Diferencia en la incidencia de hospitalizaciones por infarto agudo de miocardio con elevación de ST en los últimos 20 años / Difference in the incidence of hospitalizations for ST-segment elevation acute myocardial infarction in the last 20 years

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Sudden cardiac death during Holter recording in a patient with vasospastic angina.

Rest angina with transient ST segment elevation is the more frequent clinical presentation of coronary vasospasm. However, ventricular arrhythmias may be triggered by vasospasm episodes or reperfusion phenomenon, being vasospastic angina a rare but possible cause of sudden cardiac death in patients with structurally normal heart. We report of a patient admitted to the hospital presenting with recurrent nonexertional substernal chest pain who experienced an episode of sudden cardiac death due to malignant ventricular arrhythmias during a 24-hour Holter ECG.

Predictors and prognostic value of myocardial injury following stent implantation.

BACKGROUND: Troponin I concentrations are frequently elevated following percutaneous coronary intervention (PCI) even in procedures without complications and are considered, by some, as predictive of long-term morbidity and mortality. We assessed whether post-PCI troponin I concentrations bore any relationship to clinical, angiographic and in-laboratory minor adverse events indicative of myocardial injury and evaluated, in follow-up, whether these levels are useful as a predictive markers of adverse events. METHODS: Patients (n=147) who were scheduled for PCI for stent placement were prospectively studied. In-laboratory events recorded were protracted chest pain, electrocardiographic changes, slow flows, dissections and lateral branch affectation. Troponin I and creatinine kinase MB fraction (CK-MB) mass were measured at baseline and post-procedure. Mean clinical follow-up was for 10.4+/-3.6 months. RESULTS: During PCI, at least one adverse event occurred in 34% of patients and, in 38% of them, there was an elevation of troponin I as compared to 5.1% of those patients without any adverse event (relative risk=7.4; P<0.001). Elevation of troponin I concentrations occurred in 16.3% of all patients, 79.2% associated with an AE. CK-MB was elevated in 15.6% of patients. On multivariate analysis, protracted chest pain, lateral branch involvement and slow flow remained statistically significant in relation to post-procedure elevations of troponin I concentrations. Clinical follow-up showed a poorer prognosis in patients who had had elevated troponin I concentrations. CONCLUSIONS: In-laboratory adverse event predict elevated post-procedure troponin I concentrations which are associated with myocardial injury. These elevations, in turn, predict poorer medium-term clinical outcomes.