Women with Acute Myocardial Infarction: Clinical Characteristics, Treatment, and In-Hospital Outcomes from a Latin American Country.

Background: Women are underrepresented in acute myocardial infarction (AMI) studies. Furthermore, there is scarce information regarding women with AMI in Latin America. Aims: To describe the presentation, clinical characteristics, risk factor burden, evidence-based care, and in-hospital outcome in a population of women with AMI admitted to a coronary care unit (CCU) in Mexico. Methods: Retrospective cohort study including patients with AMI admitted from January 2006 to December 2021 in a CCU. We identified patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). We described demographic characteristics, clinical variables, treatment, and in-hospital outcomes according to gender. Cox regression analysis was used to identify predictors of mortality. Results: Our study included 12,069 patients with AMI, of whom 7,599 had STEMI and 4,470 had NSTEMI. Women represented 19.6% of the population. Women had higher rates of hypertension, diabetes, stroke, and atrial fibrillation than men. For STEMI, women were less likely to receive reperfusion therapy (fibrinolysis; 23.7 vs. 28.5%, p < 0.001 and primary percutaneous coronary intervention (PCI); 31.2 vs. 35.1%, p = 0.001) and had more major adverse events than men: heart failure (4.2 vs. 2.5%, p = 0.002), pulmonary edema (3.4% vs. 1.7%, p < 0.001), major bleeding (2.1% vs. 1%, p = 0.002), stroke (1.3% vs. 0.6%, p = 0.008), and mortality (15.1% vs. 8.1%, p < 0.001). For NSTEMI, women were less likely to undergo coronary angiography or PCI and had more major bleeding and mortality. Multivariate Cox regression analysis revealed that females had an increase in mortality in STEMI and NSTEMI (HR 1.21, CI 1.01-1.47, p = 0.05 and HR 1.39, CI 1.06-1.81, p = 0.01). Conclusion: Real-world evidence from a hospital in a Latin American low- to middle-income country (LMIC) showed that women with AMI had more comorbidities, received less reperfusion treatment or invasive strategies, and had worse outcomes. In STEMI and NSTEMI, female gender represented an independent predictor of in-hospital mortality.

Relación del supradesnivel del segmento ST en aVR con las complicaciones cardiovasculares / Relationship of ST-segment elevation in AVR to cardiovascular complications

Introducción: El patrón de supradesnivel del segmento ST en aVR en el síndrome coronario agudo se asocia con un aumento de la mortalidad. Objetivo: Evaluar la relación entre el patrón de supradesnivel del segmento ST en aVR y las complicaciones cardiovasculares no letales. Método: Estudio observacional de corte transversal, con componente analítico de todos los pacientes ingresados con síndrome coronario agudo sin elevación del segmento ST, en el Hospital Universitario Manuel Fajardo de la Habana entre los años 2016 y 2020. Resultados: Predominó el sexo femenino en el primer grupo, con una mediana de 78 años. Hubo incidencia de cardiopatía isquémica (75 por ciento y 56,4 por ciento) e hipertensión arterial (78,8 por ciento y 85,8 por ciento ). Se determinó una relación estadística significativa entre el patrón con elevación del segmento ST en aVR y las complicaciones cardiovasculares con un riesgo relativo de 5,769 veces. Conclusiones: El patrón de supradesnivel del segmento ST en un síndrome coronario agudo sin elevación del segmento ST predice complicaciones intrahospitalarias cardiovasculares no letales(AU)

Introduction: The pattern of ST-segment elevation in aVR in acute coronary syndrome is associated with increased mortality. Objective: To evaluate the relationship between the pattern of ST-segment elevation in aVR and nonlethal cardiovascular complications. Methods: Observational cross-sectional study, with analytical component of all patients admitted with non-ST-segment elevation acute coronary syndrome at the Manuel Fajardo University Hospital of Havana between 2016 and 2020. Results: Female gender predominated in the first group, with an average age of 78 years. There was incidence of ischemic heart disease (75 percent and 56.4 percent) and arterial hypertension (78.8 percent and 85.8 percent). A significant statistical relationship was determined between the pattern with ST-segment elevation in aVR and cardiovascular complications with a relative risk of 5.769 times. Conclusions: ST-segment suprathreshold pattern in non-ST-segment elevation acute coronary syndrome predicts non-lethal in-hospital cardiovascular complications(AU)

Influence of Factors Affecting Quality of Life on in-Hospital Cardiovascular Events of Patients with Acute Myocardial Infarction with and without ST-segment Elevation

Abstract Background Acute myocardial infarction (AMI), with and without ST-segment elevation (STEMI and NSTEMI, respectively), is the principal cause of cardiovascular morbidity and mortality in Brazil and around the world. Modifiable risk factors (RF) and quality of life (QOL) may correlate with the type of AMI. Objective To evaluate the influence of QOL and RF on the type of AMI and in-hospital cardiovascular events in STEMI and NSTEMI patients. Methods This was an observational, cross-sectional study. Patients with AMI attending four referral hospitals (three private and one public) for cardiovascular disease treatment were assessed for QOL using the Brazilian version of the 36-item short form survey. A p < 0.05 was considered statistically significant. Results We evaluated 480 volunteers; 51% were treated in one of the private hospitals. In total, 55.6% presented with STEMI, and 44.4% with NSTEMI. Patients from the public hospital were 8.56 times more likely to have STEMI compared to those from the private hospitals. There was a higher prevalence of smokers in STEMI (p < 0.028) patients. QOL was not associated with the type of AMI. A negative patient perception of the physical health and pain domains was observed. Although a significant difference between the physical and the mental health domains was not observed, individual domains were correlated with some in-hospital outcomes. Conclusion There was a higher prevalence of smokers among individuals with STEMI. Domains of QOL showed a statistically significant relationship with the occurrence of in-hospital cardiovascular events, with no difference between the types of AMI.

The epidemiology of acute coronary syndromes in French Guiana.

BACKGROUND: French Guiana is an overseas territory of France with marked specificities in terms of populations, socioeconomic factors, risk factors, and an access to care. In this context, the objective of the present study was to describe the epidemiology of acute coronary syndromes in French Guiana and to make comparisons with mainland France and neighbouring country. METHODS: The data were obtained from a retrospective descriptive hospital-based cohort conceived to describe the incidence of acute coronary syndromes and their epidemiologic and clinical characteristics. It included patients aged 18 or more hospitalised for a first coronary syndrome in the reference centre for coronary syndromes in Cayenne French Guiana between Jan 1st 2012 and Dec 31st 2014. Overall, 266 patients were analysed. RESULTS: The mean age was 64 years (SD=12.54). A majority of patients were men (sex ratio=1.83). The proportion of patients born in an overseas French territory (44.36%) was similar to that of those born in a foreign country (43.98%), and 11.65% were born in mainland France. Only 59% of patients had regular health insurance. Moreover, 33.21% had universal medical insurance (CMU for those below a minimal income), 4.91% had state insurance (for illegal foreign patients) and 2.64% had no insurance at all. The main risk factors were high blood pressure (73.68%), diabetes (39.85%), hypercholesterolemia (40.23%), and smoking (37.97%). Overall, 82/266 patients developed an ST elevation coronary syndrome (STEMI) and 184/266 had a non-ST elevation coronary syndrome NSTEMI or unstable angina pectoris. Thrombolysis was only performed in 20.73% of patients with STEMI. Mortality at 1 month was 8/82 (9.76%) for STEMI and 2/184 (1.09%) for NSTEMI. CONCLUSIONS: The epidemiologic profile of acute coronary syndromes in French Guiana is different from that of mainland France and Europe to the neighbouring country Brazil. Mortality of STEMI also seems higher than in mainland France, but similar to Brazil. In a context of frequent health inequalities, interventions targeting the major risk factors, notably high blood pressure, obesity and diabetes, have the potential to significantly impact cardiovascular morbidity and mortality.

Factores predictivos de complicaciones intrahospitalarias en el Síndrome Coronario Agudo sin elevación del segmento ST / Predictive factors of intra-hospital complications in Non-ST-segment elevation Acute Coronary Syndrome

Introducción: El espectro clínico de los Síndromes Coronarios Agudos sin elevación del segmento ST incluye tanto a pacientes asintomáticos como a los que presentan isquemia activa, inestabilidad eléctrica, hemodinámica o parada cardiaca. Objetivo: Evaluar probables factores predictivos de complicaciones intrahospitalarias no letales en pacientes con diagnóstico de Síndrome Coronario Agudo sin elevación del segmento ST. Material y Métodos: Estudio observacional, analítico, de corte transversal con un universo de 218 individuos ingresados en la Unidad de Cuidados Coronarios Intensivos del Hospital Clínico-Quirúrgico Manuel Fajardo en 2016 y 2017. Resultados: Predominó el sexo masculino (51.4 por ciento) y la edad media fue de 68 años. Prevaleció la Hipertensión Arterial como factor de riesgo coronario. La edad mostró asociación estadística significativa con la aparición de cualquier complicación (p=0.015) y con las complicaciones hemodinámicas (p=0,014). El riesgo intermedio-alto, según el score TIMI, tuvo asociación estadísticamente muy significativa con las complicaciones hemodinámicas (p<0.01). Conclusiones: La edad tuvo asociación estadística con la aparición de complicaciones intrahospitalarias no letales. El sexo no se asoció con las complicaciones ni los antecedentes estudiados tampoco. Los pacientes con un riesgo intermedio-alto al ingreso, se asociaron con las complicaciones hemodinámicas(AU)

Introduction: The clinical spectrum of Non-ST-segment elevation Acute Coronary Syndromes includes both asymptomatic patients and those with active ischemia, electrical instability, hemodynamic or cardiac arrest. Objective: To evaluate probable predictive factors of non-lethal intra-hospital complications in patients diagnosed with Non-ST-segment elevation Acute Coronary Syndrome. Material and Methods: An observational, analytical, cross-sectional study was conducted with a universe of 218 individuals admitted into the Intensive Coronary Care Unit of Manuel Fajardo Clinical and Surgical Hospital between 2016 and 2017. Results: Male sex predominated (51.4 percent) and the mean age was 68 years. Arterial Hypertension prevailed as a coronary risk factor. The age showed significant statistical association with the appearance of any complication (p = 0.015) and with hemodynamic complications (p =0,014). The intermediate-high risk, according to the TIMI score, had a statistically significant association with hemodynamic complications (p <0.01). Conclusions: Age was statistically associated with the appearance of non-lethal intra-hospital complications. Sex was not associated with complications, nor did the background studied either. Patients with an intermediate-high risk at admission were associated with hemodynamic complications(AU)

Factors that influence care priority for chest pain patients using the manchester triage system.

AIMS AND OBJECTIVES: To analyse crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital. METHODS: Data were collected from patients' records with a primary diagnosis of myocardial infarction, from March 2014-February 2015. Patients were divided into two groups for statistical analysis: high priority (immediate and very urgent) and low priority (urgent, standard and nonurgent). RESULTS: Most of the patients were male, with a mean age of 62.1 years, with a prevalence of high blood pressure and smoking as risk factors. Lower care priority level was assigned to 116 (53.4%) patients. Sixty-four (29.5%) patients had ST-segment elevation acute myocardial infarction, and 29 (45.3%) of these patients were assigned lower care priority level. Coughing, abdominal pain, onset of symptoms over 24 hr ago and pain of mild to moderate intensity were clinical predictors associated with lower care priority level. Sweating and high blood pressure were associated with high care priority level. Lower care priority level was associated with increased door-to-electrocardiogram and door-to-troponin times. There was no significant difference between the two groups for door-to-needle and door-to-balloon times. CONCLUSIONS: Most of the patients with myocardial infarction were classified as low care priority, showing triage failure either due to symptom variability or need for professional qualification in clinical data collection and interpretation. RELEVANCE TO CLINICAL PRACTICE: The results may support clinical evaluation, bringing chest pain assessment into focus.

STEMI and NSTEMI: Real-world Study in Mexico (RENASCA).

INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.