Цель работы: сравнение эффективности и безопасности тромболизиса стрептокиназой и тенектеплазой на догоспитальном этапе у больных острым инфарктом миокарда. Больные в первые 6 ч заболевания с показаниямидля тромболизиса на догоспитальном этапе были рандомизированы на 2 группы: пациентам 1й группы (n=86)вводилась стрептокиназа в дозе 750 тыс. ЕД за 5–10 мин, пациентам 2й группы (n=84) вводилась тенектеплазаболюсом в дозе согласно массе тела. Все больные получали двойную антиагрегантную терапию (аспирин и клопидогрел), гепарин, статины, βблокаторы, ингибиторы АПФ. Оценивались косвенные признаки реперфузии миокарда по данным ЭКГ через 90 мин после введения препаратов. Критерием реперфузии коронарной артериисчитали снижение сегмента ST≥50% от исходного уровня в отведении, где его подъем был максимальным. Обнаружено, что тенектеплаза более часто вызывает реперфузию коронарной артерии через 90 мин от начала тромболизиса по сравнению со стрептокиназой: 64,3 против 47,6% (р<0,05). В результате в группе стрептокиназычаще проводили спасительную ангиопластику: 32,5 против 16,7% (р<0,05). Различий в клинических исходах острого инфаркта миокарда с подъемом сегмента ST при догоспитальном тромболизисе стрептокиназой и тенектеплазой – частоте и степени геморрагических осложнений, фракции выброса левого желудочка (ЛЖ), летальности – не обнаружено.

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

The efficacy and risk of prehospital thrombolysis for acute myocardial infarction (MI) were evaluated in a randomized trial. Patients received streptokinase, 500,000 U, and heparin, 10,000 U, intravenously within 5-10 minutes before (Group 1, n=50) or after (Group 2, n=50) hospital admission. One hundred patients took conventional therapy (Group 3). The mean time interval between the onset of symptoms and thrombolytic therapy was 2.2, 4.5, and 3.8 hours in Groups 1, 2, and 3, respectively (p<0.001). Severe hemorrhagies were absent. The rate of ventricular fibrillation was the same in Groups 1 and 3 prior to hospitalization. Left ventricular contractility was identical in Groups 1 and 2. By the end of the fourth week, Group 1 showed a 14 % increase in ejection fraction and a 14.5 % decrease in akinetic segment, these parameters substantially unchanged in Group 2. The MI size assessed by ECG and the maximum myoglobin concentrations was significantly less in Group 1 than that in Group 2. The patients from Group 1 had fewer MI complications than those from Groups 2 and 3. Three patients died in Group 1, 6 in Group 2, and 16 in Group 3. (p<0.05).

The efficacy and risk of prehospital thrombolysis for acute myocardial infarction (MI) were evaluated in a randomized trial. Patients received streptokinase, 500,000 U, and heparin, 10,000 U, intravenously within 5-10 minutes before (Group 1, n = 50) or after (Group 2, n = 50) hospital admission. One hundred patients took conventional therapy (Group 3). The mean time interval between the onset of symptoms and thrombolytic therapy was 2.2, 4.5, and 3.8 hours in Groups 1, 2, and 3, respectively (p < 0.001). Severe hemorrhages were absent. The rate of ventricular fibrillation was the same in Groups 1 and 3 prior to hospitalization. Left ventricular contractility was identical in Groups 1 and 2. By the end of the fourth week, Group 1 showed a 14% increase in ejection fraction and a 14.5% decrease in akinetic segment, these parameters substantially unchanged in Group 2. The MI size assessed by ECG and the maximum myoglobin concentrations was significantly less in Group 1 than that in Group 2. The patients from Group 1 had fewer MI complications than those from Groups 2 and 3. Three patients died in Group 1, 6 in Group 2, and 16 in Group 3. (p < 0.05).

A total of 73 patients with myocardial infarction (MI) were included into a prospective study involving intravenous and/or intracoronary streptokinase administration. The total ejection fraction (EF) and the extent of left ventricular dys- and akinetic areas were measured by contrast ventriculography in the first 3-9 hours and 4 weeks after the onset of MI symptoms. Coronary reperfusion performed in the first 3 hours after the onset of symptoms in patients with anterior MI (n = 8) and following 3-9 hours (mean 6.6 +/- 0.89 hours) in patients with inferior MI (n = 17) significantly (p less than 0.05) reduced the extent of dys- and akinetic areas from 20.5 +/- 4.16 to 6.0 +/- 3.99 and 10.0 +/- 1.56 to 5.0 +/- 1.74%, respectively) following 4 weeks. EF significantly (p less than 0.01) increased in the former and tended to show an increase from 51.0 +/- 2.44 to 64.0 +/- 2.26% (p less than 0.1) in the latter. In patients with anterior MI (n = 19) there was a tendency to a decrease in the extent of dys- and akinetic areas from 26.0 +/- 2.85 to 17.0 +/- 3.9 (p less than 0.1) following 3-9 hours. No substantial changes were observed in the values of left ventricular dys- and akinesis and EF in patients with anterior (n = 13) and inferior (n = 16) MI without coronary reperfusion.

A total of 73 patients with myocardial infarction (MI) were included into a prospective study involving intravenous and/or intracoronary streptokinase administration. The total ejection fraction (EF) and the extent of left ventricular dys- and akinetic areas were measured by contrast ventriculography in the first 3-9 hours and 4 weeks after the onset of MI symptoms. Coronary reperfusion performed in the first 3 hours after the onset of symptoms in patients with anterior MI (n = 8) and following 3-9 hours (mean 6.6 +/- 0.89 hours) in patients with inferior MI (n = 17) significantly (p < 0.05) reduced the extent of dys- and akinetic areas from 20.5 +/- 4.16 to 6.0 +/- +/- 3.99 and 10.0 +/- 1.56 to 5.0 +/- 1.74 %, respectively) following 4 weeks. EF significantly (p < 0.01) increased in the former and tended to show an increase from 51.0 +/- 2.44 to 64.0 +/- 2.26% (p < 0.1) in the latter. In patients with anterior MI (n = 19) there was a tendency to a decrease in the extent of dys- and akinetic areas from 26.0 +/- 2.85 to 17.0 +/- 3.9 (p < 0.1) following 3.9 hours. No substantial changes were observed in the values of left ventricular dys- and akinesis and EF in patients with anterior (n = 13) and inferior (n = 16) MI without coronary reperfusion.

Reported here are 162 cases of atrial ectopic tachycardia, a specific type of the supraventricular arrhythmia, which is characterized by the distinct P waves on the ECG, which follow at the rate of 400 and more per minute. Although atrial ectopic tachycardia is similar to the supraventricular paroxysmal tachycardia and atrial flutter, it differs from them by the mechanism of the development. Atrial ectopic tachycardia is caused by the failure or weakening the sinus node and the appearance of the ectopic focus in the atria. Such arrhythmia occurs in the following 4 types: with atrial to ventricular excitation ratio 1:1; with incomplete atrio-ventricular block; with complete atrioventricular block; and in combination with atrial fibrillation. Atrial ectopic tachycardia often takes lingering course and is hardly responsive to the medical treatment. The cases of arrhythmia, characterized by the broad P waves on the ECG tend to the progressive course. 17 cases of atrial ectopic tachycardia treated by electrostimulation (ES) which had 100% positive effect are presented and ES advantages over the drug therapy are underlined. The frequent transition of this arrhythmia into the atrial fibrillation is outlined.

The article analyses 188 cases treated for acute left ventricular insufficiency (ALVI) in different forms of tachyarrhythmia. It was established that in patients with supraventricular paroxysmal tachycardia ALVI develops when the rate of cardiac contractions is 180 +/- 3/min on the average, whereas in patients with cardiac fibrillation it develops when the rate of contractions is 163 +/- 4/min. For successful treatment of ALVI of a tachyarrhythmic character it is necessary to restore the sinus rhythm or slow down the rhythm of cardiac contractions in patients with supraventricular paroxysmal tachycardia to 113 +/- 5/min on the average and in patients with cardiac fibrillation to 118 +/- 2/min. Isoptin and obsidan produce the highest decelerating effect. In half of the patients with tachyarrhythmia. ALVI was relieved by means of antiarrhythmic agents among which obsidan and isoptin proved most effective.