Mortality attributed to myocardial infarction in the male and female population of Salvador, BA, between 1981 and 1996.

OBJECTIVE: To describe according to gender the trend in mortality attributed to myocardial infarction (MI) in the population of Salvador, Bahia between 1981 and 1996. METHODS: This study was on mortality due to MI estimates by period and gender of the city of Salvador, Bahia. Data from 1981 to 1996 were stratified by quadrienia, and the percentage reduction in death rate due to MI relative to the preceding period (PRR) was determined. Comparisons between genders were expressed by the male/female death ratio (DR) based on the gender-related PPR. RESULTS: An overall increase of approximately 8% was observed in the death rate attributed to MI for the period 1985-1988 (89.2/10 5 individuals / year) versus the period 1981-1984 (82.1/10(5)/ year). In the subsequent periods, overall reductions of 10% and 20.3% were observed for the periods 1989-1992 and 1993-1996, respectively. For men, the PPRs were 11.1 in the period 1989-1992 and 22.7% in the period 1993-1996. The PPRs in women were lower: 8.6% and 17.4% between 1989 and 1992, and 1993 and 1996, respectively. Death rate reduction was greater for men than women, then the male/female DR decreased from 1.66 in 1981-1984 to 1.35 in 1993-1996. CONCLUSION: The results indicate a trend towards a reduction in the death rate attributed to myocardial infarction in the city of Salvador from the second half of the 1980s onwards, striking in men.

[Difference of hospital mortality of acute myocardial infarction between men and women treated with primary angioplasty]. / Diferença de letalidade hospitalar do infarto agudo do miocárdio entre homens e mulheres submetidos a angioplastia primária.

PURPOSE: To compare the in-hospital case-fatality rate of men and women submitted to percutaneous transluminal coronary angioplasty (PTCA) as a strategy of reperfusion in acute myocardial infarction (MI). METHODS: A retrospective cohort study based on information abstracted from medical records of MI patients admitted to a hospital where PTCA is used as the preferred method for early myocardial reperfusion. A total of 83 patients, 35 (42%) women and 48 (58%) men, who met the criteria for early myocardial reperfusion was included in the analysis. RESULTS: The mean age of women was higher than that of men (66 +/- 10 vs 58 +/- 11 years; p < 0.001). The women also had a higher frequency of diabetes mellitus (37.1% vs 6.4%; p < 0.001). Despite these differences in age and in the frequency of diabetes mellitus, the percentage of patients in whom the PTCA was considered successful was similar between men (83.3%) and women (82.3%). The case-fatality rate was also similar between men and women; 14.6% and 14.3%, respectively. CONCLUSION: The possibility that the excess risk of death in women with MI may be reduced and even eliminated with the use of PTCA, supports to the need for the development of a clinical trial to assess this question.

[Why is the in-hospital case-fatality rate of acute myocardial infarction higher in women?]. / Por que a letalidade hospitalar do infarto agudo do miocárdio é maior nas mulheres?

PURPOSE: To assess the influence of age, disease severity at admission and therapeutic interventions on the higher in-hospital case-fatality rate of acute myocardial infarction (MI) in women. METHODS: A retrospective cohort study involving a total of 388 acute MI patients (50 deaths). The following variables were treated as possible explanatory factors for the association between gender and case-fatality rate of acute MI: age (< 60 vs > or = 60 years), duration of symptoms, Killip class, type of infarction (Q wave vs non-wave), comorbidities, previous history of stroke and specific therapeutic interventions for acute MI (aspirin, beta-blocking drugs, and thrombolytic agents). Logistic regression models were used to assess the influence of potential confounders on the association between gender and in-hospital death. RESULTS: The in-hospital case-fatality rate of acute MI was higher in women (19.5% vs 9.4%) than in men (odds ratio (OR) = 2.34; 95% CI = 1.12-4.47). Although women were significantly older than men (p < 0.01), the association between gender and death was reduced only by 15 percent after adjusting for age (OR = 1.99; 95% CI = 1.07-3.67). This association became weaker after taking into account disease severity at admission (OR = 1.84; 95% CI = 0.90-3.74) and therapeutic interventions for acute MI (OR = 1.50; 95% CI = 0.67-3.38). CONCLUSION: Differences in age cannot fully explain the higher case-fatality rate in women than in men with acute MI. Severity of disease at admission and differences in therapeutic interventions might play an important role in the higher case-fatality rate of acute MI among women.

Difference in the in-hospital mortality of unstable angina pectoris between men and women.

PURPOSE: To assess differences in the in-hospital mortality (HM) rate between men and women with unstable angina pectoris (UA) according to age, depression of the ST segment, history of previous acute myocardial infarction (AMI), and risk factors for coronary heart disease. METHODS: From October 96 to March 98, 261 patients with UA were selected. Logistic regression models were developed to adjust the association between sex and HM for possible influence of covariables, such as hypertension, diabetes mellitus, dyslipidemia, sedentary lifestyle, smoking, and familial history of early coronary heart disease. RESULTS: HM due to UA was approximately three times higher in women (9.3%; 12/129) than in men (3.0%; 4/132) accounting for a relative risk of 3.07; 95% confidence interval (CI) = 1.02-9.27. In logistic regression models, the association between sex and death was not significantly altered when the following parameters were considered: age, depression of the ST segment, history of previous AMI and risk factors for coronary heart disease. The nonadjusted and adjusted odds ratio (OR) for the distinct covariables were 3.28 (CI 95% = 1.03-10.45) and 3.14 (CI = 95% = 0.88-11.20), respectively. CONCLUSION: Similarly to AMI, HM in UA is higher in women than in men. Age, risk factors for coronary heart disease, and depression of the ST segment in the electrocardiogram on patients' admission to the hospital did not significantly influence the association between sex and death.

[Pseudoaneurysm of the left ventricle resected 20 years after acute myocardial infarction]. / Pseudoaneurisma do ventrículo esquerdo ressecado vinte anos após infarto agudo do miocárdio.

A 67 year-old-man suffered an uncomplicated myocardial infarction twenty years ago. By January 1990 an abnormal cardiac contour was noted on a chest radiography. Contrast ventriculography revealed a pseudoaneurysm of the left ventricle. The patient underwent open heart surgery and remains asymptomatic 12 months after surgery. This is the longest time interval between the myocardial infarction and successful surgery that has been reported.

[Coronary-cavitary fistula after resection of vascularized left atrial myxoma]. / Fístula coronário-cavitária após ressecção de mixoma atrial esquerdo vascularizado.

A 52-year-old man with left atrial myxoma, in whom postoperative angiographic control revealed a coronary-cavitary fistula originated from a previous atrial branch from the circumflex coronary artery. These fistulas should be considered in cases of revascularized atrial myxoma.

[Frequency of utilization and reasons for exclusion from thrombolytic therapy in patients with acute myocardial infarction in Salvador-Bahia]. / Freqüência de utilização e razões de exclusão da terapia trombolítica no infarto agudo do miocárdio em Salvador-Bahia.

PURPOSE: To determine the rate of utilization and reasons for exclusion from thrombolytic therapy in acute myocardial infarction (AMI) in the setting of Intensive Care Unit (ICU) Salvador-BA. METHODS: Retrospective cohort study recording patients admitted with suspected AMI in six ICU in Salvador-BA between January/93 and December/94 were reviewed. RESULTS: Three hundred and eighty-eight of confirmed cases of AMI were analysed, 165 (42.0%) were admitted at public hospitals and 225 (58.0%) at private hospitals. Thrombolytic therapy was indicated in 143 (36.8%) patients. The thrombolysis was more frequently performed in men (PR = 1.96 IC 95% 1.39-2.77), in patients less than 60 years of age (PR = 4.46 CI 95% 2.17-9.19) and in those with Killip class I (PR = 2.62 CI 95% 1.60-4.31). The major reasons for excluding from thrombolytic therapy were late arrival, old age and lack of ST elevation. Thirty three percent of patients were excluded for more than one reasons. Multivariate analysis showed that female gender was associated with a reduced indication for thrombolytic therapy, independent of the clinical findings on admission. CONCLUSION: The frequency of the use and reasons for excluding patients from thrombolytic therapy in AMI in Salvador-BA were similar to those of other clinical studies. The recent recommendations of the Thrombolysis Brazilian Consensus will enhance the utilization of this therapy, as it expands its utilization to elderly patients and to those who arrive late to the hospital.

[Predictors of hospital mortality in the thrombolytic era for acute myocardial infarction in Salvador, State of Bahia, Brazil]. / Preditores de mortalidade hospitalar na era trombolítica para o infarto agudo do miocárdio em Salvador (BA).

PURPOSE: To determine the cumulative incidence and risk factors of in-hospital death due to acute myocardial infarction (AMI) in the thrombolytic era and to assess the degree of incorporation of new therapeutical interventions to the treatment of AMI in Salvador, Brazil. METHODS: A retrospective study based on medical records of 388 patients hospitalized with an AMI in different hospitals between January 1993 and December 1994. The relative risk (RR) was used as a measure of association for the unadjusted analysis. To control for possible confoundears and to assess interactions, odds ratios (OR) were used to estimate the RR, by logistic regression models. RESULTS: During the hospitalization period 50 (12.9%) patients died. The main predictors of hospital mortality in the unadjusted comparisons were older age (age > 60 years) (RR = 2.76; p < 0.01), female gender (RR = 2.08; p = 0.01), Killip class > 1 (RR = 5.73; p < 0.01), anterior wall AMI (RR = 1.92; p = 0.02), previous stroke (RR = 4.13; p < 0.01) and systemic disease (RR = 2.76; p < 0.01). In the multivariate analysis, older age (OR = 2.42; p = 0.02), Killip class > 1 (OR = 7.14; p < 0.01), anterior wall AMI (RR = 2.37; p = 0.02) and previous stroke (RR = 2.34; p = 0.04) were the main independent predictors of hospital death. Thrombolytic therapy was used in 143 patients (36.8%), aspirin in 322 (83%), beta blockers in 204 (52.6%) and heparin in 248 (63.9%). Cardiogenic shock was responsible for more than half of the death cases. CONCLUSION: Based on the data presented, older age, Killip class and anterior wall infarction are still important predictors of death due to AMI in the thrombolytic era, confirming other studies.

Hip fracture prognosis: could bioimpedance be an alternative to conventional nutritional assessment?

BACKGROUND: Risk-factors for mortality in hip fractures encompass nutritional status, nominally body mass index, but not body composition. Given the difficulty of anthropometric assessment in bedridden patients a prospective study with bioimpedance analysis was designed. METHODS: Elderly patients with hip fracture were consecutively recruited. Biochemical tests, primitive bioimpedance measurements (resistance, reactance and phase angle) and follow-up till one year were targeted. RESULTS: Patients (N = 69, 81.2 ± 8.1 years old, 72.5% females) stayed in the hospital for 15.5 ± 17.1 days, and 18.8% (13/69) required further hospitalization during the ensuing months. Mortality was 11.6% within 30 days, coinciding with hospital mortality, and an additional 11.6% till one year, thus reaching 23.2%. Anemia, hypoalbuminemia and low transferrin, along with elevated glucose and urea were frequent, suggesting undernutrition with metabolic derangements. Reactance, urea and creatinine were different in patients suffering both early and late demise. Resistance, white blood cell count and osteoporosis were risk factors for early mortality only , and anemia exclusively for late mortality. CONCLUSIONS: Primitive bioimpedance measurements, which had not been hitherto investigated , were prognostically related to early and late mortality. These markers of disease-related malnutrition and especially reactance should be further studied in patients unfit for anthropometric evaluation due to fracture and immobility.

Por que a letalidade hospitalar do infarto agudo do miocárdio é maior nas mulheres? / Why is the in-hospital case-fatality rate of acute myocardial infarction higher in women?

OBJETIVO - Avaliar a influência da idade, da gravidade da doença e das intervençöes terapêuticas na maior letalidade hospitalar do infarto agudo do miocárdio (IAM) em mulheres. MÉTODOS - Estudo de coorte retrospectivo, envolvendo 388 pacientes com IAM (50 óbitos). Foram avaliadas, como possíveis explicaçöes para a associaçäo entre sexo e letalidade hospitalar do IAM, as variáveis: idade (menor que 60 vs menor ou igual 60 anos), duraçäo de sintomas, classe Killip, tipo de IAM (com ou sem ondas Q), comorbidades, história de acidente vascular cerebral e intervençöes terapêuticas para o IAM (ácido acetil-salicílico, betabloqueadores e agentes trombolíticos). Modelos de regressäo logística foram usados para avaliar a influência de potenciais variáveis confundidoras na associaçäo entre sexo e letalidade hospitalar do IAM. RESULTADOS - A letalidade hospitalar do IAM foi mais alta em mulheres (19,5 'por cento' vs 9,4 'por cento') do que em homens (odds ratio (OR)=2,34;IC 95 'por cento'=1,12-4,47). Embora as mulheres fossem significativamente (p menor que 0,01) mais idosas, a associaçäo entre sexo e morte reduziu-se em apenas 15 'por cento' após ajuste para idade (OR=1,99;IC 95 'por cento'=1,07-3,67). Esta associaçäo tornou-se mais fraca ao se considerar a gravidade da doença na admissäo (OR=1,84;IC 95 'por cento'=0,90-3,74) e intervençöes terapêuticas para o IAM (OR=1,50;IC=0,67-3,38). CONCLUSÄO - Diferenças de idade näo podem explicar completamente a maior letalidade do IAM em mulheres. A gravidade da doença na admissäo e diferenças de abordagen terapêutica devem desempenhar importante papel na maior letalidade hospitalar do IAM em mulheres.