Immediate coronary angiography in survivors of out-of-hospital cardiac arrest without obvious extracardiac cause: Who benefits?

BACKGROUND: Immediate coronary angiography (iCA) and primary percutaneous coronary angioplasty (pPCI) in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA) of suspected cardiac cause is controversial. Our aims were to assess the results of iCA, the prognostic impact of pPCI after OHCA, and to identify subgroups most likely to benefit from this strategy. METHODS: In this single-centre retrospective study, patients aged ≥18 years with sustained return of spontaneous circulation after OHCA and no evidence of a non-cardiac cause underwent routine iCA at admission, with pPCI if indicated. Results of iCA, and factors associated with in-hospital survival were analysed. RESULTS: Between 2006 and 2013, 160 survivors from OHCA presumed of cardiac origin were included (median age, 60 years; 85% males). iCA showed significant coronary-artery lesions in 75% of patients, and acute occlusion or unstable lesion in only 41%. pPCI was performed in 34% of patients and was not associated with survival by univariate or multivariate analysis (P=0.67). ST-segment elevation predicted acute coronary occlusion in 40%. An initial shockable rhythm was associated with higher in-hospital survival (52% vs. 19%; P<0.001). After initial defibrillation, the first rhythm recorded by 12-lead electrocardiography was highly associated with prognosis: secondary asystole had a very low survival rate (5%, 1/21) despite PCI in 43% of patients, compared to sustained ventricular tachycardia/fibrillation (42%, 15/36) and supraventricular rhythm (71%, 50/70) (P<0.001). CONCLUSIONS: In our experience, the prevalence of acute coronary occlusion or unstable lesion immediately after OHCA of likely cardiac cause is only 41%. Immediate CA in OHCA survivors, with pPCI if indicated, should be restricted to highly selected patients.

Multiple stenting in acute myocardial infarction with double vessel occlusion, complicated with cardiogenic shock.

Stenting of the infarct-related artery during the acute phase of myocardial infarction is a controversial issue. We report a case of primary multiple stent implantation in 2 vessels in a patient with AMI, double vessel total occlusion and cardiogenic shock. No intracoronary thrombotic therapy was given. Stenting provides an optimal angiographic result which may decrease the need for repeat interventions. Primary stenting in AMI deserves further investigation.

[Evaluation of the prevalence of pathology of drug origin in a department of internal medicine]. / Evaluation de l'incidence de la pathologie d'origine médicamenteuse dans un service de médecine interne.

The authors report the results of a one year study carried out in the Department of Internal Medicine at Laennec Hospital. Out of a total of 1334 hospitalisation, 95 had drug side effects (7.1 p. 100) and 3.5 p. 100 of admissions were directly related to a iatrogenic complication. These complications were more common in women and elderly patients. Sixty-two drugs were implicated: antibiotics (32.6 p. 100), cardiovascular drugs (20 p. 100) including the diuretics (8.4 p. 100), antiinflammatory and antalgic drugs (16.8 p. 100), anticoagulants (8.4 p. 100), neuropsychiatric drugs (7.4 p. 100), oral hypoglycaemic agents (6.3 p. 100)..., 101 side effects were observed: gastro-intestinal (35.6 p. 100) dermato-anaphylactic (19.8 p. 100), cardiovascular (12.9 p. 100), endocrine or metabolic (11.8 p. 100), neuropsychiatric (10.9 p. 100), haematological (5.9 p. 100) and renal (4.2 p. 100). Iatrogenic complications were responsible for the admission to hospital of 47 patients and for 390 days of hospitalisation, costing approximately 380.000 FF.