Influence of cigarette smoking on rate of reopening of the infarct-related coronary artery after myocardial infarction: a multivariate analysis.

OBJECTIVES: This study sought to determine whether the reopening of the infarct-related vessel is related to clinical characteristics or cardiovascular risk factors, or both. BACKGROUND: In acute myocardial infarction, thrombolytic therapy reduces mortality by restoring the patency of the infarct-related vessel. However, despite the use of thrombolytic agents, the infarct-related vessel remains occluded in up to 40% of patients. METHODS: We studied 295 consecutive patients with an acute myocardial infarction who underwent coronary angiography within 15 days (mean [+/- SD] 6.7 +/- 3.2 days) of the onset of symptoms. Infarct-related artery patency was defined by Thrombolysis in Myocardial Infarction trial flow grade > or = 2. Four cardiovascular risk factors--smoking, hypertension, hypercholesterolemia and diabetes mellitus--and eight different variables-age, gender, in-hospital death, history of previous myocardial infarction, location of current myocardial infarction, use of thrombolytic agents, time interval between onset of symptoms, thrombolytic therapy and coronary angiography--were recorded in all patients. RESULTS: Thrombolysis in current smokers and anterior infard location on admission were the three independent factors highly correlated with the patency of the infarct-related vessel (odds ratios 3.2, 3.0 and 1.9, respectively). In smokers, thrombolytic therapy was associated with a higher reopening rate of the infard vessel, from 35% to 77% (p < 0.001). Nonsmokers did not benefit from thrombolytic therapy, regardless of infarct location. CONCLUSIONS: These observational data, if replicated, suggest that in patients with acute myocardial infarction, thrombolytic therapy may be most effective in current smokers, whereas nonsmokers and ex-smokers may require other management strategies, such as emergency percutaneous transluminal coronary angioplasty.

Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).

BACKGROUND: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS: Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

[Myocardial infarction caused by thrombosis of the common trunk of the left coronary artery without collateral circulation. Treatment by intra-aortic counterpulsation and subsequent heart transplantation]. / Infarctus du myocarde par thrombose du tronc commun de la coronaire gauche sans circulation de suppléance. Traitement par contrepulsion intra-aortique puis greffe cardiaque.

The authors report the case of an acute anterior myocardial infarction due to occlusion of the left main coronary artery without a collateral circulation. The patient survived after intraaortic balloon pumping followed by cardiac transplantation.

[Triple biphasic chemotherapy in the treatment of small-cell bronchial cancer]. / Chimiothérapie triple biphasique dans le traitement du cancer bronchique micro-cellulaire.

Forty-three patients with small-cell bronchial carcinoma were treated with sequential combination chemotherapy of the CMC-VAP type alternating every 6 weeks. Toxicity affected mostly blood cells and occurred during induction. The response rate was 60% in circumscribed forms with a median survival of 15 months, and 30% in diffuse forms with a median survival of 6 months. The value of alternating protocols and the place of radiotherapy are discussed in the light of these results.

[The satellite lymph node of surgically-treated epidermoid bronchial cancer. Evaluation and meaning. Apropos of 167 cases]. / Le ganglion satellite du cancer bronchique épidermoïde opéré. Evaluation et signification. A propos de 167 cas.

This study is based on the analysis of the radiological and histological features of the lymph nodes in 167 operated cases of bronchial carcinoma. The conventional evaluation by means of radiography demonstrates the difficulty of accurately diagnosing lymph node involvement; these investigations are simply able to reveal the presence or absence of enlarged lymph nodes without being able to distinguish between neoplastic and purely inflammatory lymphadenopathy. Histological examination demonstrates the presence of hilar and mediastinal node involvement: the first does not influence the survival in contrast with the second which seems to reflect an intense immune response.