Percepción y prevalencia del consumo de cigarrillos electrónicos en estudiantes de Medicina / Electronic cigarettes perception and prevalence among medical students

Diversos estudios advierten de la relación a corto plazo entre el uso de los cigarrillos electrónicos y enfermedades pulmonares, cardiovasculares, además de su potencial adictivo. No existen estudios al respecto en estudiantes universitarios chilenos. MÉTODOS: Este estudio descriptivo transversal, mide la prevalencia de consumo, percepción de riesgo, motivaciones y actitudes del uso de cigarrillos electrónicos en estudiantes de Medicina, mediante un cuestionario online. RESULTADOS: Se analizaron 354 sujetos, 32,9% han utilizado cigarrillos electrónicos alguna vez en la vida, 6,8% en el último año y 1,1% en el último mes. La edad media de inicio fue 18,0 ± 2,2 años. Respecto a las percepciones positivas hacia los cigarrillos electrónicos: 37,1% cree que ayudan a la gente a dejar de fumar; 39,7% que son menos peligrosos que los cigarrillos y 19,0% que son menos adictivos. El consumo de cigarrillos electrónicos alguna vez en la vida se asoció al consumo de tabaco y percepciones positivas hacia cigarrillos electrónicos (efectivo para dejar de fumar y menos adictivos que los cigarrillos). Las principales motivaciones al consumo fueron "simplemente porque sí", "porque me gusta el sabor", "me lo recomendó un amigo/familiar" y "porque me relaja". CONCLUSIÓN: Se sugiere prohibir la promoción de los cigarrillos electrónicos como una opción menos dañina y adictiva que el cigarrillo, tampoco como alternativa para dejar de fumar, puesto que la evidencia científica no es suficiente para respaldar tales afirmaciones. Este estudio puede contribuir a la prevención de consumo de cigarrillos electrónicos en poblaciones jóvenes.

INTRODUCTION: Several studies warn of the short-term relationship between the use of electronic cigarettes and lung and cardiovascular diseases, in addition to their addictive potential. There are no studies in this regard in Chilean university students. METHODS: This cross-sectional descriptive study measures the prevalence of consumption, risk perception, motivations and attitudes of e-cigarette use in medical students, using an online questionnaire. RESULTS: We analyzed 354 subjects, 32.9% have used electronic cigarettes once in their lives, 6.8% in the last year and 1.1% in the last month. The mean age of onset was 18.0 ± 2.2 years. Regarding positive perceptions towards e-cigarettes: 37.1% believe they help people quit smoking; 39.7% that they are less dangerous than cigarettes and 19.0% that they are less addictive. E-cigarette use was once in a lifetime associated with tobacco use and positive perceptions toward e-cigarettes (effective for quitting smoking and less addictive than cigarettes). The main motivations for consumption were "simply because I do", "because I like the taste", "it was recommended to me by a friend/family member" and "because it relaxes me". CONCLUSION: It is suggested to ban the promotion of e-cigarettes as a less harmful and addictive option than cigarettes, nor as an alternative to quitting smoking, since scientific evidence is not sufficient to support such claims. This study may contribute to the prevention of e-cigarette use in young populations.

[Temporal variation in the place of death in Chile from 1997 to 2014]. / Tendencia de las defunciones ocurridas en mayores de 1 año según lugar de ocurrencia y su relación con características sociodemográficas, Chile 1997-2014.

BACKGROUND: The place of death is a fundamental indicator for the debate on equity and access to health care. AIM: To describe the place of death of the deceased population over 1 year of age in Chile between the years 1997 and 2014. To analyze tendencies in this variable and its association with socio-demographic characteristics. MATERIAL AND METHODS: Time series study covering deaths occurred between 1997 and 2014 in Chile. National death records were used, provided by the Department of Health Statistics and Information (DEIS) of the Chilean Ministry of Health. The following variables were chosen: place of death (home, hospital, other), sex, marital status, age, level of education, activity and area of residence. Temporal trends were evaluated using Prais Winsten regressions. Logistic regression was used to assess the association of the place of death with socio-demographic characteristics. RESULTS: Between 1997 and 2014 there were 1,576,392 deaths, at a mean age of 69 years (p25-p75:60-83 years). No temporal variations in the place of death were observed with the Prais Winsten regression, hospital (P-W coefficient (coef) = 0.06 (confidence intervals (CI): -0.30; 0.19), p = 0.64), home (P-W coef = -0.03 (CI: -0.15; 0.09), p = 0.57), and other places (P-W coef = 0.07; (CI: -0.08 - 0.22), p = 0.32). The multivariate analysis showed that being women under 70 years of age, being married or widowed, having a higher educational level, being inactive and living in a rural area were factors associated with a greater chance of dying at home. CONCLUSIONS: No significant temporal variation in the place of death was observed.

Tendencia de las defunciones ocurridas en mayores de 1 año según lugar de ocurrencia y su relación con características sociodemográficas, Chile 1997-2014 / Temporal variation in the place of death in Chile from 1997 to 2014

Background: The place of death is a fundamental indicator for the debate on equity and access to health care. Aim: To describe the place of death of the deceased population over 1 year of age in Chile between the years 1997 and 2014. To analyze tendencies in this variable and its association with socio-demographic characteristics. Material and Methods: Time series study covering deaths occurred between 1997 and 2014 in Chile. National death records were used, provided by the Department of Health Statistics and Information (DEIS) of the Chilean Ministry of Health. The following variables were chosen: place of death (home, hospital, other), sex, marital status, age, level of education, activity and area of residence. Temporal trends were evaluated using Prais Winsten regressions. Logistic regression was used to assess the association of the place of death with socio-demographic characteristics. Results: Between 1997 and 2014 there were 1,576,392 deaths, at a mean age of 69 years (p25-p75:60-83 years). No temporal variations in the place of death were observed with the Prais Winsten regression, hospital (P-W coefficient (coef) = 0.06 (confidence intervals (CI): −0.30; 0.19), p = 0.64), home (P-W coef = −0.03 (CI: −0.15; 0.09), p = 0.57), and other places (P-W coef = 0.07; (CI: −0.08 - 0.22), p = 0.32). The multivariate analysis showed that being women under 70 years of age, being married or widowed, having a higher educational level, being inactive and living in a rural area were factors associated with a greater chance of dying at home. Conclusions: No significant temporal variation in the place of death was observed.

Incidencia y letalidad intrahospitalaria por insuficiencia cardiaca en Chile: ¿Existen diferencias por sexo? / Incidence and hospital mortality due to heart failure. Are there any differences by sex?

Background: Gender may influence the incidence, severity and hospital mortality due to heart failure (HF). Aim: To evaluate the influence of sex on the proportion of patients hospitalized due to heart failure, its incidence and hospital mortality. Methods: Analysis of the hospital discharge database of the Chilean Ministry of Health during 2014. All hospital admissions for HF were considered according to ICD-10 codes, including the discharge diagnosis of congestive HF (I500), left ventricular HF (I501) and non-specified HF (I509). Incidence rates, proportion of discharges due to HF and hospital mortality were calculated according to age and sex. Results: During 2014, there were 1,306,431 discharges from Chilean hospitals. Of these, 125,484 were for cardiovascular disease and 10% of these corresponded to HF (12,825). The incidence rate was slightly higher in men than in women (0.71 and 0.70 per 1,000 admissions respectively). Among patients aged 80 years or more, the prevalence of admissions for HF was higher in women (19.1 and 15.9% respectively, p < 0.01). Hospital mortality was also higher in women (9.7 and 8.6% respectively, p = 0.03). The factors associated with a higher hospital mortality were an age over 80 years (Odds Ratio (OR) 2.11; 95% confidence intervals (CI): 1.87-2.40; p < 0.01), a length of stay over seven days (OR 1.13; 95%CI: 1.01-1.29; p = 0.04), being admitted to high complexity facilities (OR 1.29; 95%CI: 1.12-1.50; p = 0.01) and being insured by the public national health fund (OR 1.94; 95%CI: 1.54-2.43; p < 0.01). Conclusions: The incidence of hospital admissions due to HF is similar in men and women. There is high hospital mortality, especially in women.

[Characteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction]. / Características, manejo y evolución intrahospitalaria de usuarios de drogas ilícitas con infarto agudo del miocardio.

BACKGROUND: Consumption of illicit drugs (ID) has been associated with an increased risk of acute myocardial infarction (AMI). There is limited national evidence about the impact of substance use over the clinical presentation, management and outcomes of AMI patients. AIM: To describe the prevalence of ID consumption in patients within the Chilean Registry of Myocardial Infarction (GEMI), comparing clinical characteristics, management and outcome according to consumption status. MATERIAL AND METHODS: We reviewed data from the GEMI registry between 2001 and 2013, identifying 18,048 patients with AMI. The sample was stratified according to presence or absence of previous ID consumption, comparing different demographic and clinical variables between groups. RESULTS: Two hundred eighty five patients (1.6%) had history of ID consumption (cocaine in 66%, cannabis in 35% and central nervous system stimulants in 24.0%). Compared with non-users, ID consumers were younger, predominantly male and had a lower prevalence of cardiovascular risk factors, except for tobacco smoking (86.3% and 42.5% respectively, p < 0.01). Among consumers, there was a higher percentage of ST segment elevation (85.2% and 67.8% respectively, p < 0.01) and anterior wall AMI (59.9 and 49.5% respectively, p = 0.01). Additionally, they had a higher rate of primary angioplasty (48.8% and 25.5% respectively, p < 0.01). There was no difference in hospital mortality between groups when stratified by age. CONCLUSIONS: A low percentage of patients with AMI had a previous history of ID consumption in our national setting. These patients were younger and had a greater frequency of ST segment elevation AMI, which probably determined a more invasive management.

Características, manejo y evolución intrahospitalaria de usuarios de drogas ilícitas con infarto agudo del miocardio / Characteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction

Background: Consumption of illicit drugs (ID) has been associated with an increased risk of acute myocardial infarction (AMI). There is limited national evidence about the impact of substance use over the clinical presentation, management and outcomes of AMI patients. Aim: To describe the prevalence of ID consumption in patients within the Chilean Registry of Myocardial Infarction (GEMI), comparing clinical characteristics, management and outcome according to consumption status. Material and Methods: We reviewed data from the GEMI registry between 2001 and 2013, identifying 18,048 patients with AMI. The sample was stratified according to presence or absence of previous ID consumption, comparing different demographic and clinical variables between groups. Results: Two hundred eighty five patients (1.6%) had history of ID consumption (cocaine in 66%, cannabis in 35% and central nervous system stimulants in 24.0%). Compared with non-users, ID consumers were younger, predominantly male and had a lower prevalence of cardiovascular risk factors, except for tobacco smoking (86.3% and 42.5% respectively, p < 0.01). Among consumers, there was a higher percentage of ST segment elevation (85.2% and 67.8% respectively, p < 0.01) and anterior wall AMI (59.9 and 49.5% respectively, p = 0.01). Additionally, they had a higher rate of primary angioplasty (48.8% and 25.5% respectively, p < 0.01). There was no difference in hospital mortality between groups when stratified by age. Conclusions: A low percentage of patients with AMI had a previous history of ID consumption in our national setting. These patients were younger and had a greater frequency of ST segment elevation AMI, which probably determined a more invasive management.

Mortalidad post infarto del miocardio en Chile: comparación de los registros de angioplastía primaria versus trombolisis / Mortality in myocardial Infarction in Chile: a comparison from the angioplasty and thrombolysis registries

Antecedentes: Desde el año 2005, se ha implementado en nuestro país un conjunto de políticas públicas para permitir un acceso universal al tratamiento trombolítico a los pacientes con infarto agudo del miocardio (IAM). Para evaluar sus resultados es importante establecer los estándares locales de las distintas opciones de reperfusión. Objetivos: 1) Comparar la mortalidad precoz y alejada de los pacientes con IAM sometidos a angioplastía primaria (angioplastía) versus los sometidos a trombolisis, en Chile. 2) Establecer los factores de riesgo de mortalidad en estos pacientes. Métodos: Utilizando los registros nacionales de angioplastía (RENAC) y de IAM (GEMI), seleccionamos a todos los pacientes con IAM tratados con angioplastía o trombolisis, durante los años 2003 y 2004. Entre ellos, comparamos mediante prueba de t de Student o chi-cuadrado, según correspondiera, sus características basales y su mortalidad hospitalaria, a 30 días, ya 12 y 24 meses. Además se hizo análisis de regresión logística multivariado para identificar los factores que independientemente se asociaron a mayor riesgo de mortalidad. Resultados: En el estudio se incluyeron 857 pacientes con IAM que recibieron trombolisis y 700 tratados con angioplastía. No hubo diferencias entre los grupos en cuanto a edad, sexo, incidencia de diabetes mellitus, hipertensión arterial, hiperlipidemia ni antecedentes de IAM previo. La mortalidad fue significativamente menor en los pacientes tratados con angioplastía (HR crudo: 0,65; 95 por ciento IC: 0,49-0,86, p=0,03). La diferencia fue evidente tanto para la mortalidad precoz como para la alejada. Así, alcanzó un 10,6 vs 6,3 por ciento (p <0,01), durante la hospitalización inicial, un 11,2 vs 8,1 por ciento a los 30 días (p <0,01), un 15,3vs 10,6 por ciento (p<0,01) a los 12 meses, y un 21,1 vs 11,7 por ciento a los 24 meses (p<0,001), para trombolisis y angioplastía respectivamente. Otros factores que independientemente se asociaron...

Background: From 2005, thrombolysis has been made available as a public health policy to treat acute myocardial infarction (AMI) in Chile. A comparison with results obtained locally with primary PTCA is relevant Aim: to compare early and late mortality in AMI between thrombolysis and PTCA treatments and to determine risk factors associated to mortality Methods: Data from national registries of PTCA (RENAC) and trombolysis (GEMI) of patients treated from 2003 through 2004 were analyzed. Early (<30day) and late (12 and 24 months) mortality was compared between groups. Logistic regression analysis was used to identify independent risk factors for mortality. Results: 857 patients received thrombolysis and 700 were treated by PTCA. Age, sex, prevalence of diabetes, hypertension, dyslipidemia and prior AMI were similar in both groups. PTCA was associated to lower mortality rates compared to thrombolysis (crude HR 0.65, 95 percent C. I. 0.49-0.86, p= 0.03). Early, 12month and 24month mortality rates for thrombolysis and PTCA treated patients were 10.6 vs. 6.3 percent, , 15.3 vs. 10.6 percent and 21.1 vs. 11.7 percent, respectively (p<0.01). Increased age, female gender and presence of diabetes were independently associated to mortality, overall. Conclusion: Primary PTCA was associated to lower early and late mortality rates compared to thrombolysis in Chilean registry data.

Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos / The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals

Background: In 2005 the Chilean government started a health care reform (AUGE) that guarantees medical treatment for acute myocardial infarction. Aim: To quantify the impact ofAUGE on the management and inhospital mortality of STEMI in a group of Chilean hospitals. Material and methods: Three thousand five hundred and forty six patients with STEMI from 10 hospitals that perform thrombolysis as the main reperfusion therapy were analyzed. We compared demographic and clinical characteristics, hospital treatments and revascularization proceduresin two periods: before (2,623 patients) and after AUGE implementation (906 patients). Logistic regression was used to assess inhospital mortality according to AUGE in the entire sample and stratified by risk groups. Results: We found no differences in demographic and clinical characteristics between the two groups. During AUGE threre was a significant increase in the use of thrombolysis (50 percent to 60.5 percent), which was associated to an increase of hypotension from 29 percent to 35 percent (p <0.02) and minor bleedings, from 1.6 percent to 3.4 percent (p <0.001). After A UGE there was a significant increase in the use ofbeta blockers (65 percent to 75 percent), angiotensin converting enzyme inhibitors (70 percent to 76 percent), statins (48 percent to 58 percent), and aspirin (96 percent to 97.5 percent) (p <0.05). Global inhospital mortality decreased from 12.0 percent to 8.6 percent (p <0.003) and from 10.6 percent to 6.8 percent (p <0.005) in patients treated with thrombolytics. The adjusted odds ratio for inhospital mortality comparing after and before AUGE, was 0.64 (IC 95 percent, 0,47-0.86). Conclusions: The implementation ofAUGE has been successful in reducing inhospital mortality of STEMI This has been achieved through a better use of evidence based medicine and reperfusion strategies.

[The impact of Chilean health reform in the management and mortality of ST elevation myocardial infarction (STEMI) in Chilean hospitals]. / Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos.

BACKGROUND: In 2005 the Chilean government started a health care reform (AUGE) that guarantees medical treatment for acute myocardial infarction. AIM: To quantify the impact of AUGE on the management and in-hospital mortality of STEMI in a group of Chilean hospitals. MATERIAL AND METHODS: Three thousand five hundred and forty six patients with STEMI from 10 hospitals that perform thrombolysis as the main reperfusion therapy were analyzed. We compared demographic and clinical characteristics, hospital treatments and revascularization procedures in two periods: before (2,623 patients) and after AUGE implementation (906 patients). Logistic regression was used to assess in-hospital mortality according to AUGE in the entire sample and stratified by risk groups. RESULTS: We found no differences in demographic and clinical characteristics between the two groups. During AUGE there was a significant increase in the use of thrombolysis (50% to 60.5%), which was associated to an increase of hypotension from 29% to 35% (p<0.02) and minor bleedings, from 1.6% to 3.4% (p<0.001). After AUGE there was a significant increase in the use of beta blockers (65% to 75%), angiotensin converting enzyme inhibitors (70% to 76%), statins (48% to 58%), and aspirin (96% to 97.5%) (p<0.05). Global in-hospital mortality decreased from 12.0% to 8.6% (p<0.003) and from 10.6% to 6.8% (p<0.005) in patients treated with thrombolytics. The adjusted odds ratio for in-hospital mortality comparing after and before AUGE, was 0.64 (IC 95%, 0.47-0.86). CONCLUSIONS: The implementation of AUGE has been successful in reducing in-hospital mortality of STEMI This has been achieved through a better use of evidence based medicine and reperfusion strategies.

[Characteristics of heart failure with preserved ejection fraction: results of the Chilean national registry of heart failure, ICARO]. / Características de la insuficiencia cardíaca en pacientes con fracción de eyección preservada: resultados del registro Nacional de insuficiencia Cardíaca, grupo ICARO.

BACKGROUND: Heart failure (HF) with preserved ejection fraction (EF) is a condition of growing interest due to its high prevalence and difficult management. AIM: To evaluate the clinical profile of patients hospitalized with HF and preserved EF in Chilean hospitals. MATERIAL AND METHODS: Prospective registry of 15 centers. Among 649 patients hospitalized in functional class III and IV, an echocardiogram was performed to 353. Preserved EF was defined quantitatively as an EF >50%. RESULTS: Out the 353 patients, 45% presented an EF >50%. Mean age in patients with EF >50 and -50% was 66+/-13 and 67+/-13 years, respectively. Among patients with HF and EF >50%, the proportion of women was higher (73.7 and 36.3%, p <0.001), the proportion of patients with a history of hypertension (76.8 and 65.5%, p <0.05) and the presence of atrial fibrillation was also higher (62.3 and 47.8%, p <0.01) and a history of myocardial infarction was lower (17.1 and 29.5%, p <0.05). The diastolic diameter of the left ventricle was significantly lower in HF with preserved EF (51.0+10 and 63.5+10 mm respectively, p <0.001). No differences in the length of hospital stay and mortality were observed between HF with depressed and preserved EF. Female gender was an independent predictor for the presence of HF with preserved EF (Odds ratio: 2.62; confidence intervals: 1.1-6.1). CONCLUSIONS: HF and preserved EF is common among hospitalized patients, particularly in women and subjects with a history of hypertension and atrial fibrillation. Hospitalization length and mortality were similar in patients with either preserved or depressed EF.

Características de la insuficiencia cardíaca en pacientes con fracción de eyección preservada: Resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Characteristics of heart failure with preserved ejection fraction: Results of the Chilean National Registry of Heart Failure, ICARO

Background: Heart failure (HF) with preserved ejection fraction (EF) is a condition of growing interest due to its high prevalence and difficult management. Aim: To evaluate the clinical profile of patients hospitalized with HF and preserved EF in Chilean hospitals. Material and Methods: Prospective registry of 15 centers. Among 649 patients hospitalized in functional class III and IV, an echocardiogram was performed to 353. Preserved EF was defined quantitatively as an EF >50%. Results: Out the 353 patients, 45% presented an EF >50%. Mean age in patients with EF >50 and ­50% was 66±13 and 67±13 years, respectively. Among patients with HF and EF >50%, the proportion of women was higher (73.7 and 36.3%, p <0.001), the proportion of patients with a history of hypertension (76.8 and 65.5%, p <0.05) and the presence of atrial fibrillation was also higher (62.3 and 47.8%, p <0.01) and a history of myocardial infarction was lower (17.1 and 29.5%, p <0.05). The diastolic diameter of the left ventricle was significantly lower in HF with preserved EF (51.0+10 and 63.5+10 mm respectively, p <0.001). No differences in the length of hospital stay and mortality were observed between HF with depressed and preserved EF. Female gender was an independent predictor for the presence of HF with preserved EF (Odds ratio: 2.62; confidence intervals: 1.1-6.1). Conclusions: HF and preserved EF is common among hospitalized patients, particularly in women and subjects with a history of hypertension and atrial fibrillation. Hospitalization length and mortality were similar in patients with either preserved or depressed EF.

Cambios en el manejo intrahospitalario del infarto del miocardio en hospitales chilenos / Changes in the in-hospital treatment of the acute myocardial infarction in chilean hospitals

Antecedentes: En comunicaciones anteriores se han descrito los cambios en el tratamiento y la evolución del infarto del miocardio (IAM) intrahospitalario durante 2 período de registro en Chile. Objetivo: Evaluar los cambios en el tratamiento farmacológico y las terapias de reperfusión en pacientes con IAM que ingresaron durante 2001 en la red GEMI. Métodos: El registro 2001 (R3) se efectuó entr marzo y diciembre en 23 hospitales de Santiago y regiones. Fue comparado con los registros 93-95 (R1) y 97-98 (R2). Se recolectó información sobre características demográficas, el tratamiento y la evolución intrahospitalaria de los pacientes que ingresaron con el diagnostico de IAM. Resultados: En R3 se incluyeron 1.091 pacientes, cuya edad promedio fue 63 ± 13 años. El 70,4 por ciento fueron hombres. La frecuencia de uso de los medicamentos en R1, R2 y R3 fue respectivamente: aspirina 93 por ciento, 96,1 por ciento y 94,7 por ciento (p=ns); I-ECA 32 por ciento, 53 por ciento y 60 por ciento (p=ns); bloqueadores 37 por ciento, 55,2 por ciento y 60,9 por ciento (p=ns); heparina 59 por ciento, 55 por ciento y 43,5 por ciento (p=ns): nitratos iv 59 por ciento, 67,6 por ciento y 63,7 por ciento (p=ns); antagonista del calcio 23 por ciento, 12,4 por ciento y 6,2 por ciento (p <0,01); trombolíticos 33 por ciento, 33,7 por ciento y 32, por ciento. La angioplastía primaria no se efectuó en R1, pero R2 y R3 fue utilizada en el 9,5 por ciento y el 7,5 por ciento de los pacientes respectivamente. La mortalidad intrahospitalaria fue de 11,6 por ciento durante 2001, comparada con el 10,8 por ciento y el 13,4 por ciento obtenida en los registros 97-98 y 93-95. Conclusión: Se aprecia un aumento de la utilización de los I-ECA y (bloqueadores, fármacos de demostrada eficacia para reducir mortalidad en el IAM. Es racional la reducción del uso del calcio antagonista y probablemente la de antiarrítmicos. No se modifica el empleo de trombolíticos y la angioplastía primaria no aumenta debido a que está limitada a algunos hospitales. Se debe continuar estimulando el uso de terapias que mejoren el pronóstico de los pacientes con IAM, especialmente las orientadas a la reperfusión.

Reducción de la mortalidad por infarto del miocardio en hospitales chilenos / Reduction of acute myocardial infarction mortality in Chilean hospitals

Background: The characteristics of patients with acute myocardial infarction (MI) admitted to 37 Chilean hospitals (GEMI Registry Group), have been analyzed in the periods 1993-1995 and 1997-1998. Aim: To report the changes in hospital mortality between these 2 periods, with a particular emphasis on the impact of treatment. Patients and methods: Between 1993-1995 we collected information from 2,957 patients and between 1997-1998 we registered 1,981 patients with MI. Analysis of the changes in mortality between periods was adjusted by demographic variables, coronary risk factors, MI location, Killip class on admission and the different therapeutic strategies utilized. The effects of different treatments on hospital mortality were adjusted by the previously determined mortality risk variables. Results: Hospital mortality decreased from 13.3 percent to 10.8 percent between both periods (Odds Ratio (OR) 0.78, confidence intervals (95 percent) (CI) 0.65-0.93). A significant reduction in mortality was observed among patients below 60 years of age, in men, in diabetics and in subjects with an infarction classified as Killip class over II. The use of beta blockers (OR 0.65, CI 0.42-0.99) and intravenous nitrates (OR 0.78, CI 0.61-0.99) and the lower use of calcium channel blockers (OR 0.72, CI 0.60-0.87) were significantly associated with a lower mortality. The administration of angiotensin converting enzyme inhibitors was associated with a 29.3 percent mortality reduction (OR 0.69, CI 0.47-1.02). Conclusions: There has been a significant reduction in the mortality rate for MI in Chilean hospitals during the 2 registry periods analyzed, which was significant among some high risk patients and was related to treatment changes, according to evidence based guidelines

Variantes genéticas de los receptores adrenérgicos y enfermedades cardiovasculares / Genetic variants of the adrenergic receptors and cardiovascular diseases

El proyecto Genoma Humano ha logrado descifrar la secuencia completa del genoma, aportando una herramienta única para el estudio de la genética humana. Sin embargo, se ha observado cada vez más frecuentemente la aparición de variantes genéticas, o polimorfismos, en cada uno de los genes estudiados. Como reguladores claves de diversos sistemas, los receptores adrenérgicos proveen un sistema único para explorar una posible relación entre los polimorfismos del receptor y la respuesta a fármacos y susceptibilidad o progresión de las enfermedades cardiovasculares. Los adrenoreceptores pertenecen la superfamilia de los receptores con siete dominios de transmembrana que producen su efecto a través del acoplamiento con distintas proteínas G. Hasta la fecha se han identificado varios subtipos de adrenoreceptores alfa sub 1A, alfa sub 1B, alfa sub 1D, alfa sub 2A, alfa sub 2B, alfa sub 2C ß1, ß2, ß3 y ß4. Este artículo provee una visión general de los polimorfismos existentes en los receptores adrenérgicos y su relación con las enfermedades cardiovasculares

Cambios en los patrones de prescripción de medicamentos en el infarto agudo del miocardio: comparación de dos períodos / Changes in pharmacotherapy for acute myocardial infarction: comparison of 2 periods

Background: Pharmacotherapy of Chilean patients with acute myocardial infarction has been recorded in 37 hospitals since 1993. Aim: to compare pharmacotherapy for acute myocardial infarction in the period 1993 to 1995 with the period 1997-1998. Patients and methods: Drug prescription during hospital stay was recorded in 2957 patients admitted to Chilean hospitals with an acute myocardial infarction in the period 1993-1995 and compared with that of 1981 subjects admitted in the period 1997-1998. Results: When compared with the former period, in the lapse 1997-1998 there was an increase in the frequency of prescription of aspirin (93 and 96.1 percent respectively) ß blockers (37 and 55.2 percent respectively) and angiotensin converting enzyme inhibitors (32 and 53 percent). The prescription of thrombolytic therapy did not change (33 and 33.7 percent respectively). There was a reduction in the prescription of calcium antagonists and antiarrhythmic drugs. Conclusions: During the period 1997-1998, the prescription of drugs with a potential to reduce the mortality of acute myocardial infarction, increased. The diffusion of guidelines for the management of this disease may have influenced this change

Infarto agudo del miocardio en hospitales chilenos: resultados finales del estudio GEMI / Acute myocardial infarction in chilean hospitals: results of the GEMI study

Background: Acute myocardial infarction is the leading cause of death in Chile. Aim: To report the main features, hospital evolution, complications and pharmacological treatment of patients admitted to Chilean hospitals with the diagnosis of acute myocardial infarction. Patients and methods: Between 1993 and 1995, the GEMI group registered 2,957 patients admitted to 37 hospitals with the diagnosis of acute myocardial infarction. Results: Mean age of patients was 62 ñ 2 years old and 74 percent were male. Forty six percent had a history of hypertension and 40 percent were smokers. During the first five days of admission, 93 percent of patients received aspirin, 59 percent received intravenous nitrates, 59 percent intravenous heparin, 56 percent oral nitrates, 37 percent beta blockers, 32 percent angiotensin-converting enzyme inhibitors, 33 percent thrombolytic agents, 29 percent antiarrhythmics and 23 percent calcium antagonists. Coronary angiograms were performed in 28 percent of patients, angioplasty in 9 percent and 8 percent were subjected to a coronary bypass. Global hospital mortality was 13.4 percent (19.5 percent in women and 11.1 percent in men, p <0.001). Conclusions: This work gives a picture of myocardial infarction in Chilean hospitals. Pharmacological treatment is similar to that used abroad, but certainly it can be optimized

Valor pronóstico de los índices no invasivos de reperfusión coronaria en pacientes con infarto agudo del miocardio tratados con trombólisis / Prognostic value of non invasive indexes of coronary reperfusion in patients with acute myocardial infarction treated with trombolysis

In 807 consecutive patients from the Chilean National Registry of Acute Myocardial Infarction we analyzed the resolution of chest pain and ST segment elevation over 50 percent within the first 90 min, abrupt CK rise within 8 h and T wave inversion in infarct related EKG leads within the first 24 h after thrombolysis. Global in-hospital mortality was 12.1 percent. Mortality of patients with the presence of 3 or 4 markers of coronary artery patency was 5.1 percent, in those with resolution of ST elevation and abrupt CK rise was 6.25 percent and in those with T wave inversion it was 3.9 percent (p<0.001). Multivariate analysis, adjusted by age, gender, risk factors, Killip class and infarct location showed that early T wave inversion was the better predictor of a low in-hospital mortality and its combination with other markers of coronary artery patency did not increase its prognostic power. Early CK rise and the presence of 3 out of 4 reperfusion criteria were also independent predictors of a low mortality. Non invasive markers of coronary artery patency are associated with a lower in-hospital mortality and may serve as surrogate end points in clinical trials