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Background and purpose: Early treatment of thrombolysis can reduce mortality in patients with myocardial infarction, so, this systematic review and meta-analysis aimed to compare the effect of pre-hospital thrombolysis and in-hospital thrombolysis on short-term mortality in patients with myocardial infarction. Materials and methods: Systematic search was conducted in electronic databases including Pubmed, Web of Science, Cochrane, and Embase without time and language constraints using related keywords. All articles were exported to EndNote. In initial search, 223 articles were found but finally 10 articles were selected for quality assessment, which was performed using the JADAD standard checklist for interventional studies and the Newcastle Ottawa Scale checklist for cohort studies. Comprehensive Meta-Analysis software was used for data analysis. Results: The total samples size was 4291 in the pre-hospital group and 4,730 in the in-hospital group. Three clinical trials and all three cohort studies were found to have a good quality. Meta-analysis showed that thrombolytic therapy at the onset of symptoms and prior to patient's transfer to hospital could reduce mortality by 36% (OR= 0.64 CI 95%: 0.45-0.91). Conclusion: Pre-hospital thrombolysis by emergency technicians can reduce mortality in patients with myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction: Health care planning for management of patients visiting emergency department (ED) requires accurate statistics and data more than anything. Since chest pain is one of the most common complaints of patients in this department, the present study was done aiming to epidemiologically assess the patients presenting to ED following chest pain with the final diagnosis of myocardial infarction (MI). Methods: In this retrospective cross-sectional study, to evaluate the characteristics of MI patients, medical profiles of all the patients presenting to ED of Shahid Mofatteh Hospital, Varamin, Iran, during 2011 to 2015, with complaint of chest pain and final diagnosis of acute MI were assessed. A pre-designed checklist was used that included demographic data, pain characteristics, history of cardiac diseases and risk factors of cardiovascular diseases, treatments received, time interval between symptom manifestation and presentation to ED, history of similar complaint, duration of hospitalization in ED, site of MI, troponin level on arrival, and final outcome. Results: 168 patients with the mean age of 58.05 ± 12.46 years (range: 28 – 85) with complaint of chest pain and final diagnosis of acute MI visited the center during the study period (76.8% male). Before hospitalization in the cardiac care unit, these patients stayed in ED for an average of 12.6 ± 6.5 hours (range: 0.2 – 23.5). Most patients were in the > 50 years age group (74.3%) and had an education level less than high school diploma (91.7%). Mean duration of being affected with hypertension, diabetes, cardiac diseases, hypercholesterolemia, and smoking for the studied patients were 6.1 ± 4.7 (1-20), 6.34 ± 5.9 (1-30), 7.1 ± 5.2 (1-21), 4.1 ± 3.3 (1-14), and 21.5 ± 11 (2-50) years, respectively. Mean time interval between symptom manifestation and ED visit was 12.9 ± 6.3 (1-24) hours. Patients reported their history of similar pains to go back to about 6.9 ± 3.4 (1-12) months prior. In most patients, pain site was in anterior chest (88.7%), with sweating (61.01%) and without radiating to arms or jaws (86.3%). Most common dysrhythmia observed in this group of patients was ventricular tachycardia (24.4%). Since angiography and surgical intervention equipment were not available, all patients underwent thrombolytic therapy. Only 16 (9.5%) patients had positive troponin on arrival. Finally, 9 (5.4%) patients died. Conclusion: Based on the findings of the present study, most cases of MI in the studied center were male, over the age of 50 years, smokers, and had an education level less than high school diploma. The most common site of MI was in the anterior heart wall with anterior chest pain and ventricular tachycardia. In this evaluation, mortality rate of patients with MI was calculated to be 5.4% in the studied center. [ABSTRACT FROM AUTHOR]

Background and purpose: So far, no spatial analysis of in-hospital mortality due to myocardial infarction (MI) has been conducted in Iran. The present study was performed to determine the geographical pattern of mortality due to myocardial infarction in Iran. Materials and methods: In a prospective hospital-based study, we used the data of cases with MI registered by Myocardial Infarction Registry of Iran, 2012. For spatial analysis, LISA, Global Moran's I, and Getis-Ord's statistics were used. Data was analyzed using Stata software and ArcGIS 9.3 Results: A total of 20,750 patients was admitted to hospital due to MI and 2511 (12.1%) deaths occurred (median age at death: 65.2 ± 15.2). The incidence of death from MI did not follow a particular pattern (Moran's Index: 0.141, P-value = 0.126). The highest standardized incidence rates of in-hospital mortality from MI in 100,000 population were observed in Ardebil (31), North Khorasan (23.7), Yazd (20.2), West Azerbaijan (19.1) and Khuzestan (18.4). The lowest incidence rates were found in Sistan- Baluchestan and Khorasan provinces. Conclusion: This study supports the hypothesis of random pattern of mortality due to myocardial infarction in Iran. [ABSTRACT FROM AUTHOR]

Background: Early, complete, and stable coronary revascularization is the main criteria for standard treatment in patients with ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of integrilin as glycoprotein IIb/IIIa receptor inhibitor in treatment of STEMI patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: In this clinical trial study, 106 STEMI patients who complained of acute chest pain and were referred to Amir Al Momenin hospital, Arak, entered the study. Patients were randomly divided into two equal groups. The first group was treated with integrilin immediately before angioplasty. The 2nd group was treated with conventional percutaneous coronary intervention. Results: After receiving treatment and undergoing angioplasty, TIMI Frame Count was equal to 15.7±8.04 in the 1st group and 14.2±5.4 in the 2nd group which showed no significant difference between them (p=0.4). Ejection fraction in patients receiving integrilin was significantly more than control group in first (p=0.043) and third month (p=0.012) after treatment. Conclusion: Based on the results of the present study, it seems that using integrilin in standard time, causes long-term benefits for patients and reduces damage to the heart wall. [ABSTRACT FROM AUTHOR]