[Risk profile in acute myocardial infarction: a necessary assessment for the population's comparisons]. / Le profil de risque dans l'infarctus du myocarde: une évaluation indispensable pour la comparaison des populations.

OBJECTIVE: The aim of this study is to show that differences of mortality, in acute myocardial infarction, observed between hospitals are not necessarily linked to a bad application of guidelines but can be linked to differences in the risk profile of the populations. METHODS: Two populations admitted for ST and non-ST elevation myocardial infarction in the same region in 2006 were compared: the population of Chalon-sur-Saône's hospital with a standard population from the observatoire des Infarctus de Côte d'Or (RICO). The risk profile of the two populations has been realised with the risk scores GRACE, EMMACE and the Simple Risk Index (SRI). RESULTS: The three scores are applicable for our populations according to the "C statistic". Moreover, there is a significant difference of in-hospital mortality between Chalon-sur-Saône and RICO. But, the population of Chalon-sur-Saône presents a higher risk. Finally, in-hospital rate mortality expected by the three scores is not different from the actual mortality. CONCLUSION: GRACE, EMMACE and SRI are valid scores for the comparison of risk profile of populations in acute myocardial infarction. Comparisons between hospitals are only possible after risk adjustment of the populations.

[Acute lung oedema during a tako-tsubo syndrome associated with mitral stenosis]. / Odème aigu du poumon lors d'un syndrome de tako-tsubo et rétrécissement mitral associé

The tako-tsubo syndrome is the subject of a lot of publications focusing on the different circumstances of discovery (emotion, anesthetic stress...). We report the original case of a patient of 56 years with a tight mitral stenosis, hospitalized for acute lung oedema, sinus rhythm, in which the original data and follow-up studies have identified a tako-tsubo syndrome with favorable evolution.

[Assessment of physical activity in cardiovascular diseases]. / Indices de mesure de l'activité physique dans le domaine des affections cardiovasculaires.

PURPOSE: To identify the more useful among many methods available for the measurement of physical activity in patients with cardiovascular disease. For practical and financial reasons only questionnaires and mechanical monitoring, which are appropriate for use in large studies, were assessed. METHODS: To select tools valuable for clinical and epidemiological measurement of physical activity, with sufficient validity, reproducibility and sensitivity, we reviewed the literature in Medline with use of keywords: accelerometry, ambulatory accelerometry, ambulatory monitoring, cardiovascular diseases, daily activity, heart disease, pedometer, physical activity, questionnaire. RESULTS: Considering appropriate level of reproducibility and validity, 15 questionnaires are available. For measuring postures and motions during daily life, activity monitor seems to be more valid than pedometers or single accelerometers. CONCLUSION: At present the preferred method is a questionnaire, provided it is valid, repeatable, easy to use and inexpensive. In the future mechanical monitoring (especially activity monitor) will be probably a good alternative.