[Effects of preceding stable or unstable angina on hospital morbidity-mortality of myocardial infarction. Results of a continuous series of 1,910 patients]. / Influence de l'angor préalable stable ou instable sur la morbidité-mortalité hospitalière de l'infarctus du myocarde. Résultats d'une série continue de 1,910 patients.

The aim of this study was to determine the effect of preceding unstable angina on the short-term prognosis of myocardial infarction based on early complications: cardiac failure, cardiac rupture, ventricular septal defect, sustained ventricular tachycardia ventricular fibrillation and hospital mortality. A continuous series of 1,910 patients admitted with 7 days of myocardial infarction was analysed retrospectively. The patients were divided into two groups according to their previous coronary history: Group A (myocardial infarction preceded by unstable angina) and Group B (myocardial infarction without preceding unstable angina). Group B was subdivided into Group B1 (myocardial infarction de novo) and Group B2 (myocardial infarction with previous stable angina). The results showed that patients with previous unstable angina (Group A) had a lower hospital mortality (7.9%) than those without (Group B) (13.3%) (p = 00017), fewer cardiac ruptures (1.1 versus 2.9%, p = 0.03) and less ventricular fibrillation (2.6 versus 4.5%, p = 0.053). Subgroups analysis showed that patients with de novo myocardial infarction (Group B1) had more sustained ventricular tachycardia than those with previous stable angina (Group B2) (5.3 versus 2.7%, p = 0.04). The authors conclude that pre-infarction unstable angina, possibly by ischaemic pre-conditioning, is an independent factor of a better prognosis in myocardial infarction.

[Association of D-dimer and helicoidal thoracic scanner for diagnosis of pulmonary embolism. Prospective study of 106 ambulatory patients]. / Association D-dimères et scanner thoracique hélicoïdal pour le diagnostic d'embolie pulmonaire. Etude prospective chez 106 patients ambulatoires.

OBJECTIVE: Ventilation/perfusion pulmonary scintigraphy (PS), the current mainspring in the diagnosis of pulmonary oedema (PE), is frequently non-conclusive. The objective of this study was to determine, prospectively, the diagnostic value of the association of D-dimers and helicoidal thoracic scanner (HTS) in a continuous series of ambulatory adults with suspected PE and admitted to a cardiologic emergency unit. METHODS: Exclusion criteria were as follows: symptoms or clinical signs of seventy, contraindication for HTS and/or on pulmonary angiography, curative anticoagulant therapy for more than 48 hours, history of PE less than 3 months before or the impossibility of conducting all the examinations with 48 hours. All the patients underwent determination of D-dimers by rapid ELISA test, HTS and 2 reference examinations, venous Doppler of the lower limbs and a PS, completed by pulmonary angiography if the PS did not permit diagnosis and the venous Doppler was negative. RESULTS: One hundred and six patients were selected over a recruitment period of 18 months. The prevalence of PE was of 45% (48/106). Forty-four of the 48 PE of the series were central form. HTS was considered dubious in 10 patients (10.4%, PE+ n = 2, PE- n = 8). The results of D-dimers were negative in only 34.5% patients without PE (20/58). Pulmonary angiography was necessary in 15 patients. The negative and positive predictive values of D-dimers were respectively of 100 and 55.8% (48/86) and those of HTS respectively 100 (46/46) and 92% (46/50). CONCLUSION: The diagnostic strategy of clinical suspicion of PE, starting with determination of D-dimers by rapid ELISA test followed by helicoidal thoracic scanner in the case of a positive result, was particularly effective in this series of patients with a high prevalence of PE. These results must be confirmed in a larger series and in a general emergency unit.