[Risk stratification in pre-hospital management of myocardial infarction with ST elevation: value of a risk score profile]. / Stratification du risque dans la prise en charge préhospitalière des infarctus du myocarde avec sus-décalage du segment ST: intérêt du profil de score de risque.

The aims of this study were to evaluate new tools of risk stratification in an unselected population of myocardial infarction (MI), usable in a pre-hospital situation, and to compare the risk profile of these patients with those of other clinical trials or myocardial infarction registries. The risk scores of death at 30 days (TIMI score and TIMI risk index) based on data available in the context of coronary emergencies, were applied to the population base of the MI observatory of myocardial infarction in the Côte d'Or (RICO). The risk profile was expressed by the smoothed graph of frequency distribution of each score. The TIMI score applied to the RICO population had a high discriminating power (c = 0.80) for mortality whereas TIMI risk index was less powerful (c = 0.57). The risk profile of the RICO population was comparable to that of InTIME II, ASSENT 2 and the NRMI with reperfusion registry. The NRMI without reperfusion and the MAGIC studies had different profiles characterised by a shift in the graph towards high risk patients. The authors conclude that risk stratification scores, like the TIMI score, are valuable tools for early triage in the management of MI patients. The risk profiles allow comparative analysis of risk levels of populations notably with respect to other registries and also with respect to randomised clinical trials.

N-terminal pro-brain natriuretic peptide levels in patients with non-ST-elevation myocardial infarction.

METHODS AND RESULTS: 101 patients hospitalized for acute non-ST-elevation myocardial infarction (NSTEMI) were included in the study. Median N-terminal fragment of the brain natriuretic peptide (BNP) prohormone (Nt-proBNP) plasma level was 136 (40-335) pmol/l. Patients with increasing levels of troponin I [from low (0.1-10 ng/ml), intermediate (10-40 ng/ml) to high (> or =40 ng/ml) levels] had significantly increased levels of Nt-proBNP (p < 0.05). High-risk patients classified by a high PURSUIT score (i.e. supramedian) had significantly increased Nt-proBNP levels compared to patients with low scores (p < 0.001). Moreover, patients with in-hospital events (death, recurrent MI or clinical heart failure: 27%) had significantly increased median levels of Nt-proBNP compared to event-free patients (184 vs. 105 pmol/l, p = 0.02). CONCLUSION: Our data in an unselected population of NSTEMI patients indicate that high levels of circulating Nt-proBNP levels are associated with an increased risk of early cardiovascular events.

[Application of risk stratification scores in acute myocardial infarction. Results of RICO (observation of infarction in the Ivory Coast)]. / Application des scores de stratification du risque dans l'infarctus du myocarde en phase aiguë. Données de RICO (observatoire des infarctus de Côte-d'Or).

Several risk stratification scores for myocardial infarction have been developed in recent years, based on clinical trials. The object of this study was to assess the application of these scores in an unselected population of myocardial in farction in a French department. One thousand and fifty-four patients with acute myocardial infarction were included in the RICO observatory in the Côte d'Or. Those with ST elevation (SST), N = 746, had 30 day-mortality rates which increased with the TIMI and GUSTO scores (khi2 tendency, p < 0.001). There was a good discriminatory power of both these scores (correlations of 0.71 and 0.69 respectively). Similarly, logistic regression analysis showed a significant relationship between TIMI and GUSTO scores and 30 day mortality (p < 0.001). No correlation was observed between mortality and increased TIMI score in cases of infarction without ST elevation, N = 308, p = 0.344. Moreover, this score had a low discriminatory value in the study population with a correlation of 0.54. On the other hand, regression analysis showed a strong predictive value of the PURSUIT score in infarction without ST elevation for mortality. In addition, there was a correlation between death and the value of this score (p < 0.05). This score also showed a good discriminatory power with a correlation of 0.71. This study shows that, in an unselected population, risk stratification scores may be used as a routine in myocardial infarction, especially in cases with ST elevation.

[Beneficial effects of direct call to Emergency Medical Services on time delays and management of patients with acute myocardial infarction. The RICO (obseRvatoire des Infarctus de Côte-d'Or) data]. / Influence de l'appel au "15" sur les délais et la prise en charge des patients présentant un infarctus du myocarde. Données de RICO (obseRvatoire des Infarctus de Côte-d'Or).

The influence of direct calls to specialized Emergency Medical Services in case of suspected myocardial infarction has not been extensively studied. The RICO registry is an exhaustive registry implemented in all six institutions participating in primary care of patients with acute myocardial infarction in one French administrative department (Côte-d'Or). From January 2001 to October 2001, 322 patients were admitted for acute myocardial infarction, among whom only 57 (18%) had directly called emergency medical services after the onset of symptoms. The baseline characteristics of patients who had directly called the emergency services were not different from those of the patients who had not. However, the time from symptom onset to first medical intervention (48 versus 105 minutes, p = 0.02) and from first medical intervention to hospital admission (60 versus 103 minutes, p = 0.02) were markedly shorter in patients who had directly called the emergency medical services. This resulted in a significant increase in the use of reperfusion therapy (70% versus 38%, p = 0.003), including a higher proportion of primary angioplasty (33% versus 20%, p = 0.04). This study documents the beneficial effect of a direct call to the Emergency Medical Services by the patients themselves. Too few patients, however use this opportunity and actions should be taken for informing the lay public of the benefits of this medical service.

[Symptomatic myocardial bridges. Apropos of 6 cases]. / Ponts myocarardiques symptomatiques. Apropos de 6 cas.

Myocardial bridge is often considered to be a simple anatomical variation often observed during coronary angiography. The responsibility of this condition for myocardial ischaemia is however uncommon and the physiopathological mechanisms are not well understood. The authors report 6 cases of myocardial bridge associated with myocardial infarction of unstable angina. The main features of this condition are discussed with respect to a review of the literature. Patients are usually young and male; the left anterior descending artery is the most commonly affected vessel: factors triggering ischaemia are discussed: coronary spasm, tachycardia and thrombosis at the site of the myocardial bridge. The diagnosis can only be made by coronary angiography showing reduction of the systolic diameter of the artery which may be accentuated by certain pharmacological tests such as injection of glyceryl trinitrate as used in the series.

[Pericardial manifestations of Lyme disease]. / Manifestations péricardiques de la maladie de Lyme.

Among cardiac manifestations of Lyme disease, pericardic involvement, as the main symptom, seems to be exceptional. We report two cases of pericarditis with typical clinical features. In both cases, pericarditis was the only clinical sign of the disease. Diagnosis was based on significant high serological antibodies levels with no evidence of any other etiological factor. Penicillin was administered and lead in one case to negativation of the serology. As cardiac involvement can occur without any preexisting cutaneous lesion, the frequency of pericardic involvement in Lyme disease is certainly underestimated.