ABSTRACT
OBJECTIVE: Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. METHODS: We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. RESULTS: Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). CONCLUSIONS: Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
Subject(s)
Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/therapy , Age Factors , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Pulmonary Edema/mortality , Pulmonary Edema/prevention & control , Recurrence , Registries , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/mortality , Shock, Cardiogenic/mortality , Shock, Cardiogenic/prevention & control , Spain , Time Factors , Treatment OutcomeABSTRACT
Prolongation of the QT interval is associated with a high risk of serious ventricular tachyarrhythmias, usually torsade de pointes (TdP) polymorphic ventricular tachycardia, although monomorphic ventricular tachycardia may also develop. Both congenital and acquired forms have been reported, acquired forms being much more prevalent. An association between human immunodeficiency virus (HIV) infection and a higher rate of dilated cardiomyopathy has also been recognized. The severity of immunodeficiency seems to influence both the incidence and severity of cardiomyopathy. A higher prevalence of QT prolongation has been reported among hospitalized HIV-positive patients with HIV infection, possibly related to drugs prescribed for such patients or to an acquired form of long QT syndrome arising from HIV infection. We report a case of QT prolongation and development of ventricular arrhythmia in one HIV patient that started with intravenous clarithromycin and cotrimoxazole therapy.
Subject(s)
Anti-Bacterial Agents/adverse effects , Clarithromycin/adverse effects , HIV Infections/complications , Long QT Syndrome/chemically induced , Tachycardia, Ventricular/chemically induced , Adult , Electrocardiography , Follow-Up Studies , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Male , Time FactorsABSTRACT
Se conoce que la prolongación del intervalo QT está asociada con un alto riesgo a desarrollar arritmias ventriculares, frecuentemente taquicardias ventriculares polimórficas tipo torsade de pointes (TdP), aunque también de tipo monomórfico. Se han descrito formas primarias y secundarias, siendo éstas las más frecuentes. Por otra parte, existe relación entre la infección por el virus de la inmunodeficiencia humana (VIH) y una mayor incidencia de miocardiopatía dilatada. El grado de inmunodeficiencia parece influir tanto sobre la incidencia como sobre la gravedad de la cardiopatía. Se ha descrito una mayor prevalencia de QT largo entre pacientes hospitalizados positivos para el VIH, lo que podría estar en relación con diferentes tratamientos administrados, o asociado a una forma adquirida propia de este grupo de pacientes.Describimos un caso de prolongación del intervalo QT con inducción de arritmia ventricular en un paciente VIH positivo tras iniciar tratamiento con claritromicina y cotrimoxazol por vía intravenosa (AU)
