Prevención de la enfermedad cardiovascular en atención primaria: comparación de la función SCORE para países europeos de bajo riesgo con la tabla calibrada para España / Prevention of cardiovascular disease in primary care: a comparison of the function SCORE for low risk European countries with the calibrated SCORE for Spain

Introducción. Estudio comparativo de 2 ecuaciones de valoración del riesgo de mortalidad cardiovascular (RCV): función SCORE para países europeos de bajo riesgo y función SCORE calibrada para España, para conocer el perfil de riesgo de los pacientes de nuestro centro de salud y valorar las diferencias entre ambos métodos. Material y métodos. Estudio descriptivo transversal, de un cupo de pacientes de un centro de salud, seleccionándose los de edades comprendidas entre los 35-74 años y sin evento cardiovascular (n=398 pacientes). Se calculó el RCV mediante las 2 ecuaciones, se evaluaron las diferencias de clasificación obtenidas con ambas tablas de manera continua y la distribución de pacientes en cada grupo de riesgo. Resultados. La muestra estudiada presenta un perfil global de RCV bajo. Ambos métodos de estimación de riesgo presentaron una buena correlación (coeficiente de Pearson de 0,975, p<0,001). El RCV promedio estimado por la función SCORE calibrada para España fue superior al RCV estimado por la función SCORE europea (2,04 frente a 1,46%, p<0,001). El SCORE calibrado para España clasificó con un riesgo alto (mortalidad ≥ 5% en 10 años) al 12,9% de los pacientes (frente al 7% del SCORE europeo de países de bajo riesgo). Conclusiones. Aunque ambos métodos de estimación de RCV presentan buena correlación, el SCORE calibrado para España clasifica a los pacientes con un RCV un 28% superior al SCORE europeo. Deben realizarse más estudios de poblaciones locales para una correcta estimación del RCV (AU)

Introduction. This is a comparative Study of two cardiovascular risk (CVR) functions; the SCORE for European countries of low risk and the calibrated SCORE for Spain and the objective is to determine the risk profile and evaluate the differences between both methods. Material and methods. This is a descriptive cross-sectional study of a group of patients in our healthcare area. We selected those with ages between 35-74 years and without any previous cardiovascular event (n=398 patients). The CVR was calculated by both equations, evaluating the differences of classification obtained with both methods. Results. The studied sample had a low CVR profile. Both methods of estimation of risk correlated well (Pearson's coefficient of 0.975, P<.001). The average CVR estimated by the function SCORE calibrated for Spain was higher than the CVR estimated by the European SCORE (2.04 vs. 1.46%, P<.001). The Spanish calibrated SCORE predicted a high risk (mortality risk ≥5% in 10 years) for 12.9% of the patients (vs. 7% of the European SCORE). Conclusions. Although both methods of CVR estimation had a good correlation, the calibrated SCORE for Spain obtained a CVR 28% higher than the European SCORE. More studies of local populations must be performed for a correct estimation of the CVR (AU)

Endocarditis precoz sobre catéter endovenoso central / No disponible

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Acute myocardial infarction caused by paradoxical tumorous embolism as a manifestation of hepatocarcinoma.

A 71 year old patient presented with a non-ST segment elevation acute myocardial infarction. The echocardiogram showed several masses attached to the interatrial septum. Several days after admission the patient died. A postmortem examination found a large hepatocarcinoma with intravascular and intracardiac metastases and several myocardial infarctions of different ages. The infarctions had been caused by coronary paradoxical embolisms through a patent foramen ovale and contained neoplastic cells from the liver carcinoma, which had not been diagnosed. The cause of death was a massive pulmonary embolism.

Pulmonary embolism after pacemaker implantation.

One day after implantation of a permanent pacemaker in an 82-year-old man, transthoracic echocardiography showed a mass in the right ventricle and a small pericardial effusion. Transesophageal echocardiography revealed a mass attached to the pacemaker lead. Subcutaneous administration of enoxaparin was begun, and the patient remained free of symptoms for the duration of his hospital stay Follow-up echocardiography performed before discharge failed to show the right ventricular mass, but a lung perfusion scan revealed multiple bilateral perfusion defects consistent with pulmonary emboli. The patient was discharged on a regimen of enoxaparin for another 30 days. Two years later, he remained asymptomatic.