[Female gender is an independent predictor of in-hospital mortality in patients with ST segment elevation acute myocardial infarction treated with primary angioplasty]. / El género femenino es un predictor independiente de la mortalidad intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST revascularizado mediante una angioplastia primaria.

OBJECTIVE: The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA). DESIGN AND SCOPE: Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA. PATIENTS: Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women. MAIN VARIABLES OF INTEREST: In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model. RESULTS: The women were older (70+/-8 versus 65+/-11; p=0.02) and had greater prevalence of diabetes (37% versus 18%; p=0.002) and hypertension (58% versus 37%; p<0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p=0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p=0.01) and in-hospital mortality (17% versus 8%; p=0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality. CONCLUSIONS: In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA.

El género femenino es un predictor independiente de la mortalidad intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST revascularizado mediante una angioplastia primaria / Female gender is an independent predictor of in-hospital mortality in patients with ST segment elevation acute myocardial infarction treated with primary angioplasty

Objetivo. Analizar la influencia del sexo en el pronóstico intrahospitalario del infarto agudo de miocardio con elevación del segmento ST (IAMEST) revascularizado mediante una angioplastia primaria (AP). Diseño y ámbito. Estudio prospectivo de una cohorte de pacientes consecutivamente ingresados en la Unidad Coronaria de un hospital terciario durante el periodo de enero a octubre de 2004, con diagnóstico de IAMEST y tratados con AP. Pacientes. Muestra consecutiva de 86 pacientes con dicho diagnóstico dividida en dos grupos en función del sexo: 52 hombres y 34 mujeres. Variables de interés principales. En ambos grupos analizamos las características clínico-demográficas basales, la extensión de la enfermedad coronaria (EEC), el éxito de la AP, la aparición de insuficiencia cardiaca (IC) y la mortalidad intrahospitalaria en los primeros 28 días tras el ingreso. Se analizaron predictores de mortalidad en un modelo multivariado. Resultados. Las mujeres presentaron mayor edad (70 ± 8 frente a 65 ± 11; p = 0,02) y prevalencia de diabetes (37% frente a 18%; p = 0,002) y de hipertensión arterial (58% frente a 37%; p < 0,001) que los hombres, mientras que estos presentaron mayor frecuencia de tabaquismo (34% frente a 22%; p = 0,001). No hubo diferencias en la presencia de hiperlipidemia, la EEC o el éxito de la AP. Las mujeres presentaron mayor incidencia de IC al ingreso (22% frente a 12%; p = 0,01) y de mortalidad intrahospitalaria (17% frente a 8%; p = 0,002). En el análisis multivariado, el sexo femenino y la IC al ingreso permanecieron como predictores de mortalidad intrahospitalaria. Conclusiones. En nuestro estudio, el sexo femenino fue un predictor independiente de mortalidad intrahospitalaria en pacientes con IAMEST tratados con AP

Objective. The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA). Design and scope. Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA. Patients. Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women. Main variables of interest. In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model. Results. The women were older (70 ± 8 versus 65 ± 11; p = 0.02) and had greater prevalence of diabetes (37% versus 18%; p = 0.002) and hypertension (58% versus 37%; p < 0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p = 0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p = 0.01) and in-hospital mortality (17% versus 8%; p = 0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality. Conclusions. In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA

[Systemic inflammatory response syndrome: incidence and influence on outcome in acute myocardial infarction treated with primary angioplasty]. / Síndrome de respuesta inflamatoria sistémica: incidencia e influencia pronóstica en el infarto agudo de miocardio tratado con angioplastia primaria.

OBJECTIVE: To assess the incidence, clinical profile and influence on outcome of systemic inflammatory response syndrome (SIRS) in patients with acute myocardial infarction (AMI) treated with primary angioplasty (PA). DESIGN: Prospective observational study. SCOPE: A 12-beds coronary care unit at a university hospital. PATIENTS AND METHODS: Patients with AMI treated with PA, admitted in 2004 were studied. PRINCIPAL VARIABLES OF INTEREST: Age, gender, anterior localization of AMI, smoking, arterial hypertension, diabetes mellitus, troponin Ic levels, time delays until PA, heart failure, left ventricular ejection fraction (LVEF), in-hospital length of stay and mortality. RESULTS: Ninety patients were included. SIRS was diagnosed in 15 patients (16.6%), who were older (72 +/- 7 vs 66 +/- 9 years; p = 0,01). These patients had a greater frequency of diabetes mellitus (42% vs 17%; p = 0.01), higher troponin Ic levels (80 +/- 12 vs 68 +/- 19 ng/ml; p = 0.02), lower LVEF (41 +/- 8% vs 51 +/- 12%; p = 0.002), longer in-hospital length of stay (18 +/- 5 vs 7 +/- 3 days, p = 0.001), and higher in-hospital mortality (10 vs 3%, p = 0.03) compared with patients without SIRS. Diabetes mellitus (OR: 1.7; 95% CI: 1.2-1.9) and lower ejection fraction (OR: 2.3; 95% CI: 1.5-3.1) were the independent predictors of the presence of systemic inflammatory response syndrome. In multivariant analysis SIRS was an independent predictor of mortality in AMI patients treated with PA (OR: 3.3; 95% CI: 1.3-6). CONCLUSIONS: Systemic inflammatory response syndrome may be present in AMI patients treated with PA and its presence is associated to a worse outcome and longer in-hospital stay.

Síndrome de respuesta inflamatoria sistémica: incidencia e influencia pronóstica en el infarto agudo de miocardio tratado con angioplastia primaria / Systemic inflammatory response syndrome: incidence and influence on outcome in acute myocardial infarction treated with primary angioplasty

Objetivo. Analizar la incidencia y efecto sobre la mortalidad del síndrome de respuesta inflamatoria sistémica (SRIS) en el infarto agudo de miocardio (IAM) tratado con angioplastia primaria (AP). Diseño. Estudio observacional prospectivo. Ámbito. Unidad de coronarias con 12 camas en un hospital universitario. Pacientes. Pacientes con IAM tratados con AP ingresados durante el año 2004. Variables de interés principales. Edad, sexo, localización anterior del IAM, tabaquismo, hipertensión arterial, diabetes mellitus, niveles de troponina Ic, tiempos de retraso hasta la AP, presencia de insuficiencia cardíaca, fracción de eyección del ventrículo izquierdo (FEVI), estancia y mortalidad intrahospitalaria. Resultados. Se incluyeron 90 pacientes, en 15 (16,6%) se diagnosticó SRIS. Éstos presentaron mayor edad (72 ± 7 frente a 66 ± 9 años; p = 0,01), mayor frecuencia de diabetes mellitus (42% frente a 17%; p = 0,01), niveles más elevados de troponina Ic (80 ± 12 frente a 68 ± 19 ng/ml; p = 0,02), FEVI más baja (41 ± 8% frente a 51 ± 12%; p = 0,002), mayor estancia hospitalaria (18 ± 5 frente a 7 ± 3 días, p = 0,001) y mortalidad intrahospitalaria (10% frente a 3%, p = 0,03) que los pacientes sin diagnóstico de SRIS. Fueron variables predictivas independientes de la presencia de SRIS la diabetes mellitus (OR: 1,7; IC 95%: 1,2-1,9) y una menor FEVI (OR: 2,3; CI 95%: 1,5-3,1). El análisis multivariante mostró que la presencia de SRIS fue variable independiente predictora de mortalidad en los pacientes con IAM tratados con AP (OR: 3,3; IC 95%: 1,3-6). Conclusiones. El SRIS se presenta, con relativa frecuencia, en pacientes con IAM tratados con AP y se asocia con una estancia hospitalaria más larga y un peor pronóstico

Objective. To assess the incidence, clinical profile and influence on outcome of systemic inflammatory response syndrome (SIRS) in patients with acute myocardial infarction (AMI) treated with primary angioplasty (PA). Design. Prospective observational study. Scope. A 12-beds coronary care unit at a university hospital. Patients and methods. Patients with AMI treated with PA, admitted in 2004 were studied. Principal variables of interest. Age, gender, anterior localization of AMI, smoking, arterial hypertension, diabetes mellitus, troponin Ic levels, time delays until PA, heart failure, left ventricular ejection fraction (LVEF), in-hospital length of stay and mortality. Results. Ninety patients were included. SIRS was diagnosed in 15 patients (16.6%), who were older (72 ± 7 vs 66 ± 9 years; p = 0,01). These patients had a greater frequency of diabetes mellitus (42% vs 17%; p = 0.01), higher troponin Ic levels (80 ± 12 vs 68 ± 19 ng/ml; p = 0.02), lower LVEF (41 ± 8% vs 51 ± 12%; p = 0.002), longer in-hospital length of stay (18 ± 5 vs 7 ± 3 days, p = 0.001), and higher in-hospital mortality (10 vs 3%, p = 0.03) compared with patients without SIRS. Diabetes mellitus (OR: 1.7; 95% CI: 1.2-1.9) and lower ejection fraction (OR: 2.3; 95% CI: 1.5-3.1) were the independent predictors of the presence of systemic inflammatory response syndrome. In multivariant analysis SIRS was an independent predictor of mortality in AMI patients treated with PA (OR: 3.3; 95% CI: 1.3-6). Conclusions. Systemic inflammatory response syndrome may be present in AMI patients treated with PA and its presence is associated to a worse outcome and longer in-hospital stay