Effect of intravenous and intracoronary melatonin as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: Results of the Melatonin Adjunct in the acute myocaRdial Infarction treated with Angioplasty trial.

The MARIA randomized trial evaluated the efficacy and safety of melatonin for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). This was a prespecified interim analysis. A total of 146 patients presenting with STEMI within 6 hours of chest pain onset were randomized to receive intravenous and intracoronary melatonin (n=73) or placebo (n=73) during primary percutaneous coronary intervention (PPCI). Primary endpoint was myocardial infarct size as assessed by magnetic resonance imaging (MRI) at 6 ± 2 days. Secondary endpoints were changes in left ventricular volumes and ejection fraction (LVEF) at 130 ± 10 days post-PPCI and adverse events during the first year. No significant differences in baseline characteristics were observed between groups. MRI was performed in 108 patients (86.4%). Myocardial infarct size by MRI evaluated 6 ± 2 days post-PPCI, did not differ between melatonin and placebo groups (P=.63). Infarct size assessed by MRI at 130 ± 10 days post-PPCI, performed in 91 patients (72.8%), did not show statistically significant differences between groups (P=.27). The recovery of LVEF from 6 ± 2 to 130 ± 10 days post-PPCI was greater in the placebo group (60.0 ± 10.4% vs 53.1 ± 12.5%, P=.008). Both left ventricular end-diastolic and end-systolic volumes were lower in the placebo group (P=.01). The incidence of adverse events at 1 year was comparable in both groups (P=.150). Thus, in a nonrestricted STEMI population, intravenous and intracoronary melatonin was not associated with a reduction in infarct size and has an unfavourable effect on the ventricular volumes and LVEF evolution. Likewise, there is lack of toxicity of melatonin with the doses used.

Usefulness of Early Treatment With Melatonin to Reduce Infarct Size in Patients With ST-Segment Elevation Myocardial Infarction Receiving Percutaneous Coronary Intervention (From the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty Trial).

Melatonin, an endogenously produced hormone, might potentially limit the ischemia reperfusion injury and improve the efficacy of mechanical reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). This study was aimed to evaluate whether the treatment effect of melatonin therapy in patients with STEMI is influenced by the time to administration. We performed a post hoc analysis of the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty trial (NCT00640094), which randomized STEMI patients to melatonin (intravenous and intracoronary bolus) or placebo during pPCI. Randomized patients were divided into tertiles according to symptoms onset to balloon time: first tertile (136 ± 23 minutes), second tertile (196 ± 19 minutes), and third tertile (249 ± 41 minutes). Magnetic resonance imaging was performed within 1 week after pPCI. A total of 146 patients presenting with STEMI within 360 minutes of chest pain onset were randomly allocated to intravenous and intracoronary melatonin or placebo during pPCI. In the first tertile, the infarct size was significantly smaller in the melatonin-treated subjects compared with placebo (14.6 ± 14.2 vs 24.9 ± 9.0%; p = 0.003). Contrariwise, treatment with melatonin was associated with a larger infarct size in the group of patients included in the third tertile (20.5 ± 8.7% vs 11.2 ± 5.2%; p = 0.001), resulting in a significant interaction (p = 0.001). In conclusion, the administration of melatonin in patients with STEMI who presented early after symptom onset was associated with a significant reduction in the infarct size after pPCI.

El factor de diferenciación de crecimiento 15, un nuevo marcador pronóstico en la miocardiopatía diabética / Growth differentiation factor 15, a new prognostic marker in diabetic cardiomyopathy

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Problemas de comunicación percibidos por las enfermeras / Communications problems as perceived by nurses

La interacción de las enfermeras con las demás personas en el desarrollo de suejercicio profesional puede ser una fuente de estrés laboral.Objetivo: describir las dificultades de comunicación percibidas por las enfermerascon los pacientes, familiares y equipos de trabajo.Diseño de estudio descriptivo transversal, con una muestra de 59 enfermeras delComplejo Hospitalario de Ourense, pertenecientes a varios servicios de hospitalizaciónde enfermos agudos.Metodología: cuestionario autoadministrado conteniendo variables demográficasy valoración de los niveles de dificultad percibida en tres áreas de relación, segúnpropuesta de Ulla et al (2002).Resultados: las enfermeras perciben más dificultades para comunicarse con losfamiliares próximos al paciente y menos para la relación con el equipo de trabajo,aunque en este área es mayor la dificultad para comunicarse con el médico.Los hombres perciben menos problemas de comunicación. Con la edad mejora lapercepción de la comunicación con el paciente y familia y empeora con los miembrosdel equipo

The interaction of nurses with other individuals during the performance of their professionalduties can be a source of professional stress.Objective: to describe communication difficulties the nurse may experience withpatients, relatives and their colleagues.This is a cross-sectional, descriptive study conducted on a sample of 59 nurses froma hospital in Ourense, working at hospitalisation wards and Acute Care Unit.Methodology: self-administered questionnaire containing demographic variablesand evaluation of the level of difficulty perceived in three interaction/relationshipareas, according to Ulla et al proposal.Results: nurses find it more difficult to communicate with relatives close to the patientand less difficult to communicate with other members of their team, eventhough it must be mentioned that within this group, communication with thephysician is the hardest. Men perceived fewer communication problems. Withage, communication is perceived to improve with the patient and family and to worse with colleagues (AU)