salicylates and Myocardial-Infarction

Triflusal (Aflen, Disgren, Tecnosal, Triflux) is a novel platelet antiaggregant with structural similarities to salicylates, but which is not derived from aspirin. It has similar efficacy to aspirin in patients with cerebral or myocardial infarction, but has a reduced risk of haemorrhagic complications. In addition, triflusal plus moderate-intensity anticoagulation has demonstrated efficacy when used as thromboprophylaxis in atrial fibrillation. As such, triflusal has a role in the primary prevention of cerebrovascular events in atrial fibrillation, and for the secondary prevention of cerebral and myocardial infarction, primarily as an alternative to aspirin in patients for whom aspirin is unsuitable.

Topics: Atrial Fibrillation; Cardiovascular Diseases; Cerebral Infarction; Drug Interactions; Humans; Meta-Analysis as Topic; Myocardial Infarction; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Salicylates; Thromboembolism

Aspirin is the standard treatment for secondary prevention of stroke and other vascular events. Several studies suggest that triflusal may have a better safety profile.. To determine in people at high risk of vascular events whether triflusal is an effective and safe treatment for primary and secondary prevention of serious vascular events.. We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched October 2004), Heart Group, Peripheral Vascular Diseases Group and Metabolic and Endocrine Disorders Group (last searched May 2003). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2003), MEDLINE (1977 to 2003) and EMBASE (1980 to 2003). We searched reference lists and contacted researchers in the field, authors of relevant trials and the drug manufacturer.. Randomised and quasi-randomised studies comparing triflusal with placebo or aspirin in people at high risk of vascular events.. Two authors independently assessed trial quality and extracted data. The primary outcome was a serious vascular event (non-fatal acute myocardial infarction (AMI), non-fatal ischemic or hemorrhagic stroke, or vascular death). Other efficacy and safety measures collected were frequency of different vascular events, adverse events, minor and major hemorrhages.. (1) Aspirin versus triflusal: five studies enrolled patients with stroke or transient ischemic attack (TIA) (4 trials; 2944 patients; followed for 6 to 47 months) or AMI (one trial; 2275 patients; followed for 35 days). Entry criteria were similar within each subgroup of patients. Patient groups were appropriately selected and well matched. The primary outcome in all trials was a composite outcome of vascular events. Trials had no important bias except in one study (217 patients). For the primary outcome of a serious vascular event there was no significant difference between triflusal and aspirin; the odds ratio (OR) was 1.04 (95% confidence interval (CI) 0.87 to 1.23). Significant differences were found for frequency of hemorrhages, both minor (OR 1.60, 95% CI 1.31 to 1.95) and major (OR 2.34, 95% CI 1.58 to 3.46) and for non-hemorrhagic gastrointestinal adverse events (OR 0.84, 95% CI 0.75 to 0.95). Sensitivity analysis of well versus poorly allocated trials showed no significant differences. (2) Triflusal versus placebo: two trials enrolled patients with unstable angina (281 patients) or peripheral arteriopathy (122 patients), who were followed for 6 months. Triflusal was associated with a reduction in serious vascular events (OR 2.29, 95% CI 1.01 to 5.19; OR greater than 1 favours triflusal) and with a higher frequency of adverse events (OR 1.68, 95% CI 1.00 to 2.80).. No significant differences were found between triflusal and aspirin for secondary prevention of serious vascular events in patients with stroke or TIA and AMI. However, our review cannot exclude moderate differences in efficacy. Triflusal was associated with a lower risk of hemorrhagic complications.

Topics: Aspirin; Humans; Ischemic Attack, Transient; Myocardial Infarction; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Risk Factors; Salicylates; Stroke

Kawasaki disease is a childhood vasculitis of medium-sized vessels, affecting the coronary arteries in particular. We have treated a therapy-resistant child who met all diagnostic criteria for Kawasaki disease. After the boy was given intravenous immunoglobulins and salicylates, as well as several courses of pulsed methylprednisolone, disease recurred and coronary artery lesions became progressively detectable. Cyclosporin A was started and seemed clinically effective. In contrast to the positive effect on inflammatory parameters, ie, C-reactive protein and white blood cell counts, a novel plasma marker for cytotoxicity (granzyme B) remained elevated. Coronary disease progressed to fatal obstruction and myocardial infarction. Echocardiography, electrocardiograms, and myocardial creatine phosphokinase did not predict impending death. At autopsy an obliterative panarteritis was observed resulting from massive fibrointimal proliferation, affecting the aorta and several large and medium-sized arteries. Immunophenotypic analysis of the inflammatory infiltrates in arteries revealed mainly granzyme-positive cytotoxic T cells and macrophages in the intima and media, as well as nodular aggregates of T cells, B cells, and plasma cells in the adventitia of affected arteries. These findings further endorse the role of specific cellular and humoral immunity in Kawasaki disease. Unremitting coronary arteritis and excessive smooth muscle hyperplasia resulted in coronary occlusion despite the use of cyclosporin A.

Topics: Aneurysm; C-Reactive Protein; Coronary Disease; Cyclosporine; Cytokines; Drug Resistance; Fatal Outcome; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Infant; Male; Methylprednisolone; Mucocutaneous Lymph Node Syndrome; Myocardial Infarction; Salicylates; Serine Endopeptidases

Triflusal is an antiplatelet agent structurally related to the salicylate group of compounds, but it is not derived from aspirin (acetylsalicylic acid). Platelet antiaggregant properties of triflusal and its active 3-hydroxy-4-trifluoro-methylbenzoic acid metabolite are primarily mediated by specific inhibition of platelet arachidonic acid metabolism. Triflusal, compared with placebo for 6 months, significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. In patients with peripheral arteriopathy, total and pain free walking distances were markedly improved in triflusal compared with placebo recipients. The cumulative event rate for stroke, ischemic cardiopathy and vascular death was lower, but not significantly different, in patients with atherothrombotic stroke who received triflusal than in aspirin recipients. Differences were significant, and favoured triflusal, in a subgroup of patients with > 70% carotid stenosis. Prophylaxis with triflusal for 6 months after aortocoronary vein grafting reduced the number of new distal anastomosis occlusions and the graft attrition rate more than aspirin or placebo. The incidence of deep vein thrombosis or pulmonary embolism in more than 500 patients undergoing hip surgery was similar for these 3 treatments. The amount of blood transfused was significantly reduced in triflusal compared with aspirin recipients who underwent hip surgery. Risk of haemorrhage was also reduced in ischemic stroke patients receiving triflusal versus aspirin.

Topics: Adult; Angina Pectoris; Animals; Aspirin; Carotid Stenosis; Humans; In Vitro Techniques; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Postoperative Complications; Pulmonary Embolism; Randomized Controlled Trials as Topic; Salicylates; Thrombophlebitis

Topics: Antidepressive Agents, Tricyclic; Arrhythmias, Cardiac; Brain Diseases; Brain Edema; Diazepam; Gastric Lavage; Humans; Hypotension; Myocardial Infarction; Pacemaker, Artificial; Physostigmine; Pyridostigmine Bromide; Respiration, Artificial; Salicylates

Topics: Adrenal Cortex Hormones; Arthritis; Electrocardiography; Humans; Inflammation; Morphine; Myocardial Infarction; Myositis; Pericarditis; Peritonitis; Pleurisy; Pneumonia; Salicylates

Triflusal has demonstrated an efficacy similar to aspirin in the prevention of vascular events in patients with acute myocardial infarction (ΜΙ) and ischaemic stroke but with less bleeding events.. We performed a randomised, multicentre, phase 4 clinical trial to compare the clinical efficacy and safety of triflusal versus aspirin, administered for 12 months in patients eligible to receive a cyclooxygenase-1 (COX-1) inhibitor.. Patients with stable coronary artery disease or with a history of non-cardioembolic ischaemic stroke were randomly assigned to receive either triflusal 300 mg twice or 600 mg once daily or aspirin 100 mg once daily for 12 months. The primary efficacy endpoint was the composite of: (a) ΜΙ, (b) stroke (ischaemic or haemorrhagic), or, (c) death from vascular causes for the entire follow-up period. The primary safety endpoints were the rate of bleeding events as defined by Bleeding Academic Research Consortium (BARC) criteria.. At 12-month follow-up, an equivalent result was revealed between the triflusal (n=559) and aspirin (n=560) in primary efficacy endpoint. Specifically, the combined efficacy outcome rate (i.e. MI, stroke or death from vascular causes) difference was equal to -1.3% (95% confidence interval -1.1 to 3.5) and lied within the a-priori defined equivalence interval (p<0.001). Regarding the primary safety endpoints, patients on triflusal treatment were 50% less likely to develop bleeding events according to the BARC criteria, and especially any clinically overt sign of haemorrhage that requires diagnostic studies, hospitalisation or special treatment (BARC type 2).. The efficacy of triflusal in the secondary prevention of vascular events is similar to aspirin when administered for 12 months. Importantly, triflusal significantly reduced the incidence of ΜΙ and showed a better safety profile compared with aspirin. (ASpirin versus Triflusal for Event Reduction In Atherothrombosis Secondary prevention, ASTERIAS trial; Clinical Trials.gov Identifier: NCT02616497).

Topics: Aged; Aspirin; Brain Ischemia; Coronary Artery Disease; Cyclooxygenase Inhibitors; Female; Greece; Hemorrhage; Humans; Intracranial Embolism; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Recurrence; Risk Factors; Salicylates; Secondary Prevention; Stroke; Time Factors; Treatment Outcome

The efficacy of the antiplatelet agent triflusal for prevention of vascular events after stroke has been reported in a pilot study. However, there is a need to confirm those results in a larger study.. We performed a randomized, double-blind, multicenter study to test the efficacy of triflusal (600 mg/d) versus aspirin (325 mg/d) for prevention of vascular events in patients with stroke or transient ischemic attack (Triflusal versus Aspirin in Cerebral Infarction Prevention [TACIP]). We assessed a combined end point (incidence of nonfatal ischemic stroke, nonfatal acute myocardial infarction, or vascular death) as well as the incidence of these events separately and the incidence of major hemorrhage.. Of 2113 patients, 1058 received triflusal and 1055 aspirin. The mean follow-up period was 30.1 months. The incidence of combined end point (13.1% for triflusal, 12.4% for aspirin) as well the survival analysis (hazard ratio [HR] for triflusal versus aspirin, 1.09; 95% CI, 0.85 to 1.38) showed no differences between groups. The incidence of nonfatal stroke (HR, 1.09; 95% CI, 0.82 to 1.44), nonfatal acute myocardial infarction (HR, 0.95; 95% CI, 0.46 to 1.98,) and vascular death (HR, 1.22; 95% CI, 0.75 to 1.96) was also similar. A significantly higher incidence of major hemorrhages in the aspirin group was recorded (HR, 0.48; 95% CI, 0.28 to 0.82). The overall incidence of hemorrhage was significantly lower in the triflusal group (16.7% versus 25.2%) (odds ratio, 0.76; 95% CI, 0.67 to 0.86; P<0.001).. This study failed to show significantly superior efficacy of triflusal over aspirin in the long-term prevention of vascular events after stroke, but triflusal was associated with a significantly lower rate of hemorrhagic complications.

Topics: Aspirin; Cardiovascular Diseases; Cerebral Infarction; Double-Blind Method; Female; Hemorrhage; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Salicylates; Secondary Prevention; Stroke; Survival Analysis

To compare the costs to the Spanish healthcare system of 35 days' treatment with triflusal (600 mg/day) and aspirin (300 mg/day) in patients with confirmed acute myocardial infarction within 24 hours of onset of symptoms.. A cost minimisation analysis based on the results of the Triflusal in Acute Myocardial Infarction study (TIM) was conducted. The hypothesis was that despite a higher acquisition cost of triflusal, savings would result because of differences in efficacy and safety outcome (non-fatal cerebrovascular event and haemorrhagic events). Diagnostic Related Groups were used as a proxy for determining hospital costs in Spain and the values were obtained from different sources and refer to year 2000 costs. Only direct medical costs were considered for the economic analysis.. Although the acquisition cost of triflusal was more expensive than that of aspirin, the cost of prevented events - non-fatal ischaemic cerebrovascular events and cerebral haemorrhages - entirely compensated for the cost of triflusal. The overall cost of treating patients with triflusal, compared with aspirin, represented a net saving of 28.4% per patient treated.. Our study showed that triflusal is cost saving compared with aspirin in the treatment of the acute phase of myocardial infarction.

Topics: Acute Disease; Aspirin; Double-Blind Method; Drug Costs; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Recurrence; Salicylates; Spain

To compare the efficacy and tolerability of the antiplatelet agent triflusal with aspirin in the prevention of cardiovascular events following acute myocardial infarction.. In this double-blind, multicentre, sequential design study, patients were randomized within 24 h of acute myocardial infarction symptom onset to receive triflusal 600 mg or aspirin 300 mg once daily for 35 days. The primary end-point was death, non-fatal myocardial reinfarction or a non-fatal cerebrovascular event. The incidences of these individual outcomes and urgent revascularization were secondary end-points. The null hypothesis of no difference between treatments in the primary combined end-point was accepted with 80% power after recruiting 2124 validated patients (odds ratio (OR) for failure [95% confidence interval (CI)]: 0.882 [0.634-1.227]). Non-fatal cerebrovascular events were significantly less frequent with triflusal (OR [95% CI]: 0.364 [0.146-0.908]; P = 0.030). There was no significant difference between treatments for death (OR [95% CI]: 0.816 [0.564-1.179]; P = 0.278), non-fatal reinfarction (OR [95% CI]: 1.577 [0.873-2.848]; P = 0.131) or revascularization (OR [95% CI]: 0.864 [0.644-1.161]; P = 0.334). Overall, both drugs were well tolerated, although there was a trend towards fewer bleeding episodes with triflusal; significantly fewer central nervous system bleeding episodes were observed in triflusal-treated patients (0.27% vs. 0.97%; P = 0.033).. Triflusal and aspirin have similar efficacy in preventing further cardiovascular events after acute myocardial infarction, but triflusal showed a more favourable safety profile. Triflusal significantly reduced the incidence of non-fatal cerebrovascular events compared with aspirin.

Topics: Aged; Aspirin; Cerebrovascular Disorders; Double-Blind Method; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Recurrence; Salicylates; Spain; Treatment Outcome

We analyzed the clinical characteristics of the 58 diabetic and 218 nondiabetic patients enrolled in the Spanish multicentre trial of trifusal in unstable angina. After 6 months of follow-up, 25 suffered from myocardial infarction or death, 10 of which were diabetics (17.2%) and 15 nondiabetics (6.9%) (P = 0.0146). This difference remained significant after multivariate analysis. We conclude that diabetes is an independent predictor of adverse outcome in patients with medically treated unstable angina.

Topics: Aged; Angina, Unstable; Diabetes Complications; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Myocardial Revascularization; Platelet Aggregation Inhibitors; Prognosis; Salicylates; Spain; Treatment Outcome

A multicenter, double-blind, placebo-controlled study was carried out to evaluate the effect of a new antiplatelet agent, triflusal (2-acetoxy-4-trifluoromethyl benzoic acid), in the prevention of nonfatal myocardial infarction and cardiac or vascular death (principal end-points) in patients with unstable angina. 281 patients were randomly assigned to triflusal (300 mg t.i.d.; n = 143) or placebo (n = 138). After 6 months of treatment, the incidence of nonfatal acute myocardial infarction was significantly lower in the triflusal than in the placebo group: 6 patients (4.2%) versus 17 (12.3%), p = 0.013. The low number of deaths (2/143 triflusal versus 0/138 placebo recipients) hampered statistical analysis of mortality rates. The need for revascularization was similar in the two groups: 24 patients (16.8%) in the triflusal group and 28 (20.3%) in the placebo group, p = 0.449. In conclusion, the results show that treatment with triflusal can reduce the incidence of myocardial infarction in patients with unstable angina.

Topics: Administration, Oral; Aged; Angina, Unstable; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Salicylates; Spain; Survival Rate

The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA. We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0-3) and high thrombus burden (HTB; TIMI 4 and 5).. The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA. The CHA. HINTERGRUND: Die Verschlussrate für V.-saphena-Transplantate (SVG) innerhalb des ersten Jahres nach der Bypass-Operation liegt bei 15%. Zur Vorhersage des Risikos thromboembolischer Ereignisse bei Patienten mit nichtvalvulärem Vorhofflimmern wird der CHA. Retrospektiv wurden 221 Patienten untersucht, die wegen AMI stationär aufgenommen wurden und bei denen zwischen 2012 und 2018 am Department of Cardiology im Turkiye Yuksek Ihtisas Education and Research Hospital eine SVG-PCI durchgeführt wurde. Die Studienpopulation wurde entsprechend ihrem Thrombusgrad gemäß Thrombolysis in Myocardial Infarction (TIMI) in 2 Gruppen unterteilt: niedrige Thrombuslast (LTB; TIMI 0–3) und hohe Thrombuslast (HTB; TIMI 4 und 5).. In die Studie wurden 221 Patienten mit einem Durchschnittsalter von 63,3 ± 6,7 Jahren aufgenommen. Patienten mit HTB wiesen signifikant höhere CHA. Der CHA

Topics: Aged; Atrial Fibrillation; Humans; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Salicylates; Thrombosis

Topics: Animals; Cardiotonic Agents; Drug Resistance; Free Radical Scavengers; Hypertrophy, Left Ventricular; Male; Mice, Inbred C57BL; Myocardial Infarction; Myocardial Reperfusion Injury; Organometallic Compounds; Oxidative Stress; Reactive Nitrogen Species; Reactive Oxygen Species; Salicylates; Sirolimus

Protein modification by small ubiquitin-like modifier (SUMO) plays a critical role in the pathogenesis of heart diseases. The present study was designed to determine whether ginkgolic acid (GA) as a SUMO-1 inhibitor exerts an inhibitory effect on cardiac fibrosis induced by myocardial infarction (MI).. GA was delivered by osmotic pumps in MI mice. Masson staining, electron microscopy (EM) and echocardiography were used to assess cardiac fibrosis, ultrastructure and function. Expression of SUMO-1, PML, TGF-β1 and Pin1 was measured with Western blot or Real-time PCR. Collagen content, cell viability and myofibroblast transformation were measured in neonatal mouse cardiac fibroblasts (NMCFs). Promyelocytic leukemia (PML) protein was over-expressed by plasmid transfection.. GA improved cardiac fibrosis and dysfunction, and decreased SUMO-1 expression in MI mice. GA (>20 μM) inhibited NMCF viability in a dose-dependent manner. Nontoxic GA (10 μM) restrained angiotensin II (Ang II)-induced myofibroblast transformation and collagen production. GA also inhibited expression of TGF-β1 mRNA and protein in vitro and in vivo. GA suppressed PML SUMOylation and PML nuclear body (PML-NB) organization, and disrupted expression and recruitment of Pin1 (a positive regulator of TGF-β1 mRNA), whereas over-expression of PML reversed that.. Inhibition of SUMO-1 by GA alleviated MI-induced heart dysfunction and fibrosis, and the SUMOylated PML/Pin1/TGF-β1 pathway is crucial for GA-inhibited cardiac fibrosis.

Topics: Animals; Animals, Newborn; Cell Survival; Dose-Response Relationship, Drug; Fibrosis; Male; Mice; Myocardial Infarction; Salicylates; Stroke Volume; SUMO-1 Protein

TNF-α inhibitor reportedly protects against myocardial ischemia/reperfusion (MI/R) injury. It can also increase Notch1 expression in inflammatory bowel disease, revealing the regulation of Notch1 signaling by TNF-α inhibitor. However, the interaction between TNF-α inhibitor and Notch1 signaling in MI/R remains unclear. This study aimed to determine the involvement of TNF-α inhibitor with Notch1 in MI/R and delineate the related mechanism. Notch1-specific small interfering RNA (20 μg) or Jagged1 (a Notch ligand, 12 μg) was delivered through intramyocardial injection. Forty-eight hours after injection, mice received 30 min of myocardial ischemia followed by 3 h (for cell apoptosis and oxidative/nitrative stress) or 24h (for infarct size and cardiac function) of reperfusion. Ten minutes before reperfusion, mice randomly received an intraperitoneal injection of vehicle, etanercept, diphenyleneiodonium, 1400W, or EUK134. Finally, downregulation of Notch1 significantly reversed the alleviation of MI/R injury induced by etanercept, as evidenced by enlarged myocardial infarct size, suppressed cardiac function, and increased myocardial apoptosis. Moreover, Notch1 blockade increased the expression of inducible NO synthase (iNOS) and gp(91)(phox), enhanced NO and superoxide production, and accelerated their cytotoxic reaction product, peroxynitrite. Furthermore, NADPH inhibition with diphenyleneiodonium or iNOS suppression with 1400W mitigated the aggravation of MI/R injury induced by Notch1 downregulation in mice treated with etanercept. Additionally, either Notch1 activation with Jagged1 or peroxynitrite decomposition with EUK134 reduced nitrotyrosine content and attenuated MI/R injury. These data indicate that MI/R injury can be attenuated by TNF-α inhibitor, partly via Notch1 signaling-mediated suppression of oxidative/nitrative stress.

Topics: Animals; Calcium-Binding Proteins; Disease Models, Animal; Down-Regulation; Enzyme Activation; Etanercept; Intercellular Signaling Peptides and Proteins; Jagged-1 Protein; Membrane Proteins; Mice; Mice, Inbred C57BL; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; NADP; Nitric Oxide Synthase Type II; Onium Compounds; Organometallic Compounds; Oxidative Stress; Peroxynitrous Acid; Reactive Nitrogen Species; Reactive Oxygen Species; Receptor, Notch1; RNA Interference; RNA, Small Interfering; Salicylates; Serrate-Jagged Proteins; Tumor Necrosis Factor-alpha

To investigate the effect of aspirin on the platelets of survivors of myocardial infarction we correlated plasma salicylate level with platelet reactivity in ten patients and ten normal controls. The patients and controls were tested at the end of 2 week periods on 75, 150 and 300 mg aspirin daily by mouth. Platelet reactivity was measured, under high shear stress conditions, using cartridges containing adrenaline and adenosine diphosphate in a PFA-100 platelet function analyser. The time taken by the developing platelet aggregate to close an aperture in the collagen membrane of the cartridge, the closure time, was taken as an index of platelet reactivity. There was no difference in baseline haematocrit, platelet count or plasma vWF antigen level between the groups. There was a dose-dependent increase in closure time of the adrenaline containing cartridge in the controls (P < 0.001), but not in the patients (P = 0.08), compatible with a reduced anti-platelet effect of aspirin in the patients. Furthermore, plasma salicylate level was higher in the patient group (P < 0.05).

Topics: Administration, Oral; Adult; Aged; Aspirin; Blood Platelets; Dose-Response Relationship, Drug; Drug Resistance; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Count; Salicylates

Most acute coronary syndromes result from a platelet-rich occlusion of the coronary arteries. Antiplatelet drugs are of proven efficacy in preventing myocardial infarction, unstable angina, and stroke. However, not all patients on aspirin (ASA) benefit. We studied the phenomenon of aspirin resistance with a simple and reliable platelet function analyzer--the PFA-100. Studying 31 patients with unstable angina and 105 controls, we found aspirin resistance in 42% of patients, most of whom were shown to be compliant utilizing concomitant salicylate levels.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Aspirin; Case-Control Studies; Female; Humans; Male; Middle Aged; Myocardial Infarction; Nitrates; Patient Compliance; Platelet Aggregation Inhibitors; Platelet Function Tests; Prevalence; Reference Values; Salicylates; Time Factors

Topics: Diabetes Mellitus, Type 2; Diagnosis, Differential; Drug Eruptions; Eczema; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Myocardial Infarction; Patch Tests; Platelet Aggregation Inhibitors; Salicylates

Topics: Aspirin; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Salicylates

From 1974 through 1991, a total of 583 children with Kawasaki disease were seen at the Hospital for Sick Children, in Toronto, of whom 80 (13.7%) had coronary artery involvement. There were 55 boys and 25 girls, whose mean age at onset was 2.9 +/- 2.5 years, followed for a mean period of 4.0 +/- 3.6 years. Giant aneurysms (maximum diameter > or = 8 mm) were found in 22 children, moderate-sized aneurysms (> or = 4 to < 8 mm) in 44, and dilation lesions (< 4 mm) in 14. Myocardial infarction occurred in 9 (1.5%), all of whom had giant aneurysms. The persistence rate for aneurysms was 72% at 1 year and 41% at 5 years of follow-up. In multivariate analysis, the regression of an aneurysm was significantly related to the severity of coronary artery lesions, initial treatment, and gender. Although > 80% of small or moderate-sized aneurysms regressed within 5 years, giant aneurysms did not regress during the follow-up period. In patients who received immune globulin therapy, coronary lesions tended to resolve more rapidly than in those treated with salicylate therapy alone, because 91% of the lesions in the former were small or moderate. These findings suggest that the severity of coronary artery involvement during the initial stages of Kawasaki disease influences the regression of these lesions, and that immune globulin treatment may improve outcome by reducing the incidence of severe lesions.

Topics: Adolescent; Child; Child, Preschool; Coronary Aneurysm; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Infant; Male; Mucocutaneous Lymph Node Syndrome; Myocardial Infarction; Prognosis; Salicylates

Reaction of tris(acetylacetonato)gallium(III) with 1,1,1-tris(5-methoxysalicladiminomethyl)ethane, H3[(5-MeOsal)3 TAME], affords a neutral six-coordinate complex, Ga[5-MeOsal)3 TAME], for which the x-ray crystal structure is reported. The 67Ga and 68Ga complexes of H3[(5-MeOsal)3 TAME] and the bis(salicylaldimine) of triethylenetetramine were prepared and characterized by paper chromatography and electrophoresis. The biodistribution of lipophilic 68Ga[(5-MeOsal)3 TAME] was determined following intravenous injection in rats. Myocardial images obtained by positron emission tomography from three dogs injected with 68Ga[(5-MeOsal)3 TAME] show a correlation between 68Ga uptake and regional myocardial blood flow. Single-pass coronary extraction studies in open-chest dogs indicate that 68Ga[(5-MeOsal)3 TAME] behaves neither as a freely diffusible tracer nor as a microsphere analog.

Topics: Animals; Dogs; Gallium Radioisotopes; Heart; Myocardial Infarction; Rats; Rats, Inbred Strains; Salicylates; Tissue Distribution; Tomography, Emission-Computed

The mission of the National Heart, Lung, and Blood Institute is to sponsor research in the prevention, diagnosis, and treatment of heart, lung, and blood diseases. As a part of its activities toward this end, the Institute plans and conducts clinical trials that test the safety and efficacy of a broad range of preventive and treatment regimens. Many of these trials involve thousands of patients and require the cooperation of many research clinics under a common protocol, often for many years. An essential component in these efforts is a standardized methodology to allow accurate tracking of adherence patterns so that problem adherence situations can be identified and rectified. This article reviews the methods that have been used to assess adherence patterns in selected clinical trials supported by the NHLBI. The most frequently used methods have been pill count and direct measurement of the drug, its metabolites, or physiological effects in some bodily fluid. Supplementary information is frequently obtained by self-report. Experience with markers has been very limited and no systematic data are available. The Aspirin Myocardial Infarction Study is used as a case study to illustrate specific strengths and weaknesses of three types of adherence assessment methods, namely, assay of salicylates in the urine, platelet aggregation, and pill count. Generalizations to other clinical trials are discussed. Based on experience to date with traditional methods of compliance assessment, several conclusions are drawn. Combinations of measures, in general, provide the most useful profiles of adherence patterns in clinical trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aspirin; Capsules; Clinical Trials as Topic; Humans; Myocardial Infarction; National Institutes of Health (U.S.); Patient Compliance; Platelet Aggregation; Salicylates; United States

Four non-steroid anti-inflammatory drugs, sulfinpyrazone, acetylsalicylic acid, sodium salicylate and indomethacin were tested in the acute phase of experimental myocardial infarction in conscious rats. A single oral dose was administered, then 1 h later the occlusion of the left anterior descending coronary artery was made by using a previously implanted silk loop. It was found that each drug markedly increased the survival rate, reduced the occurrence of ventricular fibrillation and tachycardia, and delayed the appearance and shortened the duration of arrhythmias.

Topics: Animals; Anti-Inflammatory Agents; Aspirin; Coronary Vessels; Indomethacin; Male; Myocardial Infarction; Rats; Salicylates; Sulfinpyrazone

Pericarditis complicating acute myocardial infarction assumes increasing importance in this era of quantitating infarct size by precordial ST segment mapping. Early recognition of this complication avoids diagnostic and therapeutic errors. In this study we looked for factors that could alert to the early diagnosis of pericarditis, such as ST elevation measured within 24 hours from onset, extent of CPK, LDH, and SGOT elevation, as well as degree of pump dysfunction. ST segment elevation in millimeters on admission seemed to be one factor that was of predictive value in this condition. Pericarditis occurred in three forms: (1) within a few hours from the onset of myocardial infarction and this form seems to carry a high mortality rate; (2) a more common variety occurs within 24 to 72 hours from onset and carries a higher mortality rate than matched controls; and (3) the late syndrome of Dressler's, not observed in our series. Aside from increased incidence of heart failure, other complications of myocardial infarction and the coronary risk factors were not significantly higher in patients with pericarditis. Salicylate treatment offers immediate relief in the majority of patients.

Topics: Aspartate Aminotransferases; Creatine Kinase; Heart Failure; Humans; L-Lactate Dehydrogenase; Male; Myocardial Infarction; Pericarditis; Radiography; Risk; Salicylates; Tachycardia; Time Factors

Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Humans; Myocardial Infarction; Pericarditis; Salicylates; Syndrome

Since October 1978, four cases of mucocutaneous lymph node syndrome, a disease previously not yet described in our country were observed in our childrens hospital. This particular disease has been described quite frequently in Japan since 1967. It has a characteristic manifestation being mostly benign and self limited. In a few cases however acute cardiac arrest has been described. The first case we observed expired as a result of acute coronary infarction on the twentyfifth day of illness although clinical improvement had been previously noted. At post mortem examination the coronary arteries showed changes consistent with arteriitis. The following three cases presented the more typical benign course of this disease one of them with deformities of the coronary arteries. The clinical synopsis describes the above mentioned cases.

Topics: Adrenal Cortex Hormones; Arteritis; Austria; Child, Preschool; Coronary Vessels; Electrocardiography; Humans; Infant; Lymphatic Diseases; Male; Mucocutaneous Lymph Node Syndrome; Myocardial Infarction; Salicylates

Topics: Acidosis; Aged; Alcoholic Intoxication; Alkalosis; Alkalosis, Respiratory; Arrhythmias, Cardiac; Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Encephalitis, Arbovirus; Humans; Male; Myocardial Infarction; Poisoning; Salicylates; Stomach Neoplasms; Sweating

Topics: Antibody Formation; Autoantibodies; Desensitization, Immunologic; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Pericarditis; Salicylates; Syndrome; Time Factors

Topics: Humans; Myocardial Infarction; Reflex Sympathetic Dystrophy; Salicylates

Topics: Female; Humans; Male; Myocardial Infarction; Salicylates; Tietze's Syndrome

Topics: Adult; Aged; Autoantibodies; Cardiac Surgical Procedures; Female; Fluorescent Antibody Technique; Glucocorticoids; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Myocardium; Myofibrils; Postoperative Complications; Postpericardiotomy Syndrome; Salicylates; Sarcolemma