Pseudoaneurisma postinfarto del ventrículo izquierdo: hallazgos en resonancia magnética / Left vewntricule pseudoaneurysm following myocardial infarction: MRI findings

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[Prognostic value of antibodies anti-Chlamydia pneumoniae in ischemic heart disease]. / Valor pronóstico de los anticuerpos anti-Chlamydia pneumoniae en la cardiopatía isquémica.

INTRODUCTION AND OBJECTIVES: Coronary artery disease has been related to infection by Chlamydia pneumoniae even only in a few studies the association between presence of antibodies to this microorganism and the prognosis of patients with ischemic heart disease has been assessed. The objective of our study was to assess the impact of positivity of anti-Chlamydia pneumoniae antibodies in the morbidity and mortality associated to ischemic heart disease. METHODS: 249 patients with ischemic cardiopathy were evaluated (97 with myocardial infarction, 83 with unstable angina and 69 with stable angina), recluted along 1 year and with 3-year follow-up. IgG anti-Chlamydia pneumoniae antibodies were measured with microimmunofluorescence. The cut off point considered for positive serology was set in 1/64. RESULTS: In the group of 97 patients with acute myocardial infarction, 43% showed positive titers of IgG antibody to C. pneumoniae. We observed a statistically significant association (p = 0.007) between positive serology and higher survival of acute myocardial infarction patients. A logistic regression was carried out with mortality, age, and serology as variables; age was the only variable that explained mortality (p = 0.0012), and the serology lost its statistical meaning. In the groups of 83 patients with unstable angina and of 69 patients with stable angina, 42% and 58%, respectively, showed positive serology for C. pneumoniae. We did not find a statistically significant association in both groups between positive serology to C. pneumoniae and the prognostic factors related to morbidity and mortality (rehospitalization and mortality). CONCLUSIONS: The presence of IgG antibodies to C. pneumoniae is not a marker of morbidity and mortality in our population of patients with ischemic heart disease.

[The safety of the treatment of an acute myocardial infarct by immediate intravenous fibrinolysis in the regional hospital environment]. / Seguridad del tratamiento del infarto agudo de miocardio mediante fibrinólisis intravenosa inmediata en el ámbito hospitalario comarcal.

INTRODUCTION AND OBJECTIVES: Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital. METHODS: We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital. RESULTS: 23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission). CONCLUSION: On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.