Risk stratification in non-ST elevation acute coronary syndromes: predictive power of troponin I, C-reactive protein, fibrinogen and homocysteine.

Introduction: In acute coronary syndromes, myocardial damage markers and acute-phase reactants predict adverse cardiac events. The aim of this study was to define the fitted prognostic value of the most widely used variables of necrosis and inflammation as well as of homocysteine.

Methods And Results: Troponin I, high-sensitivity C-reactive protein, fibrinogen and homocysteine were measured in 515 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome.

[An invasive strategy in non-ST-segment elevation acute coronary syndromes. From large trials to the real world].

Introduction And Objectives: We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome.

Patients And Method: We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for postdischarge revascularization) within a 12-week follow-up period.

Usefulness of C-reactive protein and left ventricular function for risk assessment in survivors of acute myocardial infarction.

The additional prognostic information provided by C-reactive protein (CRP) to parameters of left ventricular function in survivors of acute myocardial infarction (AMI) was investigated in 665 patients (326 with ST elevation and 339 with non-ST elevation). Cox multivariable analysis identified the following predictors of 6-month cardiac death: age (per 5 years hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.

[Prognostic value of Charlson comorbidity index at 30 days and 1 year after acute myocardial infarction].

Introduction And Objectives: The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for all-cause mortality and recurrent AMI 30 days and 1 year after the index event.

Patients And Method: We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST elevation=508 and non-ST elevation=527).

[Reliability of cardiac magnetic resonance imaging indicators of myocardial viability for predicting the recovery of systolic function after a first acute myocardial infarction with a patent culprit artery].

Introduction And Objective: To assess the reliability of early analysis of the most frequently used cardiac magnetic resonance (CMR)-derived indexes for predicting systolic function recovery and ventricular remodeling in patients after a first acute myocardial infarction with a patent culprit artery.

Patients And Method: 17 patients were studied with an initial CMR protocol that included regional assessment of wall thickness and wall thickening, low-dose dobutamine response, first-pass gadolinium myocardial perfusion imaging and delayed enhancement. These results were compared with those obtained for segmental and global function in a second CMR study 6 months later.

[Relationship of C-reactive protein levels with angiographic findings and markers of necrosis in non-ST-segment elevation acute coronary syndrome].

Introduction And Objectives: The mechanism responsible for elevated C-reactive protein levels (inflammation of the ruptured atherosclerotic plaque or myocardial necrosis) in acute coronary syndromes is controversial. The aim of this study was to investigate the relationship between C-reactive protein levels and angiographic complexity of the culprit lesion and troponin elevation in patients with non-ST elevation acute coronary syndromes.

Patients And Method: The study group consisted of 125 patients with single-vessel disease.

[Sex differences in mortality at one-month and at one-year after an acute coronary syndrome].

Background And Objective: We aimed to delineate the sex differences in short-term (one-month) and long-term (one-year) cardiac death after an acute coronary syndrome.

Patients And Method: After the publication of the new myocardial infarction definition, we prospectively analyzed 1,324 consecutive patients admitted with a diagnosis of acute coronary syndrome to a tertiary hospital. 483 (37%) of these patients had myocardial infarction with ST-elevation, 439 (33%) had myocardial infarction without ST elevation (troponin I > 1 ng/ml) and 402 (30%) had an unstable angina (troponin I < 1 ng/ml).

[Independent role of C reactive protein to predict major events at one-month and at one-year in acute coronary syndrome without ST elevation].

Background And Objective: We intended to determine whether C-reactive protein (CRP) provides independent prognostic information after a non-ST elevation acute coronary syndrome.

Patients And Method: We prospectively studied 630 consecutive patients admitted with a diagnosis of non-ST elevation acute coronary syndrome. Cut-off values were: troponin I > 1 ng/ml (n = 354; 56%) and CRP > 11 mg/l (n = 273; 43%).

Effects of pretreatment with intravenous flecainide on efficacy of external cardioversion of persistent atrial fibrillation.

Electrical cardioversion is the most effective and safe method to restore sinus rhythm in patients with persistent AF. However, at least 25% of electrical cardioversions are unsuccessful. The aim of the present study was to evaluate, in a prospective, randomized and double-blind study, the efficacy of a pretreatment with intravenous flecainide in patients who underwent electrical cardioversion.

Dofetilide effects on the inhibition by trains of subthreshold conditioning stimuli.

We investigated the electrophysiological actions of dofetilide upon the ventricular myocardium to determine whether the drug modifies the inhibitory effects of subthreshold stimuli trains upon ventricular refractoriness. In nine Langendorff perfused rabbit hearts, ventricular epicardial electrodes were used to determine the following parameters at baseline and during dofetilide perfusion (0.5 micromolar): effective (ERP) and functional (FRP) refractory periods, conduction velocity (CV), wavelength (WL), and ERP prolongation (inhibitory effect) induced by subthreshold stimuli trains (STr) at pulse frequencies of 100, 300, and 600 Hz.

Predictors of short-term outcome in acute chest pain without ST-segment elevation.

Background: Management of acute chest pain in the emergency room constitutes a challenge.

Methods: Seven hundred and one consecutive patients were evaluated by clinical history (chest pain score and risk factors), ECG, troponin I and early (<24 h) exercise testing in low risk patients (n=165). A composite end-point (recurrent unstable angina, acute myocardial infarction or cardiac death) was recorded during hospital stay or in ambulatory care settings for patients discharged after early exercise testing.

Why does C-reactive protein increase in non-ST elevation acute coronary syndromes? Role of myocardial damage.

Introduction: C-reactive protein is an important prognostic indicator for early risk stratification in patients with an acute coronary syndrome. The mechanisms underlying the elevation of C-reactive protein in these patients have not been fully understood. We studied the factors related to the increase of this acute-phase reactant.

[Emergency room risk stratification of patients with chest pain without ST segment elevation].

Objectives: To investigate the prognostic factors in patients who come to the emergency room with chest pain but without ST segment elevation.

Patients And Method: 743 consecutive patients were evaluated by recording clinical history, electrocardiogram and troponin I determination, and early (<24 h) exercise testing was done for the low-risk subgroup of patients (n=203). All patients were followed during 3 months for major events (acute myocardial infarction or death).

[Prognostic markers of non-ST elevation acute coronary syndromes].

Objectives: We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome.

Patients And Method: Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%).

[Usefulness of troponin I for predicting systolic dysfunction in acute coronary syndromes. Results of a prospective and quantitative study].

The relationship between troponin I and systolic function (quantitative contrast ventriculography) was evaluated in 137 consecutive patients with a first acute coronary syndrome (60 with and 77 without ST elevation). In general, a larger troponin I peak value was related with a more depressed ejection fraction and poorer regional systolic function (p < 0.0001).

Significance of the morphological patterns of electrograms recorded during ventricular fibrillation: an experimental study.

Mapping techniques are used to study the significance of the morphological patterns of the electrograms (EGMs) obtained during VF in an experimental model. In 24 isolated rabbit heart preparations recordings were made of activation during VF using a multiple electrode (121 unipolar electrodes) positioned on the lateral wall of the left ventricle. Three types of activation maps were selected: (A) with functional block of an activation front; (B) with epicardial breakthrough; and (C) with a single broad wavefront without block lines.

[Gender differences in patients with suspected non-ST-segment elevation acute coronary syndromes. Implications for invasive management].

Sex differences have been observed in the clinical profile, prognosis, and treatment of patients with unstable ischemic heart disease. Men tend to receive more invasive management. We assessed these differences in 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation who were seen since our chest pain unit opened.

Effects of acute reduction of temperature on ventricular fibrillation activation patterns.

Because of its electrophysiological effects, hypothermia can influence the mechanisms that intervene in the sustaining of ventricular fibrillation. We hypothesized that a rapid and profound reduction of myocardial temperature impedes the maintenance of ventricular fibrillation, leading to termination of the arrhythmia. High-resolution epicardial mapping (series 1; n = 11) and transmural recordings of ventricular activation (series 2; n = 10) were used to analyze ventricular fibrillation modification during rapid myocardial cooling in Langendorff-perfused rabbit hearts.

[Effects of myocardial stretching on excitation frequencies determined by spectral analysis during ventricular fibrillation].

Introduction And Objectives: The aim of this study was to analyze the effects of myocardial stretching on excitation frequencies, as determined by spectral analysis, during ventricular fibrillation.

Methods: In 12 isolated rabbit heart preparations, ventricular activation during ventricular fibrillation was recorded with multiple electrodes. Recordings were obtained before, during and after ventricular dilatation produced with an intraventricular balloon.

[Value of early exercise stress testing in a chest pain unit protocol].

Early exercise testing (first 24 hours) was evaluated in the stratification of patients seen in the emergency room for chest pain. One hundred and forty-two consecutive patients without ischemia in the ECG or troponin I elevation were included. Ninety-two patients were discharged after the exercise testing (group I, 82 negative and 10 inconclusive test results) and 50 patients were hospitalized (group II, 29 positive and 21 inconclusive test results).

[Prognostic factors in unstable angina with dynamic electrocardiographic changes. Value of fibrinogen].

Introduction And Objectives: The prognosis of unstable angina varies between series depending on the inclusion criteria and management protocol used. The aim of this study was to analyze in-hospital events and their predictors in a homogeneous single-center series of patients with unstable angina.

Material And Methods: A total of 246 patients with the following inclusion criteria were studied: 1) resting anginal pain, 2) transient electrocardiographic changes during anginal pain, 3) normal CK-MB levels and 4) exclusion of postinfarction angina.

[Short-term prognosis of patients admitted for probable acute coronary syndrome without ST-segment elevation. Role of new myocardial damage markers and acute-phase reactants].

Objectives: The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed.

Method: We prospectively studied 385 consecutive patients admitted from our chest pain unit with a high-probability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded.