Trends and geographical variation in mortality from coronary disease in Peru.

BACKGROUND: Coronary disease (CD) is the main cause of mortality worldwide. Data about trends and geographical variation in CD mortality is available in some American countries. This information varies among countries since CD risk factors frequencies vary. OBJECTIVE: To describe the trend and geographical variation of coronary disease (CD) mortality in Peru, 2005-2017. METHODS: Analysis of secondary data of the Peruvian Ministry of Health's registry of deaths. We analyzed CD mortality. We described the absolute and relative frequency of deaths and age-standardized mortality rate (ASMR) by natural regions, departments, age, sex, and year. We also described the change of ASMR between two periods (2005-2010 vs. 2011-2017). RESULTS: There were 64,721 CD deaths between 2005 and 2017 (4.12% among all deaths). The absolute frequency of CD deaths was 5,665 and 6,565 in 2005 and 2017, respectively. CD mortality was more frequent in men and older adults. The ASMR varied among natural regions, being higher in the Coast (19.61 per 100,000 inhabitants). The change between the two periods revealed that almost all departments reduced their ASMRs, except for Callao, Lambayeque, and Madre de Dios. CONCLUSION: CD mortality has increased in Peru. Mortality was higher in men and older adults, and it varied among departments. More political efforts are needed to reduce these trends.

[Mechanical complications after myocardial infarction in a National Reference Hospital]. / Complicaciones mecánicas posinfarto de miocardio en un hospital de referencia nacional.

Objective: To determine the clinical characteristics, therapeutic and in-hospital mortality of patients with mechanical complications post myocardial infarction. Materials and methods: Observational, descriptive and retrospective study. We included patients >18 years old with a diagnosis of mechanical complication post myocardial infarction hospitalized at the Instituto Nacional Cardiovascular- INCOR in Lima -Peru, from January 1, 2017 to December 31, 2021. Variables like clinical characteristics, treatments, complications, and in-hospital mortality were studied. Results: We found 37 cases, with a predominance of males (73.0%) and a median age of 73 years old. The location of the myocardial infarction was 51.4% in the anterior wall and 43.2% in the inferior wall. The patients received reperfusion therapy with fibrinolysis in 5 cases (13.5%), coronary angioplasty in 5 (13.5%), and 73% received only medical management prior to the diagnosis of mechanical complications. Of the 37 patients, 13 (35.1%) presented isolated ventricular free wall rupture, 12 (32.4%) isolated interventricular septum rupture, 10 (27.0%) the combination of ventricular free wall rupture and interventricular septum, and 2 (5.4%) papillary muscle rupture. In-hospital mortality was 51.4%. Conclusions: The ventricular free wall rupture was the most frequent complication, patients with mechanical complications after myocardial infarction still maintain high intra-hospital mortality rates, mainly in those who did not have adequate surgical treatment.

[Clinical features and complications of Takotsubo syndrome in a peruvian social security referral center]. / Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana.

In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria.

Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana / Clinical features and complications of Takotsubo syndrome in a peruvian social security referral center

RESUMEN Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria.

ABSTRACT In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

Registry of "early latecomer" patients with acute ST-segment elevation myocardial infarction at the Instituto Nacional Cardiovascular INCOR - Peru / Registro de pacientes con infarto agudo de miocardio con elevación del ST de más de 12 horas de evolución "early latecomers" en el Instituto Nacional Cardiovascular INCOR-Perú

Abstract Objective To assess the features of asymptomatic patients with acute ST segment elevation myocardial infarction who presents to the emergency with more than 12 h of evolution, and if there is a benefit of an invasive versus medical therapy. Methods Retrospective, cohort study from January 2012 to December 2014, we compare the outcomes at 6 and 12 months of follow up of the invasive group versus the conservative group. Results There were no differences in outcomes at 12 months between an invasive versus a conventional strategy; but, looking at the reperfusion state, we found more risk of death and heart failure at 12 months in the no-reperfused group versus the reperfused group (40% versus 0%, OR: 2, CI: 1.2-3.1, p = 0.028 for mortality and 53% versus 0%, OR: 2.2, CI: 1.3-3.98, p = 0.007 for heart failure). Conclusions In patients with ST elevation acute myocardial infarction with more than 12 h of evolution, the invasive strategy with optimal reperfusion is better than the conservative management or no reperfusion in terms of less mortality and heart failure at 12 months of follow up.

Resumen Objetivo Evaluar las características de pacientes con síndrome coronario agudo con elevación del segmento ST asintomáticos con más de 12 horas de evolución y si existe o no beneficio de la terapia invasiva versus el manejo médico en el seguimiento. Método Estudio retrospectivo, de cohortes desde enero 2012 a diciembre 2014, se comparó los eventos adversos a 6 y 12 meses de seguimiento del grupo en terapia invasiva versus manejo conservador. Resultados No se encontró diferencia entre la estrategia invasiva versus convencional al seguimiento a los 12 meses. Sin embargo comparando el resultado de reperfusión, se encontró mayor riesgo de muerte y falla cardiaca a 12 meses en el grupo no reperfundido versus el reperfundido (40% vs 0%, OR 2, IC: 1.2-3.1, p = 0.028 para mortalidad y 53% vs 0%, OR: 2.2, IC: 1.3-3.98, p = 0.007 para falla cardiaca). Conclusiones En pacientes con infarto agudo de miocardio ST elevado de más de 12 horas de evolución asintomáticos, la estrategia invasiva con resultados óptimos de reperfusión es mejor que el manejo conservador o no reperfusión en cuanto a disminución de la mortalidad y falla cardiaca en el seguimiento al año.

Registry of "early latecomer" patients with acute ST-segment elevation myocardial infarction at the Instituto Nacional Cardiovascular INCOR - Peru.

OBJECTIVE: To assess the features of asymptomatic patients with acute ST segment elevation myocardial infarction who presents to the emergency with more than 12h of evolution, and if there is a benefit of an invasive versus medical therapy. METHODS: Retrospective, cohort study from January 2012 to December 2014, we compare the outcomes at 6 and 12 months of follow up of the invasive group versus the conservative group. RESULTS: There were no differences in outcomes at 12 months between an invasive versus a conventional strategy; but, looking at the reperfusion state, we found more risk of death and heart failure at 12 months in the no-reperfused group versus the reperfused group (40% versus 0%, OR: 2, CI: 1.2-3.1, p=0.028 for mortality and 53% versus 0%, OR: 2.2, CI: 1.3-3.98, p=0.007 for heart failure). CONCLUSIONS: In patients with ST elevation acute myocardial infarction with more than 12h of evolution, the invasive strategy with optimal reperfusion is better than the conservative management or no reperfusion in terms of less mortality and heart failure at 12 months of follow up.

Características clínicas y epidemiológicas de los pacientes con estenosis aórtica en el Instituto Nacional Cardiovascular / Clinical and epidemiological characteristics of patients with aortic stenosis at the National Cardiovascular Institute

Objetivo: Determinar las características clínicas y epidemioIógicas de los pacientes con estenosis aórtica. Materiales y Métodos: Estudio descriptivo, retrospectivo y transversal, que incluyó a los pacientes con estenosis aórtica severa basado en uno o más criterios: velocidad máxima en válvula aórtica >=4m/s, gradiente medio transaórtico >=40mmHg, área valvular aórtica <=1cm2, área de válvula aórtica indexada al área de superficie corporal <=0,6cm2/m2. Luego se llenó los formatos para recolección de datos. Resultados: Se incluyó a 176 pacientes con edad promedio de 66.5 ±11 años y dominancia del sexo masculino (62.5 por ciento); con respecto a los factores de riesgo cardiovasculares se encontró a la hipertensión arterial (58.5 por ciento) y la dislipidemia (28.4 por ciento). La disnea se presentó en el 77 por ciento de pacientes. Electrocardiográficamente, el ritmo sinusal se presentó en el 93.2 por ciento de casos, y la fibrilación auricular en el resto. Dentro de los datos ecocardiográficos, otras valvulopatías concomitantemente diagnosticadas fueron la insuficiencia aórtica (67 por ciento) y la insuficiencia mitral (60.8 por ciento). El 94 por ciento de casos tuvo una cirugía electiva, y se usó prótesis mecánicas en el 70.2 por ciento; además, el tiempo de circulación extracorpórea y clampaje aórtico promedio fueron de 113.9 (±34) y 89.3 (±29) minutos respectivamente. Las complicaciones más frecuentes fueron la atelectasia pulmonar (34 casos) y la fibrilación auricular (29 casos). La mortalidad fue de 14 por ciento (7 casos). Conclusiones: Los pacientes con disfunción de ventrículo izquierdo (grupo 4) presentaron más alteraciones electrocardiográficas, ecocardiográficas, y hemodinámicas; además más enfermedad coronaria

Objective: This study aims to gain a better knowledge of the clinical and epidemiological features of patients with aortic stenosis. Methods: We performed a retrospective, transversal and descriptive study in patients with aortic stenosis who have one or more of the following criteria: Peak Aortic valve velocity >=4m/s, Mean transaortic gradient >=40mmHg, Aortic valve area <=1cm2, index aortic valve area / body surface area <=0,6cm2/m2. Results: Amongst 176 patients, we found an age average of 66.5±11 years old with a male predominance (62.5 per cent). Hypertension (58.5 per cent) and dyslipidemia (28.4 per cent) were the more prevalent risk factors. Dyspnea was found in 77 per cent of patients. The Electrocardiogram showed sinus rhythm in almost all the patients (93.2 per cent) and atrial fibrillation in the rest. Using echocardiography we found Aortic insufficiency (67 per cent) and Mitral insufficiency (60.8 per cent) The 94 per cent of cases were scheduled for an elective surgery, using mechanical prosthesis in 70.2 per cent with extracorporeal circulation and mean aortic clamping time of 113.9 (±34) y 89.3 (±29) minutes respectively. The most frequent postoperative complications were the pulmonary atelectasia in 34 cases and atrial fibrillation in 29 cases. AIso we reported 7 fatalities. Conclusions: The patients with severe aortic stenosis and left ventricular dysfunction had more electrocariographic, echocardiographic and hemodinamic alterations, and more coronary disease