Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart / Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart

OBJETIVO: Evaluar el impacto del género sobre el pronóstico y el manejo en una red regional de atención al infarto agudo de miocardio con elevación del segmento ST. DISEÑO: Estudio observacional sobre una base de pacientes consecutivos recogida prospectivamente. Ámbito: Red catalana de atención al infarto agudo de miocardio con elevación del segmento ST. PACIENTES: Pacientes atendidos entre enero de 2010 y diciembre de 2011. INTERVENCIONES: Angioplastia primaria, fibrinólisis o manejo conservador. Variables de interés: Se compararon, según el género, intervalos de tiempo, proporción y tipo de reperfusión, mortalidad global y complicaciones intrahospitalarias y mortalidad global a 30 días y un año. RESULTADOS: De 5.831 pacientes atendidos, 4.380 tenían diagnóstico de infarto agudo de miocardio con elevación del segmento ST, siendo 961 (21,9%) de ellos mujeres. Estas tenían mayor edad (69,8±13,4 frente a 60,6±12,8 años, p < 0,001), mayor prevalencia de diabetes (27,1 frente a 18,1%, p < 0,001), Killip>I (24,9 frente a 17,3%, p < 0,001) y ausencia de reperfusión (8,8 frente a 5,2%, p < 0,001) que los hombres. Además, las mujeres presentaban mayores retrasos en la atención (primer contacto médico-balón: 132 frente a 122min, p < 0,001; inicio de síntomas-balón: 236 frente a 210min, p < 0,001), más complicaciones intrahospitalarias (20,6 frente a 17,4%, p = 0,031) y mortalidad intrahospitalaria, a 30 días y un año (4,8 frente a 2,6%, p = 0,001; 9,1 frente a 4,5%, p < 0,001; 14,0 frente a 8,3%, p < 0,001). Sin embargo, tras el análisis multivariado no hubo diferencias en mortalidad a 30 días y un año. CONCLUSIONES: A pesar del peor perfil de riesgo y el peor tratamiento recibido, las mujeres presentaron similares resultados a 30 días y un año que sus homólogos masculinos atendidos por una red de atención al infarto

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. Scope: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. Variables of interest: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network

Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart. / Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart.

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. SCOPE: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. VARIABLES OF INTEREST: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network.

Comentarios al artículo «Accesibilidad al sistema sanitario de los pacientes diabéticos con síndrome coronario agudo con elevación del segmento ST» / Comments to article ‘Accessibility to health care of diabetic patients with ST-segment elevation acute coronary syndrome’

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Upgrade of a pacemaker defibrillator to a biventricular device: the internal jugular vein approach in a case of bilateral subclavian veins occlusion.

Cardiac resynchronization improves survival and functional class of patients with advanced chronic heart failure. Placement of a stimulation electrode in the coronary sinus via the left subclavian vein is not always possible and other alternatives are required, above all when it concerns upgrading a previous device. This paper presents the case of a patient with a pacemaker/defibrillator and occlusion of both subclavian veins who had a stimulation electrode successfully placed in the coronary sinus via the right internal jugular.

[Primary meningococcal pericarditis caused by meningococcus serogroup C]. / Pericarditis meningocócica primaria por serogrupo C.

We report the case of a 15-year-old female, with no previous medical history, who presented cardiac tamponade secondary to purulent pericarditis caused by Neisseria meningitidis serogroup C. This microorganism is the etiologic agent in 6-16% of the cases of purulent pericarditis, most in association with previous or concomitant central nervous system involvement (meningitis). Exceptionally, as in this case, the pericarditis is not accompanied by meningitis (Primary Meningococcal Pericarditis). The patient was treated with antibiotics, pericardiocentesis and steroids with excellent response. It is important to point out that meningococcal disease may present in unusual forms which may lead to diagnostic and therapeutics difficulties.

High density lipoprotein cholesterol increases with living altitude.

BACKGROUND: The relationship between high density lipoprotein cholesterol (HDL) serum level and the altitude at which people live is controversial. METHODS: A cross-sectional study was carried out in the adult population (30-64 years) of the Island of El Hierro (Canary Islands, Spain). In all, 594 individuals representative of the El Hierro population for gender, age, district and the altitude at which they lived were included. The factors measured included HDL, living altitude, body mass index (BMI), smoking habits, alcohol consumption, diabetes, menopause in women, and physical activity and dietary habits. RESULTS: The HDL showed a correlation with living altitude (r = 0.14, P < 0.01) and with BMI (r = -0.19, P < 0.01). Smokers had lower HDL levels than ex-smokers and non-smokers (P < 0.05). Men who were moderate drinkers had higher HDL levels than heavy or mild drinkers and non-drinkers (P < 0.01). Physical activity was only related to HDL in men with levels >1.52 mmol/l, who walked on the average more than the rest (P < 0.05). Variables not showing the expected relationship with HDL were diabetes and the menopause in women (probably due to a low statistical power of their subsamples). Regression analysis, with HDL as dependent variable showed that the association between HDL and altitude persists when taking altitude as a categorical or a continuous variable. CONCLUSIONS: High density lipoprotein cholesterol levels are linearly and significantly increased when living at a higher altitude. This fact should be taken into account when comparing cardiovascular risk in populations living at different altitudes.

[Infectious endocarditis of prosthetic valves due to Staphylococcus capitis: a new case]. / Endocarditis infecciosa sobre válvulas protésicas causada por Staphylococcus capitis: un nuevo caso.

We present the case of a male patient with aortic and mitral valve bioprostheses who developed infectious endocarditis due to Staphylococcus capitis, which has recently been described as an agent producing infectious endocarditis in native and prosthetic cardiac valves. The patient's course evolved unfavorably, despite specific antibiotic treatment, leading to the surgical replacement of the valve, which completely resolved the problem. This case points out that, although rare, in infectious endocarditis due to Staphylococcus capitis its pathogenicity is significant.

[Regression of left ventricular hypertrophy in hypertensive patients]. / Regresión de la hipertrofia ventricular izquierda en hipertensos.

Left ventricular hypertrophy associated with systemic hypertension differs from left ventricular hypertrophy initiated by other pressure overload diseases. Its development depends not only of hemodynamics aspects but of biochemical factors. Many studies have demonstrated a close link between left ventricular hypertrophy and cardiovascular morbidity and mortality. For that reason the idea of reversal of left ventricular hypertrophy has been a goal of the antihypertensive treatment. From the literature review has been established that the most classes of antihypertensive medications reduce the left ventricular mass, though there is a variation in required duration of treatment. At this point the angiotensin converting enzyme inhibitors, probably because a double effect: hypotensive and blockers of the trophic stimulus of angiotensin II, seemed to be the most potent for reducing the left ventricular mass. Still we don't know if reversal of left ventricular hypertrophy, by the antihypertensive treatment, reduce independently the cardiovascular risk.

[The adult respiratory distress syndrome as a complication of the APSAC treatment of acute myocardial infarct. Apropos a case]. / Síndrome de distrés respiratorio del adulto como complicación del tratamiento del infarto agudo de miocardio con APSAC. A propósito de un caso.

Thrombolytic therapy has shown to be effective in acute myocardial infarction, and its benefits on left ventricular function and later survival are well known. However it is not a therapy free of complications and side effects. Allergic reactions, anafilaxia, hypotension, and several kinds of hemorrhages have been reported. Adult respiratory distress syndrome after streptokinase administration has been also described, and one case, recently communicated, after APSAC therapy. We present the case of a male with acute myocardial infarction who developed adult respiratory distress syndrome after APSAC therapy, with different outcome than the first case published in the literature. Finally, we discussed the mechanisms by means these drugs can produce such a complication.

[Acute myocardial infarct in a cocaine-addicted young man]. / Infarto de miocardio agudo en un joven cocainómano.

We present a case of acute myocardial infarction in a 22 year old cocaine user. The absence of coronary artery stenotic lesions, as was seen in the coronary arteriography, and the absence of personal past cardiovascular or family history, suggest a cocaine-induced coronary spasm as responsible for the acute myocardial event.