RESUMO
BACKGROUND: New strategies to increase coronary patency rate before primary angioplasty are under discussion. We tested the hypothesis that use of a high dose of a standard heparin bolus could achieve an acceptable rate of re-opening occluded infarct-related arteries thus providing an alternative to chemical thrombolysis before admission of the patient to hospital, and a pretreatment for primary angioplasty. METHODS: Forty-eight patients who presented within 12 h of acute myocardial infarction with ST segment elevation were assigned randomly to groups to receive aspirin (200 mg orally) and high-dose standard heparin 300 U/kg as an intravenous bolus (n = 25), or aspirin and placebo bolus (n = 23). Thereafter, all patients underwent coronary arteriography to assess their suitability for primary angioplasty. RESULTS: The high-dose heparin group had greater patency rate (Thrombolysis in Myocardial Infarction grade 2 or 3 flow in the infarct-related artery) than the placebo group (52% compared with 13%, P = 0.006). Hemorrhages related to the puncture site that required blood transfusion occurred in two of 25 and in one of 23 patients in the high-dose heparin and placebo groups, respectively. CONCLUSION: Our study suggests that high-dose standard heparin does have a thrombolytic action when administered as an intravenous bolus.
Assuntos
Fibrinolíticos/administração & dosagem , Heparina/administração & dosagem , Reperfusão Miocárdica/métodos , Idoso , Angioplastia Coronária com Balão , Aspirina/administração & dosagem , Terapia Combinada , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Fatores de TempoRESUMO
PURPOSE: To evaluate the capacity of two-dimensional echocardiogram (2D-Echo) to establish the severity of endomyocardial fibrosis (EMF) in comparison with angiography (Angio). METHODS: Twelve patients with EMF were prospectively studied by both: 2D-Echo and Angio. The mean age was 24.6 +/- 6.6 years (14 to 35), with 8 women and 4 men. To compare the severity by the 2 methods the obliterative process was graded according to its extension relative to the long axis of the respective, in diastole, as follows: 1 + only apical: 2 + less than 50% and 3 + greater than or equal to 50% from the apex to the atrioventricular valve level. RESULTS: All patients (100%) had biventricular disease by Angio, with right ventricle (RV) predominance in 5 (42%), left ventricle (LV) predominance in 1 (8%) and balanced in 6 (50%). By 2D-Echo the se numbers were: 11 (92%), 5 (42%), 1 (8%) and 5 (42%), respectively. The degree of concordance between 2D-Echo and Angio was 100% for the RV and 75% for the LV (p less than 0.005). In only 1 patient the LV apical involvement (+) was not identified by 2D-Echo. Mitral insufficiency (MI) was detected in 7 (58%) and tricuspid (TI) in 11 (92%) patients by Angio. These patients, expect one, had the corresponding atrial area greater than 18 cm2 by 2D-Echo. It was observed a statistically significant correlation between the atrial area and the degree of AV valve insufficiency (MI p less than 0.005; TI p less than 0.05). Paradoxical movement of the interventricular septum (IVS) was noted in 6 (50%) patients, associated with predominant RV disease, severe TI and mild or absent MI. CONCLUSION: The 2D-Echo, a valuable non-invasive method to diagnose and to grade severity of the fibrotic involvement of the ventricles by EMF, has a good correlation with Angio.