Distortion of the QRS in elderly patients with myocardial infarction

Background: Distortion of the terminal portion of the QRS in the initial electrocardiogram (ECG) is a strong predictor of adverse outcome in myocardial infarction. Our purpose is to assess the relationship of distortion of QRS and other ECG characteristics with older age. Methods and results: We analysed 634 consecutive patients (age 62.6 &#177; 13.7, 77% male) admitted in the first 12 hours of ST-elevation myocardial infarction. Two groups of age were defined: < 75 years-old and &#8805; 75 years-old. Additionally, we defined two ECG groups according to the presence of ST segment elevation with distortion of the terminal portion of the QRS in two or more adjacent leads (QRS+) or the absence of this pattern (QRS&#8211;). Older people had more often QRS+ (30% vs. 20%, p = 0.023). The older group with QRS+ had an in-hospital mortality of 18%, vs. 7% with QRS&#8211; (p = 0.04), and an incidence of major adverse events of 40% vs. 14% (p = 0.002). In the multivariate analysis, age &#8805; 75 years was an independent predictor of distortion of the QRS (odds ratio 2.1, 1.2&#8211;4.9, p = 0.016). Conclusions: The distortion of the terminal portion of the QRS in myocardial infarction is more frequent in elderly people, and is significantly related to adverse prognosis. This ECG finding can be helpful to promptly stratify the risk in elderly patient

Outcomes after intensive chemotherapy for secondary and myeloid-related changes acute myeloid leukemia patients aged 60 to 75 years old: a retrospective analysis from the PETHEMA registry

Treatment options for patients with secondary acute myeloid leukemia (sAML) and AML with myeloid-related changes (AMLMRC) aged 60 to 75 years are scarce and unsuitable. A pivotal trial showed that CPX-351 improved complete remission with/without incomplete recovery (CR/CRi) and overall survival (OS) as compared with standard "3+7" regimens. We retrospectively analyze outcomes of 765 patients with sAML and AML-MRC aged 60 to 75 years treated with intensive chemotherapy, reported to the PETHEMA registry before CPX-351 became available. The CR/CRi rate was 48%, median OS was 7.6 months (95% confidence interval [CI]: 6.7-8.5) and event-free survival (EFS) 2.7 months (95% CI: 2-3.3), without differences between intensive chemotherapy regimens and AML type. Multivariate analyses identified age ≥70 years, Eastern Cooperative Oncology Group performance status ≥1 as independent adverse prognostic factors for CR/CRi and OS, while favorable/intermediate cytogenetic risk and NPM1 were favorable prognostic factors. Patients receiving allogeneic stem cell transplant (HSCT), autologous HSCT, and those who completed more consolidation cycles showed improved OS. This large study suggests that classical intensive chemotherapy could lead to similar CR/CRi rates with slightly shorter median OS than CPX-351

Outflow tract obstruction and Takotsubo syndrome

Depto. de FisiologíaFac. de MedicinaTRUEpu

Prognostic value of first fasting glucose measurement compared with admission glucose level in patients with acute coronary syndrome

Estudio observacional unicéntrico que analizó 547 pacientes consecutivos ingresados por un síndrome coronario agudo. Se evaluaron los niveles de glucemia en varios puntos como fueron durante el ingreso y la primera glucemia en ayunas. El estudio concluyó que es la primera glucemia en ayunas y no al ingreso el parámetro que se relaciona con un factor de riesgo independiente de eventos cardiovasculares (muerte o reinfarto) durante la hospitalización.Depto. de MedicinaFac. de MedicinaTRUEpu

Can resistance to aspirin be reversed after an additional dose?

Estudio observacional donde se evaluó en 141 pacientes con enfermedad coronaria estable en tratamiento crónico con aspirina 100mg al día si una dosis adicional reduce el porcentaje de pacientes no respondedores al tratamiento antiagregante. Tras una dosis “extra” de aspirina 100mg, el número de pacientes no respondedores a la inhibición plaquetaria con aspirina se redujo un 15% (del 50,7 al 35%).Aspirin resistance or aspirin non-responsiveness is a recently described phenomenon which has been consistently associated with an increased risk of cardiovascular events. This study was designed to determine the effects of an additional dose of 100 mg of aspirin on platelet function and proportion of aspirin non-responders using the platelet function analyzer-100 (PFA-100), in a well characterized population of stable coronary heart disease patients already on long-term aspirin treatment. Platelet function was assessed using PFA-100 in 141 patients (64.8 ± 10.1 years, 87.9% men) on long-term aspirin treatment (100 mg/day) before and 1 h after “in site” oral aspirin administration (100 mg). Prevalence of aspirin non-responders using PFA-100 was 50.7% (95% confidence interval 42.4–59). One hour after 100 mg of oral aspirin, reassessment of aspirin effects showed a prevalence of non-responders using PFA of 35.0% (95% CI 27.3–43.2) (P < 0.001 vs. pre-dose proportion). Using the PFA-100 system, reassessment of platelet function following oral administration of daily aspirin dosage significantly reduces the number of stable coronary disease patients considered to be non-responders to such treatment.Depto. de MedicinaFac. de MedicinaTRUEpu