Stenting of partial and total cornary occlusions in Trinidad and Tobago

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38 percent). The mean age of patients was 55 ñ 10 years. Eighty-one percent were male, 52 percent were hypertensive and 21 percent diabetic. Sixty-five percent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3 percent and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3 percent. Multivessel disease was present in 43 percent. The mean left ventricular ejection fraction was 53 ñ 12 percent. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53 percent), right coronary artery (RCA) (31 percent), circumflex artery 13 percent and saphenous vein graft (3 percent). The mean baseline diameter stenosis was occluded vs 50 percent for 8 totally occluded vessels. For the total occlusions, procedural sucess was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergency Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean (AU)

Acute admissions with atrial fibrillation in a British multiracial hospital population

To assess the clinical characteristics and management of patients with atrial fibrillation (AF), we performed a prospective survey of all acute medical admission over six months to our hospital. Of 7,451 such admissions, 245 had AF (110 male, 135 female; mean age 74.4 years). Of these, 213 were Caucasian, 10 black/Afro-Caribbean and 22 Asian. Complete data were available for 185 patients. Of these, 82 had newly diagnosed AF, 83 had previous chronic AF and 20 had paroxysmal AF. The main presenting features were dyspnoea, stroke and syncope. A history of ischaemic heart disease was present in 64, heart failure in 46, hypertension in 51 and rheumatic heart disease in 13, while 31 had a previous stroke. Chest x-ray showed cardiomegaly and pulmonary oedema in 121 patients, but was normal in 28. Echocardiography showed poor cardiac function in eight patients and enlarged atria in five. Only 28 percent of those with previously diagnosed AF were on anticoagulation. Of the newly diagnosed patients, only 18 percent were started on anticoagulants. Cardioversion was attempted or planned in only 6 percent. The primary diagnosis on discharge was heart failure in 45, stroke in 24 and myocardial infarction in 12. AF remains a common arrhythmia among acute medical admissions and is commonly associated with heart failure and a high mortality. There is still a reluctance to start anticoagulant therapy or to perform cardioversion in such patients.(AU)

Successful pregnancies in patients with the antiphospholipid syndrome treated with low-dose aspirin

Four patients with bad obstetrical histories and with positive lupus anticoagulant tests were treated with low-dose aspirin, prednisone or heparin. They had pre-term deliveries of live babies who all survived (AU)

Mortality of Jamaican patients with systematic lupus erythematosus

A retrospective study of all patients with systemic lupus erythematosus (SLE) who died at the University Hospital of the West Indies over a 14-year period is presented. The major cause of death was infection followed by renal failure. Gram-negative organisms were the major microbiological agents causing infections. Side-effects of therapy were common, in particular bone marrow depression and haemorrhage related to anticoagulants. It appears that controlling severe lupus activity without increasing the risk of life-threatening complications remains an important goal in the treatment of SLE.(AU)