Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial.

BACKGROUND: Although more than 9500 patients have been enrolled in major clinical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated for acute coronary syndromes in Latin America with those in North America. METHODS: The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST-segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient groups, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. RESULTS: For patients in Latin America, the length of hospital stay was significantly longer (10 [7, 15] days vs 6 [4, 9], P <.001). Angiograms, angioplasty, and bypass surgery were significantly less common in Latin America (46.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P <.001). Thirty-day death/myocardial infarction was not significantly higher, although mortality alone was significantly higher (6.8% vs 3.1%, P <.001). After adjustment for baseline characteristics, enrollment in Latin America remained an independent predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4]). CONCLUSIONS: Latin American patients treated for acute coronary syndromes were managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not explained by imbalances in baseline risk.

[Echocardiographic diagnosis of atrial thrombosis]. / Diagnóstico ecocardiográfico de la trombosis auricular.

Seventy patients with rheumatic mitral disease were studied by M-Mode and 2D echocardiography in order to detect left atrial thrombosis before surgery. Thrombosis were suspected by the observation of abnormal echoes in the left atrium. During surgery 17 (24%) patients had atrial thrombosis. It had been suspected by echocardiography in 12 (sensitivity 70%). In 53 patients thrombosis were not found during surgery; in 46 the echo had been also negative (specificity 86%). There was a false positive detection of thrombosis by echo in 7 patients (14%) and false negativity in 5 (30%). Patients with atrial thrombosis had atrial fibrilation in 91% of cases; and the most frequent valvular disease was mitral stenosis. There was not a direct relationship among existence of left atrial thrombosis and the anteroposterior diameter of the left atrium as measured by echo. We conclude that echocardiography has good specificity to rule out atrial thrombosis and moderate sensitivity to detect it in rheumatic mitral disease.

Diagnostico ecocardiografico de la trombosis auricular. / Echocardiography of atrial thrombosis

Se estudiaron 70 pacientes con valvulopatia mitral reumatica con ecocardiografia modo M y bidimensional, para detectar trombos en la auricula izquierda, previamente a la cirugia. La trombosis se sospecho por la observacion de ecos anormales en el interior auricular. Durante la correccion quirurgica se encontraron trombos auriculares en 17 (24%). De ellos, la trombosis se sospecho por ecocardiografia en 12 (o sea, sensibilidad de 70%). No se encontraron trombos durante la cirugia en 53 pacientes; en 46 de ellos el eco tampoco la sugirio (especificidad 86%). El eco mostro falsa positividad en 7 pacientes (14%) y falsa negatividad en 5 (30%). En el 91% de los pacientes con trombosis auricular existia fibrilacion auricular y la lesion valvular mas frecuentemente encontrada fue la estenosis mitral. No se encontro relacion directa entre la existencia de trombosis auricular y el diametro anteroposterior de dicha cavidad medido por ecocardiografia. Por los resultados obtenidos podemos concluir que la ecocardiografia tiene buena especificidad para descartar trombosis auricular y moderada sensibilidad para detectarla en la valvulopatia mitral