Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators.

OBJECTIVES: We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis. BACKGROUND: Prethrombolytic era studies report conflicting short-versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity. METHODS: Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration > or = 30 ms in lead aVF; R wave > or = 40 ms in lead V1; any Q wave or R wave < or = 10 ms and < or = 0.1 mV in lead V2; or Q wave > or = 40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed. RESULTS: No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001). CONCLUSIONS: Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.

Evaluation of the blood components considered as risk predictors in coronary heart disease.

The study included 249 patients two days before cardiovascular surgery and 73,915 control subjects. Results obtained were analyzed by grouping the individuals according to sex and age. In coronary heart disease (CHD) in males, total cholesterol was found higher than in controls (mean +/- D.S.: 241.9 +/- 44.7 vs 223.6 +/- 43.0 mg/dl, p < 0.01) between 25 and 49 years of age, this significance being lost with age. Triglycerides were also higher (197 +/- 107.3 vs 161.6 +/- 97.7 mg/dl, p < 0.01) in the CHD male population between ages 25 and 69. In CHD females, triglycerides were higher (116.9 +/- 56.2 vs 91.5 +/- 43.3 mg/dl, p < 0.05) between ages 25 and 49; cholesterol showed no difference at any of the ages studied. HDL-C was much lower in both sexes of CHD patients at all ages studied (p < 0.001). Uric acid was higher in CHD males between ages 25 and 49 (p < 0.05), this significance being lost in the older age CHD group. Other components such as glycated hemoglobin, glucose and ionized calcium, were not different from those of the control group.

Leptospirosis in South-western Spain.

INTRODUCTION: Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain. PATIENTS AND METHODS: Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded. RESULTS: The mean age was 43.1 ± 13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2 ± 9.2 versus 44.8 ± 15.2, p=0.004). The patients with Weil's disease were older (53.5 ± 15.8 versus 41.2 ± 14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7). CONCLUSIONS: In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age.

TIMI grade 3 flow and reocclusion after intravenous thrombolytic therapy: a pooled analysis.

Early and sustained flow of grade 3 according to Thrombolysis in Myocardial infarction (TIMI) criteria and reocclusion rates are the key measures that define the physiologic efficacy of thrombolytic agents in the treatment of acute myocardial infarction. We performed a systematic overview of angiographic studies after intravenous thrombolysis with accelerated and standard-dose tissue-plasminogen activator (TPA), anisoylated plasminogen streptokinase activator complex (APSAC), and streptokinase. There were 5475 angiographic observations from 15 studies for TIMI flow analysis and 3147 angiographic observations from 27 studies for reocclusion. At 60 and 90 minutes, the rates of TIMI grade 3 flow were 57.1% and 63.2%, respectively, with accelerated TPA, 39.5% and 50.2% with standard-dose TPA, 40.2% and 50.1% with APSAC, and 31.5% at 90 minutes with streptokinase. Overall reocclusion with standard-dose TPA was 11.8% versus 6.0% for accelerated TPA, 4.2% for streptokinase, and 3.0% for APSAC. Although the incidence of TIMI grade 3 flow increased over time with all thrombolytic regimens, decreased patency was observed at 180 minutes with accelerated TPA. Still, accelerated TPA is the most effective agent to establish early (90-minute) TIMI grade 3 flow.

Evaluation of blood components considered as risk predictors in coronary heart disease

Con el objeto de establecer la eficacia predictiva de enfermedad cardíaca coronaria (ECC) que poseen determinados componentes sanguíneos, se investigó su concentración en 249 pacientes 2 días antes de ser sometidos a cirugía cardiovascular. Los analitos evaliados fueron: Glucosa (glucosa-oxidasa), hemoglobina-glucosada (resina de intercambio catiónico), Calcio iónico (electrodo específico), Acido úrico (uricasa), Colesterol (enzimático), HDL-Colesterol (Gordon) y Triglicéridos (enzimático), empleándose técnicas automatizadas. El LDLColesterol fue calculado por la fórmula de Friedewald. Los resultados obtenidos fueron analizados agrupando a los enfermos por sexo y edad y comparados con una población control. En los varones con ECC el colesterol total se encontró significativamente aumentado al compararse con los controles (241,9 ñ 44,7 vs 223,6 ñ 43,0 mg/dl (p < 0,01) entre los 25 y 49 años, perdiendo luego carácter predictivo a medida que la edad avanza. Los triglicéridos fueron más altos (197 ñ 107,3 vs 161,6 ñ 97,7, p < 0,05), en la población de varones enferma entre los 25 y 69 años. Las mujeres con ECC no mostraron diferencias estadísticamente significativas en su colesterol total y sus triblicéricos fueron mayores sólo en la población enferma entre los 30 y 49 años. El ácido úrico fue mayor en los varones con ECC con edades entre los 25 y 49 años (p < 0,05). El HDL-Colesterol mostró valores francamente inferiores en ambos sexos y a todas las edades estudiadas (p < 0,001). Los valores de hemoglobina-glucosada, glucosa y calcio iónico no se diferenciaron de los controles, en los diferentes grupos estudiados. El análisis de los datos aquí presentados revela que sólo el HDL-Colesterol y la relación Colesterol/HDL-Colesterol alertan sobre el riesgo de enfermedad coronaria en ambos sexos y a cualquier edad. Es posible que los otros analitos estudiados se comporten como mejores indicadores de ECC al asociarlos con la presencia de otros factores de riesgo

Clasificación mapuche y fracasos orgánicos precoces: resultados del estudio multicéntrico / MAPUCHE classification and precocious organic failure results of multicentral study

Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores