112 Saturday 1 July 2000 ida 4S ~e 2a ......... poe I II I11 IV Fig. 1. Oxygen .saturation The fact of heavy mlcrocirculation impairments 3-12 hours prior to a shock similar to those with expressed clinical manifestation is rather essential for early diagnostics of a CS. The control of oxygen saturation in capillary arterial and venous blood and in tissue is strictly necessary: it allows revealing real threat of a cardiogenic shock in patients with AMI. P1 2/10082 1 Family history of coronary artery disease and 1 1 prognosis myocardial infarction in the thrombolytic era: Results from the israeli acute myocardial infarction national survey D. Harpaz, S. Gotflieb I , V. Boyko I , Y. Rozenman, S. Behar I . Cardiac Institute, E. Wolfson Medical Center, Holon; l Neufeld Cardiac Research Institute, Sheba Medical Center, TeI-Hashomer, Israel A positive family history (FH) of coronary artery disease (CAD) is consid- ered an independent risk factor for CAD. However, the natural history and prognosis of patients (pts.) with acute myocardial infarction (AMI) and a FH in the thrombolytic era is ill defined. The study cohort comprised 2.690 consecutive pts. with a first AMI from 2 prospective nationwide surveys conducted during 1996 and 1998 in all coronary care units operating in Israel. Baseline characteristics, hospital course, management and prognosis of 405 pts. with a FH (AMI, PTCA or CABG in a parent or a sibling under the age of 50 yrs.) were compared with that of 2.285 pts. without such a history. Pts. with a FH were on the average 11 yrs. younger (53 =1= 11 vs. 64 4- 13, p < 0.0001), included more men (79% vs. 72%, p < 0.03) than counterparts without such a history. They were more hyperlipemic (43% vs. 25%, p < 0.0001) and active smokers (54% vs. 36%, p < 0.0001) but less frequently diabetic (17% vs. 25%, p < 0.001) and hypertensive (34% vs. 41%, p < 0.02) than pts. without a FH, respectively. Pts. with a FH developed less heart failure during hospital stay (7% vs. 16%, p = 0.00001) than coun- terparts. Thrombolytic therapy was similarly administered to both groups (52% vs. 50%, p = NS) respectively, but invasive coronary procedures were used significantly more frequently during hospital stay in pts. with a FH: coronary angiography-54% vs. 39% (p < 0.0001) and PTCA-34% vs. 23% (p < 0.0001) but not CABG-6% vs. 4% (p < 0.07) than in pts. with no FH. The crude 30-day (2.2% vs. 9.6%) and cumulative 6-month (3.3% vs. 12.6%) mortality rates were significantly lower (p < 0.001 for both) in pts. with a FH than those without a FH, respectively. After adjustment for age, baseline characteristics, thrombolytic therapy and invasive coronary procedures, a FH was associated with a lower 30-day (odds ratio 0.41,95% confidence interval [CI] 0.19~).77) and 6-month (hazard ratio 0.46, 95% CI 0.24-0.80) mortality risk as compared to counterpart pts. In this nationwide survey, pts. with a FH develop AMI more than a decade earlier in comparison to counterparts without such a history. Their prognosis is not entirely explained by the younger age, the risk profile and management. P 1 J Impaired fibrinolysis coronary atherectomy 1 1 3/1 0207 in specimens in acute coronary syndromes: Increased plasminogen activator inhibitor-1 and apolipoprotein(a) T. Sakamoto, T. Ishibashi, J. Shindo, M. Kijima I , K. Nakazato, K. Nagata, A. Hirosaka, K. Maehara, T. Saitoh 2, Y. Maruyama. First Department of Internal Medicine, Fukusima Medical University, Fukusima; /Cardiovascular Center, Hoshi General Hospital, Koriyama; 2Division of Pathology, Hoshi General Hospital, Koriyama, Japan Although the expression of tissue factor has been shown to increase in atherctomy specimens from acute coronary syndromes, there is few evi- dence of impaired fibrinolysis in plaques in acute coronary syndromes. This study was conducted to determine the extent of plasminogen activator in- hibitor- 1 (PAl- 1) and apolipoprotein(a) [apt(a)], antifibrinolytic molecules, in the plaques of different types of coronary artery disease. We examined PAl-1 expression and apt(a) deposition in 44 coronary atherosclerotic specimens retrieved by directional coronary atherectomy from 19 patients with acute myocardial infarction (AMI), 12 with unstable angina (UAP) and 13 with stable angina pectoris (SAP). Immunohistochemical staining was performed on serial sections using monoclonal antibodies against PAl-l, apt(a), macrophages and smooth muscle cells. The percentages of the total areas of specimens with PAl-1 and apt(a) were estimated by NIH image analysis. The proportion of total macrophages in plaques was calculated as the macrophage density. There was a significant difference in macrophage density between acute coronary syndromes (AMI, 33 4- 7%, P < 0.001; UAE 27 4- 11%, P < 0.005) and SAP (15 4- 5%). We found significantly higher percentages of PAI-1 and apt(a) in AMI (PAI-1; 26 4- 9%, P < 0.001, apt(a); 12 ::E 7%, P < 0.005) and UAP (PAl-l; 22 ± 10%, P < 0.005, apt(a); 11 4- 6%, P < 0.01) than in SAP (PAl-l; l0 4- 5%, apt(a); 4 4- 2%). PAI-1 expression was primarily detected in smooth muscle cells, whereas apt(a) deposition was observed in dense connective tissue. Linear regression analysis of all the samples showed a correlation between PAI-I and macrophage density (r = 0.56, P < 0.001) or apt(a) deposition (r = 0.71, P < 0.001). Our results suggest a possibility of the impaired fibrinolysis associated with increased PAl-1 and apt(a) to palque thrombogenicity in acute coronary syndromes. P11 0193 J Correlation of catalase and superoxidedismutase ] 4/1 values with coronary spasm in the acute phase of myocardial infarction A. Lazar, K. Babes, L. Gilau, L. Lazar, M. Popescu, V. Papa, F. Maghiar, V. Salajan. Cardiology, County Hospital, Oradea, Romania Knowing the implication of the free radicals in myocardial injury and necrosis, we followed a possible correlation between catalase, superox- idedismutase (SOD) and nitric oxide (NO) values, in succesive stages of acute myocardial infarction. We studied a group of 86 patients admitted in the coronary care unit for signs of acute myocardial infarction, documented by clinical, ECG and enzymatic changes (68 males, 18 females, with a mean age of 5 4- 4 years). All patients taken into study had at least 2 coronary risk factors (smoking and hypercholesterolemia). Catalase ans SOD values were determined at admission and succesively after 6 hours and 24 hours after starting a Nitroglycein infusion. Results: We noticed a gradual increase of catalse and SOD values, start- ing from the baseline determinations, during the Nitroglycerin infusion; rythm disturbances and left ventricular failure appeared in only 2 patients during the treatment. After cessation of Nitroglycerin infusion, at 24 h, rythm disturbances were present in 12 patients (13.9%), death occurred in 3 patients (3.4%), concomitantly with a decrease of catalase and SOD values. Table of values Baseline 6 hours 24 hours Catalse 1535 :t- 100 U/g Hb 1670 4- 100 U/g HI) 1620 4- 100 U/g Hb SOD 335 :t= 40 U/g Hb 275 4- 40 U/g Hb 253 4- 40 U/g Hb WE wanted to stress out that catalase and SOD values are good pre- dictors for coronary spasm regression and better clinical outcome of acute myocardial infarction; a longer duration of Nitroglycerine infusion might give a better protection against oxidative stress in myocardial infarction. Pl15/10235 / In vitro study of FFR, QCA and IVUS for the 1 assessment of optimal stent deployment K. Matthys, S. Carlier I , P. Segers, J. Ligthart I , G. Sianos I , P. Serrano I , P. Serruys 1, P. Verdonck. Hydraulics Laboratory, Ghent University, Gent, Belgium; 1Thorax Center Rotterdam, Rotterdam, Netherlands Background: Recent clinical observations pointed out some limitations in the use of fractional flow reserve (FFR) to assess coronary stenosis severity in low flow condition such as post myocardial infarction. We tested whether (i) FFR discriminates between suboptimally (SOD) and optimally deployed stents (OD) and (ii) the influence of flow levels on FFR. Methods and Results: Nine 4 mm latex tubes with target diameter stenosis (stenosis length 1.5 cm) of 40% (n = 3), 55% (n = 3) and 60% (n