[Acute kidney injury in patients with myocardial infarction and efficacy of thrombolytic therapy]

Aim of the study was to assess rate and severity of acute kidney injury (AKJ) (RIFLE and AKIN criteria) in patients with ST-elevation myocardial infarction (STEMI), to determine relationship between AKJ, mortality and effectiveness of thrombolytic therapy (TLT). We examined 146 patients (117 men, 29 women, mean age 56.7+/-10.8 ) with STEMI subjected to TLT with streptokinase. AKJ was diagnosed and classified according to RIFLE and AKIN criteria by creatinine (RIFLECr, AKINCr) and diuresis (RIFLEou, AKINou). TLT was effective in 104(71%) patients. AKJ was found in 74 (51%) according to RIFLECr and in 86 (59%) - AKINCr, in 51 (35%) - RIFLEou and AKINou criteria. Eight patients 8 (5%) died. Results of logistic regression analysis showed that AKJ according to RIFLEou or AKINou irrespective of sex, age, and time after appearance of symptoms to hospitalization, was associated with mortality (relative risk [RR] 12.9, 95% confidence interval [95%CI] 1.45-115,58, p=0.002). Thus more than 50% of STEMI patients have AKJ according to RIFLECr AKINCr criteria. Frequency of AKJ according to RIFLEou and AKINou was by 40% and one third less than that according to AKINCr and RIFLECr, respectively. Presence of AKJ was associated with TLT inefficacy and elevation of mortality.

Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following ST elevation myocardial infarction

OBJECTIVE

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase.

MATERIAL AND METHODS

This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A (successful thrombolysis) and group B (unsuccessful thrombolysis) using ECG criteria.

RESULTS

Total number of patients were 200. Group A included 136 (68%) patients and group B included 64 (32%) patients. There were total 88 (44%) patients of anterior MI with 47 patients in group A and 41 patients in group B (34.6% vs 64.0%, p < 0.001). There were total 110 (55.0%) patients of inferior MI with 88 patients in group A and 22 patients in group B (64.7% vs 34.4%, p < 0.001). Lateral myocardial infarction was diagnosed in 2 (1%) patients with 1 patient each in group A and group B (0.7% vs 1.6%, p = 0.583).

CONCLUSION

Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Thrombolytic treatment of simultaneous pulmonary embolism and impending paradoxical embolism through a patent foramen ovale: a different thrombolytic regimen

A 72 year-old woman was admitted with a one-week history of weakness, right limb pain and progressive breathlessness. Her blood pressure was 60/40 mmHg, ECG showed inverted T waves in the precordial leads and incomplete right bundle branch block (RBBB). Transthoracic echocardiography revealed a large serpentine mobile mass across the atrial septum and mitrale valve extending into the left ventricular cavity. The right ventricle was dilated and peak systolic tricuspid annular velocity (RV-Sm) was 6.5 cm/sn, indicate right ventricular systolic function was severely depressed. Transoesophageal echocardiography showed a large, mobile thrombus in the foramen ovale, extending into the left atrium and ventricle. As the patient was in a haemodynamically compromised condition, high dose rapid infusion of streptokinase was administered. However, the thrombus did not fully resolve with this intervention. Therefore, low dose continuous streptokinase infusion was administered for an additional 72 h resulting in full resolution of the lesion by the third day of therapy. The optimal management of impending paradoxical embolism remains unclear. Prolonged continuous thrombolytic infusion may be a option for patients who do not experience full resolution of high risk thrombi with conventional thrombolytic therapy.

[Angioplasty compared to thrombolysis as the initial reperfusion therapy in acute myocardial infarction]

BACKGROUND

Primary angioplasty is superior to intravenous thrombolysis as reperfusion therapy for acute myocardial infarction.

AIM

To compare the results of available reperfusion strategies for initial management of acute myocardial infarction during hospitalization and 5 years follow up.

PATIENTS AND METHODS

Historical cohort study from a prospective registry of patients admitted with acute myocardial infarction to our center. Patients treated with primary angioplasty were identified and were then matched by age, sex and date of event with patients treated with throm-bolysis. The clinical outcomes were compared including hospitalization and 5-years follow-up.

RESULTS

From March 1993 to August 2001, 98 patients were treated with primary angioplasty and matched with 98 thrombolyzed patients. The groups were comparable. Compared to thrombolysis, angioplasty had a higher success rate (68 and 91% respectively), resulted in less complications and reduced mortality (11 and 2% respectively), required less revascularization procedures and shorter hospital stay (17 and 13 days, respectively). During the follow-up of survivors, no differences in events or additional mortality were detected at 1 or 5 years.

CONCLUSIONS

Primary angioplasty is superior as treatment in terms of achieving success and reducing mortality during hospitalization. Evolution after hospitalization is independent of initial therapy.

The effect of streptokinase therapy in STEMI and conventional therapy in NSTEMI patients on TIMI risk index, B-type natriuretic peptide and high-sensitive C-reactive protein

OBJECTIVE

In this study, it was aimed to investigate the effect of streptokinase therapy in ST elevation myocardial infarction (STEMI) and conventional therapy in non-ST elevation myocardial infarction (NSTEMI) patients on the thrombolysis in myocardial infarction (TIMI) risk index (TRI), B-type natriuretic peptide (BNP), and high-sensitive C-reactive protein (hs-CRP) levels.

METHODS

Eighty-six STEMI (male/female ratio: 65/21, mean age 57.52±9.87 years) and eighty NSTEMI patients (male/female ratio: 50/30, mean age 57.6±1.7 years) were included in this prospective observational study. Hs-CRP and BNP were measured and TIMI risk index was calculated in all patients. Coronary angiography was performed in all patients for principally determining TIMI flow rate. Chi-square test, paired t-test or Wilcoxon signed rank test, ANOVA and Spearman correlation analysis were used for statistical analysis where appropriate.

RESULTS

STEMI patients had higher systolic blood pressure, heart rate, BNP and hs-CRP values than NSTEMI patients at admission (p=0.04, p=0.01, p=0.001 and p=0.01, respectively). Thrombolytic therapy in STEMI patients resulted in statistically significant higher levels of BNP, hs-CRP and TRI values compared to baseline levels (p=0.001, p=0.001 and p=0.042, respectively). For NSTEMI patients conventional therapy yielded statistically significant decrease in systolic blood pressure levels and increase in TRI (p=0.001 and p=0.047, respectively). We found significantly lower BNP, hs-CRP in patients with higher TIMI flow rate (p=0.001 and p=0.001 respectively).

CONCLUSION

Thrombolytic therapy with streptokinase failed to decrease BNP, hs-CRP and TRI values in STEMI patients. Conventional therapy in NSTEMI patients also resulted in higher TRI values than baseline values. We reached TIMI 3 flow in only 10.5% of the study patients, which may be responsible for our findings.

The prognostic meaning of the full spectrum of aVR ST-segment changes in acute myocardial infarction

AIMS

ST-elevation in lead aVR is known to be associated with a worse prognosis in patients with acute ST elevation myocardial infarction (MI) but the significance of ST depression in lead aVR has been unclear. Infarction of the inferior apex of the left ventricle may not be appreciated on the standard 12-lead electrocardiogram (ECG) except by observing ST depression in lead aVR which is reciprocal to lead V(7). We therefore determined the prognostic value of the full spectrum of aVR ST changes in patients presenting with acute ST elevation MI.

METHODS AND RESULTS

Lead aVR ST level was measured on randomization and 60 min ECGs in 15 315 patients with normal conduction from the HERO-2 trial. The outcome measure was 30-day mortality. aVR ST elevation ≥1 mm was associated with higher 30-day mortality for both inferior (22.5% for ≥1.5 mm and 13.2% for 1 mm) and anterior (23.5% for ≥1.5 mm and 11.5% for 1 mm) infarction. In contrast, deeper aVR ST depression (0, 0.5, 1, and ≥1.5 mm) was associated with higher mortality for anterior infarction (9.8, 13.2, 12.8, and 16.8%, respectively, trend P-value <0.0001) but not for inferior infarction. The resolution of aVR ST depression and ST elevation 60 min after fibrinolysis was associated with lower mortality.

CONCLUSION

There is a U-shaped relationship between 30-day mortality and aVR ST level in patients presenting with anterior but not inferior ST elevation MI.

Pulmonary embolism after long duration rail travel: economy class syndrome or rail coach syndrome

Pulmonary embolism after long duration air travel is well described. However it can also occur following a long duration rail or road transport. We present a case of 43 year old male who developed deep venous thrombosis and acute pulmonary embolism after a long rail journey. We propose to call it as rail coach syndrome and stress the need for taking the same preventive measures as recommended for airline passengers.

Treatment of saddle pulmonary embolism with streptokinase in an 83 year-old man - a case report

Saddle pulmonary embolism (PE) is an embolus at the level of the bifurcation of the pulmonary trunk that extends into both main pulmonary arteries. Because of the unstable, large clot burden in the pulmonary artery and the risk of sudden haemodynamic collapse and sudden death, identifying a saddle embolus is extremely important. In this report, we describe successful treatment with streptokinase of a saddle PE in an elderly patient.

Analysis of lung function test in patients with pleural empyema treated with thoracotomy and decortication

The fibrinopurulent phase of pleural empyema has very often been treated with thoracotomy and decortications.

MATERIAL AND METHODS

We analyzed the lung function of 19 surgically treated patients in the last 3 years. The lung function was followed up at least 6 months after surgery.

RESULTS

Before surgery the expected mean forced vital capacity (FVC) was 4650 ml, the expected mean forced expiratory volume in the first second (FEV1) was 3450 ml, the realized mean FVC was 2850 ml, and the realized mean FEV1 was 1750 ml. The mean FVC 3 months after surgery was 3430 ml, and the mean FEV1 was 1700 ml. The mean FVC 6 months after surgery was 3850 ml, and the mean FEV1 was 2950 ml.

DISCUSSION

Early detection and treatment is essential in the treatment of empyema, where the use of thoracic drainage with or without streptokinase or the use of video-assisted thoracoscopic (VATS) decortication were methods of choice in treatment. Later, thoracotomy with decortication was the only treatment solution of the fibrinopurulent phase of empyema, where a trapped lung was frequently detected.

CONCLUSION

Thoracotomy with decortication is a useful method of treatment of the fibrinopurulent phase of empyema, which solved the problem and also significantly improved lung function, especially at the follow-up after 6 months.

Comparison of primary percutaneous coronary intervention and streptokinase for acute isolated inferior ST elevation myocardial infarction with a predicted low risk profile

BACKGROUND

Primary percutaneous coronary intervention (PCI) is the treatment of choice for acute myocardial infarction, especially for high-risk patients, but the data for low-risk patients are conflicting. A very low-risk subgroup of acute inferior myocardial infarction can be identified by electrocardiographic and clinical criteria during admission. We aimed to compare the outcomes of primary PCI and streptokinase treatment in this subgroup, which has not been evaluated separately before.

MATERIAL/METHODS

We retrospectively analyzed in-hospital and 10-month follow-up outcomes of 97 patients with inferior acute myocardial infarction and clinical and electrocardiographic criteria predicting low risk who have been treated with primary PCI or streptokinase.

RESULTS

Forty-eight patients received streptokinase, and 49 had undergone primary PCI. Both during the in-hospital period and follow-up, the groups did not differ in the end points of death, reinfarction, or stroke (in-hospital: 2.1% versus 4.1%, P=.57; follow-up: 8.9% versus 8.9%, P=1.000). Length of hospital stay was longer in the streptokinase group (6.5+/-2.5 versus 9.1+/-3.7 days, P=.001). Rate of repeat revascularization was reduced in the PCI group at 10 months (28.9% versus 55.6%, P=.002).

CONCLUSIONS

When streptokinase and primary PCI are compared in isolated inferior acute myocardial infarction patients with a low-risk profile, there are no differences for in-hospital and long-term rates of death, reinfarction, or stroke. Primary angioplasty reduces the length of initial hospital stay, and reduces repeat admissions by decreasing the need for subsequent revascularization procedures. Large-scale studies are needed to reach a final conclusion.

Prognostic value of lead V1 ST elevation during acute inferior myocardial infarction

BACKGROUND

Lead V(1) directly faces the right ventricle and may exhibit ST elevation during an acute inferior myocardial infarction when the right ventricle is also involved. Leads V(1) and V(3) indirectly face the posterolateral left ventricle, and ST depression ("mirror-image" ST elevation) in V(1) through V(3) may reflect concomitant posterolateral infarction. The prognostic significance of V(1) ST elevation during an acute inferior myocardial infarction may therefore be dependent on V(3) ST changes.

METHODS AND RESULTS

In 7967 patients with acute inferior myocardial infarction in the Hirulog and Early Reperfusion or Occlusion-2 (HERO-2) trial, V(1) ST levels were analyzed with adjustment for lead V(3) ST level for predicting 30-day mortality. V(1) ST elevation at baseline, analyzed as a continuous variable, was associated with higher mortality. Unadjusted, each 0.5-mm-step increase in ST level above the isoelectric level was associated with approximately 25% increase in 30-day mortality; this was true whether V(3) ST depression was present or not. The odds ratio for mortality was 1.21 (95% confidence interval, 1.07 to 1.37) after adjustment for inferolateral ST elevation and clinical factors and 1.24 (95% confidence interval, 1.09 to 1.40) if also adjusted for V(3) ST level. In contrast, lead V(1) ST depression was not associated with mortality after adjustment for V(3) ST level. V(1) ST elevation >or=1 mm, analyzed dichotomously in all patients, was associated with higher mortality. The odds ratio was 1.28 (95% confidence interval, 1.01 to 1.61) unadjusted, 1.51 (95% confidence interval, 1.19 to 1.92) adjusted for V(3) ST level, and 1.35 (95% confidence interval, 1.04 to 1.76) adjusted for ECG and clinical factors. Persistence of V(1) ST elevation >or=1 mm 60 minutes after fibrinolysis was associated with higher mortality (10.8% versus 5.5%, P=0.001).

CONCLUSIONS

V(1) ST elevation identifies patients with acute inferior myocardial infarction who are at higher risk.

Successful thrombolytic therapy for recurrent right ventricular thrombosis in Behçet's disease

Behçet's disease (BD) is a chronic inflammatory multisystem disorder characterised by recurrent oral and genital aphtosis and ocular involvement. Thrombophlebitis and major vessel thrombosis are common manifestations of vascular involvement in BD patients, whereas intracardiac thrombosis is extremely rare. We describe a 22-year-old woman who presented with deep vein thrombosis and recurrent right ventricular thrombosis complicated by pulmonary embolism. At the time, she complained of fever, recurrent painful oral and genital aphtae and papulo-pustular skin rash so she was diagnosed with BD. She received intravenous streptokinase 50,000 units/hour for three days plus corticosteroids with complete recovery. A review of intracardiac thrombosis in BD is presented and the use of thrombolytic therapy in this rare condition is briefly discussed.

[Local treatment of operation wounds in patients with acute paraproctitis using preparation distreptase]

The results of local treatment of an acute paraproctitis in 37 patients, using suppositoria Distreptase (Biomed Sara and Vassinas Production Ltd., Lyublin, Poland) were analyzed. There were noted sufficiently high efficacy of treatment, in particular, the necrolysis resolution approaching, the wounds granulation and epithelization beginning as well as reduction of the patients treatment period.

Fibrinolytic agents for peripheral arterial occlusion

BACKGROUND

Peripheral arterial thrombolysis is used in the management of peripheral arterial ischaemia. Streptokinase was originally used but safety concerns led to a search for other agents. Urokinase and recombinant tissue plasminogen activator (rt-PA) have increasingly become established as first line agents for peripheral arterial thrombolysis. Potential advantages of these agents include improved safety, greater efficacy and a more rapid response. Recently drugs such as pro-urokinase, recombinant staphylokinase and alfimperase have been introduced.

OBJECTIVES

To determine which fibrinolytic agents are most effective in peripheral arterial ischaemia.

SEARCH STRATEGY

The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched October 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2009, Issue 4) for randomised controlled trials (RCTs) comparing fibrinolytic agents to treat peripheral arterial ischaemia.

SELECTION CRITERIA

RCTs comparing fibrinolytic agents to treat peripheral arterial occlusion.

DATA COLLECTION AND ANALYSIS

Data were analysed for the outcomes vessel patency, time to lysis, limb salvage, amputation, death, complications including major haemorrhage, stroke, and distal embolization.

MAIN RESULTS

Five RCTs involving a total of 687 patients with a range of clinical indications were included. In one three-pronged study, vessel patency was greater with intra-arterial recombinant tissue plasminogen activator (rt-PA) than with intra-arterial streptokinase (P < 0.04) or intravenous rt-PA (P < 0.01). In patients with peripheral arterial occlusion there was no statistically significant difference in limb salvage at 30 days with either urokinase or rt-PA, though this may reflect the small numbers in the studies. Incidences of haemorrhagic complications varied with fibrinolytic regime but there was no statistically significant difference between intra-arterial urokinase and intra-arterial rt-PA. In the three-pronged study intravenous rt-PA and intra-arterial streptokinase were associated with a significantly higher risk of haemorrhagic complications than with intra-arterial rt-PA (P < 0.05).

AUTHORS' CONCLUSIONS

There is some evidence to suggest that intra-arterial rt-PA is more effective than intra-arterial streptokinase or intravenous rt-PA in improving vessel patency in people with peripheral arterial occlusion. There was no evidence that rt-PA was more effective than urokinase for patients with peripheral arterial occlusion and some evidence that initial lysis may be more rapid with rt-PA, depending on the regime. Incidences of haemorrhagic complications were not statistically significantly greater with rt-PA than with other regimes. However, all of the findings come from small studies and a general paucity of results means that it is not possible to draw clear conclusions.

Association between admission mean platelet volume and coronary patency after thrombolytic therapy for acute myocardial infarction

OBJECTIVES

High levels of mean platelet volume (MPV) have been shown to be a predictor of poor clinical outcome among survivors of myocardial infarction. We evaluated the association between admission MPV and infarct-related artery (IRA) patency in patients treated with thrombolytic therapy for acute myocardial infarction (AMI).

STUDY DESIGN

We retrospectively evaluated 133 consecutive patients with ST-elevation AMI, who received thrombolytic therapy within 12 hours of chest pain. Sixty-five patients received streptokinase and 68 patients received recombinant tissue-type plasminogen activator, based on the discretion of the physician. Blood samples were taken before thrombolytic therapy and MPV was measured. Coronary angiography was performed within a mean of two days after thrombolytic therapy and the flow in the IRA was assessed with the TIMI flow grade and corrected TIMI frame count (CTFC).

RESULTS

After thrombolytic therapy, TIMI 3 flow was achieved in 62 patients (46.6%), whereas 71 patients (53.4%) had insufficient TIMI flow. Patients with insufficient TIMI flow had a significantly higher mean admission MPV (9.8+/-1.5 fl vs. 8.6+/-1.4 fl; p<0.001) and were more likely to have been given streptokinase (p=0.02). The two groups were similar with respect to the type of IRA and the number of diseased vessels (p>0.05). There was a weak correlation between MPV and CTFC (p=0.01). Multivariate analysis showed MPV (OR 1.871, 95% CI 1.402-2.498; p<0.001) and the type of thrombolytic agent (OR 2.915; 95% CI 1.333-6.374; p=0.007) as independent predictors of insufficient TIMI flow. The receiver operating characteristic analysis yielded a cutoff value of 8.885 fl for MPV to predict insufficient TIMI flow, with sensitivity and specificity being 70.4% and 66.1%, respectively.

CONCLUSION

Our findings show that a higher admission MPV is associated with an increased risk for insufficient TIMI flow in the IRA after thrombolytic therapy for AMI.

Treatment of multiloculated empyema thoracis using minimally invasive methods

INTRODUCTION

The purpose of this study was to investigate the results of minimally invasive treatment modalities in early stage multiloculated empyema thoracis.

METHODS

The minimally invasive treatment modalities of 114 patients with Class 5 thoracic empyema were retrospectively reviewed. The patients' demographics, symptoms, diagnostic studies, treatment options and complications were evaluated.

RESULTS

A total of 47 patients underwent tube thoracostomy, 23 patients underwent fibrinolytic therapy with streptokinase and 44 patients underwent video-assisted thoracoscopic surgery (VATS) deloculation and debridement. No statistical differences were found in the patients' age, gender, Gram stain and antibiotherapy before intervention among the groups. Illness days before intervention was significantly longer in the tube thoracostomy group than in the others. The VATS group had a shorter drainage time and hospital stay than the others. The VATS and fibrinolytic therapy groups had lower complication rates and less open decortication requirements than the tube thoracostomy group. Success rates were 66, 95 and 100 percent in the tube thoracostomy, fibrinolytic therapy and VATS groups, respectively. In total, there were 35 patients with complications. The most frequent complication was air space. Two inhospital mortalities occurred.

CONCLUSION

In patients with early stage multiloculated empyema, VATS deloculation and debridement is superior to tube thoracostomy alone and fibrinolitic therapy in reducing drainage time and hospital stay. It has a relatively high success rate without significant morbidity. Therefore, VATS decortication may be recommended as a first-line therapy in early stage multiloculated empyema thoracis.

Guillain-Barré syndrome after streptokinase therapy for acute myocardial infarction

Some drugs including streptokinase have been reported to precipitate Guillain-Barré syndrome. We report a 70-year-old man with acute anterior myocardial infarction who developed Guillain-Barré syndrome seven days after thrombolytic therapy with streptokinase.

[Thienopyridines in the treatment and prevention of cardiovascular diseases. Part V. Combination of clopidogrel and acetylsalicylic acid in the treatment of stable patients with atherothrombotic cardiovascular diseases]

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the fifth communication we consider data of two randomized studies in which efficacy and safety of clopidogrel in combination with acetylsalicylic acid (ASA) has been assessed in comparison with ASA in stable patients with atherothrombotic cardiovascular disease. It has been shown in both studies that in stable patients with atherothrombotic cardiovascular disease long-term therapy with combination of clopidogrel and ASA was no more effective than monotherapy with ASA or clopidogrel but was associated with high risk of hemorrhagic complications. Thus contrary to acute coronary syndromes and percutaneous interventions with stenting combinations of clopidogrel and ASA is not indicated to patients with stable course cardiovascular diseases.

[Effecting factors on survival in patients taking thrombolytic treatment due to massive pulmonary embolism]

Massive pulmonary embolism (MPE) is a life threatening disease, thrombolytic treatment could save lives. The aims of this study are to identify early and late mortality rates in patients with MPE who received thrombolytic treatment, and mortality related risk factors. All the hospital records for the MPE patients who received thrombolytic treatment between 1998 and 2006 were retrospectively investigated. Pulmonary embolism was diagnosed through computed tomografi scan and V/P scintigraphy. Due to MPE, 21 women total 41 patients who undergo tPA or streptokinase were included in the study. Kaplan-Meier for the survival analysis and cox regression analysis for determining the mortality related independent risk factors were used. Dying while staying in hospital was accepted as early or hospital mortality, after discharge from hospital as late mortality. Out of 41 patients, 12 of them died while they are hospitalized (hospital mortality; 29%) 6 of them died after they were discharged (late mortality; 21%). The average survival time among discharged patients was 2304 days (95% confidence interval: 1725-2884). Among those patients who took streptokinase or tPA, late or early mortality rates (p> 0.05) and survival time did not show significant difference (p= 0.8908). The presence of arrhythmia [p= 0.01; odds rate (OR): 6.25] and jugular vein distention (JVD) (p= 0.03; OR: 6.25) for hospital mortality and multiple ongoing health problems for the late mortality were identified as the independent risk factors. For the hospital mortality, the presence of JVD or arrhythmia, for prognostic sensitivity, specificity, positive predictive value and negative predictive value were recorded as 75%, 79%, 60% and 88% respectively. In conclusion, the presence of arrhythmia and/or JVD on a patient with MPE is a negative prognostic factor for hospital mortality. The presence of other ongoing health problems influences the survival time of the discharged patients.

[Progress in the research of therapeutic enzyme]

With the development of the research on biotechnology and modern pharmacy, the application of enzyme drugs have grown rapidly and enzyme drugs have become an important branch of biopharmaceutics. In this article, some new varieties of therapeutic enzymes, enzyme targets, mechanisms and new technologies of application in therapeutic enzymes were reviewed, and the direction of development of therapeutic enzymes were discussed.

Admission creatine kinase as a prognostic marker in acute myocardial infarction

OBJECTIVES

To investigate the prognostic significance of creatine kinase (CK) in Pakistani patients suffering from acute myocardial infarction (AMI) and to find out if CK combined with troponin T (TnT) could be a better predictor for long-term adverse cardiac event.

METHODS

One hundred and eighty six consecutive patients with AMI who were eligible for streptokinase (SK) treatment were included in this prospective cohort study. The relationship between their serum/plasma CK and TnT levels at the time of admission and clinical outcome was investigated over a mean follow up of 24.12 +/- 3.75 months.

RESULTS

Admission CK was found to be associated with subsequent cardiac event and mortality (P < 0.01 and P < 0.04 respectively). Admission CK was also mildly associated with time interval between onset of symptoms to SK treatment (correlation coefficient 'r' = 0.23). Odds of encountering a cardiac event in AMI patients with above-normal CK levels (adjusted for gender) were 3.46 times higher than the odds in patients with normal CK levels. Similarly, odds of mortality in patients with positive TnT were 4.6 times the odds in patients with negative TnT. The two biochemical markers, CK and TnT, together did not provide any further information about prognosis of the disease.

CONCLUSION

Admission CK is a better prognostic marker for a subsequent cardiac event, while TnT is a better predictor of mortality over a mean follow up of nearly 2 years. Together, they do not improve predictability of an adverse cardiac event.