Early Repolarization: Not Benign Any More- the J-Wave Syndromes

An early repolarization (ER) pattern characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation has been traditionally considered to be totally benign over the past decades. A flurry of data derived from recently published studies demonstrates that an ER pattern in inferior or inferolateral leads, named early repolarization syndrome (ERS), is associated with increased risk for sudden cardiac arrest (SCA), being responsible for some cases of idiopathic ventricular fibrillation (IVF). Current evidence support the notion that although ERS and Brugada syndrome (BrS) show discrete differences, they also share similar clinical, electrocardiographic and pathophysiological features, especially concerning the presence of amplified J-waves; thus, they can be considered to represent a continuous spectrum of phenotypic expression, termed J-wave syndromes. Research has provided us with fascinating insights into the underlying mechanisms responsible for repolarization abnormalities and we presently have more evidence to implement reliable risk stratification methods to patients with ER. However, many unanswered questions remain and still need to be addressed in future studie

Pre-Therapy With Statins in Percutaneous Coronary Interventions

Statins present a number of beneficial effects on endothelial function and atherosclerotic plaque, modulating oxidative stress and inflammation. The benefits of long-term statin treatment in the entire spectrum of atherosclerotic vascular disease can largely be explained by its cholesterol-lowering effects and the associated reduction of the progression of atherosclerosis. The short-term benefits of statins use are most likely due to their non-lipid, pleiotropic effects. Myocardial injury during percutaneous coronary intervention (PCI) occurs in 10-40% of cases and is often characterized by a slight increase in the markers of myocardial necrosis, sometimes without symptoms, electrocardiographic changes or impairment of cardiac function. Periprocedural myocardial infarction is associated with a worse outcome on long term follow-up. Several randomized trials have suggested a beneficial effect of pre-treatment with statins in the outcome of the procedure. Myocardial protection by statin pre-therapy in PCI has been studied in several trials published over the last decade. The mechanisms underlying the beneficial pleiotropic effects of statins may be an anti-inflammatory action reducing myocardial injury necrosis due to microembolization, an improvement in endothelial function on microcirculation, and direct myocardial protection. This article reviews the major randomized trials which have studied the use of statins as pre-treatment in PCI and explores future perspectives. Key words: statins, percutaneous coronary intervention, acute coronary syndrome