The American journal of cardiology
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Blunt precordial blows triggering ventricular fibrillation (commotio cordis) represent a leading cause of sudden death in young athletes. Attention has focused on the primary prevention of these tragedies with chest barriers. The U. ⋯ These events occurred in 4 sports: hockey (n = 13; 1 goalie), football (n = 10), lacrosse (n = 6; 3 goalies), and baseball (n = 3; all catchers). Scenarios included the failure of the padding to cover the precordium so that blows circumvented the protective barrier (n = 25) or projectiles that struck the chest barrier directly (n = 7). In conclusion, a significant proportion (about 40%) of sudden deaths reported in young competitive athletes due to blunt chest blows (commotio cordis) occur despite the presence of commercially available sports equipment generally perceived as protective.
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Randomized Controlled Trial
Impact of initial heart rate and systolic blood pressure on relation of age and mortality among fibrinolytic-treated patients with acute ST-elevation myocardial infarction presenting with cardiogenic shock.
Older age is associated with worse outcomes in patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI). However, significant heterogeneity exists in different age groups with respect to outcomes. Identification of factors that modulate age-related risk of death in patients with cardiogenic shock may help clinical decision making and facilitate patient counseling. ⋯ In contrast, those with a systolic blood pressure < or = 80 mm Hg and heart rate >100 beats/min had 30-day death rates >90% even if they were young. In conclusion, our data suggest that, although elderly patients with cardiogenic shock have poor prognosis, presenting heart rate and systolic blood pressure provide important information to differentiate who may have greater chance of recovery. This information may help physicians in deciding treatment options for patients with cardiogenic shock and counseling them about their risks.
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Comparative Study
Comparison of coronary drug-eluting stents versus coronary artery bypass grafting in patients with diabetes mellitus.
We compared 1-year outcome after drug-eluting stent (DES) implantation with off-pump bypass grafing (OPCABG) in patients with type 2 diabetes mellitus and multivessel coronary artery disease involving the proximal segment of the left anterior descending coronary artery. All consecutive diabetic patients treated by DES (DES group) or OPCABG (CABG group) in our institution from April 2002 to December 2004 because of de novo coronary lesions were included. Patients in the CABG group (n = 149) were older and had a higher rate of 3-vessel disease than those in the DES group (n = 69). ⋯ In contrast, there was no difference in the rate of the composite end points of death, myocardial infarction, and stroke (DES group 13%, CABG group 12%; adjusted analysis, hazard ratio 0.80, 95% CI 0.80 to 1.35, p = 0.40). In conclusion, at 1 year in diabetic patients with multivessel coronary artery disease involving the proximal left anterior descending coronary artery, the advantage of OPCABG over DES implantation seems to be limited at a lower rate of repeat revascularization. No difference seems to exist in the rate of death, stroke, and myocardial infarction.
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Location (anterior) and type (Q wave) of myocardial infarction (MI) might be considered of prognostic significance when predicting mortality. However, there are limited data regarding the prognostic significance of type and location of MI in patients with severely depressed left ventricular function. In 1,221 patients in the MADIT II, Q-wave MI was observed in 763 patients (62%), 115 (10%) had non-Q-wave MI, and 343 (28%) had conduction abnormalities. ⋯ However, when analyzing location of MI, inferior wall MI was associated with a significantly (hazard ratio 1.58, p = 0.048) higher risk of mortality than anterior wall MI. In addition, patients with conduction abnormalities had a higher risk of mortality (hazard ratio 1.36, p = 0.088) than patients with anterior wall MI. In conclusion, in the setting of severely depressed ejection fraction (< or =30%), inferior wall MI was associated with a significantly higher risk of mortality than anterior wall MI.
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Multicenter Study
Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes.
Although chronic obstructive pulmonary disease (COPD) is common in patients with myocardial infarction (MI), its association with long-term mortality after MI is controversial and little is known about its influence on patients' health status (symptoms, function, and quality of life). We prospectively enrolled 2,481 patients presenting with MI at 19 United States centers to examine the relations between COPD and patients' long-term mortality, rehospitalization rates, and health status after MI. Patients were administered the disease-specific Seattle Angina Questionnaire and the generic Short Form 12 at baseline and 1 year later. ⋯ In addition, COPD was associated with a trend toward a greater prevalence of angina at 1 year (risk ratio 1.12, 95% CI 0.89 to 1.41). In conclusion, patients with COPD have greater mortality, higher rehospitalization rates, and poorer health status 1 year after a MI. Although additional research is needed, clinicians should recognize that patients with COPD are at high risk for poor outcomes after MI.