Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results

OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid), 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid), and 1 had a tricuspid bioprosthesis. The success rate was 64.8%, the partial success rate was 17.6%, and the nonsuccess rate was 17.6%. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h). The mortality rate due to the use of streptokinase was 5.8% and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6%) embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33% in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8%) patient, and embolic complications occurred in 3 (17.6%) patients. In a mean 42-month follow-up, 67% of the patients were free from rethrombosis.

Comparison of immediate results and follow-up of patients with single-vessel and multivessel coronary artery disease younger than 50 years of age undergoing coronary stent implantation

OBJECTIVE: To assess the in-hospital results and clinical follow-up of young patients (< 50 years) with multivessel coronary artery disease undergoing stent implantation in native coronary arteries and to compare their results with those of patients with single-vessel coronary artery disease. METHODS: We retrospectively studied 462 patients undergoing coronary stent implantation. Patients were divided into 2 groups: group I (G-I) - 388 (84%) patients with single-vessel coronary artery disease; and group II (G-II) - 74 (16%) patients with multivessel coronary artery disease. RESULTS: The mean age of the patients was 45±4.9 years, and the clinical findings at presentation and demographic data were similar in both groups. The rate of clinical success was 95% in G-I and 95.8% in G-II (P=0.96), with no difference in regard to in-hospital evolution between the groups. Death, acute myocardial infarction, and the need for myocardial revascularization during clinical follow-up occurred in 10.1% and 11.2% (P=0.92) in G-I and G-II, respectively. By the end of 24 months, the actuarial analysis showed an event-free survival of 84.6 % in G-I and 81.1% in G-II (P=0.57). CONCLUSION: Percutaneous treatment with coronary stent implantation in young patients with multivessel disease may be safe with a high rate of clinical success, a low incidence of in-hospital complications, and a favorable evolution in clinical follow-up.

Report on the scientific results of the voyage of H.M.S. Challenger during the years 1873-76 under the command of Captain George S. Nares ... and the late Captain Frank Tourle Thomson, R.N.

Botany v.2=pt.4 (1886)

Report on the scientific results of the voyage of S.Y. "Scotia" during the years 1902, 1903 and 1904, under the leadership of William S. Bruce.

v. 3,pt.1-11

Report on the scientific results of the voyage of S.Y. "Scotia" during the years 1902, 1903 and 1904, under the leadership of William S. Bruce.

v. 6,pt.1-11

Report on the scientific results of the voyage of S.Y. "Scotia" during the years 1902, 1903 and 1904, under the leadership of William S. Bruce.

v. 7,pt.1-13

Report on the scientific results of the voyage of S.Y. "Scotia" during the years 1902, 1903 and 1904, under the leadership of William S. Bruce.

v. 4.pt.1

Fisheries : Zoological results of the fishing experiments carried out by F.I.S. "Endeavor" 1909-10 under H.C. Dannevig, / Commonwealth Director of Fisheries.

3

Report on the scientific results of the voyage of S.Y. "Scotia" during the years 1902, 1903 and 1904, under the leadership of William S. Bruce.

v. 4,pt.2-20

Fisheries : Zoological results of the fishing experiments carried out by F.I.S. "Endeavor" 1909-10 under H.C. Dannevig, / Commonwealth Director of Fisheries.

5

Fisheries : Zoological results of the fishing experiments carried out by F.I.S. "Endeavor" 1909-10 under H.C. Dannevig, / Commonwealth Director of Fisheries.

2

Fisheries : Zoological results of the fishing experiments carried out by F.I.S. "Endeavor" 1909-10 under H.C. Dannevig, / Commonwealth Director of Fisheries.

1

Report on the scientific results of the voyage of H.M.S. Challenger during the years 1873-76 under the command of Captain George S. Nares ... and the late Captain Frank Tourle Thomson, R.N.

Zoology v.13=pt.35-37 (1884-1885)

Report on the scientific results of the voyage of H.M.S. Challenger during the years 1873-76 under the command of Captain George S. Nares ... and the late Captain Frank Tourle Thomson, R.N.

Zoology v.6=pt.15;17 (1881-1882)