[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

Descripción de los aspectos generales del manejo del síndrome coronario agudo en España durante el año 2002 / Description of general aspects of the management of acute coronary syndrome in Spain during the year 2002

Objetivo. Describir los aspectos más relevantes en el manejo inicial del paciente con síndrome coronario agudo (SCA) durante el año 2002. Diseño y ámbito. Estudio observacional prospectivo. Participaron 84 hospitales. Pacientes, variables y resultados. Se han seleccionado los 12.743 casos incluidos en el registro ARIAM desde el 1 de enero al 31 de diciembre de 2002. Las variables analizadas se agrupan en 4 apartados: características generales, diagnóstico de infarto agudo de miocardio (IAM), atención prehospitalaria y tratamiento fibrinolítico. Ingresaron 6.879 pacientes con diagnóstico de IAM, incrementándose este diagnóstico en un 16,8% al alta. La mortalidad en Unidad de Cuidados Intensivos (UCI) para los pacientes con IAM ha sido del 8,4%. Cinco mil trescientos sesenta y ocho (47%) casos llegaron al hospital a través del sistema sanitario prehospitalario con una mediana de retraso desde el inicio de los síntomas de 155 minutos. El 59% de los IAM ST elevado recibieron tratamiento fibrinolítico. El 6,7% de las fibrinolisis se realizaron en la primera hora y el 31,1% en las dos primeras horas. De los pacientes con menos de tres criterios de reperfusión sólo se realizó angioplastia de rescate en 144 casos (7%). Conclusiones. El descenso de mortalidad del IAM respecto a años previos puede estar en relación con la aplicación de los nuevos criterios diagnósticos. La atención prehospitalaria comporta mayor retraso a su llegada al hospital pero aporta un acceso más precoz acceso a las medidas básicas de atención. Los porcentajes de fibrinolisis en las dos primeras horas y de angioplastias de rescate son bajos respecto a otras series

Objective. A description of the most relevant aspects in the initial management of the patient with acute coronary syndrome (ACS) during the year 2002. Design and scope. Prospective observational study. Eighty-four participating hospitals. Patients, variables and results. The 12,743 cases included in the ARIAM registry from January 1 to December 31, 2002 were selected. The variables analyzed have been grouped into 4 sections: general characteristics, acute myocardial infarction (AMI) diagnosis, prehospital care and fibrinolytic treatment. A total of 6,879 patients were admitted with the diagnosis of AMI, this diagnosis increasing by 16.8% on discharge. Mortality in the Intensive Care Unit (ICU) for patients with AMI was 8.4%. The number of cases that reached the hospital through the prehospital health care system was 5,368 (47%) with a median delay from onset of the symptoms of 155 minutes. A 59% of the elevated ST AMI received fibrinolytic treatment. A 6.7% of the fibrinolysis were performed in the first hour and 31.1% in the first 2 hours. Rescue angioplasty was only done in 144 cases (7%) of the patients with less than three reperfusion criteria. Conclusions. Decrease in AMI mortality regarding previous years may be related with the application of new diagnostic criteria. Prehospital care entails greater delay of arrival to the hospital but supplies earlier access to the basic care measures. The percentage of fibrinolysis in the first 2 hours and rescue angioplasties are low regarding other series

Variabilidad en el manejo del infarto agudo de miocardio en el registro ARIAM en el año 2002 / Variability in the management of acute myocardial infarction in the ARIAM registry in the year 2002

Objetivo. Analizar las diferencias en el manejo del infarto agudo de miocardio (IAM) entre las distintas comunidades autónomas de los hospitales participantes en el registro ARIAM durante el año 2002. Diseño. Registro multicéntrico nacional de base hospitalaria de pacientes ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC) por sospecha de síndrome coronario agudo. Ámbito. UCIC de 80 hospitales españoles de 14 comunidades autónomas. Pacientes o participantes. Se incluyen todos los pacientes del registro ARIAM del año 2002 cuyo motivo de ingreso hospitalario es IAM de menos de 24 horas de evolución. Intervenciones. Ninguna Variables de interés principales. Se registraron variables demográficas, antecedentes, clínicas, retrasos y lugar de actuación inicial, uso de técnicas diagnósticas y terapéuticas, tiempos de estancia y morbimortalidad. Se agruparon los casos por áreas geográficas que corresponden a las diferentes comunidades autónomas de España. Se analizaron las diferencias mediante el uso del coeficiente de variación (CV). Resultados. Se incluyeron 6.820 pacientes. Las características basales fueron similares, salvo para la presencia de diabetes como factor de riesgo (CV: 21%). Los CV excesivos correspondieron al modo de acceso al sistema sanitario (061: 29%), lugar de realización de la fibrinolisis (extrahospitalaria: 155%, urgencias: 120%), tipo de fibrinolítico (rTPA: 78%), retrasos intrahospitalarios (puerta-aguja: 24% y puerta-balón: 39%), uso de angioplastia coronaria transluminal percutánea (ACTP) primaria (122%), realización de coronariografía (75%) y tratamiento con anti-IIb/IIIa (34%). La mortalidad en UCIC global fue del 8,0%, con un CV de 16%. Conclusiones. Existen diferencias en el manejo del IAM entre las distintas comunidades autónomas estudiadas, especialmente en lo concerniente a la atención prehospitalaria y el uso de las técnicas de revascularización. Sin embargo, en la población estudiada, no se traducen en diferencias significativas respecto al resultado a corto plazo

Objective. Analyze the differences in the management of acute myocardial infarction (AMI) between the different regional communities of the hospitals participating in the ARIAM registry during the year 2002. Design. Hospital based multicenter, national registry of patients admitted to cardiology intensive care units (CICU) due to suspicion of acute coronary syndrome. Scope. CICU of 80 Spanish hospitals in 14 regional communities. Patients or participants. All the patients from the ARIAM registry in the 2002 whose cause of hospitalization is AMI of less than 24 hours evolution are included. Interventions. None. Variables of principal interest. Demographic variable, background, symptoms, delays and site of initial action, use of diagnostic and therapeutic techniques, stay time and morbidity-mortality were recorded. The cases were grouped by geographic areas that correspond to the different regional communities of Spain. Differences were analyzed with the variation coefficient (VC).Results. A total of 6,820 patients were included. Basal characteristics were similar, except for the presence of diabetes as risk factor (VC: 21%). Excessive variation coefficients corresponded to way of access to health care system (061: 29%), site fibrinolysis was done (community: 155%, emergency service: 120%), fibrinolytic type (rTPA: 78%), interhospital delays (door-to-needle: 24% and door-to-balloon: 39%), use of primary percutaneous transluminal coronary angioplasty (PTCA) (122%), conduction of coronariography (75%) and treatment with anti-IIb/IIIa (34%). Global mortality in the CICU was 8.0%, with a 16% VC. Conclusions. There are differences in the management of AMI between the different regional communities studied, especially in that regarding prehospital care and the use of revascularization techniques. However, no significant differences are found in the study population regarding short term result