Coffee consumption and risk of cardiovascular events after acute myocardial infarction: results from the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevenzione trial.

BACKGROUND: The relation between coffee consumption and cardiovascular disease has been studied extensively, but results are still debated. In addition, little evidence is available on patients with established coronary heart disease. METHODS AND RESULTS: Prospectively ascertained information among 11,231 Italian patients (9584 males and 1647 females) with recent (< or = 3 months) myocardial infarction enrolled in the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevenzione trial was used. Usual dietary habits were assessed at baseline and updated at 0.5 and 1.5 years. Coffee consumption was categorized as never/almost never, < 2 cups per day, 2 to 4 cups per day, and > 4 cups per day. Medication use and fasting glucose were assessed at 0.5, 1, 1.5, 2.5, and 3.5 years. Risk was evaluated with Cox proportional hazards with time-varying covariates. The main outcome measure was the cumulative incidence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke). A total of 1167 cardiovascular events occurred during 36,961 person-years of follow-up. After multivariable adjustment for potential confounders in the time-dependent analysis, the relative risk of cardiovascular events across categories of coffee consumption was 1.02 (95% CI 0.87 to 1.20) for < 2 cups per day, 0.91 (95% CI 0.75 to 1.09) for 2 to 4 cups per day, and 0.88 (95% CI 0.64 to 1.20) for > 4 cups per day compared with abstainers (P for trend=0.18). Ultimately, coffee consumption did not change the risk of coronary heart disease events, stroke, and sudden death. CONCLUSIONS: No association between moderate coffee intake and cardiovascular events was observed in post-myocardial infarction patients.

Efficacy of n-3 polyunsaturated fatty acids according to clinical characteristics of patients with recent myocardial infarction: insights from the GISSI-Prevenzione trial.

The GISSI-Prevenzione trial established the efficacy of n-3 polyunsaturated fatty acids (PUFAs) for reducing mortality in patients after recent myocardial infarction. The generalisability of such results to clinical practice could vary according to other individual patient characteristics. We analysed the GISSI-Prevenzione database to assess whether other major risk factors, comorbidities, dietary habits, or medications could interact with the efficacy of n-3 PUFA treatment to reduce total mortality. We found no evidence that concomitant disease states, habits, or interventions altered the therapeutic benefit of n-3 PUFA consumption in survivors of recent myocardial infarction.

[Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature]. / L'infarto miocardico acuto nell'ultrasettantacinquenne. Studio caso-controllo con una popolazione più giovane e rassegna della letteratura.

BACKGROUND: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. METHODS: 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. RESULTS: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. CONCLUSION: The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.

[Nursing role in cardiac prevention]. / Il ruolo nursing nella prevenzione cardiovascolare.

The lack of a multidisciplinary approach is certainly among the causes of the ineffectiveness of intervention in the field of cardiovascular secondary prevention. By multidisciplinary approach is meant involving cardiologists, nurses, rehabilitation therapists, dieticians as well as psychologists in the framing of interventions tailor made to patients needs. In particular, people working in the nursing area can play a very important role which can be summed up into three different levels: a technical level, aiming at the cooperation with cardiologists to carry out diagnostic examinations and give a portrait of patients in terms of risks; a second level consists in giving information, and helping to face the disease, as well as stepping in during its evolution, almost a health counsellor for the patients; finally the nurse can act as a psychological support both to the patient and his/her family during acute illnesses and reassure him/her that he/she is being treated properly and that successively will resume a good quality of life. Hospital represent an ideal place for secondary prevention, at least in the first phases of the intervention. The results collected during hospitalization would be rapidly lost if they were not followed and sustained in the medium-long term by structured follow-up programmes. The development of ambulatories might represent a link between hospitals and the territory, i.e. the specialist and one's personal physician. The staff of ambulatories should comprise a cardiologist and a trained professional nurse, this being specialized, specifically, in cardiology and cardiovascular prevention. Staff of the type described could work independently, co-ordinating ambulatories on the territory within the framework of standardized recognized protocols and relating information concerning patients, general practitioners and other surgeries. In this way, an essential link of the continuity in medical care would be guaranteed.

[Pharmacologic therapy in failed thrombolysis: sequential infusion of tirofiban. Pilot study with 47 patients]. / La terapia farmacologica nella trombolisi fallita: infusione sequenziale di tirofiban. Studio pilota in 47 pazienti.

Glycoprotein IIb/IIIa inhibitors have been recently proposed as a bridge to rescue transluminal coronary angioplasty in ST elevation myocardial infarction patients in whom thrombolysis fails; but data in its feasibility, safety and efficacy are still limited. In 47 consecutive acute myocardial infarction patients in whom thrombolysis failed to achieve 90 minute reperfusion, tirofiban was given at full regimen. Our results have been compared with those obtained in a control group of 48 consecutive acute myocardial infarction patients admitted two years before, period in which tirofiban and rescue angioplasty were not available in our hospital. Our preliminary data suggest this approach is feasible and safe, with possible clinical benefit in this high-risk subgroup of patients.

Effectiveness of tirofiban for failed thrombolysis during acute myocardial infarction.

The clinical outcome of 48 consective patients with myocardial infarction who received tirofiban for unsuccessful thrombolysis was compared with that of 48 patients matched for age, gender, and infarct location who did not receive rescue treatment. Those who received tirofiban had more successful reperfusions, and there were few bleeding complications.

[Partial atrio ventricular septal defect diagnosed in adult age: description of a case in a 67 years old woman]. / Difetto settale atrio ventricolare parziale diagnosticato in età adulta: descrizione di un caso in una paziente di 67 anni.

Authors describe a case of partial atrio ventricular septal defect--cushion defect--with only a mitral valve cleft and mild valvular insufficiency. There were present also, since the childhood, an atrio ventricular primary block, and a left axis deviation. Late appeared a RBBB. The correct diagnosis has been done at the age of 67 years. The patient refers mean rhythm disorders and effort dyspnea. She refused surgical correction successful also in the late age.