Shock index: a simple clinical parameter for quick mortality risk assessment in acute myocardial infarction.

BACKGROUND: Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction and cardiogenic shock. Early identification of patients at risk for developing cardiogenic shock allows rapid decision making to determine reperfusion and transportation to a PCI centre. The aim of this analysis was to evaluate shock index (SI) as a marker for patients at risk of cardiogenic shock. METHODS: A total of 644 consecutive patients (73% male) with acute myocardial infarction with ST elevations were analyzed retrospectively. Primary PCI was performed in 92% of patients, and 7% of patients underwent rescue PCI. The SI parameter was defined as the ratio of heart rate to systolic blood pressure at hospital admission. RESULTS: SI (odds ratio [OR], 81.26; 95% confidence interval [CI], 9.76-676.51; P<0.001), age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), and diabetes (OR, 4.94; 95% CI, 1.44-16.97; P<0.011) were independent predictors of mortality. In the group of patients with SI≥0.8, 20% died, whereas in the group with SI<0.8, 4% of patients died (P<0.01). CONCLUSIONS: The proposed clinical parameter SI correlates with patients' prognosis and could therefore be used as a simple indicator of mortality risk of acute myocardial infarction. The simplicity of this proposed index makes its use accessible in large-scale clinical practices for risk stratification during first contact with patients.

Synthesis, antimycobacterial and antifungal evaluation of 3-arylaminopyrazine-2,5-dicarbonitriles.

This paper describes preparation and biological evaluation of pyrazinamide analogues. Pyrazinamide with its simple structure gives a good opportunity for further modification regarding an increase of its antimycobacterial activity. We prepared a series of compounds derived from pyrazine-2,5-dicarbonitrile with arylamino substitution in position 3. All compounds were assayed in vitro against major Mycobacterium and various Fungi species. The best activity was found in 3-{[3-(trifluoromethyl)phenyl]amino}pyrazine-2,5-dicarbonitrile 11 with the value of 6.25 micromol(-1) against M. tuberculosis H(37)Rv and moderate activity against minor Mycobacterium pathogens.

One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial.

BACKGROUND: Off-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump). METHODS AND RESULTS: The PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus 52% off-pump patients (P=NS). Grafts anastomosed distally to collateralized chronic total occlusions of native coronary arteries remained patent in 100% on the left anterior descending artery compared with 23% on other arteries (P<0.0001). CONCLUSIONS: The patency of arterial coronary bypass grafts done on the beating heart is excellent and equal to grafts done on pump. The off-pump procedure in the unselected patient population results in fewer patent saphenous grafts per patient.