[Ischemic cardiopathy in the young: coronarographic and autopsy picture in 100 subjects]. / La cardiopatia ischemica nel giovane: quadro coronarografico ed autoptico in 100 soggetti.

Many aspects of coronary artery disease in young people are not completely understood. Our study concerns a series of 100 patients < 45 years with acute coronary artery disease. Sixty patients survived and 40 died suddenly. All subjects have been divided into four groups: Group I includes 20 deceased patients with anatomic features of acute myocardial infarction. Group II includes 20 subjects dead without features of acute myocardial infarction. Group III includes 30 patients surviving the first acute myocardial infarction. Group IV includes 30 patients surviving unstable angina. The coronary arteries have been studied by anatomic dissection in Group I and II and with coronarography in Groups III and IV. The left main was only involved in Group I and II patients. Multivessel disease was more frequent in Group I and II, but the difference was not significant. These results underline that coronary artery disease with multivessel involvement is not rare in young patients. The rare occurrence of left main disease at coronary angiography could be the consequence of the natural preselection determined by sudden death.

Morbidity and mortality of patients with sinus node disease: comparative effects of atrial and ventricular pacing.

In patients with sinus node disease (SND), VVI pacing seems an inappropriate method of cardiac stimulation because of its potential adverse hemodynamic and arrhythmic effects. AAI-DDD pacing, preferred because of lower morbidity, may also determine a higher survival rate. We examined retrospectively two groups of patients with SND. Stimulated respectively with VVI pacing (group 1 = 57 patients) and AAI pacing (group 2 = 53 patients). The mean duration of the follow-up interval was 40.1 months for group 1 and 45 months for group 2. Ten patients (17.5%) in the VVI group and five (9.4%) in the AAI died. During the follow-up, in the VVI group three patients developed congestive heart failure and ten developed chronic atrial fibrillation, whereas only one case of heart failure and two with atrial fibrillation have been recorded in the AAI group. Moreover, four patients had embolic complications in group 1. Five patients (9.4%) with AAI pacing were converted to sequential pacing due to the occurrence of second-degree heart block. The statistical analysis was developed by the X2 test for the comparison of the proportion of the events (atrial fibrillation, congestive heart failure, embolic accidents) in the two groups: a significantly higher morbidity (P less than 0.01) was recorded in the AAI group. Survival is also higher in AAI patients, but the survival rate difference, calculated using the Mantel-Cox method, is not statistically significant. The findings of our study show that in SND the superiority of AAI pacing over VVI is statistically significant as far as morbidity is concerned, and we have also noticed an evident but not statistically significant superiority regarding mortality.

[Comparative effects of atrial and ventricular stimulation on morbidity and mortality in patients with sinus node disease]. / Effetti comparativi della stimolazione atriale e ventricolare sulla morbilità e mortalità dei pazienti con malattia del nodo del seno.

In patients with sinus node disease (SND) the VVI pacing seems an inappropriate mode of cardiac stimulation because of its potential hemodynamic and arrhythmic adverse effects. The AAI-DDD pacing, preferred because of a lower morbidity, might also determine higher survival. We examined retrospectively 2 groups of patients with SND respectively stimulated with VVI pacing (Group I:57 patients) and AAI (Group II:53 patients). The mean follow-up was 43 months for Group I and 50 for Group II: 10 (17.5%) patients in VVI group and 5 (9.4%) in AAI group died. During the follow-up in the VVI group 3 patients developed congestive heart failure and 10 chronic atrial fibrillation whereas 1 case of heart failure and 2 of atrial fibrillation have been recorded in AAI group. Moreover, 4 patients had embolic complications in Group I; 5 (9.4%) patients with VVI pacing were converted into sequential pacing owing to occurrence of II degree heart block. The statistical analysis was performed by chi 2 test for the comparison among the proportions of events (atrial fibrillation, congestive heart failure, embolic accidents) in the 2 groups: a significative higher morbidity (p less than 0.01) was recorded in VVI group. Survival also is higher in AAI patients but the survival rate difference, calculated with Mantel-Cox method, is not statistically significant. The findings of this study show that in SND the superiority of AAI pacing over VVI is statistically significant as regards morbidity and we have also noticed an evident but not statistically significant superiority as regards mortality.