Long‐term follow‐up of patients with cardiac syndrome X treated by spinal cord stimulation

Objective: To assess the long-term effect of spinal cord stimulation (SCS) in patients with refractory cardiac syndrome X (CSX). Methods: A prospective, controlled, long-term follow-up was performed of 19 patients with CSX with refractory angina who underwent SCS ( SCS group, 5 men, mean (SD) age 60.9 (8.5) years); 9 comparable patients with CSX who refused SCS treatment ( 3 men, mean ( SD) age 60.9 (8.8) years) constituted the control group. Clinical and functional status were assessed at the time of screening for SCS indication ( basal evaluation) and at a median ( range) follow-up of 36 (15-82) months. Results: The two groups at baseline did not show any difference in clinical characteristics and angina status. All indicators of angina status ( angina episode frequency, duration and short-acting nitrate use) improved significantly at follow-up in the SCS group (p<0.001) but not in controls. Functional status, as assessed by the Seattle Angina Questionnaire and a visual analogue scale for quality of life, improved at follow-up in the SCS group (p<0.001 for all scales) but not in controls. Exercise tolerance, exercise-induced angina and ST segment changes also significantly improved in the SCS group but not in controls. Conclusions: Data show that SCS can be a valid form of treatment for long-term control of angina episodes in patients with refractory CSX

Long-term prognosis of patients with cardiac syndrome X

BACKGROUND: Previous follow-up studies of patients with cardiac syndrome X (CSX) reported good prognosis. However, some recent reports challenged this finding by showing appreciable mortality rates in patients with angina and normal coronary arteries admitted for acute coronary syndromes. METHODS: We performed clinical follow-up of 155 patients (mean age 58.9+/-10 years, 40 men) with typical CSX. The occurrence of major cardiac events (cardiac death, acute myocardial infarction), readmission for chest pain, revascularization procedures, angina status, and non cardiac events during follow-up were collected for each patient. RESULTS: At a mean follow-up time of 137+/-78 months (range 24-372) from the onset of symptoms, 4 patients died, 3 for cancers and 1 for acute pancreatitis. No patient died from cardiovascular causes or had any major cardiovascular event. Hospital readmission for recurrent chest pain was reported by 89 patients (58%), and 33 (22%) underwent at least one more coronary angiography. During follow-up, chest pain had remained unchanged in 33% of patients and had worsened in 14% of patients. CONCLUSION: Our data show that patients with CSX have excellent long-term clinical prognosis. A significant number of patients, however, shows persistence or worsening of symptoms, as well as further recurrence to medical evaluation

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La mise en place de directives anticipées est-elle souhaitable ? L’accouchement à domicile est-il une bonne pratique ? Faut-il laisser une entière liberté de mouvement à un patient en fin de vie hospitalisé ? Le champ médical est l’une des sphères privilégiées où se définissent les modalités de la venue au monde ou de la fin de la vie, participant ainsi à cadrer des expériences qui ont en commun de « mettre l’humanité en lien avec l’inconnu » et qui constituent des « formes élémentaires de l’événement » dont la nature biologique est toujours socialisée et symbolisée. En étant confrontée au début et à la fin de l’existence, la médecine est susceptible d’être ramenée aux arbitraires sociaux, politiques et culturels qui la fondent. Ce dossier thématique met en lumière l’ambiguïté des prises en charge de ces événements et analyse la manière dont « la vie et la mort sont attribuées, contestées et mises en acte de manière pragmatique ». Il explore symétriquement ce que les technologies biomédicales font faire aux acteurs.trices qui donnent la vie ou se confrontent à la mort, et ce que ceux-ci/celles-ci leur font faire en retour. Il analyse également les nouvelles catégories de sujets qui en ressortent et dont l’ontologie incertaine doit être négociée et (re)définie dans chaque contexte. Is the implementation of living wills desirable? Is home birth a good practice? Should a dying patient be allowed to move freely inside the hospital? The medical field is one of the core spheres where the modalities of coming into the world and of the end of life are defined. This participates in framing experiments that all "put humanity in touch with the unknown" and constitute "elementary forms of the event" whose biological nature is always socialized and symbolized. By confronting the beginning and end of life, medicine is likely to be reduced to the social, political and cultural arbitrariness that underpins it. This special issue highlights the ambiguity of the handling of such events and analyzes how "life and death are pragmatically attributed, challenged and enacted". It symmetrically explores how biomedical technologies impact actors who give life or face death, and how these very actors impact these very technologies in return. The articles presented here also analyze new categories of subjects that emerge out of these confrontations and whose uncertain ontology must be negotiated and (re)defined in each context

Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

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