Martine Montigny

Electrophysiologic effects and long-term efficacy of bepridil for recurrent supraventricular tachycardias*

Thirteen patients underwent electrophysiologic evaluation for recurrent supraventricular tachycardia (SVT). The effects of intravenous bepridil (4 mg/kg) were evaluated during the initial study in 5 patients, and 12 patients underwent repeat study 7 to 10 days later taking oral bepridil, 300 to 400 mg/day. Intravenous bepridil increased the pacing cycle length inducing atrioventricular (AV) (276 +/- 43 vs 334 +/- 31 ms, p less than 0.01) and ventriculoatrial (VA) block (268 +/- 34 vs 310 +/- 35 ms, p less than 0.001), the retrograde refractory period of the accessory pathway (251 +/- 17 vs 295 +/- 25 ms, p less than 0.05) and the ventricular refractory period (216 +/- 17 vs 226 +/- 11 ms, p less than 0.05), and prevented induction of sustained SVT in 3 patients. Oral bepridil increased the sinus cycle length (723 +/- 64 vs 800 +/- 118 ms, p less than 0.05), corrected QT (403 +/- 14 vs 431 +/- 21 ms, p less than 0.05) and the pacing cycle inducing AV (288 +/- 63 vs 353 +/- 78 ms, p less than 0.01) and VA block (271 +/- 31 vs 408 +/- 124 ms, p less than 0.01). It prolonged the refractory period of the atrium (195 +/- 29 vs 233 +/- 36 ms, p less than 0.05), AV node (264 +/- 35 vs 303 +/- 22 ms, p less than 0.05), ventricle (221 +/- 16 vs 245 +/- 21 ms, p less than 0.01), accessory pathway in the AV (290 +/- 47 vs 329 +/- 54 ms, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of an invasive strategy in the elderly hospitalized with acute coronary syndrome with emphasis on the nonagenarians

Published data about nonagenarians with acute coronary syndrome (ACS) were mainly descriptive and limited by small sample sizes and unadjusted outcomes. We aim to describe the characteristics, management, and the impact of an invasive strategy on major adverse events in elderly patients hospitalized with ACS with focus on the nonagerians.

Recurrent Cardiovascular Events in Survivors of Myocardial Infarction With ST-Segment Elevation (from the AMI-QUEBEC Study)

The characteristics and predictors of long-term recurrent ischemic cardiovascular events (RICEs) after myocardial infarction with ST-segment elevation (STEMI) have not yet been clarified. We aimed to characterize the 10-year incidence, types, and predictors of RICE. We obtained 10-year follow-up of STEMI survivors at 17 Quebec hospitals in Canada (the AMI-QUEBEC Study) in 2003. There were 858 patients; mean age was 60 years and 73% were male. The majority of patients receive reperfusion therapy; 53.3% and 39.2% of patients received primary percutaneous coronary intervention (PCI) and fibrinolytic therapy, respectively. Seventy-five percent of patients underwent in-hospital PCI (elective, rescue, and primary). At 10 years, 42% of patients suffered a RICE, with most RICEs (88%) caused by recurrent cardiac ischemia. The risk of RICE was the highest during the first year (23.5 per patient-year). At 10 years, the all-cause mortality was 19.3%, with 1/3 of deaths being RICE-related. Previous cardiovascular event, heart failure during the index STEMI hospitalization, discharge prescription of calcium blocker increased the risk of RICE by almost twofold. Each point increase in TIMI (Thrombolysis In Myocardial Infarction) score augmented the risk of RICE by 6%, whereas discharge prescription of dual antiplatelets reduced the risk of RICE by 23%. Our findings suggested that survivors of STEMI remain at high long-term risk of RICE despite high rate of reperfusion therapy and in-hospital PCI. Patients with previous cardiovascular event, in-hospital heart failure, and high TIMI score were particularly susceptible to RICE. Future studies are needed to confirm the impacts of calcium blocker and dual antiplatelets on long-term risk of RICE.