[Inflammation study in unstable angina and myocardial infarction without ST segment elevation. Value of ultra-sensitive C-reactive protein]. / Estado inflamatorio en el angor inestable e infarto de miocardio sin elevación del segmento ST. Valor de la proteína C-reactiva ultrasensible.

OBJECTIVES: To analyse the inflammatory state in Acute Coronary Syndromes without ST-segment elevation by means of the value of the High-sensitivity C-reactive protein and other markers of inflammation. To assess if there are differences between unstable angina and myocardial infarction and if it has prognostic value of cardiovascular complications during one year follow up. METHODS: 61 patients diagnosed of Acute Coronary Syndrome without ST-segment elevation were studied: mean age of 67 +/- 11 years old, 26% women. The value of high-sensitivity C-reactive protein and other inflammatory markers (leukocytes and fibrinogen) were analysed and were compared in those patients with unstable angina versus myocardial infarction without ST elevation. Follow up during one year of cardiovascular complications (death with cardiac origin, infarction, refractory ischemia or rehospitalization because of cardiovascular cause) and its relation with the inflammatory markers. RESULTS: 75% of the patients showed increased levels of High-sensitivity C-reactive protein (> 2 mg/l). 47 patients (77%) were diagnosed of Infarction without ST elevation and the remainders of Unstable Angina. There were no statistically significant differences between subgroups, neither in the median value of the C-reactive protein: 4.49 mg/l in infarction versus 4.5 mg/l in Angina (p = ns) nor in the percentage of patients with high levels of C-reactive protein (77% in infarction versus 71% in Angina). With regard to the other inflammatory markers (fibrinogen and leukocytes) no differences between subgroups were found. None of the inflammatory markers showed predictive value about the appearance of the composite end-point during one year follow up. CONCLUSIONS: The high-sensitivity C-reactive protein is elevated in patients with Acute coronary syndromes without ST-segment elevation, but no difference in the inflammatory state of patients with unstable angina versus myocardial infarction without ST elevation was found. In our series, these markers were not related with the risk of cardiovascular complications.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

[Inflammatory state in patients with atrial fibrillation before and after electrical cardioversion]. / Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica.

OBJECTIVE: To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. DESIGN: Prospective observational case-control study. PATIENTS: We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. RESULTS: Median age was 66 +/- 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). CONCLUSIONS: There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation.