Cardiotoxicity, including heart failure, thromboembolic events, and myocardial ischemia, is a concern for cardiologists and oncologists. The most frequently involved drugs are anthracyclines. We report an episode of coronary spasm due to vincristine, a vinca alkaloid, in a 49-year-old man treated for a diffuse undifferentiated carcinoma. The patient suffered recurrent episodes of typical chest pain with ST-elevation in the inferior area. Coronary spasm was confirmed by an angiogram, which showed normal coronary arteries. No recurrence occurred with the medical management. Coronary spasm induced by vincristine is a newly described facet of chemotherapy-related cardiotoxicity.

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Aims While elevated resting heart rate measured at a single point of time has been associated with cardiovascular outcomes, utility of continuous monitoring of nocturnal heart rate (NHR) has never been evaluated. We hypothesized that dynamic NHR changes may predict, at short term, impending cardiovascular events in patients equipped with a wearable cardioverter-defibrillator (WCD). Methods and results The WEARIT-France prospective cohort study enrolled heart failure patients with WCD between 2014 and 2018. Night-time was defined as midnight to 7 a.m. NHR initial trajectories were classified into four categories based on mean NHR in the first week (High/Low) and NHR evolution over the second week (Up/Down) of WCD use. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. A total of 1013 [61 (interquartile range, IQR 53–68) years, 16% women, left ventricular ejection fraction 26% (IQR 22–30)] were included. During a median WCD wear duration of 68 (IQR 44–90) days, 58 patients (6%) experienced 69 events. After considering potential confounders, High-Up NHR trajectory was significantly associated with the primary endpoint compared to Low-Down [adjusted hazard ratio (HR) 6.08, 95% confidence interval (CI) 2.56–14.45, P < 0.001]. Additionally, a rise of >5 bpm in weekly average NHR from the preceding week was associated with 2.5 higher composite event risk (HR 2.51, 95% CI 1.22–5.18, P = 0.012) as well as total mortality (HR 11.21, 95% CI 3.55–35.37, P < 0.001) and cardiovascular hospitalization (HR 2.70, 95% CI 1.51–4.82, P < 0.001). Conclusion Dynamic monitoring of NHR may allow timely identification of impending cardiovascular events, with the potential for ‘pre-emptive’ action. Registration number Clinical Trials.gov Identifier: NCT03319160

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ProgramIn 2002, the regional agency of health in Rhone-alps area set up a health care network with the goal to optimise patient management, by a better coordination of existing facilities in the northern Alps. The ‘RESeau des URgences CORonariennes’ (RESURCOR), a subgroup of this network, is in charge of urgent cardiac care. The RESURCOR involves three French departments: Isere, Haute-Savoie and Savoie, which includes 1.8 million people with wide seasonal variations related to tourism. It coordinates urgent care between one university hospital, 12 general and three private hospitals, three emergency medical aid departments (SAMU), 12 mobile intensive care units (SMUR) and four cardiac interventional units. Emergency physicians and interventional and non-interventional cardiologists meet regularly to set up regional procedures for the management of patients suffering from acute myocardial infarction. It highlights the importance of reperfusion techniques, delays to have reperfusion and where the patient has to be admitted. A permanent regional registry monitors the management of these patients, the types of management and time.ResultsSince 2002, 3940 patients have been included in this registry. The accuracy was assessed at 84%. During the studying period, the number of primary percuntaneous interventions (PCI) gradually increased (33% in 2002 to 53% in 2008). The average time from the first medical contact to intravenous thrombolysis (62 mn in 2002 to 24 mn in 2008) and to arterial puncture of primary PCI (101 mn in 2002 to 78 mn in 2008) significantly decreased. Prehospital management by air increased from 3% in 2002 to 12% in 2008. According to the regional recommendations, 92% of the patients were directly admitted to an interventional coronary center in 2008.DiscussionRESURCOR submit recommendations for patient management and assess through a registry if the recommendations have been followed by physicians. Myocardial infarction was the first condition which the network took care of. Since this approach succeeded, we have followed the same pattern for the other diseases requiring cooperations between hospitals without the same technical equipment: Unstable angina, stroke (fibrinolysis sometimes required), cardiac arrest (urgent coronary angiography or extra corporeal membrane oxygenation sometimes required) and severe traumatology (trauma-system).ConclusionRESURCOR is a network for patient management which needs urgent care. It allows coordination of care between different institutions in a large area.ObjectifAmélioration des prises en charge des infarctus du myocarde.ProgrammeEn 2002, le RENAU (REseau Nord Alpin des urgences), réseau de prise en charge des urgences a été mis en place sur le Nord des Alpes, a l`initiative de l`Agence Régionale d`Hospitalisation. Au sein de ce réseau, la filière cardiologique s`est organisée autour du RESURCOR.Le RESURCOR couvre les départements de l`Isère, la Haute-Savoie et la Savoie, soit un total de 1.8 million d`individus, avec de larges variation saisonnières. Il concerne...