[Determinants of long-term follow-up after stent implantation in acute myocardial infarction]. / Determinanten des Langzeitverlaufes über drei Jahre nach Stent-Implantation bei akutem Myokardinfarkt.

Coronary stent implantation is an effective treatment of acute myocardial infarction. Little is known about long-term follow-up of patients undergoing stent implantation in the setting of acute myocardial infarction, since most studies restrict the follow-up to six months. The aim was to investigate the clinical follow-up of patients over a period of three years and to identify predictive factors of an adverse cardiovascular outcome. The study retrospectively analyzes a consecutive series of 204 patients receiving stent implantation in the setting of an acute myocardial infarction. Follow-up angiography was performed after 5+/-2 months following myocardial infarction analyzing the incidence of angiographic restenosis. Adverse cardiovascular outcome was defined as cumulative end point including death, myocardial infarction, coronary artery bypass grafting and PTCA/stent implantation of the target vessel occurring in the first three years following myocardial infarction. Multivariate analysis correlated clinical, procedural and angiographic variables with an adverse outcome. Restenosis occurred in 38% of patients. An adverse outcome was observed in 42% of patients. Multivariate analysis identified target vessel CABG, time to treatment >10 h, TIMI flow <3 after stent implantation, number of stents >1, male gender, multivessel disease and arterial hypertension as independent predictors of an adverse cardiovascular outcome. Critical consideration of these risk factors may help to identify patients who are poor candidates for stent implantation in acute myocardial infarction. However, further investigation is required to corroborate the results of this investigation on determinants of a three year follow-up after stent implantation in acute myocardial infarction.

Conversion of recent-onset atrial fibrillation or flutter with ibutilide after amiodarone has failed.

OBJECTIVE: To evaluate whether ibutilide can convert atrial fibrillation or flutter in patients in whom amiodarone has failed. DESIGN AND SETTING: Clinical study in a university hospital intensive care unit (ICU). PATIENTS: Twenty-six patients were studied, in whom atrial fibrillation or flutter persisted for a maximum of 6 h at maximum. Patients were monitored continuously during the arrhythmia. Medical conversion was necessary due to symptomatic or hemodynamic causes. INTERVENTIONS: All patients initially received amiodarone (150 mg i.v.) and after 2 h of persistent arrhythmia ibutilide (1 mg or, without success and body weight > 70 kg, 2 mg i.v.). Before the administration of ibutilide 1 g magnesium was administered, and high normal levels of potassium serum levels were achieved (4.5-5.0 mmol/l). RESULTS. After amiodarone atrial flutter persisted in 73% and atrial fibrillation in 27% of patients. After ibutilide the QT interval was prolonged from 327 +/- 61 to 387 +/- 62 ms. The QTc interval increased from 456 +/-32 to 461 +/- 66 ms. Conversion to normal sinus rhythm was achieved in 22 of 27 of cases. Nonsustained torsade de pointes tachycardia was seen in three patients (11%). No patient showed sustained ventricular tachycardia. Patients with proarrhythmic effects were characterized by a decreased left ventricular function. CONCLUSIONS: In ICU patients ibutilide led to conversion to sinus rhythm in 81.5% of patients in whom amiodarone was unsuccessful. Nonsustained tachycardias were seen in 11%; sustained ventricular tachycardia was not seen. Ibutilide seems to be well suitable for conversion of recent onset atrial fibrillation or flutter and had no severe side effects in this study population.