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Background Ischemia-reperfusion injury remains a major clinical problem in patients with ST-elevation myocardial infarction (STEMI), leading to myocardial damage despite early reperfusion by primary percutaneous coronary intervention (PPCI). There are no effective therapies to limit ischemia-reperfusion injury, which is caused by multiple pathways activated by rapid tissue reoxygenation and the generation of reactive oxygen species (ROS). FDY-5301 contains sodium iodide, a ubiquitous inorganic halide and elemental reducing agent that can act as a catalytic anti-peroxidant. We tested the feasibility, safety and potential utility of FDY-5301 as a treatment to limit ischemia-reperfusion injury, in patients with first-time STEMI undergoing emergency PPCI. Methods STEMI patients (n = 120, median 62 years) presenting within 12 h of chest pain onset were randomized at 20 PPCI centers, in a double blind Phase 2 clinical trial, to receive FDY-5301 (0.5, 1.0 or 2.0 mg/kg) or placebo prior to reperfusion, to evaluate the feasibility endpoints. Participants underwent continuous ECG monitoring for 14 days after PPCI to address pre-specified cardiac arrhythmia safety end points and cardiac magnetic resonance imaging (MRI) at 72 h and at 3 months to assess exploratory efficacy end points. Results Intravenous FDY-5301 was delivered before re-opening of the infarct-related artery in 97% participants and increased plasma iodide levels ~1000-fold within 2 min. There was no significant increase in the primary safety end point of incidence of cardiac arrhythmias of concern. MRI at 3 months revealed median final infarct sizes in placebo vs. 2.0 mg/kg FDY-5301-treated patients of 14.9% vs. 8.5%, and LV ejection fractions of 53.9% vs. 63.2%, respectively, although the study was not powered to detect statistical significance. In patients receiving FDY-5301, there was a significant reduction in the levels of MPO, MMP2 and NTproBNP after PPCI, but no reduction with placebo. Conclusions Intravenous FDY-5301, delivered immediately prior to PPCI in acute STEMI, is feasible, safe, and shows potential efficacy. A larger trial is justified to test the effects of FDY-5301 on acute ischemia-reperfusion injury and clinical outcomes. Clinical Trial Registration: CT.gov NCT03470441 ; EudraCT 2017-000047-41

Összefoglaló. A ritmuszavarok előfordulása gyakoribb a terhes nők esetén, mint a nem várandósok körében. A legtöbb esetben terápiás beavatkozás nélkül is kihordható a magzat. Hemodinamikai instabilitás és magzatkárosodáshoz vezető fetalis hypoperfusio jöhet létre, amennyiben tartós, magas kamrai frekvenciával járó epizódok jelentkeznek. Ezekben az esetekben a ritmuszavar megszüntetése indokolttá válhat. Az antiarrhythmiás gyógyszerek korlátozottan és nagy körültekintéssel alkalmazhatók a gyermeket várók körében, így a katéterablatio jelenthet biztonságos és használható alternatívát. Ezen beavatkozásokat hagyományosan röntgensugár segítségével végzik, ez azonban az ionizáló sugárzásnak a magzati fejlődésre gyakorolt hatása miatt magas rizikót jelentene. Több éve elérhető a szív-elektrofiziológiában az ún. zéró fluoroszkópiás ablatio, mely a pitvarfibrilláció kezelésében és más ritmuszavarok esetében egyaránt alkalmazható. A terheseknél alkalmazott eljárást két eseten keresztül mutatjuk be. A röntgensugár használatát, a jelen cikkben bemutatott beavatkozások esetén is, sikerült teljesen kiküszöbölnünk. Az első, 23 hetes gravid páciensnél recidív paroxysmalis supraventricularis tachycardia miatt végeztünk elektrofiziológiai vizsgálatot. E vizsgálat során atrioventricularis nodalis reentry tachycardiát igazoltunk és abláltunk sikerrel. Második esetbemutatásunkban egy anteroseptalis járulékos köteg katéterablatiós megoldását mutatjuk be. A terhesség során jelentkező, az anyára és/vagy magzatára veszélyt jelentő ritmuszavar esetén a háromdimenziós térképező rendszer (szükség esetén intracardialis ultrahangvizsgálattal kiegészítve) biztonságos és hatásos alternatívát jelent, olyan esetekben, ha röntgensugár nem használható. Orv Hetil. 2021; 162(41): 1643–1651. Summary. Arrhythmias are more common in pregnant women than in others. In most cases, the fetus can be delivered without therapeutic intervention. Hemodynamic instability and fetal hypoperfusion leading to fetal harm may occur if persistent episodes of high ventricular rate occur. In these cases, resolution of the arrhythmia may be advised. Antiarrhythmic drugs can be used with limitations and great caution in those expecting a child, so catheter ablation may be a safe and usable alternative. These interventions are traditionally performed using X-ray, however, due to the effect of ionizing radiation on fetal development, this would pose a high risk. Zero-fluoroscopic ablation has been available for several years in cardiac electrophysiology, which can be used both in the treatment of atrial fibrillation and in other arrhythmias. The procedure which we used in pregnant women is presented in two cases. We also managed to completely eliminate the use of X-ray during the interventions presented in this article. In the first case, a 23-week-old gravid patient underwent electrophysiological examination for recurrent paroxysmal supraventricular tachycardia. In the electrophysiological study, atrioventricular nodal reentry tachycardia was confirmed and successfully ablated. In our second case study, we present a catheter ablation for anteroseptal accessory pathway. Three-dimensional mapping system (supplemented with intracardiac ultrasound, if necessary), in the case of significant arrhythmia, is a safe and effective alternative where X-rays, which poses a risk to the mother and/or the fetus, cannot be used during pregnancy. Orv Hetil. 2021; 162(41): 1643–1651.

Introduction: According to the current clinical guidelines, CRT-D implantation is indicated for patients with history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS or high-degree AV block. Case presentation: A patient with DCM received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. We believed, that the 40 years old burn injury was the reason for the necrosis, resulted from the altered microcirculation of the skin. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue. We decided to perform surgical reimplantation of the device using mini thoracotomy: right atrial and right ventricular leads were introduced through the right atrial appendage and the left ventricular lead was inserted transapically. The device was implanted under the less scabby abdominal skin. 6 weeks later there was no sign of other complications and the surgical wounds were healed completely.Conclusions: We successfully applied the combination of trans-atrial and trans-apical lead placement, which has not been reported in the literature yet. It serves as an alternative method, if the standard approach is not feasible.

Abstract: Introduction: There are conflicting data on the prevalence and prognosis of AMI patients with non-obstructive coronary artery disease (MINOCA). Aim: We studied the prevalence and prognosis of MINOCA patients. Method: In the Hungarian Myocardial Infarction Registry (HUMIR) 45,223 patients (pts) with acute myocardial infarction (AMI) were found who were treated between Jan 1, 2014, and June 30, 2018, and coronary arteriography was performed. ST-elevation myocardial infarction was diagnosed in 22,469 pts (49.7%). Patients without obstructive coronary artery disease who had no previous myocardial infarction, heart failure, PCI and CABG procedure were selected to the MINOCA group (n = 2003). Patients with obstructive coronary artery disease belonged to the MICAD group (n = 43,220). We investigated clinical characteristics of the patients, overall survival and reinfarction. Survival curves were estimated with the Kaplan–Meier method and were modeled with the Cox proportional hazards model. Results: The proportion of MINOCA pts among all myocardial infarction was by 4.4% higher in the STEMI pts compared to the NSTEMI group (2.0% vs. 6.8%). The MINOCA pts were younger (age 64.0 ± 14.4 vs. 65.5 ± 12.2 years), and the proportion of women was higher (55.7% vs. 36.5%). Hypertension, diabetes mellitus and peripheral artery disease were more common in the MICAD group (79.1% vs. 73.7%, 33.0% vs. 21.2%, and 12% vs. 8%). The mortality was higher among the MICAD pts. In the MINOCA group, the mortality of men did not differ between STEMI and NSTEMI, as opposed to women: women with STEMI had higher mortality than women with NSTEMI. The risk of reinfarction was higher in the MICAD group, especially in NSTEMI, the risk in the MINOCA group was lower, and there was no substantial difference between types. Conclusion: In this real word, retrospective, observational study, we found a significant difference in the prevalence of MINOCA pts according to different types of myocardial infarction. In the MINOCA group, the mortality of women with STEMI was substantially higher. Orv Hetil. 2019; 160(45): 1791–1797.

Background: The authors analyzed data from the Hungarian Myocardial Infarction Registry (HUMIR) to examine the potential impact of gender on the treatment and 30-day and 1-year mortality o...

Objective Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice. Methods We developed a simplified ICE guided technique to perform ablation procedures for AF, with the aid of a 3D electroanatomical mapping system. The workflow was implemented in two phases: (1) the Introductory phase, where the first 16 ZF PVIs were compared with 16 cases performed with fluoroscopy and (2) the Extension phase, where 71 consecutive patients (including repeat procedures) with ZF approach were included. Standard PVI (and redoPVI) procedures were performed, data on feasibility of the ZF approach, complications, acute and 1-year success rates were collected. Results In the Introductory phase, 94% of the procedures could be performed with complete ZF with a median procedure time of 77.5 (73.5–83) minutes. In one case fluoroscopy was used to guide the ICE catheter to the atrium. There was no difference in the complication, acute and 1-year success rates, compared with fluoroscopy guided procedures. In the Extension phase, 97% of the procedures could be completed with complete ZF. In one case fluoroscopy was used to guide the transseptal puncture and in another to position the ICE catheter. Acute success of PVI was achieved in all cases, 64.4% patients were arrhythmia free at 1-year. Acute major complications were observed in 4 cases, all of these occurred in the redo PVI group and consisted of 2 tamponades, 1 transient ischemic attack and 1 pseudoaneurysm at the puncture site. The procedures were carried out by all members of the electrophysiology unit in the Extension phase, including less experienced operators and electrophysiology fellows (3 physicians) under the supervision of the senior electrophysiologist. Consequently, procedure times became longer [90 (75–105) vs 77.5 (73.5–85) min, p = 0.014]. Conclusions According to our results, a ZF workflow of AF ablations can be successfully implemented into the routine practice of an electrophysiology laboratory, without compromising safety and effectivity.

Összefoglaló. A ritmuszavarok előfordulása gyakoribb a terhes nők esetén, mint a nem várandósok körében. A legtöbb esetben terápiás beavatkozás nélkül is kihordható a magzat. Hemodinamikai instabilitás és magzatkárosodáshoz vezető fetalis hypoperfusio jöhet létre, amennyiben tartós, magas kamrai frekvenciával járó epizódok jelentkeznek. Ezekben az esetekben a ritmuszavar megszüntetése indokolttá válhat. Az antiarrhythmiás gyógyszerek korlátozottan és nagy körültekintéssel alkalmazhatók a gyermeket várók körében, így a katéterablatio jelenthet biztonságos és használható alternatívát. Ezen beavatkozásokat hagyományosan röntgensugár segítségével végzik, ez azonban az ionizáló sugárzásnak a magzati fejlődésre gyakorolt hatása miatt magas rizikót jelentene. Több éve elérhető a szív-elektrofiziológiában az ún. zéró fluoroszkópiás ablatio, mely a pitvarfibrilláció kezelésében és más ritmuszavarok esetében egyaránt alkalmazható. A terheseknél alkalmazott eljárást két eseten keresztül mutatjuk be. A röntgensugár használatát, a jelen cikkben bemutatott beavatkozások esetén is, sikerült teljesen kiküszöbölnünk. Az első, 23 hetes gravid páciensnél recidív paroxysmalis supraventricularis tachycardia miatt végeztünk elektrofiziológiai vizsgálatot. E vizsgálat során atrioventricularis nodalis reentry tachycardiát igazoltunk és abláltunk sikerrel. Második esetbemutatásunkban egy anteroseptalis járulékos köteg katéterablatiós megoldását mutatjuk be. A terhesség során jelentkező, az anyára és/vagy magzatára veszélyt jelentő ritmuszavar esetén a háromdimenziós térképező rendszer (szükség esetén intracardialis ultrahangvizsgálattal kiegészítve) biztonságos és hatásos alternatívát jelent, olyan esetekben, ha röntgensugár nem használható. Orv Hetil. 2021; 162(41): 1643-1651. Summary. Arrhythmias are more common in pregnant women than in others. In most cases, the fetus can be delivered without therapeutic intervention. Hemodynamic instability and fetal hypoperfusion leading to fetal harm may occur if persistent episodes of high ventricular rate occur. In these cases, resolution of the arrhythmia may be advised. Antiarrhythmic drugs can be used with limitations and great caution in those expecting a child, so catheter ablation may be a safe and usable alternative. These interventions are traditionally performed using X-ray, however, due to the effect of ionizing radiation on fetal development, this would pose a high risk. Zero-fluoroscopic ablation has been available for several years in cardiac electrophysiology, which can be used both in the treatment of atrial fibrillation and in other arrhythmias. The procedure which we used in pregnant women is presented in two cases. We also managed to completely eliminate the use of X-ray during the interventions presented in this article. In the first case, a 23-week-old gravid patient underwent electrophysiological examination for recurrent paroxysmal supraventricular tachycardia. In the electrophysiological study, atrioventricular nodal reentry tachycardia was confirmed and successfully ablated. In our second case study, we present a catheter ablation for anteroseptal accessory pathway. Three-dimensional mapping system (supplemented with intracardiac ultrasound, if necessary), in the case of significant arrhythmia, is a safe and effective alternative where X-rays, which poses a risk to the mother and/or the fetus, cannot be used during pregnancy. Orv Hetil. 2021; 162(41): 1643-1651.

Absztrakt

Abstract: The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure. Conclusion: comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90–93.

Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96% vs PFT guided: 85%, p

The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure.comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90-93.

Transradial primary PCI has been shown to cut mortality risk and is gaining popularity worldwide. To reflect this change in practice, a new risk model including access site has been developed for predicting 30-day mortality. Though the ALPHA (Age, Life support, Pressure, Heart rate, Access site; <

Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI).Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching.A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1±12.4years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p0.001, both). This benefit remained consistent in age-dependent subgroup analyses.Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.

Introduction Morbidity and mortality data of acute myocardial infarction highlight the significance of this patient population worldwide. Rapid and accurate diagnosis and timely initiation of an appropriate therapy are of crucial importance in this group of patients. Invasive cardiology, i.e. primary percutaneous coronary intervention is already a basic requirement of up-to-date medical care for acute myocardial infarction. However, American and European guidelines of 1999 positioned primary percutaneous coronary intervention as Class I recommendation, only as an alternative to thrombolysis and for the treatment of patients with a complicated cardiogenic shock. In Hungary, we organized a 24 h intervention service for acute myocardial infarction at the Department of Cardiology in the Zala County Hospital, Zalaegerszeg for the first time in 1998. Objectives Our study was aimed at demonstrating that the timely intervention therapy of acute myocardial infarction reduced the mortality rate of the dise...

A heveny szívinfarktus morbiditási és mortalitási adatai világszerte rámutatnak ezen betegcsoport kiemelt jelentőségére. A gyors és korrekt diagnózis, az adekvát terápia időben történő indítása kulcsfontosságú ezen betegcsoportnál. Ma már a heveny szívinfarktus korszerű ellátásának alapkövetelménye az invazív kardiológiai beavatkozás, a primer percutan coronariaintervenció. Az 1999-es amerikai és európai ajánlások azonban a primer percutan coronariaintervenciót I. osztályú ajánlásként csak mint a thrombolysis alternatíváját, illetve a kardiogén sokkal szövődött betegcsoport kezelését javasolták. A Zala Megyei Kórház Kardiológiai Osztályán 1998-ban Magyarországon elsőként szerveztük meg a heveny szívinfarktus 24 órás intervenciós ügyeletét. Cél: Vizsgálatunk célja annak igazolása, hogy a heveny infarktus korán elkezdett intervenciós kezelése az országos átlagnál jelentősebb mértékben csökkentette térségünkben a kórkép mortalitását, és ennek hatásai a mai napig érezhetőek. Módszerek: Az Állami Népegészségügyi és Tisztiorvosi Szolgálat Nyugat-dunántúli Regionális Intézete feldolgozta a nyugat-dunántúli régió és a zalaegerszegi kistérség 1996–2005 közötti időszak halálozási adatait, és egymással, valamint a statisztikai hivatal által közölt országos átlaggal hasonlította össze. Saját számítógépes adatbázisunk segítségével vizsgáltuk ezen időszakban végzett invazív beavatkozások számának változását, és összevetettük a mortalitási statisztikákkal. Eredmények: Az első „teljes” évben, 1998-ban 82 primer és 283 „elektív” percutan coronariaintervenciót végeztünk, ezek a számok 2005-re 318-ra és 1265-re emelkedtek. Ezzel párhuzamosan a szívinfarktus miatti korai, illetve teljes halálozás a férfiak körében a zalaegerszegi kistérségben szignifikánsan (pKövetkeztetés: A Magyarországon elsőként elindított 24 órás akut infarktus intervenciós ellátás a térség mortalitási statisztikáit jelentős mértékben javította az országos átlaghoz képest. A gyakorlott, nagy tapasztalatot szerzett team munkájának eredményei napjainkig előnyt jelentenek a zalaegerszegi kistérség betegei számára.

Platelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this complex process has made antiplatelet therapy the cornerstone of cardiovascular disease management. However, numerous patients will experience a recurrent atherothrombotic vascular event despite adequate antiplatelet therapy. Individual differences in the rate of platelet activation and reactivity markedly influence normal hemostasis and the pathological outcome of thrombosis. Such an individual variability is largely determined by environmental and genetic factors. These are known to either hamper platelets' response to agonists, and thereby mimic the pharmacological modulation of platelet function or mask therapy effect and sensitize platelets. In this article, we reviewed the antiplatelet mechanisms of aspirin and clopidogrel and the possible role of different polymorphisms, which may affect the efficacy of antiplatelet therapy. Heterogeneity in the way patients respond to aspirin and clopidogrel may in part reflect variation in cyclooxygenase (COX)-1, COX-2, glycoprotein (GP) Ib alpha, GP Ia/IIa, GP IIb/IIIa, UGT1A6*2, P2Y(1), P2Y(12), CYP2C9, CYP3A4 and CYP3A5 genotypes.

UNLABELLED Restenosis is the most common disadvantage of percutaneous coronary interventions. The incidence of restenosis can be lowered with the use of stents. After the use of stents, 'in-stent' restenosis can occur. To avoid it drug-eluting stents were developed, but the occurrence of stent thrombosis is higher than observed in case of bare-metal stents. Endeavor is a new zotarolimus-eluting stent developed to reduce the stent thrombosis. AIMS In a prospective study we aimed to follow-up our patients regarding the incidence of in-stent restenosis, stent thrombosis, and clinical end points after Endeavor stent implantation. PATIENTS AND METHODS Endeavor stents have been implanted in patients undergoing coronary angiography with the following indications: complex lesions susceptible to restenosis and after recanalization of chronic total occlusions. RESULTS Endeavor stent implantations were successfully performed in 99 patients and has been successful in 98% of cases, two stents could not be implanted because of technical difficulties. Significant restenosis was observed in eight patients (8.1%). Subacute stent thrombosis (within 10 days) occurred in two patients (2.0%). Any late stent thrombosis was not observed. CONCLUSION Our registry affirmed the results of the Endeavor I trial in a population with more severe and longer coronary stenosis. We can conclude that the Endeavor stent is suitable for implantation in complex, longer coronary lesions. Our long-term follow-up data do not prove those opinions which prefer bare-metal stent implantation in all patients because of the late adverse events of the drug-eluting stents.

Mortality data of patients with acute myocardial infarction are incomplete in Hungary.The aim of the authors was to analyse the data of 8582 myocardial infarction patients (4981 with ST-elevation myocardial infarction) registered in the Hungarian Myocardial Infarction Register in order to define the hospital, 30-day, and 1-year mortality. To evaluate the prehospital mortality of myocardial infarction, all myocardial infarction and sudden death were registered in five districts of Budapest.Multivariate logistic regression was performed to define risk factors of mortality and the model were assessed using c statistics.The hospital, 30-day and 1-year mortality of patients with ST elevation myocardial infarction were 3.7%, 9.5% and 16.5%, respectively. In patients without ST elevation myocardial infarction these figures were 4%, 9.8% and 21.7%, respectively. The 1-year mortality of patients without ST elevation was higher than those of with ST elevation and the difference was statistically significant. Age, Killip class, diabetes mellitus, history of stroke and myocardial infarction were independent predictors of death. Coronary intervention improved the prognosis of patients with myocardial infarction significantly.The rate of pre-hospital mortality was considerably high; 72.5% of 30 day mortality occurred before admission to hospital.Bevezetés: A heveny szívizominfraktust elszenvedett betegek halálozására vonatkozó hazai adatok hiányosak. Célkitűzés: A szerzők a Magyar Infarctus Regiszterben szereplő 8582 infarktusos beteg (4981 ST-elevációval járó myocardialis infarctus) adatainak elemzésével a kórházi, a 30 napos és az egyéves halálozás vizsgálatát tűzték ki célul. Budapest öt kerületében rögzítették a prehospitális haláleseteket. Módszer: A halálozás kockázati tényezőinek vizsgálatára logisztikus regressziós analízist végeztek, majd ellenőrizték a modell illeszkedését. Eredmények: A kórházi, a 30 napos, illetve az egyéves halálozás az ST-elevációval járó infarktusos betegcsoportban 3,7%, 9,5%, illetve 16,5%, a nem ST-elevációs betegcsoportban 4%, 9,8% és 21,7% volt. A nem ST-elevációval járó infarktus miatt kezelt betegek egyéves halálozása szignifikánsan magasabb volt. A halálozás kockázati tényezőit vizsgálva az életkor, a Killip-stádium, a kórelőzményben szereplő myocardialis infarctus, stroke, valamint a diabetes bizonyult prognosztikus jelentőségűnek. A percutan coronariaintervenció mindkét típusú infarktusban nagyon jelentősen javította a betegek rövid és hosszú távú életkilátásait. Következtetések: A prehospitális halálozás igen jelentős volt, a 30 napon belül bekövetkező események 72,5%-a kórházon kívül történt. Orv. Hetil., 2013, 154, 1297–1302.

background: Repeated loading doses (LD) of clopidogrel were shown to effectively overcome high on-clopidogrel platelet reactivity (HPR); however, comparison to potent P2Y12-inhibitors is lacking. We sought to compare the antiplatelet effect of high-dose clopidogrel versus prasugrel at both short- and long-term in acute coronary syndrome patients (ACS) with HPR. methods: ACS patients receiving 600 mg clopidogrel pretreatment were randomized to prasugrel or high-dose clopidogrel in a multicenter, controlled trial if platelet function testing revealed HPR (>46U) after PCI. In the prasugrel group, patients received an immediate 60-mg LD followed by 10 mg for three days. After day 3, patients were randomized to either standard (10 mg) or reduced (5 mg) maintenance doses up to 30 days. Patients randomized to high-dose clopidogrel received repeated loading doses of 600 mg clopidogrel based on controlled platelet function testing for three days, then were randomized to 75 mg or 150 mg maintenance doses for 30 days. ADP-induced platelet reactivity was measured with the Multiplate assay at day 0 (randomization), 1, 2, 3 and 25. Results: Between May 2011 and March 2013, 147 patients were randomized. Although baseline platelet reactivity did not differ between groups (p=0.22), prasugrel provided significantly more rapid and more potent platelet inhibition compared to repeated LD-s of clopidogrel through all three days after randomization (p

Twenty-two patients with single-vessel left anterior descending coronary artery disease were investigated by means of dipyridamole stress thallium-201 myocardial perfusion scintigraphy, using single photon emission tomography (SPET), 1 week before and 2–5 weeks after coronary bypass surgery. The dose of dipyridamole was 0.56 mg/kg, and the injected activity of 201T1 was 74 MBq. Before surgery, and after completion of the redistribution study, a further 37 MBq of 201T1 was injected. Ten minutes and 1 h later, repeated SPET imaging were performed. SPET images were evaluated both subjectively and semiquantitatively, using a five-grade segmental defect score system, with higher scores for more severe perfusion defects. Before surgery, the 3-h redistribution images revealed complete or partial persistence of the perfusion defects in all patients. On the images taken 10 min after reinjection, these defects were completely filled in four cases, and partially filled in ten cases. Further positive changes were observed on the 1-h post-reinjection images in four cases. Three of the 1-h post-reinjection images exhibited a paradox redistribution. The stress images after surgery corresponded well to the 201T1 distribution on the preoperative 1-h post-reinjection images in 11 cases. The average of the segmental defect severity scores was 17.0 after stress, 10.1 at rest, 7.1 10 min after reinjection and 6.4 1 h after reinjection. After surgery, the average of both the post-stress and the 3-h redistribution scores was 3.1. The correlation coefficients between the segmental scores of the postoperative resting study and the preoperative 3-h resting and the 10-min and 1-h post-reinjection studies were 0.72, 0.69 and 0.78, respectively. It is concluded that post-reinjection 201T1 images before surgery are good predictors of myocardial perfusion after revascularization. The best results are obtained if imaging is performed 1 h after reinjection.