Diferencias angiográficas y epidemiológicas entre hombres y mujeres que desarrollan síndrome coronario agudo / Angiographic and epidemiological differences between men and women who developacute coronary syndrome

Resumen Introducción: la enfermedad cardiovascular es la principal causa de muerte en Colombia. Se han demostrado peores resultados clínicos en las mujeres a pesar de ser más prevalente en hombres. Objetivo: describir las diferencias angiográficas y epidemiológicas entre género de pacientes con síndrome coronario agudo. Métodos: se hizo un estudio descriptivo retrospectivo entre 2013-2014, en el que se incluyeron pacientes con síndrome coronario agudo que fueron separados por género. Se describieron factores de riesgo cardiovascular, biomarcadores de isquemia, angiografía coronaria y mortalidad intrahospitalaria. Los datos se analizaron en SPSS 20.0 Resultados: se estudiaron 148 pacientes; 35% tenían infarto con elevación del ST, 42,9% sin elevación del ST y 21% angina inestable. La prevalencia de enfermedad renal crónica para hombres y mujeres fue de 18,9 vs. 4,1% (p = 0,004); ataque cerebrovascular 2,7% vs. 14,9% (p = 0,009), de predominio femenino, este último. El valor de troponina fue mayor en hombres, 71,6 vs. 56,8% (p = 0,043). Las mujeres requirieron mayor implante de stent, 72,6 vs. 58,1% (p = 0,002); sin embargo, en el género masculino la prevalencia de enfermedad multivaso con indicación de revascularización coronaria fue mayor, 25,7 vs. 6,8% (p = 0,002). La afectación simultánea de las arterias descendente anterior proximal y circunfleja como criterio de severidad, fue mayor en hombres, 5,4 vs. 16,4%, con diferencias significativas (p = 0,032). Conclusiones: este estudio plantea la posibilidad de que en nuestra población pueden existir diferencias clínicas y fisiopatológicas entre género, constituyéndose en un factor fundamental para posibles cambios en su diagnóstico e intervención.

Abstract Introduction: Cardiovascular disease is the primary cause of death in Colombia. Poorer results have been shown in women, despite it being more prevalent in males. Objective: To describe the between-gender angiographic and epidemiological differences in patients with acute coronary syndrome. Methods: Between the years 2013 and 2014, a retrospective descriptive study was performed on patients with acute coronary syndrome that were grouped according to gender. An analysis was made of cardiovascular risk factors, ischaemia biomarkers, coronary angiography, and hospital mortality. The data were analysed using the SPSS 20.0 statistics package. Results: Of the 148 patients studied, 35% had an infarction with an ST elevation, 42.9% an infarction with no ST elevation, and 21% with unstable angina. The prevalence of chronic kidney disease for men and women was 18.9% vs. 4.1% (P=.004), and stroke 2.7% vs. 14.9% (P=.009), with the latter predominantly female. The Troponin value was higher in males, 71.6% vs. 56.8% (P=.043). The women required more stent implants, 72.6% vs. 58.1% (P=.002). However, the prevalence of multivessel disease with a coronary re-vascularisation indication was higher in males, 25.7% vs. 6.8% (P=.002). The simultaneous involvement of the proximal anterior descending and circumflex arteries as a criterion of severity was higher in males, 16.4% vs. 5.4%, with significant differences (P=.032). Conclusions: This study establishes the possibility that there can be between-gender clinical and pathophysiological differences, which may be a fundamental factor for possible changes in its diagnosis and intervention.

Integrating Oncology Massage Into Chemoinfusion Suites: A Program Evaluation.

OBJECTIVE: This article reports on the development, implementation, and evaluation of an integrative clinical oncology massage program for patients undergoing chemotherapy for breast cancer in a large academic medical center. MATERIALS AND METHODS: We describe the development and implementation of an oncology massage program embedded into chemoinfusion suites. We used deidentified program evaluation data to identify specific reasons individuals refuse massage and to evaluate the immediate impact of massage treatments on patient-reported outcomes using a modified version of the Distress Thermometer delivered via iPad. We analyzed premassage and postmassage data from the Distress Thermometer using paired t test and derived qualitative data from participants who provided written feedback on their massage experiences. RESULTS: Of the 1,090 massages offered, 692 (63%) were accepted. We observed a significant decrease in self-reported anxiety (from 3.9 to 1.7), nausea (from 2.5 to 1.2), pain (from 3.3 to 1.9), and fatigue (from 4.8 to 3.0) premassage and postmassage, respectively (all P < .001). We found that 642 survey participants (93%) were satisfied with their massage, and 649 (94%) would recommend it to another patient undergoing treatment. Spontaneous patient responses overwhelmingly endorsed the massage as relaxing. No adverse events were reported. Among the 398 patients (36%) who declined a massage, top reasons were time concerns and lack of interest. CONCLUSION: A clinical oncology massage program can be safely and effectively integrated into chemoinfusion units to provide symptom control for patients with breast cancer. This integrative approach overcomes patient-level barriers of cost, time, and travel, and addresses the institutional-level barrier of space.