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Objective. – To assess the use of mobile coronary care units (MCU) in hypertensive patients previously treated for cardiovascular diseases in comparison with those with no history of cardiovascular disease and to estimate the influence of the use of MCU on cardiovascular outcome in this population. Patients. – We used a nationwide prospective registry of all patients admitted for AMI in French intensive care units in 2000. Patients without history of hypertension or patients admitted with pulmonary oedema or cardiogenic shock were excluded. Men (N = 514) and women (N = 291) were analysed separately . Results. – The proportion of patients with history of myocardial infarction, peripheral artery disease and stroke was not significantly higher in subjects who used physician-staffed MCU as compared with patients with no history of myocardial infarction, peripheral artery disease or stroke. In each sex, revascularization (pre hospital fibrinolysis, in hospital fibrinolysis or coronary angioplasty) were more frequent in patients who used MCU. Also, one year cardiovascular mortality was lower in men who used MCU. Conclusion. – known high risk hypertensive patients did not use physician-staffed MCU more than subjects free of such condition. Education of hypertensive patients at risk during routine visits is required to increase of the use of physician-staffed MCU in case of symptoms suggestive of AMI.

Resume Objectif. – Plusieurs etudes rapportent un pronostic plus sombre apres un infarctus du myocarde (IdM) chez ceux ayant une arteriopathie obliterante des membres inferieurs (AOMI). Notre objectif a ete de decrire la presentation et la prise en charge d'une cohorte de patients avec AOMI victimes d'IdM, comparee a ceux sans AOMI. Materiel et methode. – Le registre USIC 2000, colligeant les donnees des patients pris en charge pour un IdM aigu dans les soins intensifs francais en novembre 2000, a ete utilise. Resultats. – Parmi les 2311 sujets, une AOMI etait rapportee chez 215 sujets (9,3 %). En analyse multivariee, les facteurs positivement lies ( p ≤ 0,05) a une AOMI sont : âge superieur a 75 ans (OR = 2,3), diabete (OR = 2,0), hypertension (OR = 1,4), tabagisme actif (OR = 4,6), insuffisance renale (OR = 3,1), les antiagregants (OR = 3,9), antivitamine K (OR = 1,9), statines (OR = 1,7) et HBPM (OR = 6,8). En introduisant dans le modele les donnees a l'arrivee, le sexe masculin (OR = 1,6) et les antecedents de coronaropathies (OR = 2,2) etaient egalement plus frequents. Ces patients presentaient plus souvent un bloc de branche gauche (OR = 1,8) et moins souvent un sus-decalage du segment ST (OR = 0,7). Une prise en charge tardive superieure six heures etait plus frequente (OR = 1,4). L'introduction des donnees des 48 premieres heures revele un moindre recours au stent (OR = 0,7), et les betabloquants (OR = 0,6). A la sortie de l'hopital, les taux de prescription des therapeutiques de prevention secondaire sont moindres chez l'arteritique. Conclusion. – Au-dela de l'AOMI, un grand nombre de facteurs pejoratifs et une sous-prescription de traitements a interet pronostique, existent chez ces patients.

Objective: To assess actual practices and in-hospital outcome of patients with acute myocardial infarction on a nationwide scale. Methods: Of 443 intensive care units in France, 369 (83%) prospectively collected data on all cases of infarction (within < 48 hours of symptom onset) in November 2000. Results: 2320 patients (median age 68 years, 73% men) were included, of whom 83% had ST segment elevation infarction (STEMI). Patients without STEMI were older and had a more frequent history of cardiovascular disease. Median time to admission was 5.0 hours for patients with and 6.5 hours for those without STEMI. Reperfusion therapy was used for 53% of patients with STEMI (thrombolysis 28%, primary angioplasty 25%). In-hospital mortality was 8.7% (5.5% of patients without and 9.3% of those with STEMI). Multivariate analysis found that age, Killip class, lower blood pressure, higher heart rate on admission, anterior location of infarct, STEMI, diabetes mellitus, previous stroke, and no current smoking independently predicted in-hospital mortality. At hospital discharge, 95% received antiplatelet agents, 75% received β blockers, and over 60% received statins. Angiotensin converting enzyme inhibitors were prescribed for 40% of the patients without and 52% of those with ST elevation. Conclusions: This nationwide registry, including all types of centres irrespective of their size and experience, shows continued improvement in patient care and outcomes. Time from symptom onset to admission, however, has not improved in recent years and reperfusion therapy is used for just over 50% of patients with STEMI, with an increasing use of primary angioplasty.

We assessed the in-hospital management and short- and long-term outcomes of two series of patients admitted for acute myocardial infarction, 5 years apart, in France. The most recent cohort was younger and with a less frequent history of cardiac diseases, but was more often diabetic and with anterior infarcts. Five-day mortality significantly improved from 7.7% to 6.1% (P < 0.03) and 1-year survival was also less in the most recent period (15% versus 19%, P < 0.01). Multivariate analyses showed that the period of inclusion (2000 versus 1995) was an independent predictor of both short- and long-term mortality. In analyses restricted to the patients who were alive by day 5, initial treatment with statins was associated with a 38% decrease in the risk of death at 1 year. Likewise, in patients with left ventricular ejection fraction ≤35%, the early prescription of ACE inhibitors was associated with a 41% reduction in the risk of 1-year mortality. Thus, in the real world setting, a continued decline in 1-year mortality is observed in patients admitted to intensive care units for recent acute myocardial infarction. This goes along with a shift in reperfusion therapy towards a broader use of coronary angioplasty and with an increased use of the early prescription of recognised secondary prevention medications.

Background: The efficacy and tolerability of oral telithromycin 800 mg once daily for 5 vs. 10 days were assessed in patients with acute maxillary sinusitis (AMS). Methods: Adults (n = 341) with confirmed AMS diagnosed on clinical signs and symptoms and sinus X-ray showing total opacity or air-fluid level were randomized to receive oral telithromycin for 5 days (followed by placebo for 5 days; n = 170) or 10 days (n = 171). Causative pathogens were isolated by pretreatment sinus puncture (day 1). Clinical and bacteriologic outcomes, and safety and tolerability endpoints were assessed. Results: Clinical cure rates post-therapy (per-protocol; days 17–21) were comparable (91.1% in the 5-day group, n = 123; 91.0% in the 10-day group, n = 133). Bacteriologic eradication rates (per-protocol) were also similar (90.7 vs. 91.3%). Both regimens were well tolerated. Conclusions: A 5-day course of telithromycin 800 mg once daily is an effective, well-tolerated treatment for adults with AMS, comparable to a 10-day regimen.