217 Six-hour holter recording of microvolt T-wave alternans and heart rate turbulence in the CCU compared to classical 24-hour ambulatory ECG

BackgroundT-wave alternans (TWA) and heart rate turbulence (HRT) measured during 24 hour-ECG recordings are 2 powerful non-invasive tools to risk-stratify cardiovascular patients. The aim of our study is to assess whether a fast ECG-holter scan yields different information from classical 24-hour ambulatory ECG regarding TWA and HRT measurements.MethodsAll consecutive 21 patients with a non-ST-elevated myocardial infarction and admitted in intensive care unit of cardiology, have been monitored with an ECG-holter for classical, TWA and HRT analysis over 24 hours. TWA has been measured with the modified moving average method. Routine reading of the holters has been followed by a specific analysis. Each 24-hour period has been divided into four equal periods. Maximal TWA, T-onset and T-slope for HRT over those four 6-hour periods have been analyzed and compared with full day results using a repeated measures analysis of variance (ANOVA).Results16 men and 5 women aged between 31 and 90 (mean 57.5 +/− 24.8) have been included. Mean maximal TWA was 73±25μV. 6-hour maximal TWA was 59 +/− 23μV, 55 +/− 26μV, 56 +/− 30.01 and 48 +/− 23.27μV (p=0.11). HRT as assessed by T onset and T slope were −0.00619% +/− 0.02, 0.00333% +/− 0.04, 0.00571% +/− 0.03, −0.00952% +/− 0.03 (p=0.46) and 3.75 +/− 3.99, 5.46 +/− 7.29, 6.32 +/− 9.13, 5.96 +/− 10.85 (p=0.46) respectively for each time period.ConclusionThis preliminary study suggests that a 6-hour ECG-Holter recording could be a reliable and feasible method to assess cardiovascular mortality and risk of SCD in patients admitted for an acute coronary syndrome in intensive care unit by studying TWA and HRT. Faster risk stratification could thus be done during hospitalization in order to optimize therapeutics and better identify candidate for fast ICU discharge

In-hospital complications after invasive strategy for the management of Non STEMI: women fare as well as men

<p>Abstract</p> <p>Background</p> <p>To analyze the in-hospital complication rate in women suffering from non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) compared to men.</p> <p>Methods</p> <p>The files of 479 consecutive patients (133 women and 346 men) suffering from a Non STEMI (Non ST-segment elevation myocardial infarction) between the January 1^st2006 and March 21^st2009 were retrospectively analyzed with special attention to every single complication occurring during hospital stay. Data were analyzed using nonparametric tests and are reported as median unless otherwise specified. A p value < .05 was considered significant.</p> <p>Results</p> <p>As compared to men, women were significantly older (75.8 <it>vs</it>. 65.2 years; p < .005). All cardiovascular risk factors but tobacco and hypertension were similar between the groups: men were noticeably more often smoker (p < .0001) and women more hypertensive (p < .005). No difference was noticed for pre-hospital cardiovascular drug treatment. However women were slightly more severe at entry (more Killip class IV; p = .0023; higher GRACE score for in-hospital death - p = .008 and CRUSADE score for bleeding - p < .0001). All the patients underwent PCI of the infarct-related artery after 24 or 48 hrs post admission without sex-related difference either for timing of PCI or primary success rate. During hospitalization, 130 complications were recorded. Though the event rate was slightly higher in women (30% <it>vs</it>. 26% - p = NS), no single event was significantly gender related. The logistic regression identified age and CRP concentration as the only predictive variables in the whole group. After splitting for genders, these parameters were still predictive of events in men. In women however, CRP was the only one with a borderline p value.</p> <p>Conclusions</p> <p>Our study does not support any gender difference for in-hospital adverse events in patients treated invasively for an acute coronary syndrome without ST-segment elevation and elevated troponin.</p

CARACTERISATION PHARMACOLOGIQUE DES MECANISMES DE LA VASOCONSTRICTION NORADRENERGIQUE DANS LES ARTERES DE RESISTANCE DE RAT ET DE SA MODULATION PAR LE GMP CYCLIQUE

STRASBOURG-Sc. et Techniques (674822102) / SudocSudocFranceF

Impact of fondaparinux versus enoxaparin on in-hospital bleeding and 1-year death in non-ST-segment elevation myocardial infarction. FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) 2010

International audienceAims: Fondaparinux is an alternative to low molecular weight heparin (LMWH) for non-ST-elevation myocardial infarction (NSTEMI) with levels of recommendation that differ according to guidelines. The aim of this study was to assess outcomes in real world practice in NSTEMI patients participating in the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 according to the use of fondaparinux, in comparison with patients receiving enoxaparin. Methods and Results: FAST-MI 2010 is a nationwide French registry that included 4,169 patients with acute myocardial infarction at the end of 2010 in 213 centres (76% of active centres in France); 1,734 had NSTEMI, with 240 receiving fondaparinux and 1,027 enoxaparin. Patients receiving enoxaparin vs. fondaparinux had essentially characteristics with a similar GRACE (Global Registry of Acute Coronary Events) score. Invasive strategy was used in 69% in both groups. In-hospital bleeding was similar with both anticoagulant strategies and 1-year survival was 94.6% and 91.7%, respectively. Using fully adjusted Cox multivariate analysis, the use of fondaparinux was not associated with a reduced risk of death (hazard ratio: 1.35; 95% confidence interval: 0.70-2.51). After propensity score matching (207 patients per group), 1-year survival was similar with both strategies. There was, however, an interaction between fondaparinux and unfractionated heparin, with higher survival in fondaparinux-treated patients who received UFH, compared with those who did not. Conclusions: In this French cohort of NSTEMI patients, predominantly managed invasively, there was no evidence that fondaparinux was superior to enoxaparin as regards bleeding events or 1-year mortality (FAST-MI 2010; NCT01237418)