Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy

Article Abstract:

The risk of fatal and nonfatal complications following anticlotting therapy for heart attack appears to be greater in women than in men. As part of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial, researchers studied 10,315 women and 30,706 men suffering from heart attacks treated at 1,081 hospitals in 15 countries. Four treatment regimens were used, involving heparin in combination with streptokinase and/or the plasminogen activator alteplase. Women suffered more complications due to shock, congestive heart failure and bleeding, and had a higher risk of death than men, even after adjustment for baseline differences between the sexes. On average, women arrived at the hospital 18 minutes later after onset of symptoms and were 7 years older than men. The time before treatment was also longer for women. After age-adjustment, women had higher incidences of smoking, hypertension and diabetes. Use of alteplase appeared to reduce mortality in both sexes.

author: Ohman, E. Magnus, Califf, Robert M., Topol, Eric J., White, Harvey D., Weaver, W. Douglas, Morris, Douglas, Betriu, Amadeo, Wilcox, Robert G., Aylward, Philip E., Sadowski, Zygmunt, Barbash, Gabriel I., Guerci, Alan
Health aspects, Evaluation, Women, Complications and side effects, Sex factors in disease, Disease sex factors, Women's health, Thrombolytic therapy

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Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block

Article Abstract:

Analysis of one portion of electrocardiograms, the ST segment, may help identify heart attacks in patients with left bundle-branch block (LBBB), an abnormal conduction of the heart impulse between ventricles. The presence of LBBB may hide indications of a heart attack, preventing diagnosis and treatment. Researchers developed distinct electrocardiographic criteria using the data of 131 patients with LBBB, chest pain, and confirmed heart attacks. The control group consisted of 131 patients without chest pain who had stable heart disease and LBBB. The most dependable sign of a heart attack was any degree of wave abnormality in the ST segment of at least 1 millimeter. On the other hand, changes in the QRS segment of the electrocardiogram were unexpectedly not useful markers of heart attacks.

author: Califf, Robert M., Topol, Eric J., Barbagelata, Alejandro, Pinski, Sergio L., Sgarbossa, Elena B., Underwood, Donald A., Gates, Kathy B., Wagner, Galen S.
Diagnosis, Physiological aspects, Electrocardiogram, Electrocardiography, Heart ventricle, Left, Left heart ventricle, Heart block

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Determinants of the use of coronary angiography and revascularization after thrombolysis for acute myocardial infarction

Article Abstract:

The use of coronary angiography or revascularization after a heart attack may depend on the patient's age and heart anatomy. Researchers analyzed the variables determining either procedure among 15,471 patients who underwent angiography and 8,973 revascularized patients. Statistical modelling revealed that younger age and the availability of procedures at the hospital mainly determined angiography utilization. The choice of revascularization was dependent on coronary anatomy, such as the nature of blocked arteries.

author: Califf, Robert M., Topol, Eric J., Weaver, W. Douglas, Miller, Dave P., Pilote, Louise, Rao, J. Sunil
Care and treatment, Standards, Usage, Practice guidelines (Medicine), Myocardial revascularization, Cardiac patients, Angiocardiography

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subjects list: Heart attack
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