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Male (227) and female (37) participants in a supervised rehabilitation programme for patients with coronary artery disease were compared in relation to their compliance with and response to the programme. The drop-out rate was higher in females (18.9% vs 7.9%) and their attendance rate at sessions was lower (77% vs 87%). Following the programme, exercise duration was significantly increased in both groups to a similar degree, although absolute values were consistently higher in males. The heart rates required to perform given workloads were reduced for both sexes, the magnitude of reduction being similar. Blood pressure was not altered after rehabilitation. These findings show that female patients, despite poorer compliance than males, can benefit equally from exercise rehabilitation.

Two hundred and sixteen patients with acute myocardial infarction were treated with immediate infusion of high-dose (1.5 million units) intravenous streptokinase followed by emergency coronary angioplasty. The infarct lesion was crossed and dilated in 99% and persistent coronary perfusion after the procedure was achieved in 90% (including 3% with significant residual stenosis). Total in-hospital mortality was 12%. Multivariable analysis showed a higher hospital mortality with cardiogenic shock (41% vs 5% without shock), older age, lower left ventricular ejection fraction, and female sex. Final patency of the infarct-related vessel was determined by follow-up in-hospital cardiac catheterization. Coronary reocclusion occurred in 11% (symptomatic in 7%, treated with emergency angioplasty or bypass surgery; silent in 4%, treated medically). Ofthe surviving patients with successful initial establishment of infarct vessel patency, 94% were discharged from the hospital with an open infarct artery or a bypass graft to the infarct vessel. There was significant improvement in both ejection fraction (44% to 49%; p < .0001) and regional wall motion in the infarct zone (-3.0 SD to -2.4 SD; p < .0001) among patients with persistent coronary perfusion and insignificant residual stenosis at the time of the follow-up cardiac catheterization. Thus, a treatment strategy for acute myocardial infarction that includes immediate administration of streptokinase followed by emergency coronary angioplasty, and coronary bypass surgery when necessary, results in a high rate of early and sustained patency of the infarct-related vessel.