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AMI: The Scale Of The Problem

Acute myocardial infarction (AMI) remains one of the leading causes of death in the Western world, with prevalence predicted to increase dramatically in developing countries, especially India and China. Around 40-50% of AMIs are the result of a persistent, complete thrombotic occlusion of a coronary artery. In such cases fast reopening of the infarct vessel is the primary goal of treatment. This "reperfusion" therapy has been shown to save lives, especially when applied with 2-3 hours after the onset of infarction. Recanalisation of the infarct vessel can be obtained by administering thrombolytic agents (to dissolve the occlusive thrombus) or by performing a mechanical recanalisation followed by angioplasty of the culprit lesion (primary percutaneous intervention, PCI).

The Benefits Of Reperfusion Therapy

The wider use of reperfusion therapy in patients with heart attack (AMI) can save millions of lives in Europe. Effective reperfusion therapy in an AMI patient can cut the individual risk of dying by half. AMI is caused by a sudden blockage of a coronary artery, one of the vessels supplying the heart muscle with oxygen and nutrients. Effective reperfusion therapy provides a timely and sustainable reopening of the blockage. The WHO MONICA* project showed that in European centres in the mid-1990s, in-hospital mortality of AMI patients was 13%; this was a time when only about 40% of the patients had reperfusion therapy. Today, specialist centres can provide effective reperfusion therapy to more than 90% of their AMI patients.

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PreSCD II Registry

The goals of the PreSCD II (Prevention of Sudden Cardiac Death II) registry are to collect recent data on patients with high risk for sudden cardiac death after a heart attack and to describe their prognosis in relation to initial left ventricular ejection fraction (LVEF) as the primary risk marker. Findings from the latest PreSCD II analysis show that patients protected against sudden cardiac death by an implantable cardioverter defibrillator (ICD) one month or more after MI showed a non-significant (p=0.053) 44% lower mortality than comparable patients without an ICD. In those patients with severely reduced heart function (ejection fraction of 30% or less) mortality was reduced by 47%, with borderline significance (p=0.

Results From The European CRT Survey

The European cardiac resynchronization therapy (CRT) Survey is a joint initiative taken by the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology. Its primary objective is to describe current European practice and routines associated with the implantation of a CRT device with or without an ICD (implantable cardioverter defibrillator) capability in patients with heart failure. The data collected from the survey provide useful information in CRT for heart failure on patient demographics and selection, clinical characteristics, diagnostic criteria, implantation routines and techniques, short-term outcomes, adverse experience, and assessment of adherence to guideline recommendations.

Heart Failure And Renal Impairment PROTECT Study

Despite the promising findings of the PROTECT Pilot study, the larger PROTECT trial found no difference with rolofylline versus placebo with respect of the primary and main secondary end-points of the study. Although more rolofylline patients than placebo patients experienced moderate or marked dyspnea improvement at 24 and 48 hours from randomization, this was counterbalanced by a lack of effect on persistent renal impairment. Lastly, the risk of important neurological events was increased in patients on rolofylline. Acute heart failure (HF) is the most common cause of hospitalization for patients aged >65 years. Its prevalence continues to rise as the population ages.

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Sudden Death During Sport: Education To Improve Survival Rates

More widespread availability of defibrillators and education of the general public could boost survival rates fourfold amongst athletes suffering cardiac arrest, a study has found. In less than half of cases, a bystander initiated cardiopulmonary reanimation. This is crucial as survival at hospital admission is 4 times higher when CPR is attempted and 10 times greater when an electric shock is delivered. The study by a Paris hospital outlined the poor prognosis of sudden death during sport, despite the fact that efficient measures are known, but not correctly and systematically applied, across France. Until now, studies of sudden death during sport focused on young competitive athletes, although this group represents a small percentage of sudden deaths during sport.

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