Data_Sheet_1_Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials.PDF

BackgroundSex- and gender-associated differences determine the disease response to treatment.AimThe study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women.Methods and resultsWe performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p 6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0–2.23]), and also for an optimal procedural result (4.24 [2.12–8.49], p ConclusionThe prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.</p

Prevalence of depression and anxiety symptoms in the course of 1 year after PCI.

<p>Prevalence of depression and anxiety symptoms in the course of 1 year after PCI.</p

Occurrence of positivity of questionnaire SAS.

<p>Occurrence of positivity of questionnaire SAS.</p

Delayed-Type Hypersensitivity to Metals of Environmental Burden in Patients with Takotsubo Syndrome – Is There a Clinical Relevance?

<div><p>Objective</p><p>Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA®.</p><p>Methodology, Results</p><p>A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA®); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029).</p><p>Conclusion</p><p>Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity to metals (mercury in particular) evaluated by LTT-MELISA®. We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.</p></div

Occurrence of positivity of questionnaire BDI-II.

<p>Occurrence of positivity of questionnaire BDI-II.</p

Loss of interest in sex in the course of 1 year after PCI.

<p>Loss of interest in sex in the course of 1 year after PCI.</p

Suggested hypothesis of pathological immune mechanisms in the Takotsubo syndrome.

<p>TS is associated with increased levels of catecholamines in the acute phase of this condition. Hypersensitivity reactions to environmental burden with metals, which are mediated by antigen/hapten-specific T-lymphocytes, were proved in 96% of our patients with Takotsubo syndrome. Chronic or acute hypersensitivity reactions are accompanied by an inflammatory reaction with the production of many cytokines and free radicals (i.e., an increased oxidative stress). The methionin-homocysteine cycle is one of the main endogenous antioxidant systems. At the same time, the methionine-homocysteine cycle provides methyl groups for the degradation of catecholamines, a process catalysed by catechol-O-methyltransferase (COMT). An “exhaustion” of the methionine-homocysteine cycle as a result of chronic oxidative stress can lead to a decreased degradation of catecholamines; in a subsequent stressful situation, which is generally characterised by an increased production of catecholamines, excessively high levels of catecholamines can occur, such as those typically found in TS patients. TS develops most frequently in postmenopausal women, who have decreased levels of sex hormones, particularly oestrogens. In general, oestrogens have a cardioprotective effect (by reducing the chronotropic and ionotropic effects of catecholamines); additionally, when taking into account the potential hypersensitivity, oestrogens also have anti-inflammatory effects. On top of that, progesterone–of which levels also decrease with age–has immunosuppressive effects.</p

Comparison of a number of patients with positive stimulation index (SI ≥ 3) for individual metals between TS group and healthy controls.

<p>Comparison of a number of patients with positive stimulation index (SI ≥ 3) for individual metals between TS group and healthy controls.</p

Bleeding complications (major minor, in per cent) among all study patients and among PCI patients only

<p><b>Copyright information:</b></p><p>Taken from "Clopidogrel pre-treatment in stable angina: for all patients >6 h before elective coronary angiography or only for angiographically selected patients a few minutes before PCI? A randomized multicentre trial PRAGUE-8"</p><p></p><p>European Heart Journal 2008;29(12):1495-1503.</p><p>Published online 25 Apr 2008</p><p>PMCID:PMC2429977.</p><p>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: [email protected]</p

Changes of sleep in the course of 1 year after PCI.

<p>Changes of sleep in the course of 1 year after PCI.</p