Prognostic impact of atrial fibrillation in acute coronary syndromes: results from the ARIAM registry.

AIMS: The prognostic ability of atrial fibrillation (AF) in acute coronary syndromes (ACS) is unclear. Studies regarding patient outcomes with respect to the timing of AF are scarce and conflicting. The present study aimed to determine the frequency, predictors and impact on clinical outcome of AF in patients with ACS. METHODS: We analysed 39,237 consecutive patients with ACS included in the ARIAM registry between January /2001 and December 2011. Patients with AF were compared with patients in sinus rhythm. We differentiate between new-onset AF and previous AF cases to analyse mortality and other major adverse cardiac events (MACE) during hospitalization. RESULTS: Of the patients, 2851 (7.3%) developed AF; 1568 (55%) of these were new-onset AF and 1283 (45%) had previous AF. The AF group had a higher risk profile at baseline and poorer clinical presentation at admission than non-AF patients. Compared with previous AF patients, new-onset AF presented with fewer comorbidities, including hypertension, diabetes, prior myocardial infarction, and chronic renal impairment. The inhospital mortality for new-onset AF, previous AF, and non-AF patients were 14, 11.6, and 5.2%, respectively (new-onset AF unadjusted HR 2.19, 95% CI 1.9-2.53, p<0.001; adjusted HR 1.70, 95% CI 1.12-3.4, p<0.001). After propensity score analysis, only new-onset AF persisted as an independent predictor for mortality (HR 1.62, 95% CI 1.09-2.89, p<0.001). Other MACE such as reinfarction, malignant arrhythmias, and heart failure were also more frequent in new-onset AF patients than in previous AF or non-AF patients. CONCLUSIONS: These findings suggest that the presence of new-onset AF during ACS is associated with a significant increase in mortality, even after adjusting for confounding variables.

Tabaco y corazón. Programas actuales del control del hábito / Smoking and the heart. Current smoking cessation programs

El consumo de tabaco es la principal causa aislada de morbilidad y de mortalidad prematuras prevenibles en países desarrollados. Este consumo se ha asociado con un importante aumento del riesgo de infarto por tres mecanismos principales: 1) la formación de carboxihemoglobina, el aumento del hematocrito y de la viscosidad sanguínea que produce el monóxido de carbono; 2) la acción de la nicotina que produce liberación de adrenalina y noradrenalina, y 3) la absorción de gran cantidad de los radicales libres, implicados en gran cantidad de mecanismos protrombóticos y aterogénicos. Por esto, la lucha agresiva contra el tabaco ha demostrado un efecto prácticamente inmediato sobre la salud de la población. Afortunadamente contamos con un amplio abanico de intervenciones eficaces para el abandono del consumo del tabaco, que puede incrementar la posibilidad de éxito hasta un 30%: el consejo mínimo o intervención breve, el tratamiento psicológico y el tratamiento farmacológico (AU)

Smoking is the main isolated cause of preventable premature morbidity and mortality in developed countries. Smoking has been associated with a substantial rise in the risk of infarction through three main mechanisms: 1) the formation of carboxyhemoglobin and increase in hematocrit and blood viscosity, which produce carbon monoxide; 2) the action of nicotine, which releases adrenaline and noradrenaline, and 3) the absorption of a large amount of free radicals, which are involved in many prothrombotic and atherogenic mechanisms. Therefore, the offensive against smoking has produced an almost immediate effect on the population's health. Fortunately, there is a wide spectrum of effective interventions for smoking cessation, which can increase the possibility of success by up to 30%: minimal advice or brief intervention, psychological treatment and drug therapy (AU)

Current indications for infective endocarditis antibiotic prophylaxis.

Indications of endocarditis prophylaxis have changed in the past years, because of the absence of any evidence that justified its use. The last guidelines only recommend prophylaxis in patients with underlying cardiac conditions with the higher risk of adverse outcomes, including patients with a previous history of infective endocarditis, patients with prosthetic heart valve or prosthetic material used for valve repair, patients with a valvulopathy after cardiac transplantation, and patients with an specific congenital heart disease. The list of procedures in which prophylaxis is necessary has been limited too. Nowadays it is recommended in patients who undergo any dental procedure that involves the gingival tissues or periapical region of a tooth and for those invasive procedures of the oral cavity or an invasive procedure of the respiratory tract that involves incision or biopsy of the respiratory mucosa. In this revision we try to expose the recent tendencies recommended by the international guidelines.