[Primary percutaneous angioplasty. An analysis of reperfusion delays, their determining factors and their prognostic implications]. / Angioplastia primaria en nuestro medio. Análisis de los retrasos hasta la reperfusión, sus condicionantes y su implicación pronóstica.

INTRODUCTION AND OBJECTIVES: The optimum treatment for patients with ST-segment elevation acute myocardial infraction (AMI) is primary percutaneous coronary intervention (PCI), provided that the door-to-balloon time is less than 90 min. The aims of this study were to determine actual treatment times in our patients, to investigate the effect of different factors in reducing those times, and to evaluate the impact of any delay on prognosis. METHODS: The study involved patients who underwent primary or rescue PCI at our center between January 2005 and October 2007. Treatment times, clinical and angiographic characteristics, and follow-up findings at 1 and 12 months were recorded prospectively. RESULTS: Overall, 389 PCIs were performed: 361 primary and 28 rescue interventions. The median total duration of ischemia was 235 [interquartile range, 170-335] min. The median door-to-balloon time was 79 [53-104] min. The door-to-balloon time was shorter when the ambulance service was able to notify the on-duty cardiologist, who alerted the interventional cardiology team. The difference was 30 [60-90] min (P< .01). Patients who arrived at the emergency department by their own means had the longest door-to-balloon time (100 min vs. 74 min; P< .01). A door-to-balloon time >120 min was associated with higher mortality at 30 days; multivariate analysis showed a clearly increasing trend. CONCLUSIONS: The door-to-balloon time at our center was in line with current recommendations, with the time being markedly shorter for patients for whom the ambulance service was able to give advanced warning. A shorter time was associated with a trend towards lower 30-day mortality.

[Optimizing antithrombotic therapy in non-ST-elevation acute coronary syndrome]. / Terapia antitrombótica óptima en el síndrome coronario agudo sin elevación del segmento ST.

The acute coronary syndromes (i.e., ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina) share a common pathophysiology: the rupture or breakdown of atheromatous plaque superimposed on intracoronary thrombosis (i.e., atherothrombosis). The aim of this review article was to summarize developments occurring during the last year in antithrombotic therapy for non-ST-segment elevation acute coronary syndromes. Four specific issues are considered: pretreatment with clopidogrel before percutaneous coronary intervention, antiplatelet resistance, indications for glycoprotein IIb/IIIa inhibitors in patients pretreated with clopidogrel, and the role of bivalirudine and fondaparinux in the treatment of these patients.