[Quality of life in patients with idiopathic ventricular arrhythmias treated at the Instituto Nacional Cardiovascular - INCOR]. / Calidad de vida en pacientes con arritmias ventriculares idiopáticas tratados en el Instituto Nacional Cardiovascular - INCOR.

Objective: To describe the quality of life in patients with idiopathic ventricular arrhythmias treated at the Instituto Nacional Cardiovascular INCOR in Lima -Peru. Materials and methods: . Analytical and cross-sectional study of patients with idiopathic ventricular arrhythmias treated by 3D ablation or antiarrhythmic therapy between July 2017 and December 2019 to whom the SF-36 health questionnaire was applied to assess quality of life related to health. Results: Fifty-two patients with idiopathic ventricular arrhythmias were included (34 underwent 3D ablation, and 18 underwent antiarrhythmic therapy only). The percentage of recurrence (14.7% vs. 50%, p=0.01) and adverse effects (0% vs. 22.2%, p=0.011) were lower in the 3D ablation group compared to the antiarrhythmic group. The mean standardized scores obtained from the Spanish version of the Health Survey SF-36v2, applied to the 3D ablation and antiarrhythmic groups were 85.1 vs 68.4 (p<0.001), respectively. Were found statistically significant differences in 6 of the eight components that evaluate health-related quality of life: physical function (96.0 vs. 76.0, p<0.001), physical role (93.4 vs. 61.1, p<0.001), general health (74.5 vs. 47.4, p<0.001), vitality (69.9 vs 54.7, p=0.008), emotional role (92.2 vs. 77.8, p=0.006) and mental health (73.8 vs. 60, p<0.001). Conclusions: Patients with idiopathic ventricular arrhythmias who underwent 3D ablation have a higher mean standardized score for health-related quality of life.

[Ablation of cardiac arrhythmias using a three-dimensional electro-anatomical mapping system in the Instituto Nacional Cardiovascular - INCOR]. / Ablación de arritmias cardiacas empleando un sistema de mapeo electroanatómico tridimensional en el Instituto Nacional Cardiovascular - INCOR.

Objective: To describe the initial experience in ablation of cardiac arrhythmias using 3D mapping at the Instituto Nacional Cardiovascular INCOR (Lima, Peru). Methods: A retrospective descriptive study was carried out. During February 2020, data was collected from the medical records of all patients in whom ablation was performed using 3D mapping from July 2017 to December 2019. This procedure was performed in patients with symptomatic arrhythmia refractory to antiarrhythmic therapy. Results: Data were collected from 123 patients (median age: 46 years, 64.2% male), who had a median time of illness of 6 years. Among the arrhythmias treated, 19% had atrial fibrillation, 17.5% atrial tachycardia, 17.5% idiopathic ventricular arrhythmias, 16.6% Wolf Parkinson White syndrome / Atrioventricular reentrant tachycardia, 11.1% ventricular arrhythmias of the His-Purkinje conduction system, 9.5% scar related ventricular tachycardia associated, 6.4% atrial flutter and 2.4% intranodal tachycardia. The median fluoroscopy time was 26 minutes. Ablation was acutely successful in 95.9% of cases, acute complications were observed in 4.8%, and recurrence-free survival during the first year of follow-up was 74%. Conclusions: Our experience in ablation of cardiac arrhythmias using 3D mapping had a high acute success rate, low frequency of complications, and one-year recurrence-free survival of 74 %.

[Current Features and Mortality Risk Factors in Cardiogenic Shock due to Myocardial Infarction in a Latin-American hospital]. / Características actuales y factores de riesgo de mortalidad en choque cardiogénico por infarto de miocardio en un hospital latinoamericano.

Objective: To know the clinical characteristics and determine the related factors to higher in-hospital mortality in patients with cardiogenic shock (CS) due to myocardial infarction in a Peruvian reference hospital. Materials and methods: . We conducted a prospective single-center cohort study, to evaluate the clinical characteristics, treatment, and complications of patients with CS due to myocardial infarction from March 2019 to August 2020 at the Instituto Nacional Cardiovascular INCOR. Factors related to higher in-hospital mortality and during follow-up were evaluated. Also, the IABP shock II score was applied to stratify the cohort. Results: Forty patients were included in the study, 75% of cases were due to left ventricular dysfunction, most of the men and with a median age of 75 (69-82) years. Fifty percent of cases presented CS after admission to the emergency room. Patients stratified by the IABP shock II score as low, intermediate, and high risk, had in-hospital mortality of 37.5%, 71.4%, and 91.6% respectively. In a hospital, mortality was 70%, higher in women, in those over 75 years old, and in those who developed CS during their hospitalization. Serum lactate > 4 mmol/L in univariate analysis was associated with higher mortality risk (HR: 2.8; IC:1.6-3.6, p=0.009). Survival to the end of the study was 12.8%. Conclusions: CS due to myocardial infarction is a clinical entity with high mortality in spite of revascularization and the available treatment in our reality. The highest mortality predictor was the serum lactate at admission > 4 mmol/L. The IABP shock II score showed to be an accurate parameter to stratify the death risk in our population.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI).

OBJECTIVES: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. METHODS: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. RESULTS: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age>75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age>75 years, and the absence of electrocardiographic signs of reperfusion. CONCLUSIONS: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI) / Insuficiencia cardiaca complicando el infarto de miocardio. Un reporte de Peruvian Registry of ST-elevation Myocardial Infarction (PERSTEMI)

Abstract Objectives: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. Methods: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. Results: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age > 75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age > 75 years, and the absence of electrocardiographic signs of reperfusion. Conclusions: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Resumen Objetivos: Se desea saber la incidencia, los factores asociados y la mortalidad a 30 días de los pacientes con insuficiencia cardiaca (IC) postinfarto de miocardio con elevación del segmento ST (IMCEST) en Perú. Métodos: Estudio observacional, de cohortes, multicéntrico a nivel nacional, de pacientes enrolados en el registro peruano de IMCEST, excluyendo los pacientes con antecedente de IC. Se compararon las características epidemiológicas, tratamiento y evolución a 30 días de los pacientes con (grupo 1) y sin (grupo 2) IC postinfarto. Resultados: De 388 pacientes se encontró un 48.7% con síntomas de IC o fracción de eyección de ventrículo izquierdo < 40% postinfarto (grupo 1). La edad > 75 años, el infarto de pared anterior y la ausencia de signos electrocardiográficos de reperfusión fueron los factores relacionados a mayor incidencia de IC. La mortalidad intrahospitalaria en el grupo 1 fue del 20.6% y los factores independientes relacionados a mayor mortalidad fueron la edad > 75 años y la ausencia de signos electrocardiográficos de reperfusión. Conclusiones: La IC complica casi al 50% de pacientes con IMCEST y está asociada a mayor mortalidad intrahospitalaria y a 30 días. La edad > 75 años y la ausencia de ondas T negativas en el electrocardiograma posreperfusión son factores independientes de mayor incidencia de IC y de mortalidad a 30 días.

Impacto del intervencionismo percutaneo en lesiones complejas en el INCOR - EsSalud (imleco) / Impact of the interventionism percutaneo in complex injuries in the INCOR - EsSalud (imleco)

Objetivos: Evaluar la asociación entre la complejidad de las lesiones y los resultados angiogrßficos, eventos clínicos adversos al mes, a los 6 meses y al a±o. Métodos: Se revisaron retrospectivamente las historias clínicas de 154 pacientes que fueron sometidos a intervencionismo percutßneo coronario en el Instituto Nacional del Corazón- Hospital Guillermo Almenara Irigoyen, entre octubre del 2001 a setiembre del 2002. Se trataron 156 lesiones, de las cuales 91 eran lesiones complejas (definida como la lesión que muestra trombo, calcificación, lesión ostial, bifurcación, aneurisma, oclusión crónica o lesión en puente safeno) y 65 no complejas. Se analizaron variables clínicas, angiogrßficas y resultados de eventos adversos en el seguimiento. Resultados: La edad media de los pacientes fue de 61,7±10,2 a±os, el 83,8 por ciento correspondía al sexo masculino, 63,6 por ciento eran hipertensos y 18,8 por ciento diabéticos. El intervencionismo en lesiones complejas estuvo relacionado con mayor tasa de complicaciones periprocedimiento como fenómeno de no reflujo (71,4 por ciento, p< 0,000), compromiso de brazo colateral (39,6 por ciento, p< 0,000), disección (8,8 por ciento, p< 0,014), embolización distal ( 7,7 por ciento, p<0,02), y eventos adversos al mes de muerte (p< 0,08), muerte/IM (p<0,05), cirugía (p<0,014), muerte/IM/RM( p<0,01), muerte/IM/RM/H (p<0,004), a los 6 meses muerte(p<0,02), muerte/IM (p<0,009), muerte/IM/RM, muerte/IM/RM/H (p< 0,000) y al a±o muerte. Cirugía, muerte/IM, muerte/IM/RM y muerte/IM/RM/H (p<0,01). Conclusiones: Los pacientes con lesiones complejas presentaron una mayor tasa significativa de complicaciones periprocedimiento y eventos adversos (muerte, cirugía, Muerte/infarto, muerte/infarto/revascularización ymuerte/infarto/revascularización/rehospitalización) al mes, a los 6 meses y al a±o.

OBJECTIVES: To evaluate association between coronary lesion complexity and angiographic results, clinical events at first, sixth and twelveth month. METHODS: We retrospectively reviewed clinical charts of 154 patients who underwent coronary percutaneous intervention at the Instituto Nacional del Corazón (INCOR) - National Hospital Guillermo Almenara Irigoyen, between October 2001 and September 2002. 156 lesiones were treated, 91 of them were complex ones (defined as a lesion with thrombus, calcified, ostial lesion, bifurcation, with aneurysm, closed cronically or lesion of a vein graft) and 65 non complex lesions. Clinical, angiographic and clinical events during the foolw up were analyzed. RESULTS: Mean age was 61.7±10.2 years old, 83.8 percent were male, 63.6 per cent had hypertension and 18.8 per cent were diabetic. Intervention in complex lesions was associated with higher rate of periprocedure complications as non reflow phenomenon(71.4 per cent pï0.000), side branch compromise (39.6 per cent pï0.000), dissection (8.8 per cent pï0.014), distal embolisation (7.7 per cent pï0.02) and adverse clinical events at one month of death (pï0.08), death/MI (pï0.05), CABG (pï0.014), death/MI/CABG (pï0.01), death/MI/CABG/hospitalization (pï0.004), at six months death (pï 0.02), death/MI (pï0.009), death/MI/CABG, death/MI,CABG/ hospitalization (pï0.000 ) and death at a year as CABG/death/ MI, death/I/CABG and death/MI,CABG/hospitalization (pï0.01). CONCLUSIONS: Patients with complex lesions showed higher rate of periprocedure complications and adverse cinical events (death, CABG, death/MI, death/MI/CABG and death/MI,CABG/hospitalization) at one, 6 and 12 months.