Document Detail


Infarct Size Limitation: acute N-acetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients.
MedLine Citation:
PMID:  8821417     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Our previous experimental research and initial clinical observations regarding the use of N-acetylcysteine in the treatment of ischemic and reperfusion injury in acute myocardial infarction gave rise to a study entitled the Infarct Size Limitation: Acute N-acetylcysteine Defense (ISLAND) trial. Today, this randomized, echocardiographically and angiographically controlled study includes the first 30 patients with a first anterior wall myocardial infarction: Group A (n = 10) consisting of patients with successful recanalization of the infarct-related left anterior descending artery by streptokinase without any further treatment, Group B (n = 10) consisting of patients with failed infarct-related artery recanalization, and Group C (n = 10) comprising patients who had successful streptokinase-induced recanalization of the left anterior descending artery plus N-acetylcysteine administration at a dose of 100 mg/kg body weight. The parameters monitored in our study include changes in global and regional left ventricular ejection fraction of the infarct-related segment using echocardiography and, using electrocardiograms and the Wagner QRS scoring system, the amounts of acutely jeopardized and finally infarcted myocardium. In Group A, global left ventricular ejection fraction rose nonsignificantly within 2 weeks from 37.5 +/- 9.6% to 38.5 +/- 13.8%; it declined significantly in Group B from 36.2 +/- 6.1% to 30.1 +/- 6.7% (p < 0.05), while it considerably improved in Group C from 41.7 +/- 4.1% to 59.6 +/- 8.1% (p < 0.001). Regional left ventricular ejection fraction changed significantly only in Group C: from -4.5 +/- 27.3 to 45.6 +/- 16.3 (p < 0.001). In Group A, in which the amount of acutely jeopardized myocardium was 21.7 +/- 7.2, infarction actually occurred in 20.4 +/- 9.7% (practically no myocardial salvage). In Group B, risk area was 18.1 +/- 4.3%, but infarct size rose to a resulting 29.1 +/- 6.0%. Significant myocardial salvage was accomplished only in Group C: of 26.2 +/- 8.1% of jeopardized myocardium, infarct size was reduced to 10.8 +/- 7.1% (salvage by 58.8%). Also, basic division of patients by therapy showed that, although those with nonidentical findings on their coronary arteries were included into the same groups, patients treated with streptokinase plus N-acetylcysteine had significantly more favorable values of the monitored parameters than those treated with streptokinase alone. We conclude our interim analysis suggests that N-acetylcysteine has a beneficial effect, reducing the functional and structural impacts of myocardial infarction.
Authors:
J Sochman; J Vrbská; B Musilová; M Rocek
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical cardiology     Volume:  19     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  1996 Feb 
Date Detail:
Created Date:  1996-11-21     Completed Date:  1996-11-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  94-100     Citation Subset:  IM    
Affiliation:
Department of Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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MeSH Terms
Descriptor/Qualifier:
Acetylcysteine / therapeutic use*
Aged
Creatine Kinase / blood
Drug Therapy, Combination
Electrocardiography
Fibrinolytic Agents / therapeutic use
Free Radical Scavengers / therapeutic use*
Humans
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  physiopathology
Myocardial Reperfusion Injury / drug therapy,  etiology
Pilot Projects
Streptokinase / therapeutic use
Stroke Volume
Thrombolytic Therapy
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Free Radical Scavengers; 616-91-1/Acetylcysteine; EC 2.7.3.2/Creatine Kinase; EC 3.4.-/Streptokinase

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