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Background: Elevations of hepatic transaminase (serum alanine transaminase [ALT] and serum aspartate aminotransferase [AST]) levels in patients with acute coronary syndrome (ACS), although transient, may result in exclusions from clinical efficacy trials due to suspected liver disease. The aim of this study was to evaluate the concentrations of serum transaminases in ACS and relate these to currently accepted AST/ALT exclusion criteria from clinical trials., Methods: One hundred consecutive patients with ACS were prospectively examined. Blood samples for AST, ALT, total bilirubin and troponin I concentration were obtained at the time of admission and after 6, 12 and 24 hours., Results: Eighty percent of patients had elevated AST, and 47% ALT; 43% of patients characterized AST concentration > 3 × upper limit of normal (ULN) in at least one measurement, while 8% of patients presented ALT concentration > 3 × ULN. AST presented higher concentrations when compared to ALT, resulting in a high De-Ritis ratio at every time point. No significant or high correlations were found between the concentrations of serum transaminases, De-Ritis ratio and troponin I. Two different cut-off values of troponin I were adopted to define the amount of infarcted myocardium that distinguished 28-31% of individuals with "large infarction". Among these patients, approximately 93% presented AST concentrations > 3 × ULN., Conclusions: Hepatic transaminases are often elevated in ACS, with the majority of patients with more extensive myocardial injury presenting high concentrations of AST. In the setting of ACS, current transaminase thresholds for liver dysfunction used in clinical trials may lead to excessive and inadequate exclusions of patients with larger infarcts from such trials.

Background: The purpose of this study was to compare risk predicted using available risk scores and actual outcomes in patients with left main coronary artery disease undergoing percutaneous coronary intervention with stent implantation (PCI LM)., Methods: We studied 204 patients treated with elective or emergent coronary angioplasty. We estimated in-hospital mortality using the EuroSCORE, Parsonnet and GRACE risk scores and compared this data with actual in-hospital mortality., Results: There were no deaths among 62 patients undergoing elective PCI LM regardless of the estimated risk. Acute coronary syndrome (ACS) was diagnosed in all 142 patients undergoing emergent PCI LM. Mortality in this group was 24% (34/142). Area under receiver operating characteristic curve (AUC) values for the EuroSCORE, Parsonnet and GRACE risk scores in patients with ACS were 0.812 (p = 0.0001), 0.857 (p = 0.0001), and 0.870 (p = 0.0001), respectively. No statistically significant differences were found when these AUC values for different evaluated risk scores were compared. Overall, the EuroSCORE and Parsonnet risk scores had no discriminative value, as all deaths occurred in the highest risk group. Only the GRACE risk score discriminated risk among intermediate- and high-risk patients with ACS., Conclusions: The EuroSCORE and Parsonnet scoring systems are of no value in predicting periprocedural mortality risk in patients undergoing elective PCI LM. Overall, discriminative ability of the EuroSCORE, Parsonnet, and GRACE risk scores in unselected patients with ACS undergoing emergent PCI LM was good. In this group of patients, the EuroSCORE and Parsonnet scoring systems had no discriminative value in low and moderate risk patients. Only the GRACE risk score discriminated risk among intermediate and high risk patients.

We report a case of young patient with dilated cardiomyopathy and implanted cardioverter-defibrillator in which resynchronisation therapy (CRT-D) induced an electrical storm. One month after implantation of a cardiac resynchronisation pacemaker (CRT-P) the patient suffered from ventricular tachycardia with poor haemodynamic status and was treated by implantation of a CRT-D with a Y adaptor. After replacement of the CRT-D due to Y adaptor damage (new device without a Y adaptor) we observed an electrical storm during ventricular pacing (biventricular, right and left ventricular pacing respectively). Changing pacing mode from DDDR to AAIR resolved ventricular tachycardias in that patient.

Background: We aimed to assess in-hospital outcomes of percutaneous transluminal coronary angioplasty (PTCA) in elderly subjects., Methods: A total of 1000 consecutive patients, who had all been admitted for interventional treatment of symptomatic coronary artery disease, were retrospectively analysed., Results: Elderly patients (>/= 70 years of age) were more likely to be diabetic, hypertensive and of female gender. They more frequently were diagnosed with chronic heart failure as well as prior stroke. Significantly higher proportions of the elderly population presented with cardiogenic shock and underwent PTCA as a result of acute coronary syndromes. Multivessel coronary disease affected a large majority of senior patients. Although stenting dominated in both age groups, balloon angioplasty was relatively more frequently applied in the elderly. Coronary angioplasty in elderly patients was associated with fewer direct stenting procedures, longer exposure to X-rays and a higher volume of the contrast medium. The efficacy of intervention, assessed according to clinical and angiographic criteria, was high in both groups, although revascularisation was significantly less complete while crude in-hospital mortality higher in the elderly group. Advanced age remained an independent predictor of both increased in-hospital mortality and longer exposure to X-rays after an adjustment for the baseline characteristics in multivariable analyses., Conclusions: Despite frequent comorbidities and more extensive coronary athersoclerosis, a high rate of procedural success was achieved in the elderly population who underwent PTCA. However, after an adjustment for the baseline characteristics advanced age was still associated with a less favourable in-hospital outcome and a higher degree of procedural complexity. (Cardiol J 2007; 14: 143-154).