[Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome]. / Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo.

OBJECTIVE: To study delay times in women with acute coronary syndrome (ACS) and ST segment elevation (STSEACS) until administration of possible reperfusion therapy as well as its possible differences in relationship to the men. MATERIAL AND METHODS: A study was conducted in 1,849 patients consecutively hospitalized in a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS. Different delay times were studied from the beginning of the symptoms, comparing them between genders and correcting this by variable age. RESULTS: The percentage of women was 24.4% with a mean age of 71.5 years. Medium delay time from the beginning of the symptoms to contact with the first health care agent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min. Reperfusion treatments were used in 57.6% of the subjects, with a significant difference (p < 0.01) of 7.6% between men (59.5%) and women (51.9%). CONCLUSIONS: Delay times are greater in women than men, above all regarding the beginning of the symptoms until arrival to the first health care agent. Currently, reperfusion treatments are performed more in men than in women, the differences are minimum when adjusted by age.

Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo / Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome

Objetivo. Estudiar los tiempos de retraso hasta una eventual terapéutica de reperfusiónen las mujeres con síndrome coronario agudo (SCA) y elevación del segmento ST, así comolas posibles diferencias en relación con los varones.Material y métodos. Se ha llevado a cabo un estudio con 1.849 pacientes con diagnósticode SCA ingresados consecutivamente en una Unidad Coronaria, desde enero de 2000 a diciembrede 2005. Se estudian diversos tiempos de retraso desde el inicio de los síntomas,se comparan entre sexos y se corrigen por la variable edad.Resultados. Fueron mujeres el 24,4%, con una media de edad de 71,5 años. La medianaen el tiempo de retraso desde el inicio de los síntomas hasta el contacto con el primerescalón sanitario fue significativamente (p < 0,001) más prolongada en las mujeres queen los hombres, 164 minutos frente a 120 minutos. Los tratamientos de reperfusión seemplearon en el 57,6% de los sujetos, con una diferencia significativa (p < 0,01) del 7,6%entre hombres (59,5%) y mujeres (51,9%).Conclusiones. Los tiempos de retraso son mayores en las mujeres que en los hombres,sobre todo desde el inicio de los síntomas hasta la llegada al primer escalón sanitario.Los tratamientos de reperfusión se realizan más en hombres que en mujeres, aunque,ajustando por edad, las diferencias son mínimas(AU)

Objective. To study delay times in women with acute coronary syndrome (ACS) and STsegment elevation (STSEACS) until administration of possible reperfusion therapy as wellas its possible differences in relationship to the men.Material and methods. A study was conducted in 1,849 patients consecutively hospitalizedin a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS.Different delay times were studied from the beginning of the symptoms, comparing thembetween genders and correcting this by variable age.Results. The percentage of women was 24.4% with a mean age of 71.5 years. Mediumdelay time from the beginning of the symptoms to contact with the first health careagent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min.Reperfusion treatments were used in 57.6% of the subjects, with a significant difference(p < 0.01) of 7.6% between men (59.5%) and women (51.9%).Conclusions. Delay times are greater in women than men, above all regarding thebeginning of the symptoms until arrival to the first health care agent.Currently, reperfusion treatments are performed more in men than in women, thedifferences are minimum when adjusted by age(AU)

Fibrinólisis con TNK en un caso de trombosis de prótesis valvular mitral / Fibrinolysis with TNK in a case of thrombosis of mitral valvular prosthesis

Se presenta el caso de una mujer de 74 años, portadora de una prótesis valvular mitral (CarboMedics de 27 mm), que ingresa en la Unidad de Cuidados Intensivos en situación de edema agudo de pulmón. Se comprueba disfunción de la prótesis compatible con trombosis, por ecocardiografía transesofágica (ETE), y considerando la situación general de la paciente, se plantea la opción del tratamiento con fibrinolíticos como alternativa a la cirugía. Tras dos dosis sucesivas de 100 unidades por kg de Tenecteplasa, se consigue apertura completa de la prótesis, confirmada por ETE, y una excelente evolución clínica posterior (AU)

Contrapulsación intraaórtica en el shock cardiogénico postinfarto. ¿Un recurso infrautilizado? / Intra-aortic counterpulsation in postinfarction cardiogenic shock: an underutilized resource?

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Parálisis diafragmágtica bilateral tras cirugía cardíaca / Bilateral diaphragm paralysis after cardiac surgery

Se describe a 2 pacientes sometidos a cirugía cardíaca en los que se utilizó hipotermia local con hielo picado como método de protección miocárdica. En el postoperatorio presentaron una insuficiencia respiratoria grave secundaria a una parálisis diafragmática bilateral completa. El diagnóstico de esta complicación y su posterior seguimiento se realizaron, en ambos casos, mediante un estudio neurofisiológico. Los 2 enfermos precisaron ventilación mecánica durante algunas semanas y la parálisis revirtió de forma completa después de varios meses (AU)

[Thrombolysis in the elderly with acute myocardial infarction. The PRIAMHO study]. / Trombólisis en el anciano con infarto agudo de miocardio. El estudio PRIAMHO.

INTRODUCTION: In the elderly with acute myocardial infarction the risks and benefits of thrombolytic therapy are not well defined due mainly to the lack of randomized trials. In the present study we examined the clinical profile of the aged treated with thrombolytic agents and the effects of that therapy on 28 day and 1 year mortality. PATIENTS AND METHODS: We studied 733 patients aged > 75 years (mean: 79.9) admitted to the Coronary Care Unit (CCU) of 24 Spanish hospitals with a confirmed diagnosis of Q-Wave myocardial infarction (MI). On admission, 293 patients were treated with thrombolytics and 440 patients received standard therapy. The difference between the two groups in the clinical profile of MI, treatments administered in CCU, evolutive course and 28 day and 1 year mortality were assessed. RESULTS: The independent predictors related to the use of thrombolytic therapy were age (OR: 0.93; 95% CI: 0.89-0.97), history of arterial hypertension (OR: 0.85; 95% CI: 0.71-1.01), delay time to admission (OR: 0.998; 95% CI: 0.997-0.999), anterior location of infarct (OR: 1.21; 95% CI: 1.01-1.24) and Killip Class III-IV (OR: 0.79; 95% CI: 0.64-0.97). During the evolution thrombolysis therapy was associated with lower rates of Killip III-IV (p < 0.00001), complete AV block (p = 0.037), intraventricular conduction defects (p = 0.046) and a higher incidence of stroke (p < 0.01). The 28-day mortality was also significantly lower in the group receiving thrombolytics (27 vs 31. 3%; p = 0.035). However, this difference disappeared when the analysis was adjusted with other variables such as age, administration of aspirin and Killip Class III-IV (OR: 1.29; 95% IC: 0.87-1.92). CONCLUSIONS: The results of this trial suggest that in the elderly with acute myocardial infarction thrombolysis is associated with a less complicated evolutive course and a lower 28-day mortality. However, these findings could be mediated by other covariables such as age, more frequent use of aspirin and a higher number of patients with Killip Class III-IV excluded from the thrombolytic therapy.

[The effect of myocardial infarct on the employment situation of patients]. / Impacto del infarto de miocardio en la situación laboral de los pacientes.

INTRODUCTION AND OBJECTIVES: The impact of acute myocardial infarction in labour activity changes from one country to another as well as patients' characteristics. Our purpose was aimed to learn the main demographic, professional, clinical and therapeutic variables which might affect the return to work after suffering a myocardial infarction in our environment. METHODS: 584 patients treated consecutively in our Coronary Unit for 4 years, aged under 65, were studied. The following aspects were analyzed: age, sex, previous ischaemic heart disease, previous working condition, professional level, economical area of labour activity, main therapeutic procedures and complications, number of days of sick leave, posterior labour status and date of invalidity or death, should it occur. The minimum follow up period was two years. RESULTS: 65.3% of patients were regularly working before suffering the myocardial infarction. Mean length of sick leave after myocardial infarction was 243.9 days although it changed according to age and economical areas. 56.6% of the patients returned to work according to age (odds ratio = 0.92), high professional status (odds ratio = 2.14), economical area of services (odds ratio = 2.03), and the presence of previous anginal attacks (odds ratio = 1.73). CONCLUSIONS: In our environment, patients less likely to resume their work after suffering a myocardial infarction are older, working in agricultural and industrial areas, with a lower professional level and without known ischemic heart disease antecedents.

[Early discharge in uncomplicated acute myocardial infarction]. / Alta precoz en el infarto agudo de miocardio no complicado.

INTRODUCTION AND OBJECTIVES: The length of hospital stay for uncomplicated myocardial infarction is still a debatable issue. Our study tries to establish the rate of patients amenable early discharged and the safety of this practice. PATIENTS AND METHODS: We studied retrospectively the clinical features, in-hospital events and 30-day follow up of 238 patients discharged early (5 or 6 days) during the last three years. These patients were compared with the remaining group of 929 patients discharged after a conventional stay (mean 10.4 days) in the same time frame. RESULTS: The mean hospital stay in the early discharged group was 5.4 days. They had no ischemic, arrhythmic or haemodynamic complications in the acute phase. In the 30-day follow up there was only one death (at the 14 th post-myocardial infarction day) and 17 readmissions to the hospital, none with re-infarction. By contrast, there were 14 deaths and 43 readmissions among the patients with the standard stay at the hospital. CONCLUSIONS: At least 20% of patients with uncomplicated myocardial infarction can be discharged early. This practice seems to be safe in low risk groups, and is not associated with a higher rate of complications when compared with longer hospital stays.

[Early thrombosis of aortic porcine bioprosthesis]. / Trombosis precoz de bioprótesis porcina en posición aórtica.

A case of thrombosis on an aortic bioprosthesis after the fourth month of implantation is presented. The patient had been well anticoagulated for the first three months after surgery. A suspicious diagnosis was made when the patient started with symptoms of cardiac failure and angina and an Echo-Doppler showed a significant transvalvular gradient. The definitive diagnosis will be determined with the removal of the valve at surgery. Although this is a rarity as an early complication, it should be kept in mind in such cases. Surgical intervention is mandatory and life-saving.

[Electrocardiographic differentiation between lesions of the right coronary artery and circumflex artery in acute inferior myocardial infarction]. / Diferenciación electrocardiográfica entre la lesión de la arteria coronaria derecha y circunfleja en el infarto agudo de miocardio inferior.

INTRODUCTION AND OBJECTIVES: The objective of this prospective study is to analyze the value of the standard electrocardiogram in the identification of the lesioned coronary artery in the inferior acute myocardial infarction. METHODS: One-hundred consecutive patients with inferior acute myocardial infarction were studied, 67 with lesion in the right coronary artery and 33 in the circumflex artery. The ST segment changes in inferior, lateral and precordial leads were analized, as was the ST segment relation between the DII and DIII. The arithmetic sum of the ST segment in the inferior and V2 leads (II+V2, III+V2 and aVF+V2). RESULTS: This study shows that the most useful parameters to predict the lesioned coronary artery in the inferior acute myocardial infarction, with specificity and positive predictive value of 100% are: a) the arithmetic sum of the ST segment: aVF+V2 > 0, with a sensibility of 86.5%, for the right coronary artery; b) the arithmetic sum of the ST segment: III+V2 < 0, with a sensibility of 90.9%, for the circumflex artery, and c) the arithmetic sum of the ST segment: aVF+V2 > 1, with a sensibility of 97.6%, for the proximal right coronary artery. Other useful predicting parameters, with specificity of 100%, although with a lower sensibility, are: a) ST segment elevation in I and ST segment in II > III, for the circumflex artery, and b) ST segment elevation in V1-V3 for the lesion in the proximal right coronary artery. CONCLUSIONS: These findings demonstrate that the standard electrocardiogram represents an important tool in predicting the lesioned coronary artery, right coronary and circumflex artery, in the acute myocardial infarction, with a sensibility and specificity between 86.5% and 100%, respectively, which are within the published range of the traditionally used right thoracic leads.

[Angina pectoris. The concept and its classification. The Angina Pectoris Study Group of the Ischemic Cardiopathy Section and Coronary Units of the Spanish Society of Cardiology]. / Angina de pecho. Concepto y clasificación. Grupo de Estudio de Angina de Pecho de la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología.

Angina pectoris is one of the most important manifestation of coronary artery disease. In this review, the Ischemic Cardiopathy and Coronary Units Group defines the Spanish Society of Cardiology policy concerning angina pectoris definition and classification.

[Depression and elevation of the ST segment in the V4R lead during the stress test of a patient with a proximal lesion of the right coronary artery]. / Descenso y elevación del segmento ST en la derivación V4R durante la prueba de esfuerzo de un paciente con lesión proximal de la arteria coronaria derecha.

We report a patient with a proximal right coronary artery lesion in whom opposite shifts of ST segment in V4R lead were observed during and after exercise. ST-segment depression was provoked by exercise, while ST-segment elevation appeared in the recovery phase. We speculate that different degrees of myocardial ischemia (non-transmural vs transmural) may explain this apparently paradoxical response.