[One-year clinical and angiographic follow-up after primary stenting]. / Evolución clínica y angiográfica al año de pacientes con infarto agudo de miocardio tratados con stent primario.

INTRODUCTION AND OBJECTIVES: The late reocclusion or restenosis rate of the infarct related artery is frequent after primary angioplasty. An implanted stent may be able to improve the coronary angioplasty results and long-term outcome of these patients. We present the clinical and angiographic outcome of a cohort of patients treated with primary stenting. PATIENTS AND METHODS: A group of 74 consecutive patients with acute myocardial infarction treated with primary angioplasty and stenting were followed for one year. An angiographic control was performed at the 6th month of follow-up in 91% of patients to assess the restenosis and reocclusion rates of the infarct-related artery. RESULTS: There were eight in-hospital deaths and three during follow-up (mortality rate 14.8%) and one non-fatal reinfarction (1.5%). The cumulative rate of recurrent ischemia was 6% at 3 months and 15% at 6 months, without any further increment at one-year follow-up. A new angioplasty was performed in 7 patients and three patients underwent surgical revascularization. Thus 80% of patients after discharge were free of events. The angiographic control showed only one reocclusion of the infarct related artery and a restenosis rate of 27%. CONCLUSIONS: These results show that primary stenting is an effective procedure in treating non-selected patients with acute myocardial infarction with a low long-term incidence of adverse events and a low restenosis rate.

[Changes in hospital mortality from acute myocardial infarction during the last 15 years. The impact of reperfusion treatments]. / Evolución de la mortalidad hospitalaria por infarto agudo de miocardio durante los últimos 15 años. Influencia de los tratamientos de reperfusión.

INTRODUCTION AND OBJECTIVES: There are not any conclusive data about the changes in in-hospital mortality in a non-selected series of patients admitted with acute myocardial infarction in different periods of time. We studied the in-hospital mortality of three extensive series of patients admitted to our Coronary Care Unit during different periods of time, the influence of reperfusion methods and their early application, as well as the changes in baseline characteristics of the three populations studied. METHODS: The in-hospital mortality of 1,858 consecutively-admitted patients during three different periods of time (1983-1986, 1992-1994, and 1995-1998) were studied. The demographic data, the previous history and risk factors, the evolution during the acute phase and the treatment prescribed with special attention to the reperfusion methods applied and the delay on its administration were compared. RESULTS: The differences in the baseline characteristics of the populations studied are described. In the two groups of the nineteen-nineties, an increase in the age and in the percentage of women, diabetics and hypertensives was compared. As for the characteristics of acute myocardial infarction, an increase of patients in Killip class 3 and 4 stands out besides other changes. Fibrinolitic treatment decreased during the third period due to the increment in primary angioplasty. There were no significant differences in hospital mortality among the three series studied. The treatment with thrombolysis and primary angioplasty during the first two hours showed a significant independent reduction of mortality. CONCLUSIONS: The early application of thrombolysis and primary angioplasty showed an independent reduction of the hospital mortality in our study. Nevertheless the non-adjusted mortality rate did not show any change during the last 15 years.

[Torsades de pointes during treatment of leishmaniasis with meglumine antimoniate]. / Torsade de pointes durante el tratamiento de la leishmaniasis con antimoniato de meglumina.

Antimonial agents are the main drug to treat all forms of leishmaniasis. Meglumine antimoniate is the drug available in Spain and it is usually well tolerated. Nevertheless, this drug frequently alters ventricular repolarization, but few cases of sudden death, presumably related to ventricular arrhythmias, have been reported. We present a case of torsade de pointes during treatment with meglumine antimoniate coexisting with a severe hypokalemia probably due to an acute transitory tubulopathy.

[Intracoronary stent in primary angioplasty in acute myocardial infarction]. / Stent intracoronario en la angioplastia primaria en el infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: Stent implantation has been generally contraindicated during primary percutaneous transluminal balloon angioplasty in AMI, because of its possible trombogenicity. Report the early outcome of patients undergoing coronary stenting during primary PTCA. METHODS: From january 1995 to april 1996, 31 patients underwent stent implantation in primary. Mean age 62 +/- 11 years. Infarct location was anterior in 20 (65%), and inferior in 11 patients (35%). Four patients were in Killip class IV. Mean onset of chest pain was 129 +/- 29 minutes. Indications for stenting were suboptimal result (64%), dissection (29%) and elective (6%). All patients were treated with heparin during 72 hours and antiplatelet therapy with ticlopidine and aspirin. RESULTS: Coronary stenting restored vessel patency with TIMI 3 flow in 29 patients (94%) and TIMI 2 flow in 2 patients. Angiographic control was performed in 80% of the patients: no stent occlusion was observed and all patients showed a TIMI 3 flow. There were 3 deaths (9%): 2 patients died due to cardiogenic shock and 1 to severe right ventricular dysfunction. 2 patients (6%) had recurrent angina, due to other artery. One patient with left main coronary disease underwent elective coronary artery bypass graft surgery. CONCLUSIONS: Intracoronary stent can be used successfully during primary angioplasty with a low incidence of complications. The long term benefits remains to be established.