Background There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). We aimed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events (MACE). Methods 121 patients with at least one non-culprit lesion were randomised in a 2:1 manner, 80 were randomised to early fractional flow reserve (FFR)-guided PCI (invasive group), and 41 to medical treatment (conservative group). The primary endpoint was MACE at 3 years.Results Three-year follow-up was available in 119 patients (98.3 %). There was no significant difference in all-cause mortality between the invasive and conservative strategy, 4 patients (3.4 %) died, all in the invasive group (P00.29). Re-infarction occurred in 14 patients (11.8 %) in the invasive group versus none in the conservative group (p00.002). Re-PCI was performed in 7 patients (8.9 %) in the invasive group and in 13 patients (32.5 %) in the conservative group (P00.001). There was no difference in MACE between these two strategies (35.4 vs 35.0 %, p00.96). Conclusions In STEMI patients with MVD, early FFRguided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy. The rate of MACE in the invasive group was predominantly driven by death and re-infarction, whereas in the conservative group the rate of MACE was only driven by repeat interventions.

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Also in CZT SPECT image quality decreases with weight. The use of a tracer dose and scan time that depends linearly on patient's body weight corrected for the varying image quality in CZT-SPECT MPI. This leads to better radiation exposure justification.

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BackgroundThe decreasing image quality in heavier patients can be compensated by administration of a patient-specific dose in myocardial perfusion imaging (MPI) using a cadmium zinc telluride-based SPECT camera. Our aim was to determine if the same can be achieved when using a conventional SPECT camera.Methods148 patients underwent SPECT stress MPI using a fixed Tc-99m tetrofosmin tracer dose. Measured photon counts were normalized to administered tracer dose and scan time and were correlated with body weight, body mass index, and mass per length to find the best predicting parameter. From these data, a protocol to provide constant image quality was derived, and subsequently validated in 125 new patients.ResultsBody weight was found to be the best predicting parameter for image quality and was used to derive a new dose formula; Aadmin (MBq) = 223·body weight (kg)0.65/Tscan (min). The measured photon counts decreased in heavier patients when using a fixed dose (P < .01) but this was no longer observed after applying a body-weight-dependent protocol (P = .20).ConclusionsApplication of a patient-specific protocol resulted in an image quality less depending on patient’s weight. The results are most likely independent of the type of SPECT camera used, and, hence, adoption of patient-specific dose and scan time protocols is recommended.

1 To identify risk factors associated with taste loss to terbinafine, we performed a case-control study of 87 reports of probable terbinafine-induced taste loss and 362 controls on terbinafine without taste loss, who had filled prescriptions from the same pharmacy and GP. Data on general health, diet, alcohol, smoking, drug use and medical history were collected by means of a selfadministered questionnaire. 2 The mean latent period between first intake of terbinafine and taste loss was 35 days. Most patients recovered within 4 months after discontinuation. Cases were significantly older than controls. The odds ratio of taste loss in patients of 65 years and older was 4.4 in comparison with persons younger than 35 years of age (95% CI: 1.4-16.1). The risk in persons with a body mass index (BMI) below 21 kg m−2 was 4.4 times higher than in those with a BMI of more than 27 kg m−2 ( 95% CI: 1.6-14.2). The risk of taste loss in patients of 55 years and older with a BMI below 21 kg m−2 was 12.8 times higher than that in patients below 35 years of age (95% CI: 1.9-88.6). 3 A low BMI, a history of taste loss, and ageing are risk factors for developing taste loss to terbinafine. Prescription of this drug to elderly patients with low BMI and low daily intake of nutrients requires careful follow-up.

In patients undergoing primary PCI, location of infarction is an important independent predictor of high peak CK, low LVEF, and increased mortality. LVEF is a strong predictor of 1-year mortality.

Abstract. Timmer JR, Ottervanger JP, Hoorntje JCA, de Boer M-J, Suryapranata H, van't Hof AWJ,