A study of the SCN5A gene in a cohort of 76 patients with Brugada syndrome.

We aim to study the SCN5A gene in a cohort of Brugada syndrome (BS) patients and evaluate the genotype-phenotype correlation. BS is caused by mutations in up to 10 different genes, SCN5A being the most frequently involved. Large genomic rearrangements in SCN5A have been associated with conduction disease, but its prevalence in BS is unknown. Seventy-six non-related patients with BS were studied. Clinical characteristics and family risk profile were recorded. Direct sequencing and multiplex ligation-dependent probe amplification (MLPA) of the SCN5A gene for identification of mutations and larger rearrangements were performed, respectively. Eight patients (10.5%) had point mutations (R27H, E901K, G1743R (detected in three families), V728I, N1443S and E1152X). Patients with mutations had a trend toward a higher proportion of spontaneous type I Brugada electrocardiogram (ECG) (87.5% vs 52.9%, p = 0.06) and had evidence of familial disease (62.5%, vs 23.5%, p = 0.03). The symptoms and risk profile of the carriers were not different from wild-type probands. There were non-significant differences in the prevalence of type I ECG, syncope and history of arrhythmia in carriers of selected polymorphisms. None of the patients had any deletion/duplication in the SCN5A gene. In conclusion, 10.5% of our patients had mutations in the SCN5A gene. Patients with mutations seemed to have more spontaneous type I ECG, but no differences in syncope or arrhythmic events compared with patients without mutations. Larger studies are needed to evaluate the role of polymorphisms in the SCN5A in the expression of the phenotype and prognosis. Large rearrangements were not identified in the SCN5A gene using the MLPA technique.

Acute disabling low-back pain during intravenous administration of amiodarone: could intravenous to oral switch therapy be a safe strategy?

We report for the first time a case of an acute disabling low-back pain episode during intravenous administration of amiodarone in a patient with atrial fibrillation. The symptoms completely resolved after terminating the infusion, and switching amiodarone from intravenous to oral administration was well tolerated.

Symmetrical compression distance for arrhythmia discrimination in cloud-based big-data services.

The current development of cloud computing is completely changing the paradigm of data knowledge extraction in huge databases. An example of this technology in the cardiac arrhythmia field is the SCOOP platform, a national-level scientific cloud-based big data service for implantable cardioverter defibrillators. In this scenario, we here propose a new methodology for automatic classification of intracardiac electrograms (EGMs) in a cloud computing system, designed for minimal signal preprocessing. A new compression-based similarity measure (CSM) is created for low computational burden, so-called weighted fast compression distance, which provides better performance when compared with other CSMs in the literature. Using simple machine learning techniques, a set of 6848 EGMs extracted from SCOOP platform were classified into seven cardiac arrhythmia classes and one noise class, reaching near to 90% accuracy when previous patient arrhythmia information was available and 63% otherwise, hence overcoming in all cases the classification provided by the majority class. Results show that this methodology can be used as a high-quality service of cloud computing, providing support to physicians for improving the knowledge on patient diagnosis.

Effect of sotalol on RR interval variability during induced ventricular tachycardia.

The effect of sotalol on the rate and the RR interval variability of induced ventricular tachycardia was studied in 26 patients. Sotalol increased the mean cycle length and irregularity of RR intervals, which may affect detection of ventricular tachycardia by implantable cardioverter-defibrillator devices.

Effects of verapamil on indexes of heart rate variability after acute myocardial infarction.

In patients with previous myocardial infarction (MI), depressed heart rate variability (HRV) may reflect a reduction in vagal activity and lead to cardiac electrical instability. Interventions designed to increase HRV may be of clinical interest. Data on the effects of calcium antagonists on HRV in post-MI patients are very limited. The aim of our study was to assess the effects of verapamil on HRV and on the sympathovagal balance after MI. Fifty consecutive patients with a first MI, stable sinus rhythm, and left ventricular ejection fraction >0.40 were studied. Each patient underwent two 24-hour Holter recordings, 1 at baseline and another after 4 days of treatment with verapamil retard (180 mg 2 times daily). Time and frequency domain parameters of HRV were analyzed. All time domain measurements increased significantly after verapamil: the standard deviation of all NN intervals (SDNN) from 87.1 +/- 31.4 to 98.1 +/- 30.3 ms (p <0.05) and the log-transformed percentage of pairs of adjacent NN intervals that differ >50 ms (pNN50) from 0.57 +/- 0.42 to 0.76 +/- 0.45 (p <0.01). The standard deviation of the averages of RR interevals (SDANN) (75.9 +/- 30.1 vs 86.3 +/- 29.4 ms, p <0.05), root-mean-square of successive differences between RR intervals (rMSSD) (23.0 +/- 11.7 and 28.1 +/- 13.1 ms, p <0.01), and the triangular HRV index (28.3 +/- 9.6 vs 23.4 +/- 8.6, p <0.001) also increased. A significant inverse correlation was found between improvement in HRV indexes induced by verapamil and baseline values. Spectral analysis showed a significant increase in high-frequency power of 58.5% without changes in low and very low components. With normalized units, significant reductions in low-frequency power and low- to high-frequency ratio were observed. Diabetic patients did not show any significant changes in HRV on administration of verapamil. These findings indicate that verapamil, administered during the subacute phase of MI, improves both global and short-period indexes of HRV and induces a shift in the sympathetic-parasympathetic interaction toward vagal predominance. This effect may contribute to an explanation of the beneficial effects of verapamil that have been reported in post-MI patients.

Prognostic significance of diabetes in acute myocardial infarction. Are the differences linked to female gender?

A prospective study of acute myocardial infarction was carried out in 1239 patients in order to assess both the prognostic significance of diabetes mellitus and the clinical characteristics associated with age and gender. Diabetes mellitus (DM) was found in 386 cases, often associated with old age, female gender, and more prevalent history of angina, heart failure, and hypertension. DM patients were admitted later and they were less likely to receive thrombolytic therapy, 47.9 vs. 58.1% (P<0.001). Complications more often associated with DM were: heart failure, 45 vs. 24.5% (P<0.01), and early, in-hospital and 1-year mortalities, 7.2 vs. 3.9% (P<0.05), 17.6 vs. 9.1% (P<0.001), and 29.2 vs. 16.2% (P<0.001), respectively. Compared with diabetic men, diabetic women were older and had a more prevalent history of hypertension and congestive heart failure. Diabetic women also had a higher rate of heart failure during hospitalisation, and of mortality, than diabetic men: early: 11.7 vs. 4.5% (P<0.01); in-hospital: 29.6 vs. 10.3% (P<0.001); and 1-year: 42.7 vs. 21.1% (P>0.001). DM was not selected by the multivariate analysis as a variable with independent prognostic value for mortality. In separate multivariate analysis for diabetic and non-diabetic patients, female gender had independent prognostic value for mortality only in the case of the diabetic population.

Prognostic significance of bundle-branch block in acute myocardial infarction: the importance of location and time of appearance.

BACKGROUND: The presence of bundle-branch block (BBB) is associated with high mortality rates and is considered an important predictor of poor outcome in patients with acute myocardial infarction (AMI). HYPOTHESIS: The objective of this study was to assess the prognostic significance of BBB in patients with AMI depending on its form of presentation. METHODS: A multicenter prospective 1-year follow-up study involving 1,239 consecutive patients diagnosed with AMI was performed. RESULTS: Bundle-branch block was present in 177 cases (14.2%), associated with worse clinical characteristics, lower rate of thrombolytic therapy, and higher mortality: in-hospital (23.8 vs. 9.7%, p < .01) and 1-year (40.9 vs. 16.9%, p < 0.01). Compared with right BBB (n = 135), left BBB (n = 42) was more often associated with female gender and higher prevalence of cardiovascular diseases, but had a similar 1-year mortality. In the absence of heart failure or complete atrioventricular (AV) block, there was no difference in in-hospital mortality of patients with BBB (n = 76) and without BBB (n = 786) (2.6 vs. 3.9%). Compared with existing BBB (n = 113), BBB of new appearance (n = 64) was more often accompanied by complete AV block and heart failure and higher in-hospital and 1-year mortality rates. Only BBB of new appearance was an independent predictor of mortality: in-hospital (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.7) and 1-year mortality (OR 3.2, 95% CI, 1.7-9.1). CONCLUSIONS: In patients with AMI, the classification of BBB according not only to location but also to time of appearance is of practical interest. New BBB is an independent predictor of short- and long-term mortality.

[The spectral analysis of the P wave in patients with paroxysmal atrial fibrillation]. / Análisis espectral de la onda P en pacientes con fibrilación auricular paroxística.

INTRODUCTION AND OBJECTIVE: The aim of this study is to establish if patients with paroxysmal atrial fibrillation have an abnormal spectrum of the P wave. PATIENTS AND METHODS: Thirty-five patients with previous documented atrial fibrillation were compared with a control group of 29 patients. A signal-averaged ECG was performed using an ART-1200-EPX system, and a segment covering the last 75 ms of the P wave and the next 25 mg was analyzed in each of three orthogonal leads (X, Y, Z) and in a combined one (C). The area under the spectral curve between 20 and 50 Hz was divided by the area between 0 and 20 Hz (x 100 = AR50). RESULTS: Patients with paroxysmal atrial fibrillation had greater AR50 on leads Y (78.3 +/- 42.9 vs 54.4 +/- 14.8; p < 0.01) and C (82.2 +/- 52.1 vs 58.4 +/- 14.6, p < 0.05) when compared with the control group. In the subset of patients without structural heart disease AR50 in lead X was greater. The criterion "AR50 > 55 in lead Y" identified paroxysmal atrial fibrillation with a sensitivity of 77.1% and a specificity of 85%. CONCLUSIONS: This method may be useful to detect patients at risk for paroxysmal atrial fibrillation.

[Recurrent syncope without angina: an uncommon presentation of coronary spasm]. / Síncope recurrente sin angina: una presentación infrecuente del espasmo coronario.

We report the case of a 64-year-old patient admitted for repetitive syncope as an isolated clinical manifestation probably due to coronary artery spasm. The patient had no history of previous cardiac disease, and was studied because of two nonspecific syncopes. Long-term electrocardiographic monitoring showed many episodes of transient ST segment elevation, associated with premature ventricular beats and runs of ventricular tachycardia. Coronary angiography during ergonovine infusion was performed to confirm the diagnosis. We discuss the incidence of coronary spasm provoking syncope and the need to establish a correct diagnosis in order to administer an effective therapy to the patient.

[Intracoronary stents in small vessels: short- and long-term clinical results]. / Stents intracoronarios en vasos pequeños: resultados clínicos a corto y largo plazo.

OBJECTIVE: To assess the clinical outcome of coronary stenting in small vessels (< 3 mm), using high pressure balloon inflation and antithrombotic therapy. PATIENTS AND METHODS: Vessel size was evaluated as < or >= 3 mm at the time of procedure and measured at a level of maximum diameter. We studied 234 consecutive patients with placement of 300 stents in 279 lesions, comprising 84 stents implanted in 79 lesions located at small vessels (< 3 mm). The standard technique included high pressure balloon inflation (15.8 +/- 2.2 atm) and post-stenting therapy with ticlopidine and aspirin for one month. Mean clinical follow-up was 17.6 +/- 10 months. RESULTS: Procedural success without in-hospital major events was similar between small and large vessels (93.7 in vessels of < 3 mm vs 93.5% in vessels of >= 3 mm; p = NS). Three small vessels presented subacute stent thrombosis, whereas no thrombotic occlusion occurred in large vessels (3.8 vs 0%; p = 0.006). At two years, small vessels had a lower target lesion revascularization free survival (73.6 vs 90.3%; p < 0.001). After adjustment for variables previously described as predictors of stent restenosis, in multivariate analysis, a small vessel of < 3 mm was an independent predictor of target lesion revascularization (p = 0.001). Although patients with stenting in small vessels did not differ significantly in terms of any cause death (4.6 vs 3.8%; p = 0.7) nor acute myocardial infarction (2.9 vs 1.1%; p = 0.3), event-free survival was significantly lower after two years (69.1 vs 86.6%; p < 0.001). CONCLUSIONS: As compared to large vessels, coronary stenting in small vessels was performed with similar rates of initial success, however they had a significantly worse clinical long-term outcome in terms of subacute stent thrombosis and target lesion revascularization at follow-up.

[Subacute thrombosis with antiplatelet treatment in a non-selected population of intracoronary stents: incidence and predictors]. / Trombosis subaguda con tratamiento antiagregante en una población no seleccionada de stents intracoronarios: incidencia y predictores.

INTRODUCTION: After coronary stenting, the incidence of subacute stent thrombosis have been reduced to 0% using aspirin and ticlopidine, in studies with selected populations and intracoronary ultrasounds. OBJECTIVE: To evaluate the incidence and predictors of subacute stent thrombosis in a nonselected population, using antithrombotic therapy. METHODS: We studied 285 stents, consecutively and successfully implanted in 268 lesions of 226 patients. We used high pressure balloon inflation without intracoronary ultrasound. Post-stenting protocol included aspirin and ticlopidine during four weeks with no anticoagulation. We defined subacute stent thrombosis as death, acute myocardial infarction myocardial infarction or angiographic occlusion of stent, with TIMI flow 0-1, after the first 24 hours and during the first month. RESULTS: Four patients presented events (1.7%): Three nonfatal myocardial infarction after discharge, with documented angiographic thrombosis of stent, and one death due to in-hospital myocardial infarction. All three non-fatal AMI, occurred in vessels less than 3 mm (p = 0.07) and in patients taking aspirin without ticlopidine (p < 0.001). After discharge, three (17%) of 18 patients with inadvertent discontinuation of ticlopidine presented subacute stent thrombosis, in contrast to none of 25 patients taking ticlopidine without aspirin. Excluded patients with discontinuation of ticlopidine, the incidence of subacute stent thrombosis was 0.5%. CONCLUSION: After intracoronary stenting in a nonselected population, using antithrombotic treatment with aspirin and ticlopidine, we may expect a rate of subacute stent thrombosis about 1%. Ticlopidine seems to have the main role in preventing subacute stent thrombosis, above all in predisposing circumstances as small vessels.

[The long-term clinical results of the implanting of intracoronary stents in current practice]. / Resultados clínicos a largo plazo del implante de stents intracoronarios en la práctica actual.

INTRODUCTION: Published Stress and Benestent studies, obtained in selected populations under technical conditions that do not reflect present practice with intercoronary stenting showed a clinical benefit of coronary stenting. OBJECTIVE: To assess clinical longterm outcome of coronary stenting in current practice and to compare coronary lesions with and without Stress/Benestent criteria. METHODS: 216 consecutive patients with successful placement of 279 stents in 256 lesions and no major in-hospital events. Mean clinical follow-up was 16.7 +/- 10.4 months. Standard technique included seven types, high pressure balloon inflation (15.6 +/- 2.2 atm) and post-stenting treatment of four weeks with aspirin and ticlopidine. RESULTS: Cumulative rates of target lesion revascularization were 9.7% at 6 months, 13.5% at 12 months and 15.1% at 18, 24 and 36 months. Cumulative rates of combined clinical end-point (death, myocardial infarction and target lesion revascularization) were 11.3%, at 6 months, 13.9% at 1 year, 19.3% at 2 years and 21.1% at 3 years. No Stress/Benestent lesions were 193; 75%, and had a higher incidence of target lesion revascularization (17.9 vs 7.5%, Log Rank = 0.015) and combined clinical end-point (22.4 vs 10%, Log Rank = 0.025), than Stress/Benestent lesions. CONCLUSION: Coronary stenting of no Stress/Benestent lesions have a less favourable clinical longterm outcome. However, clinical outcome in a nonselected population at the present time is similar to the old Stress/Benestent studies, probably because of technical improvements.

[The prognostic significance of complete atrioventricular block in patients with acute inferior myocardial infarct. A study in the era thrombolytics]. / Significación pronóstica del bloqueo auriculoventricular completo en pacientes con infarto agudo de miocardio inferior. Un estudio en la era trombolítica.

INTRODUCTION AND OBJECTIVES: Complete atrioventricular block (CAVB) during inferior acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. This study was designed to determine the incidence and meaning of CAVB associated with inferior AMI and their peculiarities in relation to thrombolytic therapy. METHODS: Prospective and multicenter, involving 605 patients consecutively admitted with inferior AMI. We studied clinical characteristics and complications occurring during hospitalization and one-year follow-up were monitored. RESULTS: CAVB was found in 57 (9.4%) patients and was more frequently associated with: right ventricular involvement (35% vs 10%; p < 0.001), higher indexes of infaret size: ST elevated ECG leads (4.67 +/- 1.67 vs 4.1 +/- 1.4; p < 0.01) and peak of creatinkinase (2,219 +/- 1,543 vs 1,589 +/- 1,203; p < 0.01). Patients with CAVB had a higher incidence of cardiogenic shock (14% vs 5%; p < 0.05) and in-hospital mortality (21% vs 8.7%). CAVB had an independent value for predicting in-hospital mortality (odds ratio 2.7, 95% confidence interval, 1.3-5.5). CAVB appeared more frequently in the first hour of evolution (91% vs 41%; p < 0.01); its duration was shorter than 6 hours in a higher ratio (80% vs 5%; p < 0.01), and in- hospital mortality was lower (8.5 vs 40.9%; p < 0.05), in patients receiving thrombolytic treatment compared with patients without this treatment. CONCLUSIONS: CAVB is a relatively frequent complication of inferior AMI and is often associated with larger infarcts, high incidence of complications and mortality. Earlier appearance, shorter duration and fewer in-hospital mortalities seem to characterize those CAVBs occurring in patients treated with thrombolytics.

[Incidence, clinical characteristics and prognostic significance of supraventricular tachyarrhythmias in acute myocardial infarction]. / Incidencia, características clínicas y significación pronóstica de las taquiarritmias supraventriculares en el infarto agudo de miocardio.

OBJECTIVES: The study of incidence and prognostic significance of supraventricular tachyarrhythmias in patients with acute myocardial infarction. PATIENTS AND METHODS: Prospective study on 1,239 patients consecutively admitted because of a diagnosis of acute myocardial infarction. Clinical characteristics, indexes of myocardial infarction and complications were analysed. RESULTS: Supraventricular tachyarrhythmias were observed in 116 (9.3%) cases: atrial fibrillation in 96 (7.7%); atrial tachycardia in 15 (1.2%); and atrial flutter in the remaining five cases (0.4%). Patients with supraventricular tachyarrhythmias were older, and presented higher heart rate, lower blood pressure, a higher number of affected leads in ECG, and higher Killip class. A higher creatine kinase peak and a lower left ventricular ejection fraction were associated with the presence of supraventricular tachyarrhythmias. Predictors of supraventricular tachyarrhythmias were: age, systolic blood pressure, number of affected leads in ECG, and congestive heart failure at admission. The following complications were found more frequently in patients with supraventricular tachyarrhythmias: bundle-branch block, complete A-V block, ventricular tachycardia, ventricular fibrillation; heart failure; stroke; and mortality, in-hospital 18.1% vs 11.1% (p < 0.05) and one-year, 38.7% vs 18.4% (p < 0.001). The logistic regression model showed that supraventricular tachyarrhythmias had no independent prognostic value on mortality. CONCLUSIONS: The appearance of supraventricular tachyarrhythmias during the acute phase of myocardial infarction is a relatively frequent finding, often associated with older age and larger infarctions. Supraventricular tachyarrhythmias are accompanied by higher short and long-term mortalities, although there is no independent prognostic significance.

[The incidence, clinical characteristics and prognostic significance of a left bundle-branch block associated with an acute myocardial infarct]. / Incidencia, características clínicas y significación pronóstica del bloqueo de rama izquierda asociado a infarto agudo de miocardio.

To assess the current incidence and meaning of left bundle-branch block associated with acute myocardial infarction we studied 1,239 patients consecutively admitted in three hospitals. Left bundle branch block was present in 42 cases (3.3%). Compared to the patients without left bundle-branch block, those with left bundle-branch block were older (70 +/- 8.8 versus 63.9 +/- 11.4 years; p < 0.001), and had a more prevalent history of diabetes, angina, myocardial infarction and heart failure. Left bundle-branch block was associated more frequently with female gender and poor left ventricular ejection fraction. Patients with left bundle branch block were admitted with a longer interval from the onset of the symptoms (7.8 +/- 6.3 versus 5.4 +/- 6.7 hours; p < 0.01) and received in a lesser rate thrombolytics agents (21% versus 56%; p < 0.001), than those without left bundle-branch block. Complications significatively associated with left bundle-branch block were: complete AV block; heart failure and one-year mortality (40.4% versus 19.5%, p < 0.01). Female gender, age and heart failure were independent predictors of mortality whereas left bundle-branch block was not. In conclusion, current incidence of left bundle-branch block in acute myocardial infarction is lower than that referred in the pre-thrombolytic era. Left bundle-branch block is accompanied by a low rate of thrombolysis, whereas a higher mortality rate of these patients seems to depend on their clinical characteristics.

[Retrospective study of auricular fibrillation of recent onset in a hospital emergency service: frequency, clinical presentation, and predictive factors of early conversion to sinus rhythm]. / Estudio retrospectivo de la fibrilación auricular de reciente comienzo en un servicio de urgencias hospitalario: frecuencia, presentación clínica y factores predictivos de conversión precoz a ritmo sinusal.

AIM: To evaluate the proportion of emergencies due to recent-onset atrial fibrillation (AF), its clinical characteristics and in-hospital follow-up. The clinical predictors of conversion to sinus rhythm within the first 24 hours were analyzed. PATIENTS AND METHODS: 34,445 consecutive reports from patients presenting themselves at the emergency room of a community hospital during 15 months were retrospectively studied. The clinical reports of all patients (n = 186) with symptoms of recent onset AF (< 15 days) were reviewed. RESULTS: Hypertension (n = 77.41%) and lone AF (52 patients, 28%) were the most common etiologies. Forty seven patients (25%) presented with heart failure and the onset time was > 24 hours in 77 cases (41%). Conversion to sinus rhythm was observed in 71 out of 166 patients with at least 24 hours of follow-up (42.8%). Age < 60 years, the absence of cardiac disease, a NYHA functional class I, the absence of heart failure at the emergency room and the time from onset < 24 hours were significantly associated with conversion to sinus rhythm. The last two variables were selected as independent predictors by logistic regression analysis (sensitivity: 80%, specificity: 68%). CONCLUSIONS: We conclude that recent-onset AF represents 0.54% of all the hospital emergencies. The time from onset and the presence of heart failure predict the probability of conversion to sinus rhythm within the first 24 hours.

[Comparative study of 3 algorithms to localize the accessory pathway in Wolff-Parkinson-White syndrome]. / Estudio comparativo de tres algoritmos de localización de la vía accesoria en el síndrome de Wolff-Parkinson-White.

BACKGROUND AND OBJECTIVES: Some electrocardiographic algorithms have been developed to predict the location of the accessory pathway in the WPW syndrome. Few studies address the interobserver variability of such algorithms and the possible observer-dependent changes of accuracy. This study analyzes three algorithms to localize accessory pathways recently published, comparing the inter-observer variability, their predictive value and the most frequent problems observed during their application. METHODS: Ninety-six electrocardiograms from patients who underwent successful ablation of a single accessory pathway were reviewed. The location of each pathway was predicted by two independent observers according to three different reported electrocardiographic algorithms. The interobserver agreement, percentage of correct predictions and critical steps of each algorithm were analyzed. RESULTS: The interobserver agreement varied between 64 and 79% and the accuracy between 38 and 67%. The best results were obtained in the left lateral accessory pathways (69 to 89% correctly located). All the algorithms presented critical steps at which more than 20% of pathways were incorrectly classified. CONCLUSIONS: The analyzed algorithms present a high interobserver variability. The accuracy obtained is clearly lower than that reported by the corresponding authors. These facts should be considered when being used them in clinical settings.

[Prognostic significance of the implantation of a temporary pacemaker in patients with acute myocardial infarction]. / Significado pronóstico de la implantación de marcapasos transitorio en pacientes con infarto agudo de miocardio.

OBJECTIVE: Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction. PATIENTS AND METHODS: In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis. RESULTS: A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19). CONCLUSION: The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.

[Impact of diabetes mellitus on the late clinical outcome of coronary revascularization with stents]. / Influencia de la diabetes mellitus en los resultados clínicos tardíos de la revascularización coronaria con stents.

INTRODUCTION: The Influence of diabetes mellitus in the late outcome of coronary stenting remains controversial. AIM: The aim of this study was to determine the late clinical outcome of diabetics in comparison with non diabetics and to establish whether there are subgroups of diabetic patients with a greater need for target lesion revascularization. METHODS: Two hundred sixteen consecutive patients (74 diabetics; 95 stents in 90 lesions and 142 non diabetics) who had successfully undergone coronary stenting were included in the study and followed over 17.6 +/- 10 months. The clinical events evaluated were target lesion revascularization, death and acute myocardial infarction. Independent predictive variables of target lesion revascularization were studied in both groups of patients. RESULTS: The diabetic patients presented greater cardiovascular mortality (6.7% vs 1.4%; p=0.02) but the incidence of infarction was similar in the two groups (2.7% vs. 3.5%; p=0.6). The accumulated rate of target lesion revascularization at two years was 18.2% in diabetics vs 13.3% in non diabetics (p=0.09), respectively. The presence of three vessel disease (p=0.014), history of arterial hypertension ([=0.011) and residual stenosis > 0% (p=0.005) were specific predictive factors of target lesion revascularization for diabetic patients and together with vessel diameter < 3mm (p<0.001) subgroups of diabetics were independently selected with a significantly greater incidence of target lesion revascularization than the non diabetic patients. CONCLUSIONS: Following coronary stenting, diabetic patients show a greater cardiovascular mortality than non diabetics, but only some subgroups of diabetics (small vessels extensive coronary disease, associated arterial hypertension, residual stenosis) show a significantly greater risk of target lesion revascularization.