[Effect of pulseless ventricular tachycardia on sympathetic activity]. / Pulzus nélküli kamrai tachycardia hatása a szimpatikus aktivitásra.

The role of sympathetic activation in the genesis of life threatening ventricular arrhythmia is abundantly documented. The protective effect of sympathetic activation at the time of destabilizing ventricular tachycardia is less well known. Recently, muscle sympathetic nerve activity was recorded at our cardiac electrophysiology laboratory in a 62-year-old man who suffered from severe left ventricular failure. In order to elucidate the complex relationship between arrhythmias and autonomic nervous activity, his muscle sympathetic nerve activity recording depicting response to pulseless ventricular tachycardia is hereby presented.

Renal function and outcomes in acute coronary syndrome: impact of clopidogrel.

INTRODUCTION: Patients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes. METHODS AND RESULTS: Patients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12 253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel to standard treatment in non-ST elevation acute coronary syndrome was observed in all three tertiles of renal function {(lower third relative risk (RR)=0.89 [95% confidence interval (CI) 0.76-1.05]; medium third RR=0.68 (95% CI 0.56-0.84); upper third RR=0.74 (95% CI 0.60-0.93) (P for heterogeneity=0.11)}. Clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function. The risk of major or life-threatening bleeding increased moderately with the addition of clopidogrel to standard treatment [lower third RR=1.12 (95% CI 0.83-1.51); medium third RR=1.4 (95% CI 0.97-2.02); upper third RR=1.83 (95% CI 1.23-2.73)], but this did not appear to be greatest in those with the lowest renal function. CONCLUSIONS: Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes. Clopidogrel was beneficial and safe in patients with and without chronic kidney disease.

[Comparison of invasive diagnostic techniques and revascularization therapy of acute coronary syndrome in Hungarian and international databases]. / Az akut coronariasyndromában alkalmazott invazív diagnosztika és terápia gyakorisága a magyar és a nemzetközi gyakorlatban (nemzetközi vizsgálatok adatai alapján).

UNLABELLED: INTRODUCTION, AIMS, METHODS: The databases of large multicentric trials dealing with acute coronary syndrome (OASIS Registry, CORE, PURSUIT, FRAX.I.S.) were analysed. RESULTS: Significant differences were disclosed comparing the baseline and history characteristics of patients randomized from Eastern or Western Europe. In most investigations the patients from Eastern Europe had a higher prevalence of hypertension, diabetes, angina and myocardial infarction. Invasive diagnostics and revascularization therapy were less frequently used in Eastern than in Western Europe in all the trials. The prevalence of myocardial infarction and the case fatality rate were not uniformly different during the early days, but after 30 days the case fatality rate in Eastern Europe was significantly higher than in Western Europe. CONCLUSION: It is suggested that the differences in demographic and baseline characteristics were only partially responsible for the difference in mortality. The low intervention rate and delayed revascularization may contribute to the high rate of myocardial infarction and mortality in Eastern Europe.