RESUMEN

AIMS: Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered therapy with implantable cardioverter defibrillators (ICDs). Whether plasma biomarkers can help risk stratify for SCD and ventricular arrhythmias (VT/VF) is unclear. METHODS AND RESULTS: The primary objective of the CAMI-GUIDE study is to assess the predictive role of C-reactive protein for SCD or VT/VF in ischaemic patients with the ejection fraction <30% and ICDs. Secondary endpoints included all-cause mortality, hospitalizations, and death from heart failure. Additional analyses incorporated cystatin-C and NT-ProBNP in multi-marker approach for the prediction of adverse outcomes. A total of 300 patients were enrolled. All-cause mortality at 2 years was 22.6%, mortality from heart failure was 8.3%. Primary endpoint occurred in 17.3%. At a competing risk multivariable analysis adjusted for baseline variables, no significant difference in primary endpoint was found between patients with C-reactive protein ≤3 vs. >3 mg/L [heart rate (HR) 0.91 (0.50-1.64) P = 0.76], while C-reactive protein >3 mg/L was strongly associated with mortality due to heart failure [HR: 3.17 (1.54-6.54) P = 0.002]. NT-proBNP above median was significantly associated with the primary endpoint [adjusted HR: 1.46 (1.020-2.129) P = 0.042]. A risk function, including the three biomarkers, NYHA class and resting HR, allowed stratification of patient mortality risk from 5 to 50%. CONCLUSION: C-reactive protein >3 mg/L is not associated with SCD or fast VT/VF, however, is a strong predictor of HF mortality. Biomarkers combined with clinical markers allow an excellent risk stratification of mortality at 2 years.

Asunto(s)

Proteína C-Reactiva/metabolismo , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Infarto del Miocardio/sangre , Taquicardia Ventricular/terapia , Anciano , Biomarcadores/metabolismo , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Taquicardia Ventricular/sangre , Taquicardia Ventricular/mortalidad

RESUMEN

Background: In the daily clinical practice, patients with atrial fibrillation (AF) lasting more than 48h (or not datable at all) are not uncommon. In long-lasting AF changes in electrophysiological features (electrical remodeling) can occur, resulting in a loss of sensibility to most antiarrhythmic drugs. There is strong evidence that the main mechanism involved in electrical remodeling is a global shortening in refractory period. To assess safety and efficacy of quinidine in pharmacological cardioversion of long-lasting AF, compared with propafenone and amiodarone. Methods and Results: Ninety consecutive patients with AF lasting more than 6 weeks were randomized to amiodarone (5mg\kg bolus, then 15mg\kg in 24h) , propafenone (2 mg\kg bolus then 0.007mg\kg for 2h), and quinidine (275mg of quinidine arabogalattan sulphate per os every 2h for 8h maximum) for pharmacologic cardioversion. All patients had been previously treated with adequate oral anticoagulation and had been submitted to transthoracic echocardiogram. The 3 groups of patients did not differ for baseline and echocardiographic characteristics. Sinus rhythm was restored in 16 patients treated with quinidine (53%), compared with 6 patients (20%) in the amiodarone and propafenone groups (p<0.01). No major adverse effect was reported during the treatment. Conclusions: Quinidine seems to be safe and effective in pharmacological cardioversion of long-lasting AF.

RESUMEN

BACKGROUND: Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can currently be offered effective means of prevention, such as implantable cardioverter-defibrillators (ICD). However, predictors of SCD able to identify those patients who are at higher risk are still lacking. Whether C-reactive protein (CRP), a serum inflammatory marker with established prognostic accuracy after MI, can also be a predictor of SCD is unclear. METHODS: The CAMI GUIDE study is designed to evaluate the prognostic role of CRP in patients undergoing ICD implantation after MI according to MADIT II criteria (i.e. left ventricular ejection fraction

Asunto(s)

Proteína C-Reactiva/metabolismo , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Infarto del Miocardio/terapia , Biomarcadores/sangre , Estudios de Cohortes , Interpretación Estadística de Datos , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Estudios de Seguimiento , Humanos , Italia/epidemiología , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Selección de Paciente , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Proyectos de Investigación , Medición de Riesgo , Factores de Riesgo , Tamaño de la Muestra , Taquicardia Ventricular/sangre , Taquicardia Ventricular/prevención & control , Resultado del Tratamiento , Fibrilación Ventricular/sangre , Fibrilación Ventricular/prevención & control