Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction. / Impacto del sexo en los tiempos de cateterismo y en el uso de pretratamiento antiagregante plaquetario en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST).

OBJECTIVES: To assess differences in the clinical management of nonST-segment elevation myocardial infarction (NSTEMI), including in-hospital events, according to biological sex. MATERIAL AND METHODS: Prospective observational multicenter study of patients diagnosed with NSTEMI and atherosclerosis who underwent coronary angiography. RESULTS: We enrolled 1020 patients in April and May 2022; 240 (23.5%) were women. Women were older than men on average (72.6 vs 66.5 years, P .001), and more women were frail (17.1% vs 5.6%, P .001). No difference was observed in pretreatment with any P2Y12 inhibitor (prescribed in 68.8% of women vs 70.2% of men, P = .67); however, more women than men were prescribed clopidogrel (56% vs 44%, P = .009). Women prescribed clopidogrel were more often under the age of 75 years and not frail. Coronary angiography was performed within 24 hours less corooften in women (29.8% vs 36.9%, P = .03) even when high risk was recognized. Frailty was independently associated with deferring coronary angiography in the adjusted analysis; biological sex by itself was not related. The frequency and type of revascularization were the same in both sexes, and there were no differences in in-hospital cardiovascular events. CONCLUSION: Women were more often prescribed less potent antithrombotic therapy than men. Frailty, but not sex, correlated independently with deferral of coronary angiography. However, we detected no differences in the frequency of coronary revascularization or in-hospital events according to sex.

OBJETIVO: Evaluar las diferencias en el manejo clínico y eventos intrahospitalarios en una cohorte de pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) en función del sexo. METODO: Estudio observacional, prospectivo y multicéntrico que incluyó pacientes consecutivos con diagnóstico de SCASEST sometidos a coronariografía con enfermedad ateroesclerótica responsable. RESULTADOS: Entre abril y mayo de 2022 se incluyeron 1.020 pacientes; de ellos, 240 eran mujeres (23,5%). En comparación con los hombres, las mujeres fueron mayores (72,6 años vs 66,5 años; p 0,001) y más frágiles (17,1% vs 5,6%; p 0,001). No hubo diferencias en el pretratamiento con un inhibidor del receptor P2Y12 (68,8% vs 70,2%, p = 0,67), aunque las mujeres recibieron más pretratamiento con clopidogrel (56% vs 44%, p = 0,009), principalmente aquellas de edad 75 años y sin fragilidad. En las mujeres se realizaron menos coronariografías precoces (# 24 h) (29,8% vs 36,9%; p = 0,03) a pesar de presentar la misma indicación (criterios de alto riesgo). En el análisis ajustado, la fragilidad, pero no el sexo, se asoció de forma independiente con la realización de una coronariografía diferida. La tasa y el tipo de revascularización fue igual en ambos sexos, y no hubo diferencias en los eventos cardiovasculares intrahospitalarios. CONCLUSIONES: Las mujeres recibieron con mayor frecuencia un tratamiento antitrombótico menos potente. La fragilidad y no el sexo se asoció con la realización de coronariografía diferida. Sin embargo, no hubo diferencias en la tasa de revascularización coronaria ni en los eventos intrahospitalarios en función del sexo.

Atrial fibrillation de novo in acute coronary syndrome.

One of the complications during an acute coronary syndrome event is the presence of arrhythmias. Among them, those of the supraventricular type, especially atrial fibrillation, carry a poor prognosis both in the short and long term, being the cause of situations such as cerebrovascular event, ventricular arrhythmias, and increased mortality. The arrhythmia tends to appear in a certain population group with particular risk factors during the index event in approximately 10% of cases. Appropriate treatment at the time of its onset, thanks to the use of drugs that modulate heart rate, rhythm, and anticoagulant management in the most vulnerable groups, will lead to a less bleak outcome for these patients.

Una de las complicaciones durante un evento de síndrome coronario agudo es la presencia de arritmias. Dentro de ellas, las de tipo supraventricular, en especial fibrilación auricular, acarrea un mal pronóstico tanto a corto como a largo plazo y es la causa de situaciones como evento vascular cerebral, arritmias ventriculares y aumento de la mortalidad. Dicha arritmia tiende a aparecer en cierto grupo de población con particulares factores de riesgo durante el evento índice en aproximadamente 10% de los casos. Un tratamiento apropiado en el momento de su aparición, gracias al uso de fármacos que modulan la frecuencia cardiaca, el ritmo y el manejo anticoagulante en los grupos más vulnerables conllevará un desenlace menos sombrío para estos pacientes.

Tratamiento de la depresión comórbida después de un síndrome coronario agudo: metaanálisis de ensayos controlados aleatorizados / Treatment of comorbid depression after acute coronary syndrome: meta-analysis of randomized controlled trials

La depresión postsíndrome coronario agudo (post-SCA) aumenta el riesgo cardíaco; sin embargo, la eficacia de las terapias antidepresivas para su tratamiento no está suficientemente demostrada. Nuestro objetivo es metaanalizar ensayos controlados con muestras homogéneas que permitan explicar la inconsistencia de los resultados obtenidos hasta el momento. Tras revisar 1525 artículos, dos revisores independientes identificaron 7 estudios que cumplían criterios muy restrictivos para asegurar la homogeneidad de las muestras. Los resultados indicaron que los pacientes tratados con intervenciones de eficacia demostrada para la depresión reducen sus niveles de trastorno depresivo significativamente más que los sujetos sin este tratamiento, y que existen diferencias significativas en el número de pacientes que reducen los síntomas depresivos de forma clínicamente relevante. Además, se observaron menos eventos cardiovasculares adversos durante el tratamiento, aunque esta diferencia fue mínimamente significativa y no se mantuvo tras el seguimiento. Estos resultados sugieren que la inconsistencia de los datos actualmente disponibles podría deberse a dificultades metodológicas que evidencian la necesidad de nuevas investigaciones que aclaren el efecto del tratamiento de la depresión sobre el pronóstico post-SCA.(AU)

Depression post-acute coronary syndrome (ACS) increases the cardiac risk;however, the efficacy of antidepressant therapies for its treatment has not beensufficiently demonstrated. Our aim is to meta-analyze controlled trials withhomogeneous samples that allow us to explain the inconsistency of the resultsobtained so far. After reviewing 1525 articles, two independent reviewersidentified 7 studies that met very restrictive criteria to ensure homogeneity of thesamples. The results indicated that patients treated with interventions of provenefficacy for the depression, reduce their levels of depressive disorder significantlymore than subjects without this treatment and that there are significantdifferences in the number of patients who reduce depressive symptoms in clinically relevant way. In addition, fewer adverse cardiovascular events wereobserved during treatment, although this difference was minimally significant andwas not maintained after the follow-up. These results suggest that theinconsistency of the currently available data could be due to methodologicaldifficulties evidencing the need for further research to clarify the effect ofdepression treatment on post-ACS prognosis.K EY WORDS : coronary heart disease, acute coronary syndrome, depressiontreatment, meta-analysis.(AU)

Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain.

INTRODUCTION AND OBJECTIVES: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. METHODS: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. RESULTS: Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). CONCLUSIONS: In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Safety of helicopter transport in patients with acute coronary syndrome.

BACKGROUND: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. OBJETIVES: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. METHODS: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. RESULTS: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. CONCLUSIONS: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.

ANTECEDENTES: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. OBJETIVOS: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. MÉTODOS: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. RESULTADOS: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. CONCLUSIONES: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.

Tiempos de cateterismo y uso de pretratamiento antiagregante plaquetario en pacientes con SCASEST en España / Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain

Introducción y objetivos El momento óptimo para un cateterismo en el síndrome coronario agudo sin elevación del segmento ST (SCASEST) y la necesidad de pretratamiento son motivo de controversia. El objetivo principal del registro IMPACT-TIMING-GO es conocer el porcentaje de pacientes examinados con una coronariografía precoz (0-24 h) y que no recibieron doble antiagregación plaquetaria antes del cateterismo (estrategia sin pretratamiento) en España. Métodos Estudio observacional, prospectivo y multicéntrico, que incluyó a pacientes consecutivos con diagnóstico de SCASEST sometidos a cateterismo en los que se evidenció enfermedad coronaria ateroesclerótica causal. Resultados Entre abril y mayo de 2022 se incluyó a 1.021 pacientes (media de edad, 67±12 años; el 23,6% mujeres). El 86,8% de los pacientes cumplían criterios de alto riesgo (elevación de troponina, cambios electrocardiográficos o puntuación GRACE>140); sin embargo, únicamente el 37,8% se sometió a una estrategia invasiva precoz, y el 30,3% no recibió pretratamiento. Globalmente, solo el 13,6% de los pacientes se sometieron a una estrategia invasiva precoz sin un segundo antiagregante plaquetario, y la estrategia diferida con pretratamiento fue la más utilizada (46%). Durante el ingreso, 9 pacientes (0,9%) fallecieron y 34 (3,3%) presentaron una hemorragia grave. Conclusiones En España, solo el 13,6% de los pacientes con SCASEST sometidos a cateterismo reciben una estrategia invasiva precoz sin pretratamiento. La incidencia de eventos cardiovasculares y hemorragias graves en el ingreso es baja. (AU)

Introduction and objectives The optimal timing of coronary angiography in patients admitted with non–ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. Methods This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. Results Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). Conclusions In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low. (AU)

Falta de adherencia a ticagrelor frente a clopidogrel y riesgo de eventos en pacientes con SCA. Resultados del registro CREA-ARIAM / Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry

Introduction and objectives Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). Methods We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. Results Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,−0.99-1.24). Conclusions In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor (AU)

Introducción y objetivos Una baja adherencia al tratamiento antiagregante plaquetario doble (TAPD) condiciona peor pronóstico tras un síndrome coronario agudo (SCA). Se analizó si el riesgo de eventos adversos cardiovasculares mayores (MACE) tras la interrupción prematura del TAPD varía según el inhibidor del P2Y12. Métodos Análisis preespecificado de pacientes con SCA tratados con ticagrelor o clopidogrel entre 2015 y 2019 dentro de un registro prospectivo multicéntrico. Se categorizó la suspensión prematura como indicada por el médico o como interrupción por hemorragia, efectos secundarios o incumplimiento del paciente. La asociación entre la suspensión del TAPD y los MACE se analizó mediante modelos multivariantes de Cox dependientes del tiempo, con estimadores robustos ponderados por probabilidad inversa de censura. Resultados De 2.180 pacientes, 174 (8,3%) suspendieron el TAPD precozmente (126 por indicación médica y 48 por disrupción). Los pacientes incumplidores tenían más edad y más comorbilidad que los adherentes. Frente a la suspensión indicada por el médico, la disrupción del TAPD fue más precoz y frecuente con el ticagrelor que con el clopidogrel. La suspensión del TAPD condicionó mayor riesgo de MACE (HRajustada=1,32; IC95%, 1,10-1,76), principalmente en caso de la disrupción (HRajustada=1,47; IC95%, 1,22-1,73). Este riesgo aumentó exponencialmente en los 90 días posteriores al SCA y fue más evidente con ticagrelor (pinteracción<0,001). Tras considerar la duración del TAPD, esta interacción no resultó significativa en la escala aditiva (exceso de riesgo debido a interacción=0,12; IC95%, –0,99 a 1,24)(AU)

Cognitive predictors and decision-making in the experience of coronary syndrome symptoms.

OBJECTIVE: To determine the predictive value of Cognitive Assessment, Symptom Severity, Personal Control and Self-Efficacy on decision making in the experience of Acute Coronary Syndrome symptoms. METHOD: Quantitative study of cross-sectional analytical design, a probabilistic sampling was carried out for 256 participants diagnosed with coronary syndrome in three health institutions. The effects between the independent variables Cognitive Assessment, Symptom Severity, Personal Control, Self-Efficacy and the dependent Decision-Making were analyzed. Using inferential statistics, a Generalized Linear Regression Model was carried out, which allowed establishing the causal relationships between the variables. RESULTS: Two predictive models were obtained between decision making and cognitive evaluation, in which personal control, severity of symptoms, sex and context were significant. Self-efficacy was not reported as a predictor variable. The values ​​of the independent variables showed a behavior directly proportional to the Decision Making score. CONCLUSION: A verification of the conceptual model for the management of symptoms was carried out.

Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry.

INTRODUCTION AND OBJECTIVES: Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). METHODS: We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. RESULTS: Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,-0.99-1.24). CONCLUSIONS: In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor. Clinical trial registered at ClinicalTrials.gov (Identifier: NCT02500290).

Ceftriaxone-induced Kounis syndrome: A case report and review of the literature.

Kounis syndrome is defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults, and is also called allergic angina and allergic myocardial infarction. We report a case of pre-operative ceftriaxone-induced Kounis syndrome with no evident dermatological manifestation, and describe our diagnostic dilemma. The patient was symptomatically managed and discharged in stable condition with a warning against future use of ceftriaxone.

Sirolimus-coated balloon in acute and chronic coronary syndromes: subanalysis of the EASTBOURNE registry.

INTRODUCTION AND OBJECTIVES: The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). METHODS: This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events. RESULTS: Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure. CONCLUSIONS: This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.

Eficacia de un programa de rehabilitación cardiaca en polideportivo municipal comparado con el programa hospitalario: ensayo controlado aleatorizado eCARCEX / Efficacy of a cardiac rehabilitation program in a municipal sports center compared to the hospital program: randomized controlled trial eCARCEX

Fundamento. El objetivo de este estudio es analizar los efectos de un programa de rehabilitación cardiaca (PRC) extrahospitalario en un centro municipal deportivo sobre la capacidad funcional y la adherencia al ejercicio físico, entre otras variables, en comparación con un modelo hospitalario. Métodos. Ensayo clínico aleatorizado con dos grupos paralelos de pacientes con síndrome coronario agudo que realizaron un PRC con ejercicio físico moderado interválico coordinado con educación en hábitos saludables en un centro deportivo municipal (GE) y en un hospital terciario (GC), entre septiembre de 2019 y junio de 2020. Se analizaron variables de adherencia, antropométricas, clínicas, psicológicas, de fuerza, de prevención secundaria (dieta, tabaco) y capacidad funcional en la prueba de ergoespirometría. Resultados. Veintidós pacientes completaron el PRC (GC=10, GE=12). Se observaron mejoras significativas pre-post en GC (colesterol, test de la silla, frecuencia cardiaca en VT1 y VT2, y vatios en VT1) y en GE (colesterol HDL, triglicéridos, test de la silla, y frecuencia cardiaca y vatios en VT1). Estas mejoras fueron mayores en el GC para la frecuencia cardiaca en VT2 (11,17 vs 2,88 lpm) y en el GE para el colesterol HDL (11,0 vs 0,63 mg/dL). Conclusiones. Este estudio no ha podido determinar la eficacia de los PRC extrahospitalarios por falta de potencia (abundantes abandonos debidos al confinamiento por COVID-19). A pesar de ello, en el GE se observó mayor aumento en colesterol HDL que en el GC, aunque la frecuencia cardiaca en VT2 fue mayor en el GC (AU)

Background. This study aimed to analyze the effects of an outpa-tient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical activity – among other variables – compared to an in-hospital program.Methods. Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a car-diac rehabilitation program that consisted of moderate physical ex-ercise intervals along with learning healthy habits in a municipal sports center (EG) and in a tertiary hospital (CG) between Septem-ber 2019 and June 2020. We collected the following data: compli-ance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirom-etry. Results. Twenty-two patients completed the cardiac rehabilitation program (EG=12, CG=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the CG, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the EG. Better achievement was found in the CG for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL).Conclusions. We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). How-ever, the EG achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the CG (AU)

IAMCEST en mujeres. Recuperación de la expectativa de vida tras la intervención coronaria percutánea / STEMI in women. Life expectancy recovery after primary percutaneous coronary intervention

Introducción y objetivos: La mortalidad tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) sigue siendo alta a pesar de los avances médicos. Las mujeres están poco representadas en los estudios, lo que limita el conocimiento sobre su tratamiento y su pronóstico. Se desconoce si las mujeres tratadas con intervención coronaria percutánea (ICP) primaria recuperan una esperanza de vida similar a una población de referencia. El objetivo del estudio es determinar si las mujeres sometidas a ICP primaria recuperan una supervivencia similar a la población general de iguales edad y región. Métodos: Se incluyeron todos los IAMCEST desde enero de 2014 a octubre de 2021. Se emparejó la muestra con una población de referencia de iguales edad y región, obtenida del Instituto Nacional de Estadística. Se determinaron las supervivencias observada y esperada y el exceso de mortalidad (EM) mediante el método Ederer II. Se repitió el análisis para mujeres de edad ≤ 65 y> 65 años. Resultados: Se reclutó a 2.194 personas; 528 casos eran mujeres (23,9%). Entre las mujeres que sobrevivieron los primeros 30 días, los EM del 1.er, el 5.o y el 7.o año fueron del 1,6% (IC95%, 0,3-4), el 4,7% (IC95%, 0,3-10,1) y el 7,21% (IC95%, 0,5-15,1) respectivamente. Conclusiones: Las mujeres con un IAMCEST tratadas con ICP primaria que sobreviven al evento agudo reducen significativamente su EM y presentan una esperanza de vida similar a la de la población de referencia de iguales edad y región.(AU)

Introduction and objectives: Despite medical advances, mortality after ST-elevation myocardial infarction (STEMI) remains high. Women are often underrepresented in trials and registries, limiting knowledge of their management and prognosis. It is unknown whether life expectancy in women of all ages treated with primary percutaneous coronary intervention (PPCI) is similar to that in a reference population free of the disease. The main objective of this study was to determine whether life expectancy in women undergoing PPCI and surviving the main event returns to a similar level to that in the general population of the same age and region. Methods: We included all patients diagnosed with STEMI from January 2014 to October 2021. We matched women to a reference population of the same age and region from the National Institute of Statistics to determine observed survival, expected survival, and excess mortality (EM) using the Ederer II method. We repeated the analysis in women aged ≤ 65 and> 65 years. Results: A total of 2194 patients were recruited, of whom 528 were women (23.9%). In women surviving the first 30 days, EM at 1, 5 and 7 years was 1.6% (95%CI, 0.3-4), 4.7% (95%CI, 0.3-10.1), and 7.2% (95%CI, 0.5-15.1), respectively. Conclusions: EM was reduced in women with STEMI who were treated with PPCI and who survived the main event. However, life expectancy remained lower than that in a reference population of the same age and region.(AU)

¿El pretratamiento en los SCASEST recomendado por las guías es lo que refleja el mundo real? / Is the NSTEACS pretreatment recommended by the guidelines what reflects the real world?

Resumen El momento adecuado para la administración de los inhibidores P2Y12 en pacientes con síndrome coronario agudo sin elevación del segmento ST es tema de debate desde hace dos décadas. Las recomendaciones actuales de las guías europeas sugieren administrar ácido acetilsalicílico y aguardar el momento de la cinecoronariografía, y una vez conocida la anatomía agregar un inhibidor P2Y12 solo en aquellos casos en que se programe una estrategia intervencionista precoz. Sin embargo, en el mundo real la estrategia de realizar o no pretratamiento es más compleja. Existe la incertidumbre respecto a que el paciente pueda acceder o no a una cinecoronariografía dentro de las 24 horas. En este escenario, el pretratamiento al ingreso de un paciente de riesgo intermedio o alto podría ser una opción si no va a ser estudiado con cateterismo dentro de las 2 a 4 horas del ingreso, analizando previamente el riesgo isquémico y de sangrado del paciente. Aún faltan estudios a gran escala que comparen estas dos opciones.

Abstract The appropriate time for the administration of P2Y12 inhibitors in patients with non-ST elevation acute coronary syndrome has been the subject of debate for two decades. The current recommendations of the European guidelines suggest administering acetylsalicylic acid and waiting for the coronary angiography and once the anatomy is known, adding a P2Y12 inhibitor only in those cases in which an early interventional strategy is scheduled. However, in the real world, the strategy to perform pretreatment or not is more complex. There is uncertainty regarding whether the patient can access a coronary angiography within 24 hours. In this scenario, pretreatment upon admission of intermediate or high-risk patients could be an option if it is not studied with catheterization within 2 to 4 hours of admission, previously analyzing the patient's ischemic and bleeding risk. Large-scale studies comparing these two options are still lacking.

Predicción de riesgo cardiovascular y periodontitis en pacientes con síndrome coronario agudo, Holguín 2020

Introducción : La predicción del riesgo cardiovascular favorece la prevención de eventos cardiovasculares. Objetivo : Estimar el riesgo cardiovascular y determinar la condición periodontal de pacientes con síndrome coronario agudo. Método : Se realizó un estudio transversal en 60 sujetos admitidos en la Unidad de Cuidados Coronarios del Hospital Provincial Vladimir Ilich Lenin, con diagnóstico de síndrome coronario agudo, que a su vez cumplieron con los criterios de inclusión. Se tuvieron en cuenta los principios de ética médica, se empleó el índice Periodontal de Russell y se determinó el riesgo cardiovascular según las Tablas de Predicción de Riesgo Cardiovascular aprobadas para Cuba. Se evaluaron las variables incluidas en dichas tablas. Resultados : El infarto agudo de miocardio se presentó en el 58,3 %. El 55,0 % eran del sexo masculino, 35,0 % se encontraban en el grupo de edad de 55 a 64 años. En relación con la condición periodontal, el 76,7 % presentó periodontitis. Según los factores de riesgo explorados la adicción tabáquica estuvo presente en el 71,7 % y la hipertensión arterial en el 65,0 % de los sujetos. El 25,0 % de los pacientes con riesgo cardiovascular bajo presentaba periodontitis. Conclusiones : Según las tablas de predicción de riesgo cardiovascular empleadas, más de la mitad de los pacientes con síndrome coronario agudo presentaron riesgo cardiovascular bajo o moderado, sin embargo, la mayoría de estos presentaban periodontitis.

Introduction : Prediction of cardiovascular risk favors prevention of cardiovascular events. Objective : To estimate cardiovascular risk and determine the periodontal condition of patients with acute coronary syndrome. Methods : A cross-sectional study was carried out with 60 subjects admitted to the coronary care unit at Hospital General Docente Vladimir Ilich Lenin, with a diagnosis of acute coronary syndrome and, in turn, meeting with the inclusion criteria. The principles of medical ethics were taken into account, the Russell's Periodontal Index was used, and cardiovascular risk was determined according to the cardiovascular risk prediction tables approved for Cuba. The variables included in these tables were evaluated. Results : Acute myocardial infarction occurred in 58.3 % of the patients. 55.0 % were male, and 35.0 % were in the age group 55-64 years. Regarding their periodontal condition, 76.7 % presented periodontitis. According to the explored risk factors, tobacco addiction was present in 71.7 %, while arterial hypertension was present in 65.0 % of the subjects. 25.0 % of the patients with low cardiovascular risk had periodontitis. Conclusions : According to the used cardiovascular risk prediction tables, more than half of the patients with acute coronary syndrome presented low or moderate cardiovascular risk; however, most of these had periodontitis.

[Takotsubo cardiomyopathy associated with abnormal birth of the coronary arteries]. / Miocardiopatía de Takotsubo asociada al nacimiento anómalo de las arterias coronarias.

Background: Takotsubo cardiomyopathy (TM) is a form of non-ischemic cardiomyopathy. It is characterized by transient regional systolic dysfunction of the left ventricle that mimics acute myocardial infarction. The main objective of this article is to report the case of a patient with TM associated with abnormal birth of the left coronary trunk. Clinical case: A 76-year-old woman with typical angina at rest, with an electrocardiogram that showed dynamic changes in the T wave and elevation of biomarkers. Coronary angiography showed epicardial coronary arteries without significant lesions and abnormal birth of the left coronary trunk from the proximal segment of the right coronary artery. The patient progressed favorably, and the transthoracic echocardiogram showed no mobility disorders 3 months after the event. Conclusions: TM and abnormal birth of the coronary arteries are rare diseases whose simultaneous presentation is extraordinary. The diagnosis of both clinical entities is made by coronary angiography and echocardiogram, and their treatment is similar to that of patients with acute coronary syndrome. Abnormal birth of the left coronary trunk with retroaortic switch reaching the contralateral site has a good clinical prognosis and echocardiographic follow-up should be performed 4 weeks after the onset of the condition.

Introducción: la miocardiopatía de Takotsubo (MT) es una forma de miocardiopatía no isquémica. Se caracteriza por la disfunción sistólica regional transitoria del ventrículo izquierdo que imita al infarto agudo de miocardio. El objetivo principal de este artículo es reportar el caso de una paciente con MT asociada al nacimiento anómalo del tronco coronario izquierdo. Caso clínico: paciente mujer de 76 años que presentó angina típica en reposo, con un electrocardiograma que evidenció cambios dinámicos en la onda T y elevación de biomarcadores. La coronariografía evidenció a las arterias coronarias epicárdicas sin lesiones significativas y el nacimiento anómalo del tronco coronario izquierdo proveniente del segmento proximal de la arteria coronaria derecha. La paciente evolucionó de manera favorable y el ecocardiograma transtorácico no mostró trastornos en la movilidad a los tres meses del evento. Conclusiones: la MT y el nacimiento anómalo de las arterias coronarias son enfermedades raras cuya presentación simultánea es extraordinaria. El diagnóstico de ambas entidades clínicas se realiza mediante la coronariografía y el ecocardiograma, y su tratamiento es similar al de los pacientes con síndrome coronario agudo. El nacimiento anómalo del tronco coronario izquierdo con cruce retroaórtico que alcanza el sitio contralateral tiene un buen pronóstico y se debe realizar seguimiento clínico y ecocardiográfico a las cuatro semanas del inicio del padecimiento.

Protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en el diagnóstico del dolor torácico: una revisión sistemática / Accelerated Diagnostic Protocols Based on High-Sensitivity Troponin in the Diagnosis of Thoracic Pain: A Systematic Review

RESUMEN Introducción: Los protocolos de diagnóstico acelerado de dolor torácico, con el avance de la troponina de alta sensibilidad, permiten identificar a los pacientes que ingresan al servicio de urgencias con dolor torácico de bajo riesgo para un evento cardiovascular adverso mayor, que podrían ser dados de alta de forma temprana y segura, con ahorro de tiempo y recursos. Objetivo: Evaluar ensayos clínicos que utilicen protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad. Material y métodos: se realizó una búsqueda de ensayos clínicos aleatorizados que evaluaran protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en los servicios de urgencias, en las bases de datos MEDLINE/Ovid, Cochrane y EMBASE utilizando los criterios de evaluación del manual Cochrane y la estrategia PRISMA Resultados: Tras una tamización de 3509 estudios se incluyeron 5 ensayos clínicos que incluyeron 1513 pacientes; se identificaron 409 (27%) altas tempranas, el 91% para el protocolo 0/3 h ESC, 72% para el 0/1 h, 48% para el EDACS, 40% para el HEART, 19 y 32% para ADAPT y 8 y 18% para el cuidado usual. El valor predictivo negativo fue alto, en un rango de 99,1 al 100% La duración media de la estancia hospitalaria fue más baja para los protocolos 0/1 h y 0/3 h ESC, con 4,6 y 5,6 horas respectivamente. Conclusiones: Los protocolos de diagnóstico acelerado en dolor torácico que implementan el uso de troponina de alta sensibilidad permiten lograr alta proporción de altas tempranas con baja tasa de eventos cardiovasculares mayores, con disminución del tiempo de estancia y recursos consumidos.

ABSTRACT Background: Accelerated diagnostic protocols for chest pain, with the advancement of high-sensitivity troponin, make it possible to identify patients admitted to the emergency department with chest pain and low risk for a major adverse cardiovascular event, who could be discharged immediately, early and safely, saving time and resources. Objective: The aim of this study was to assess clinical trials using accelerated diagnostic protocols based on high-sensitivity troponin. Methods: A search of randomized clinical trials evaluating accelerated diagnostic protocols based on high-sensitivity troponin in emergency services was carried out in MEDLINE/Ovid, Cochrane and EMBASE database, using the assessment criteria of the Cochrane manual and the PRISMA strategy. Results: After screening 3509 studies, 5 clinical trials, including 1513 patients, were analyzed. Early discharges were identified in 409 (27%) of patients, in 91% of cases for ESC 0/3-h protocols, 72% for 0/1-h, 48% for EDACS, 40% for HEART, 19% and 32% for ADAPT and 8% and 18% for standard care protocols. The negative predictive value was high, in the 99.1-100% range. Mean length of hospital stay was lower for the 0/1-h and ESC 0/3-h protocols, with 4.6 and 5.6 hours, respectively. Conclusions: Accelerated diagnostic protocols in chest pain using high-sensitivity troponin allow a higher proportion of early discharges with a low rate of major cardiovascular events, with reduction in length of hospital stay and resources used.

Trastornos del ritmo cardiaco en pacientes con síndrome de Tako-tsubo / Heart rate disorders in patients with Tako-tsubo syndrome

Objetivos El presente estudio pretende evaluar la incidencia, el pronóstico y el tratamiento de los trastornos del ritmo (TdR) en el síndrome de Tako-tsubo (STT). Antecedentes El STT se asocia frecuentemente a TdR. El valor pronóstico de estos TdR aún no está bien caracterizado en el STT. Material y métodos Se analizaron los TdR de los pacientes incluidos en el REgistro nacional multicéntrico sobre síndrome de Tako-tsubo, ingresados entre 2002 y 2018, aportados por 38 hospitales de todo el país. Analizamos en los pacientes TdR previos, en el ingreso y en el seguimiento a largo plazo. Resultados Se describió cualquier tipo de TdR en 259 (23,5%) casos, de una cohorte de 1.097 pacientes consecutivos con STT. Los TdR se presentan más en pacientes con diabetes mellitus, tabaquismo, hiperuricemia, apnea del sueño y anemia, además de con una fracción de eyección del ventrículo izquierdo (FEVI) menor al ingreso. El TdR más frecuente fue el inicio de fibrilación auricular. Durante el ingreso hospitalario, los pacientes con TdR mostraron más complicaciones, como shock al ingreso, hemorragia mayor, insuficiencia renal aguda y el combinado de infecciones. En el seguimiento, presentaron mayor mortalidad y numéricamente más episodios adversos combinados. Conclusiones Los TdR no son infrecuentes en fase aguda del STT. El STT asociado a TdR se presenta con más complicaciones y peor pronóstico tanto hospitalario como a largo plazo (AU)

Objectives This study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS). Background TTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. Methods The HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. Results All types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation. Conclusions The incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term (AU)

Registro de síndromes coronarios agudos en centros de alta complejidad de Argentina. ReSCAR 2022 / Acute Coronary Syndromes in High Complexity Centers of Argentina. The ReSCAR Registry

RESUMEN Introducción : Realizamos un registro multicéntrico para analizar el abordaje diagnóstico y terapéutico de todos los tipos de síndromes coronarios agudos; este registro es el primero en abordar en detalle aquellos cuadros que cursan sin enfermedad coronaria epicárdica significativa. Es importante conocer la realidad del actual accionar médico con el objeto de hallar oportunidades de mejora. Material y métodos : Se registraron en forma prospectiva pacientes hospitalizados por síndrome coronario agudo en 15 centros de Argentina, con diagnóstico con troponina ultrasensible, servicio de unidad coronaria y hemodinamia disponible las 24 horas, entre enero y agosto de 2022. Resultados : Se incluyeron 984 pacientes consecutivos, un 22,2% con angina inestable, 39,1% con infarto agudo de miocardio sin elevación del segmento ST (IAMSEST) y 24,1% con infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Por otro lado, el 4,1% se presentó como IAM tipo 2, 1,2% como miocarditis, 0,7% como síndrome de Takotsubo y 8,6% como infarto de miocardio con enfermedad coronaria no obstructiva (MINOCA). La mediana (rango intercuartílico, RIC) de edad fue de 66 años (56,5-74), con un 75,3% de pacientes de sexo masculino. El manejo inicial de los pacientes sin elevación del segmento ST fue invasivo en el 84%, con una tasa de enfermedad coronaria significativa del 76,5%. En cuanto a la evolución intrahospitalaria, las complicaciones isquémicas más relevantes fueron el reinfarto (2,84%), angina recurrente (2,4%), angina post infarto (2%) y trombosis intra stent (0,5%). El porcentaje de eventos hemorrágicos totales fue de 4,4% y la mortalidad intrahospitalaria total fue de 3,76%. Conclusiones : El registro tiene una buena representación del espectro de pacientes con sospecha inicial de síndrome coronario agudo, manejados en centros con una estrategia inicial principalmente invasiva, con una baja tasa de complicaciones hospitalarias y una mortalidad global aceptable.

ABSTRACT Background : We conducted a multicenter registry to analyze the diagnostic and therapeutic approach to all types of acute coronary syndromes; this registry is the first to provide detailed information on conditions without significant epicardial coronary artery disease. Knowing the reality of current medical practice is important to find opportunities for improvement. Methods : Patients hospitalized for acute coronary syndrome between January and August 2022 in 15 centers of Argentina, with high-sensitivity cardiac troponin, coronary care unit, and catheterization laboratory available 24 hours, were prospectively recorded. Results : A total of 984 consecutive patients were included, 22.2% with unstable angina, 39.1% with non-ST-segment elevation myocardial infarction (NSTEMI) and 24.1% with ST-segment elevation myocardial infarction (STEMI). Additionally, 4.1% presented as type 2 AMI, 1.2% as myocarditis, 0.7% as Takotsubo syndrome and 8.6% as myocardial infarction with non-obstructive coronary arteries (MINOCA). Median age was 66 years [interquartile range (IQR) 56.5-74] and 75.3% were men. An early invasive management was used in 84% of patients without ST segment elevation, and 76.5% of them had significant coronary artery disease. During hospitalization, 2.84% of the patients presented reinfarction, 2.43% recurrent angina, 2% postinfarction angina and 0.5% stent thrombosis. Bleeding events occurred in 4.4% of the patients, and overall in-hospital mortality was 3.76%. Conclusions : The registry has a good representation of the spectrum of patients with initial suspicion of "acute coronary syndrome", managed in centers with an invasive initial strategy and with low rate of in-hospital complications and acceptable overall mortality.

A pessoa com síndrome coronário agudo: descrição dos fatores de risco numa amostra atendida num serviço de urgência de Portugal / The person with acute coronary syndrome: description of risk factors in a sample attended at an emergency department in Portugal

O Síndrome Coronário Agudo (SCA) é uma das principais causas de morte no mundo, no qual se inclui Portugal, sendo por isso uma área de intervenção prioritária. Objetivo: Descrever os fatores de risco das pessoas com SCA, atendidas num serviço de urgência (SU) de uma Unidade Local de Saúde (ULS) do Norte de Portugal. Métodos: Trata-se de um estudo descritivo, inserido numa abordagem quantitativa. A amostra foi constituída por 40 doentes admitidos num serviço de urgência de uma ULS do Norte de Portugal, com SCA no período compreendido entre 1 de janeiro de 2021 e 31 de dezembro de 2021. Para recolher os dados foi utilizada uma grelha na qual foram reunidas todas as informações referentes às características sociodemográficas dos doentes, os fatores de risco cardiovascular, os antecedentes pessoais específicos, os tipos de SCA, o fluxograma do PTM selecionado e cor atribuída na triagem. O referido instrumento foi elaborado atendendo à pesquisa bibliográfica efetuada e foi analisado e validado por um enfermeiro especialista em médico-cirúrgica e por um médico de cirurgia geral. O estudo obteve o consentimento por parte de uma Comissão de Ética e do Conselho de Administração da ULS. Resultados: A média de idade para a ocorrência de SCA foi de 74,40 anos, sendo que foi mais prevalente no sexo masculino. Ao nível dos fatores de risco o mais prevalente foi a hipertensão e o menos prevalente, o tabagismo. Quanto aos antecedentes pessoais específicos verificou-se que o mais prevalente foi a insuficiência cardíaca e o menos prevalente foi o acidente vascular cerebral. No que concerne aos biomarcadores cardíacos a maioria apresentava T positivo. Quanto aos tipos de SCA verificou-se que no enfarte do miocárdio o mais prevalente foi sem elevação ST. Relativamente ao fluxograma, 72,5% apresentavam enfarte do miocárdio sem elevação ST. Quanto à cor atribuída na triagem, a maioria obteve cor laranja. Relativamente ao enfarte do miocárdio, o mesmo é mais frequente em pessoas com idades compreendidas entre os 84-94 anos. No que concerne aos tipos de SCA em função do sexo, constatou-se que, relativamente ao enfarte do miocárdio, este é mais frequente no sexo masculino. Já relativamente à angina instável, esta ocorreu somente no sexo masculino. Ao nível da distribuição dos fatores de risco em função da idade, constatou-se que no caso da hipertensão é mais prevalente nas pessoas mais idosas (≥74 anos). Quanto ao sedentarismo, também foi mais frequente nas pessoas mais idosas. Relativamente às dislipidemias foi mais prevalente entre os 84-94 anos e 74-84 anos. Quanto à diabetes, esta foi mais evidente entre os 74-84 anos e os 84-94 anos. Por último e relativamente à obesidade, está mais presente entre os 54-64 anos e os 84-94 anos. Da distribuição dos fatores de risco em função do sexo, verificou-se que a hipertensão, o sedentarismo, a dislipidemias e a obesidade são mais frequentes no sexo masculino. Da análise da distribuição dos antecedentes pessoais em função da idade, verificou-se, relativamente à insuficiência venosa e/ou arterial, estava prevalente nos intervalos de idade entre os 74- 84 anos e os 84-94 anos. Quanto à insuficiência cardíaca foi mais prevalente nas idades entre os 84-94 anos e os 74-84 anos. No caso da doença renal crónica esteve presente entre os 74-84 anos e os 84-94 anos. Por último, e relativamente à doença pulmonar obstrutiva crónica (DPOC) foi mais prevalente em pessoas com idade igual ou superior a 64 anos. Quanto aos antecedentes pessoais, os mais frequentes no sexo masculino foram a insuficiência cardíaca e a doença renal crónica. Quanto ao sexo feminino verificou-se maior prevalência dos antecedentes pessoais como insuficiência venosa e/ou arterial, AVC e DPOC. Conclusão: A avaliação de utentes, que se apresentam nos SU com suspeitas de SCA, utilizando o STM, pode ser realizada a partir de diferentes fluxogramas, uma vez que os utentes nem sempre apresentam sintomas típicos e queixas frequentes como queixa principal, permitindo distinguir condições urgentes de outras não-urgentes, possibilitando ao avaliador o estabelecimento dos níveis de prioridade mais elevados no tratamento de utentes em situações de urgência. O enfermeiro especialista na prevenção de complicações, deve prever e detetar de forma precoce após a admissão hospitalar as complicações do doente com SCA, devendo as intervenções preventivas, caso existam, ser continuadas. É fundamental, após a estabilização da situação aguda, o ensino do doente e da família acerca da influência dos fatores de risco cardiovascular e a importância da adoção de um estilo de vida saudável.

Acute Coronary Syndrome (ACS) is one of the main causes of death in the world, which includes Portugal, and is therefore a priority area of intervention. Aim: Describe the factors of people with ACS admitted to the emergency department of a Local Health Unit (ULS) in the north of Portugal. Methods: This is a descriptive study, inserted in a quantitative approach. The sample consisted of 40 patients admitted to an emergency department of a ULS in the north of Portugal, with Acute Coronary Syndrome in the period between January 1, 2021 and December 31, 2021. A grid was used to collect the data, in which all the information regarding the sociodemographic characteristics of the patients, cardiovascular risk factors, specific personal history, types of ACS, the flowchart of the selected PTM and the color assigned in the screening were gathered. This instrument was elaborated according to the bibliographical research carried out and was analyzed and validated by a specialist nurse in medical-surgical surgery and by a general surgery doctor. The study obtained consent from an Ethics Committee and the ULS Board of Directors. Results: The average age for the occurrence of ACS was 74.40 years, and it was more prevalent in males. In terms of risk factors, the most prevalent was hypertension and the least prevalent was smoking. As for specific personal antecedents, it was found that the most prevalent was heart failure and the least prevalent was stroke. With regard to cardiac biomarkers, the majority had positive T. As for the types of ACS, it was found that in myocardial infarction the most prevalent was without ST elevation. Regarding the flowchart, 72.5% had non-ST elevation myocardial infarction. As for the color assigned in the screening, the majority obtained an orange color. With regard to myocardial infarction, it is more frequent in people aged between 84-94 years. With regard to the types of ACS according to sex, it was found that, with regard to myocardial infarction, this is more frequent in males. Regarding unstable angina, this occurred only in males. In terms of the distribution of risk factors according to age, it was found that, in the case of hypertension, it is more prevalent in older people (≥74 years). As for sedentary lifestyle, it was also more frequent in older people. With regard to dyslipidemia, it was more prevalent among 84-94 year olds and 74-84 year olds. As for diabetes, this was more evident among the 74-84 and 84-94 years old. Finally, and with regard to obesity, it is more prevalent between 54-64 years old and 84-94 years old. From the distribution of risk factors according to sex, it was found that hypertension, sedentary lifestyle, dyslipidemia and obesity are more frequent in males. From the analysis of the distribution of personal antecedents according to age, it was verified, in relation to venous and/or arterial insufficiency, it was prevalent in the age ranges between 74-84 years and 84-94 years. As for heart failure, it was more prevalent in the ages between 84-94 years and 74-84 years. In the case of chronic kidney disease, it was present between 74-84 years and 84-94 years. Finally, and regarding chronic obstructive pulmonary disease, it was more prevalent in people aged 64 years and over. As for personal history, the most frequent in males were heart failure and chronic kidney disease. As for females, there was a higher prevalence of personal history such as venous and/or arterial insufficiency, stroke and COPD. Conclusion: The assessment of users, who present to the ER with suspected ACS, using the MTS, can be carried out from different flowcharts, since users do not always present typical symptoms and frequent complaints as the main complaint, allowing to distinguish urgent conditions from other non-urgent ones, allowing the evaluator to establish the highest priority levels in the treatment of users in urgent situations. Nurses specializing in the prevention of complications must anticipate and detect complications in patients with ACS early after hospital admission, and preventive interventions, if any, must be continued. It is fundamental, after the stabilization of the acute situation, to teach the patient and family about the influence of cardiovascular risk factors and the importance of adopting a healthy lifestyle.