 0.26 NS; T wave inversion time within six hours: IT 168 +/- 45.17 min, HT 170 +/- 58.99 min, p = 0.94; reperfusion arrhythmia: IT 7, HT 3, p = 0.15; CK peak time: IT 16.89 +/- 6.94 hour, HT 20.00 +/- 6.72 hour, p = 0.18 NS; CK-MB peak time: IT 12.22 +/- 7.19 hour, HT 16.67 +/- 6.17, hour, p = 0.55; > 3 x CK peak time: IT 14.18 +/- 6.03 hour, HT 20.00 +/- 7.37 hour, p = 0.06, > 3 x CK-MB peak time: IT 8.80 +/- 4.54 hour, HT 15.20 +/- 6.19 hour, p = 0.02, ECHO EF: IT 48.53 +/- 6.81%, HT 43.14 +/- 4.90%, p = 0.02, Isotope ventriculography EF: IT 50.87 +/- 5.45%, HT 44.57 +/- 4.89%, p = 0.003), however the bleeding rate was moderately higher (minor bleeding: IT 7, HT 3, p = 0.15, major bleeding: IT 3, HT 1). The frequency of ischemic episodes at 3-month visit, and 3-month mortality were similar in the two groups (episodes of angina: IT 2.00 +/- 1.57, HT 2.42 +/- 1.88, p = 0.55; mortality: IT 4, HT 6, p = 0.46). Repeated thrombolysis is an effective therapeutical tool in centres without cath lab--according to the risk-benefit ratio too--in the case of early repeated myocardial infarct.
Király
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Bács-Kiskun Megyei Onkormányzat Kórháza, a Szegedi Tudományegyetem Altalános Orvostudományi Kar, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum.
Timár
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D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D013300:Streptokinase; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator