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Biomedical subjects

Doron Zahger

Publications and source records attributed to Doron Zahger.

26 records · Page 2Linked to original sources
PubMed2003

Effect of short-term treatment with azithromycin on recurrent ischaemic events in patients with acute coronary syndrome in the Azithromycin in Acute Coronary Syndrome (AZACS) trial: a randomised controlled trial.

BACKGROUND: There is serological and epidemiological evidence of an association between Chlamydia pneumoniae infection and coronary artery disease. Results of previous smaller studies have indicated a reduction of recurrent ischaemic events in patients with acute coronary syndrome when given macrolide antibiotics. We aimed to assess whether short-term treatment with the macrolide antibiotic azithromycin reduces recurrent ischaemic events in patients admitted for unstable angina or myocardial infarction. METHODS: We assessed the effect of azithromycin in a multicentre, double-blind randomised trial in 1439 patients with unstable angina or acute myocardial infarction. Patients were randomly allocated to receive 500 mg azithromycin on the first day after randomisation, followed by 250 mg daily for 4 days or placebo. Patients were followed up for 6 months. The primary endpoints were death, recurrent myocardial infarction, or recurrent ischaemia necessitating revascularisation. Analysis was done by intention to treat. FINDINGS: Treatment with azithromycin did not result in reduction of either individual endpoints or any of the primary endpoints. Of the 716 patients in the azithromycin group, 23 (3%) died, 17 (2%) developed myocardial infarction, 65 (9%) had recurrent ischaemia needing revascularisation, and 100 (14%) had one or more of these endpoints. In the placebo group (n=723) the corresponding numbers of patients were 24 (4%), 22 (3%), 59 (8%), and 106 (15%), respectively (p=0.664, 95% CI 0.72-1.24). 62 (9%) of patients in the azithromycin group and 59 (8%) in the placebo group reached the secondary endpoint of ischaemia or congestive heart failure necessitating admission (difference 0.5%, 95% CI 0.75-1.53; p=0.707). We recorded few side-effects. INTERPRETATION: Short-term treatment with azithromycin does not reduce development of recurrent events in patients with acute coronary syndrome.

Aged↗
PubMed2003

Reperfusion arrhythmias during coronary angioplasty for acute myocardial infarction predict ST-segment resolution.

BACKGROUND: Despite early recanalization of an occluded infarct-related artery, myocardial reperfusion may remain impaired due to microvascular injury. Reperfusion arrhythmias may indicate successful microvascular reperfusion. METHODS: Microvascular reperfusion was assessed prospectively in 42 consecutive patients with ST-segment elevation acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation (<50% of initial level) immediately after successful coronary angioplasty. Patients were divided into two groups: those with ST resolution (n=24) and those without ST resolution (n=18). The presence of reperfusion arrhythmias immediately after recanalization was recorded. RESULTS: Patients with ST resolution were younger (54+/-12 years compared with 64+/-17 years, P=0.04), their pain-to-recanalization time was shorter (195+/-87 min compared with 294+/-179 min, P=0.05), they were less often diabetic (13% compared with 24%, P=0.05) and were more often given IIb/IIIa inhibitors (58% compared with 22%, P=0.02). Reperfusion arrhythmias were observed in 15 out of 24 patients with ST resolution (62%) but in only one out of 18 without ST resolution (5%) (P<0.01). Reperfusion arrhythmias included accelerated idioventricular rhythm, 13 (81%); multifocal ventricular premature beats, two (13%); and ventricular tachycardia, one (6%). The sensitivity and specificity of reperfusion arrhythmias for ST resolution were 62 and 95%, respectively. In a logistic regression model including age, time to treatment, diabetes, use of IIb/IIIa inhibitors and reperfusion arrhythmias, only the latter was found to be an independent predictor of ST resolution (P<0.01). CONCLUSION: Reperfusion arrhythmias following coronary angioplasty for AMI are a highly specific marker for ST resolution and may indicate successful microvascular reperfusion.

Adult↗
PubMed2003

Characteristics, management and outcome of patients with prior coronary bypass surgery presenting with acute myocardial infarction.

We compared the characteristics, management and outcome of patients with or without prior coronary artery bypass graft surgery (CABG) presenting with AMI to any coronary care unit in Israel, from four national surveys performed during 1992-1998. Of 5,396 patients, 171 (3.2%) had prior CABG, 39 of whom received thrombolysis. Thrombolysis was administered less often in patients with prior CABG, but the utilization of coronary angiography was similar. Mortality rates were higher in patients with prior CABG, particularly among those given thrombolysis. The use of coronary angiography was a strong independent predictor of survival, but its utilization was similar in patients with or without prior CABG. Patients with prior CABG constitute a small minority among current AMI patients. They are sicker and their mortality is higher compared to patients without prior surgery, especially among those given thrombolysis. Coronary angiography is associated with improved outcome in these patients but is currently used to the same extent as in patients without prior surgery.

Angioplasty, Balloon, Coronary↗
PubMed2003

[The use of cardiac troponins in acute coronary syndromes].

In patients with acute coronary syndromes cardiac troponins are sensitive markers of myocardial damage. The troponin complex comprises subunits C, T and I and is a major component in the process of myocyte contraction and relaxation. The T and I subunits have cardiac isoforms with distinct specific immunologic properties which distinguish them from similar subunits of non-cardiac muscle tissue. The high sensitivity and specificity of cardiac troponins make them the preferred biochemical markers for diagnosing acute myocardial infarction and for the triage of patients admitted with chest pain without ST segment elevation on the E.K.G. There is a correlation between cardiac troponin levels and prognosis in patients with acute coronary syndromes. In addition to their prognostic role, cardiac troponins play a role in selecting patients for contemporary treatments. Thus, their level can identify the patients most likely to benefit from treatments such as low molecular-weight heparin, IIb/IIIa receptor blockers and early angiography and coronary intervention. Recently, the American heart Association, the European Heart Society and the Israel Cardiology Society have published guidelines for the use of cardiac troponins. This review summarizes the current data regarding the use of cardiac troponins in the acute coronary syndromes.

Anticoagulants↗
PubMed2003

Door to balloon and door to needle: temporal trends in delays to reperfusion.

BACKGROUND: Reperfusion practices have changed markedly over the last few years with the introduction of primary percutaneous coronary intervention. This technique has gained growing popularity in Israel, but little published data are available regarding the delays to primary PCI in real life in this country. OBJECTIVES: To examine temporal trends in time to reperfusion achieved in a large tertiary center over 6 years. RESULTS: Between 1997 and 2002, 1,031 patients were admitted to our hospital with ST elevation myocardial infarction. Of these, 62% underwent thrombolysis and 38% primary PCI. The proportion of patients referred for primary PCI increased steadily, from 14% in 1997 to 68% in 2002. Door to treatment time among patients referred for thrombolysis or primary PCI was 54 +/- 42 and 117 +/- 77 minutes, respectively (P < 0.00001). The door to needle time in patients given thrombolysis remained virtually unchanged during the study period at around 54 minutes. In contrast, the door to balloon time progressively and substantially decreased, from 175 +/- 164 minutes in 1997 to 96 +/- 52 minutes in 2002. CONCLUSIONS: There is a steady increase in the proportion of patients referred for primary PCI than for thrombolysis. The door to needle delay in patients given thrombolysis substantially exceeds the recommended time. The door to balloon time has declined considerably but still slightly exceeds the recommended time. Given the inherent delay between initiation of lysis and arterial recanalization, it appears from our experience that PCI does not substantially delay arterial reperfusion as compared to thrombolysis. Efforts should continue to minimize delays to reperfusion therapy.

Analysis of Variance↗
PubMedDate not supplied

Thrombocytopenia, immunoglobulin treatment, and acute myocardial infarction--a case report.

Platelets play a pivotal role in the pathophysiology of the acute coronary syndromes, and platelet inhibition is a cornerstone in the management of these patients. Patients with profound thrombocytopenia who present with an acute coronary syndrome present a difficult challenge. The authors report a patient with immune thrombocytopenic purpura who presented with acute myocardial infarction despite a very low platelet count and who sustained recurrent infarction after receiving immune globulin treatment. The best management of thrombocytopenic patients with acute coronary syndromes is uncertain, but extreme caution is needed before efforts are made to raise the platelet count in order to allow conventional treatment.

Coronary Angiography↗