Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction.

OBJECTIVE: To determine the impact of the attention given by emergency medical services teams working in mobile intensive care units (MICU) versus patients arriving at the hospital under their own means with ST-elevation myocardial infarction (STEMI) event in terms of time to reperfusion (TR), mortality at 30 days and six months. METHODS: We retrospectively studied 634 consecutive patients with STEMI who underwent primary a percutaneous coronary intervention from January 1st 2015 to December 31st 2018 in a single centre. Depending on the first medical contact patients were classified into two groups, MICU versus walk-in patients. We extracted data on patients' characteristics, symptoms, treatments, times to reperfusion and mortality. RESULTS: In our study 634 patients were included, of whom 59.0% were initially attended by the MICU. Differences were seen between the two groups in time delays to the first medical contact (120.0 vs 63.0 min; p < 0.001) and TR (208.0 Vs 150.0 min; p < 0.001). Patients attended by the MICUs presented a shorter ICU and hospital stay. The lowest 30-day mortality rate was observed in MICU group: 9.0% in contrast with 4.5%, p = 0.03; remaining after 6 months. The multivariable analysis showed that the initial attention given by MICU to STEMI patients was a protective agent against mortality [OR: 0.32 (0.11-0.90); p = 0.03]. CONCLUSION: Initial attention of the patients with STEMI by doctor-on-board-MICU and available 24 h a day 7 days a week as part of a regional network (CORECAM), was associated with a decrease in the ischemia time, hospital stay and mortality of these patients in our environment.

Kounis Syndrome During Anesthesia: Presentation of Indolent Systemic Mastocytosis: A Case Report.

Mastocytosis comprises a heterogeneous group of disorders characterized by mast cell accumulation and proliferation in distinct organs. Kounis syndrome is defined as the concurrence of acute coronary syndromes with mast cell activation in a setting of allergic or hypersensitivity reactions. This is the first reported case of an intraoperative Kounis syndrome as the onset of an indolent systemic mastocytosis probably triggered by succinylated gelatin infusion during general anesthesia. The presentation of this case is intended to contribute to the knowledge of mastocytosis and Kounis syndrome at the time of diagnostic workup during intraoperative anaphylaxis or myocardial ischemia.

Fibrilación auricular no valvular: el problema de una definición indefinida / Nonvalvular atrial fibrillation: the problem of an undefined definition

No disponible

Paciente anciano portador de marcapasos: características y evolución en función del tipo de dispositivo empleado / Pacemakers in the elderly. Characteristics and outcomes according to the type of device used

Objetivo: describir las características de un grupo de pacientes ancianos portadores de marcapasos, en términos de evolución clínica, funcional y mortalidad en los 4 años posteriores a la implantación en función del tipo de dispositivo implantado. Material y métodos: estudio retrospectivo de mayores de 75 años a los que se había implantado un marcapasos mediante revisión de las historias clínicas. Evaluación de antecedentes personales, medicación empleada, presentación clínica y electrocardiográfica, situación funcional (escalas de Cruz Roja Física [CRF] y Cruz Roja Mental [CRM]) y complicaciones. Se realizó una entrevista telefónica, 4 años después de la implantación del marcapasos, con datos funcionales, morbilidad y mortalidad. En el análisis estadístico se compararon las medias y proporciones y se realizó una regresión logística con un intervalo de confianza (IC) del 95% (p 0,05). La situación física y cognitiva al final del estudio no mostró diferencias significativas entre ambos grupos. Fallecieron 47 pacientes (37,6% de 125 casos). La mortalidad en el grupo de pacientes con dispositivo de doble cámara fue inferior a la del grupo con unicameral (p < 0,01), pero estos pacientes eran también más jóvenes (p < 0,01); esta diferencia se mantuvo en el análisis de regresión logística. Conclusiones: en los ancianos de esta muestra, con síncope y bloqueo auriculoventricular de alto grado, se eligió un marcapasos unicameral con mayor frecuencia. Los bicamerales asociaron a una menor mortalidad y a menos eventos cardiovasculares en el seguimiento, aunque sin diferencias estadísticamente significativas

Objective: the objectives of this study were two-fold: a) to describe the characteristics of a group of elderly patients with pacemakers, and b) to evaluate clinical and functional outcomes and mortality in these patients according to the type of device implanted during a 4-year follow-up. Material and methods: retrospective study of patients over 75 with a pacemaker performed through a review of medical records. Previous diseases, medications, clinical and electrocardiographic findings, and functional data (the functional and mental evaluation scales of the Spanish Red Cross [CRF, CRM]), were evaluated. To gather data on functional outcomes, morbidity and mortality, telephone interviews were conducted 4 years after pacemaker implantation. Statistical analysis consisted of comparison of means and proportions and logistic regression analysis with 95% confidence intervals (p.05). Functional and cognitive status at the end of the study showed no statistically significant differences between the two groups. Of 125 patients, 47 (37.6%) died. Mortality was lower in patients with dual-chamber devices than in the single-chamber group (P<.01) but patients in the former group were younger (P<.01). This difference was maintained in the logistic regression analysis. Conclusions: In our sample of elderly patients with syncope and high-grade atrioventricular blockade, there was a tendency to implant single-chamber pacemakers. Dual-chamber devices were associated with lower mortality and fewer cardiovascular events during follow-up, although no statistically significant differences were found