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Background: The purpose of our study was to compare the efficacy and safety of alteplase in acute myocardial infarction (AMI), when administered in a double bolus regimen or an accelerated regimen during admission to an intensive care or coronary care unit (ICU/CCU)., Material/methods: A retrospective cohort study including all the AMI patients treated with alteplase recorded in the ARIAM register (Analysis of Delay in AMI), a multi-center register in which 77 Spanish hospitals participate. The study period was from January 1995 to January 2000., Results: 4,615 AMI patients were studied. The accelerated regimen (Group I) was administered to 57.51% (2,654 patients) and the remaining 42.49% (1,961 patients) received the double bolus regimen (Group II). There were no differences in mortality or in the incidence of hemorrhagic stroke between the groups. The mortality was 7.15% in Group I versus 6.43% in Group II (not significant). The incidence of hemorrhagic stroke was 1.09% in Group I versus 1.22% in Group II (not significant). Fewer coronary angiographies were required in Group I (6.28% vs. 8.99%; p<0.001) and fewer rescue angioplasties (10.67% vs. 21.88%, p=0.03). Group I also showed a smaller requirement for stent insertion (2.45% vs. 4.77%; p<0.0001) and for assistance using intra-aortic balloon contrapulsation (0.47% vs. 1.36%; p=0.02)., Conclusions: The two regimens appear to be similar in efficacy and safety. Nevertheless, from these results it may be hypothesized that further revascularization techniques are required after double bolus administration.

Objective: To determine by the measurement of extravascular lung water (EVLW) whether the timing of positive-end expiratory pressure (PEEP) application influences the intensity of lung injury., Design: Animal experimental study., Setting: Animal experimental laboratory., Subjects: Mixed-breed pigs (n = 18), aged 4 to 5 mos, weighing 25 to 30 kg., Interventions: The animals were anesthetized and tracheotomized, after which a permeability pulmonary edema was instigated by infusing oleic acid (0.1/kg) into the central vein. All animals were then randomly divided into three groups. In group 1 (n = 5), 10 cm H2O of PEEP was applied immediately after the oleic acid infusion and maintained throughout the 6 hrs of the experiment. Group 2 (n = 7) received the same level of PEEP 120 mins after the insult for 4 hrs. Group 3 (n = 6), the control group, was ventilated without PEEP for the six hrs of the experiment., Measurements and Main Results: At the end of the experiment, EVLW was calculated by gravimetric method. EVLW in group 1 (11.46+/-2.00 mL/kg) was significantly less than in group 2 (19.12+/-2.62 mL/kg) and group 3 (25.81+/-1.57 mL/kg), (p<.0001). Oxygenation also showed important differences by the end of the experiment when the Pao2/Fio2 ratio was significantly better in group 1 (467+/-73) than in group 2 (180+/-82) and group 3 (39+/-9), (p<.0001)., Conclusions: The application of 10 cm H2O of PEEP reduces EVLW in a time-dependent manner and maximum protective effect is achieved if it is applied immediately after lung injury production.