Angiographic coronary morphology in postinfarction angina

Recurrent ischemia after thrombolysis: importance of associated clinical findings. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-plasminogen activator] for Occluded Coronary Arteries

OBJECTIVES

We sought to assess the incidence and clinical relevance of examination data to recurrent ischemia within an international randomized trial.

BACKGROUND

Ischemic symptoms commonly recur after thrombolysis for acute myocardial infarction.

METHODS

Patients (n = 40,848) were prospectively evaluated for recurrent angina and transient electrocardiographic (ECG) or hemodynamic changes. Five groups were developed: Group 1, patients with no signs or symptoms of recurrent ischemia; Group 2, patients with angina only; Group 3, patients with angina and ST segment changes; Group 4, patients with angina and hemodynamic abnormalities; and Group 5, patients with angina, ST segment changes and hemodynamic abnormalities. Baseline clinical and outcome variables were compared among the five groups.

RESULTS

Group 1 comprised 32,717 patients, and Groups 2 to 5 comprised 20% of patients (4,488 in Group 2; 3,021 in Group 3; 337 in Group 4; and 285 in Group 5). Patients with recurrent ischemia were more often female, had more cardiovascular risk factors and less often received intravenous heparin. Significantly more extensive and more severe coronary disease, antianginal treatment, angioplasty and coronary bypass surgery were observed as a function of ischemic severity. The 30-day reinfarction rate was 1.6% in Group 1, 6.5% in Group 2, 21.7% in Group 3, 13.1% in Group 4 and 36.5% in Group 5 (p < 0.0001); in contrast, the 30-day mortality rate was significantly lower (p < 0.0001) in Groups 1, 2 and 3 (6.6%, 5.4% and 7.7%, respectively) than in Groups 4 and 5 (21.8% and 29.1%).

CONCLUSIONS

Postinfarction angina greatly increases the risk of reinfarction, especially when accompanied by transient ECG changes. However, mortality is markedly increased only in the presence of concomitant hemodynamic abnormalities.

Dual purpose computer aided program for cardiac catheterization laboratory data management

This communication describes the design criteria used in the early systems analysis activity of the cardiac laboratory. This analysis activity required an understanding of the cardiology laboratory environment, the establishment of needs to be answered by the program, and the goals of the entire system. The rationale for inclusion of various cardiologic, demographic, quality assurance, and personnel safety parameters is discussed. The input forms used, the database structure created, and the information provided by an applications system are described. Since the system is built around a general-purpose computer (the IBM PC or compatible) and widely available powerful general purpose software, the entire system may be used for many other cardiology laboratory data management tasks.