The American journal of cardiology
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Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000. ⋯ Thus, patients with WPW syndrome who had SVT at <1 year of age have 29-fold higher odds of recurrence at >1 year of age versus those patients with preexcitation. These patients are also more likely to require additional antiarrhythmic therapy to control SVT. Furthermore, children with WPW syndrome who are refractory to treatment with digoxin and/or propranolol are at increased risk of SVT recurrence.
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Conventional electrical cardioversion failed to restore normal sinus rhythm (NSR) in 49 of 364 patients (13.5%) with persistent atrial fibrillation. After receiving up to 2 mg of atropine, 40 (81%) of these 49 "electrical-refractory" patients were successfully cardioverted to NSR by subsequent attempts of electrical cardioversion.
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Information about the impact of race/ethnicity on adverse outcomes after percutaneous coronary intervention (PCI) in the modern era is limited. Using consecutive patients from the National Heart, Lung, and Blood Institute Dynamic Registry, this study investigated differences in clinical presentation, treatment strategy, and acute and long-term outcomes in 3,669 white, 446 black, 301 Hispanic, and 201 Asian patients who underwent PCI. All comparisons were made to whites. ⋯ All other in-hospital complications were similar to whites. At 1 year, there were no statistical differences in cumulative adverse event rates by ethnicity; however by 2 years there was a modestly higher mortality rate (adjusted RR 1.87; 95% confidence interval 1.15 to 3.04) and adverse event rate (death/MI, death/MI/CABG) among black patients. Thus, although differences in patient demographics, clinical presentation, angiographic characteristics and treatment strategies did not impact the incidence of acute and 1-year adverse outcomes of non-whites, there appears to be a significant reduction in event-free survival among blacks by 2 years.
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Randomized Controlled Trial Clinical Trial
Reduction of myocardial ischemic injury following coronary intervention (the MC-1 to Eliminate Necrosis and Damage trial).
Myocardial ischemic injury complicating acute myocardial infarction (AMI) and coronary revascularization procedures remains an unresolved clinical dilemma. In preclinical studies, treatment with pyridoxal-5'-phosphate monohydrate (MC-1), a vitamin B6 metabolite, has demonstrated cardioprotective effects. Sixty patients scheduled for elective percutaneous coronary intervention (PCI) who had clinically high-risk characteristics for ischemic complications were randomized to treatment with MC-1 or placebo in a 2:1 double-blinded fashion. ⋯ There were no significant differences in ischemia parameters per continuous electrocardiographic monitoring, and no safety issues were identified. In this phase II pilot study, treatment of high-risk patients who underwent PCI with MC-1 was associated with a decrease in the total amount of CK-MB released after PCI. These results support the evaluation of MC-1 in pivotal trials of patients at risk for developing myocardial ischemia, infarction, or reperfusion injury.