Cascade screening can be life‑saving: a family with multiple cases of brugada syndrome and sudden cardiac death

Brugada syndrome (BrS) may cause a spectrum of symptoms from asymptomatic patients to those who experience cardiac arrest and sudden cardiac death. The diagnosis is confirmed after observation of type I Brugada pattern on the electrocardiogram. Following the diagnosis, risk stratification can help select therapeutic options. Cascade screening should be started to find other family members with BrS. We present a 41-year-old woman diagnosed with BrS, and cascade screening of her relatives unveiled a pedigree of BrS among their family.

Risk factors of reperfusion failure following primary angioplasty for ST-segment elevation myocardial infarction [STEMI]

Although percutaneous coronary intervention [PCI] improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction [STEMI] patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. Totally, 155 patients [124 men; mean age = 56.6 +/- 11.03 years, range = 31- 85 years] with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GP2b/3a inhibitor were not the determining factors [p value > 0.05]. According to our multivariate analysis, time of symptom onset [OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044] and ejection fraction [OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050] had reverse and male gender had direct significant associations with failed reperfusion [OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068]. More degrees of ST resolution occurred when the right coronary artery was the culprit vessel [p value = 0.001]. The presence of more than three cardiac risk factors was associated with failed reperfusion [p value = 0.050]. Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy