Sun exposure influences the prognostic power of components of mineral metabolism in patients with coronary artery disease.

BACKGROUND AND AIM: Calcidiol (vitamin D metabolite) plasma levels vary with sun exposure (SE). However, it is not known if SE influences its prognostic ability. We have studied the effect of SE on plasma levels of the components of mineral metabolism (calcidiol, fibroblast growth factor-23 [FGF-23], parathormone [PTH], and phosphate [P]) and on their prognostic value in patients with coronary artery disease (CAD). METHODS AND RESULTS: We studied prospectively 704 patients with stable CAD. Clinical variables and baseline calcidiol, FGF-23, PTH, and P plasma levels were assessed. We divided the population in two subgroups, according to the period of plasma extraction: High SE (HSE) (April-September) and low SE (LSE) (October-March). The outcome was the development of acute ischemic events (acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Mean follow-up was 2.15 ± 0.99 years. Calcidiol and P levels were higher in HSE group. In the whole population, calcidiol (HR = 0.84 for each 5 ng/ml increase, 95% CI = 0.71-0.99; p = 0.038) and FGF-23 (HR = 1.14 for each 100 RU/ml increase, 95% CI = 1.05-1.23; p = 0.009) were predictors of the outcome, along with age, hypertension, body-mass index, peripheral artery disease, and P levels. In the LSE subgroup, calcidiol (HR = 0.75; 95% CI = 0.57-0.99; p = 0.034) and FGF-23 (HR = 1.34; 95% CI = 1.13-1.58; p = 0.003) remained as predictors of the outcome. In the HSE group calcidiol and FGF-23 had not independent prognostic value. CONCLUSIONS: In patients with stable CAD, low calcidiol and high FGF-23 plasma levels predict an adverse prognosis only when the sample is obtained during the months with LSE. SE should be taken into account in the clinical practice.

Carpentier's annulus and De Vegas annuloplasty. The end of the tricuspid challenge.

A study evaluating the durability of two recent techniques of tricuspid annuloplasty was conducted simultaneously in two institutions. One group working in Madrid, Spain, used Carpentier's ring in 32 patients. The other in Montreal, Canada, employed De Vega's semicircular annuloplasty in 17 cases. Competence of the tricuspid valve was obtained in nearly all cases at the time of surgery and persisted after a mean follow-up of 10.3 months (Madrid) and 11.5 months (Montreal) in 77 per cent of the cases. Light (1/3) residual tricuspid insufficiency was detected in 16.5 per cent; moderate (2/3) incompetence persisted in only 6.5 per cent. The majority of the patients with residual tricuspid insufficiency had unsuccessful or incomplete repair of left-sided heart lesions.

Hemodynamic evaluation of the Angell-Shiley porcine xenograft.

The Angell-Shiley porcine xenograft was evaluated in 48 asymptomatic subjects who underwent cardiac catheterization an average of 14 months after operation. Nineteen patients had mitral and 29 had aortic valve replacement. The average mitral valve gradient was 8 +/- 3 mm Hg and the average effective orifice area was 1.8 +/- 0.6 cm2. The average aortic valve gradient was 22 +/- 7 mm Hg and the average effective orifice area was 1.2 +/- 0.3 cm2. During supine leg exercise, the average mitral valve gradient increased to 12 +/- 4 mm Hg (p less than 0.001) and the average aortic valve gradient increased to 27 +/- 8 mm Hg (p less than 0.001) compared to findings at rest. On the basis of data obtained with a regression analysis model, there is a high probability that an Angell-Shiley aortic xenograft with a stent diameter less than 25 mm will have a postoperative effective orifice area of less than 1 cm2, and that an Angell-Shiley mitral xenograft with a stent diameter less than 30 mm will have a postoperative effective orifice area of less than 1.5 cm2. Our data suggest that the Angell-Shiley xenograft has suboptimal hemodynamic performance in stent sizes less than 30 mm in the mitral position and less than 25 mm in the aortic position.

[Aspirin and heparin in the fibrinolytic treatment of acute myocardial infarction]. / Aspirina y heparina en el tratamiento fibrinolítico del infarto agudo de miocardio.

There is now extensive evidence of activation of platelet and the coagulation cascade with coronary thrombosis, and further activation with exogenous thrombolysis. Administration of aspirin and heparin has been shown to improve mortality when combined with thrombolytic therapy in acute myocardial infarction, probably by enhancing lysis and reducing subsequent reocclusion of infarct related artery. Most studies have evaluated the effect of aspirin or heparin in combination with streptokinase. These results can probably be extrapolated to rtPA, as it has much shorter, half live, and induces lower systemic lytic state. Although aspirin and heparin have been tested independently, they probably have a synergistic action post fibrinolysis. With current information it is mandatory to include aspirin in the treatment of AMI, with or with out thrombolytic treatment. Intravenous administration of heparin seems justified, specially if rtPA is used as fibrinolytic agent. Potent new drugs capable of inhibiting platelets an the coagulation cascade emerge as a promising future. Until their effect is clinically proven, aspirin and i.v. heparin should remain as adjunctive therapy to fibrinolytic treatment in AMI.

[Platelet activation and inhibition. Old and new platelet antiaggregants]. / Activación e inhibición plaquetaria en la angina inestable. Papel de los viejos y nuevos antiagregantes plaquetarios.

Aggregates of activated platelets, at the level of a plaque fissure, seem to have a pivotal role in acute coronary syndromes. The glycoprotein IIb-IIIa receptors of the platelet surface are thought to be the final common pathway of platelet aggregation. The possibility of using a basic treatment to control platelet aggregation, in the whole clinical spectrum of acute coronary syndromes is attractive. The results of different clinical studies show evidence that glycoprotein IIb-IIIa antagonists, given intravenously, are effective in the management of acute coronary intervention with high thrombogenic risk, and also help to control the early phase of acute coronary syndromes. In patients who have responded to the acute i.v. infusion, the chronic oral administration of those agents might contribute to their clinical stabilization and reduce the risk of further coronary events.

[Experience with a protocol of systematic postfibrinolysis angioplasty in acute myocardial infarct]. / Experiencia con un protocolo de angioplastia sistemática posfibrinólisis en el infarto agudo de miocardio.

Two hundred twenty one patients admitted for AMI in the CCU, and treated with systemic thrombolysis with streptokinase have been retrospectively analysed and divided in two groups: the first 98 patients (group A) were included in a research protocol: The following 123 patients (group B) represent the clinical application of thrombolytic therapy in our unit. In group A coronary arteriography in the first 48 hours (84 patients), and PTCA to the infarct related artery with significant stenosis (39 patients) were performed systematically. In group B, 54 patients had coronary arteriography PTCA was restricted to 12 patients with symptomatic ischemia. No significant differences in base line clinical parameters were detected between groups A and B. Total hospital mortality was 5% and similar in both groups. Reinfarction rate was greater in group A, 13% than in group B, 5%, but not significantly different. Reinfarction was related to PTCA (chi 2 test p less than 0.05). The incidence of post infarction angina was related to the existence of more than one diseased vessel. These data suggest that protocol PTCA post thrombolysis is not effective in reducing post infarction ischemia or mortality.

[Role of noninvasive examinations in the management of ischemic cardiopathy. V. Noninvasive examinations in the management of patients with chronic ischemic cardiopathy]. / Papel de las exploraciones no invasivas en el manejo de la cardiopatía isquémica. V. Las exploraciones no invasivas en el manejo de los pacientes con cardiopatía isquémica crónica. Recomendaciones para su utilización.

In the last few years the has been an enormous development in noninvasive testing in the field of clinical cardiology. In fact, excellent monographs on each one of these techniques have been published elsewhere, but fewer publications exist that treat the topic of their indications and use in an integrated way, except for in the most common clinical situations. In this paper, the treatment of patients who present chest pain, stable and unstable angina is discussed, including the study of postinfarction patients. Furthermore, the role of noninvasive tests in the detection of coronary heart disease in women and in patients with left bundle branch block is thoroughly analyzed; as well as their usefulness after surgical or percutaneous coronary revascularization and in patients with peripheral vascular disease.

[Use of thrombolytic treatment in patients with acute myocardial infarction in Spain. Observations from the PRIAMHO study]. / Utilización de la trombólisis en los pacientes con infarto agudo de miocardio en España: observaciones del estudio PRIAMHO.

INTRODUCTION AND OBJECTIVES: Scarce information is actually available in our country regarding the use of thrombolytic treatment in patients with acute myocardial infarction and how consistently the recommendations of the clinical guidelines are being implemented. METHODS: Cohort study with one year follow-up of patients with acute myocardial infarction admitted in 24 Spanish hospitals in 1995. Differences in clinical characteristics and prognosis from patients treated with or without thrombolysis were compared. RESULTS: 2,191 of the 5,242 patients (42%) admitted with an acute myocardial infarction received thrombolytic therapy (range: 23%-63%). Reasons for exclusion in the rest were the absence of ST segment elevation (35%), contraindications (16%), prehospital delay >12 h (35%), and other causes (15%). Thrombolysis treated patients were at lower risk in general because they had shorter prehospital delays and were younger, more likely to be male, less frequently diabetic, with less prior history of angina or infarction. The average delay in administering therapy was of 3 hours while the average in-hospital delay was 50 minutes and depended only on the hospital where patients where admitted, as it was shorter in small centers. t-PA was administered in 49% of patients, streptoquinase in 46% and other drugs in 5%. Although t-PA was given more often to younger patients, smokers, anterior and Q-wave infarctions, and to patients with shorter prehospital delays, the determinant factor was the admission hospital with a frequency ranging from 9% to 96%. Patients not treated with thrombolytics had more complications during the acute phase, and required more invasive procedures. They also had a higher mortality at 28 days (17% vs. 10%, p < 0.0001) and at one-year follow-up (27% vs. 15%, p < 0.0001). Furthermore, a correlation was observed between mortality and delay of treatment application. In multivariate analysis, thrombolytic treatment was an independent predictor of survival at one year, with an odds ratio for mortality of 0.8 (95% CI: 0.66-0.96). CONCLUSIONS: Thrombolytic therapy in Spain does not yet conform to the recommendations of the actual guidelines for the treatment of patients with acute myocardial infarction because it is underused, especially in high-risk patients, the prehospital and in-hospital delays are too long, and a huge variability exists between hospitals in the frequency and delays of administration and selection of the drug that are not sufficiently explained by the characteristics of the patients. In spite of this, mortality of treated patients was 20% lower in comparison to the non-treated patients, after adjusting for the other clinical factors with demonstrated prognostic value.

[Electrocardiographic diagnosis and acute treatment of atrial fibrillation and flutter episodes]. / Diagnóstico electrocardiográfico y tratamiento agudo de los episodios de fibrilación y flutter auricular.

Both atrial flutter and fibrillation are common arrhythmias in the clinical setting. Although we have been aware of them for decades, little has been known until recently about their triggering or maintenance mechanisms. The diagnosis of these arrhythmias lies largely in the electrocardiogram, which shows characteristic features of atrial electrical activity, leading to a correct diagnosis. Usually, some maneuvers such as adenosine infusion, carotidus sinus massage, etc., are required, in order to unmask the atrial activity, that are often obscured by the QRS complex or T wave. Several therapeutic options can be attempted for the acute termination of both atrial flutter and fibrillation episodes. The choice of one or another depends on some extent, on the clinical status of the patient during the arrhythmia, the presence of structural heart disease and the preceding arrhythmic history. Antiarrhythmic drugs are quite efficacious in the acute conversion of atrial fibrillation, but such an effect is not expected in atrial flutter. Drugs that depress AV nodal conduction can be used in both instances, as a therapeutic end-point or as a previous measure to the arrhythmia conversion. Direct current cardioversion is a good and efficacious option for both arrhythmias, however sedation is mandatory which, may be a contraindication in some patients. Rapid atrial pacing is an elegant and reliable method for the acute termination of atrial flutter of the common type, although a transvenous catheter insertion is needed.

[Variability in the management and prognosis at short- and medium-term of myocardial infarct in Spain: the PRIAMHO study. Registration Project of Hospital Acute Myocardial Infarct]. / Variabilidad en el manejo y pronóstico a corto y medio plazo del infarto de miocardio en España: el estudio PRIAMHO. Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario.

BACKGROUND AND PURPOSE: The paucity of data on myocardial infarction management and results in Spain lead to the design of the PRIAMHO study (Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario [Acute Myocardial Infarction Hospital Registration Project]) which developed standard methods to collect information on the management of patients with such a condition and their characteristics. The variability results among hospitals in myocardial infarction management and in one-year mortality are presented. METHODS: A cohort study with a one-year follow-up was designed to register all patients diagnosed with acute myocardial infarction discharged from 24 Spanish hospitals that completed all the requisites to participate. The demographic and clinical characteristics of the patients, their management during the coronary care unit stage, and the outcome and complications were prospectively registered. Standard definitions for diagnosis were used. Confidentiality regarding patient identity and participating centers was guaranteed. RESULTS: 5,242 (77.6%) of the 6,756 patients with myocardial infarction admitted in the 24 participating hospitals were registered in the coronary care units. Half of the centers had an on-site hemodynamic laboratory and in seven coronary surgery. The delay between symptom-onset and emergency room admission was 2 hours. Acute pulmonary edema or cardiogenic shock was developed by 16.6% of patients and 41.8% received thrombolysis. Mean time delay between symptom-onset and thrombolysis was 3 hours. A large variability in the use of beta-blockers, thrombolysis, echocardiography, coronary catheterization angiography and invasive revascularization was observed among hospitals. Mortality in the coronary care unit was 10.9% and increased to 14.0% at 28 days and to 18.5% at one year with considerable variation among hospitals. Four hospitals showed higher mortality among their patients, independently from the proportion of diabetes, hypertension, women, anterior location of myocardial infarction, non-Q-wave infarction, age and severity. CONCLUSIONS: The results of this study show that early and mid-term mortality from myocardial infarction is still high in Spain in the reperfusion era, and that a considerable variability in management and outcome exists among Spanish hospitals, which is not explained by the different case-mix among them.

[Management of myocardial infarction in Spain (1995-99). Data from the registry of the Ischaemic Heart Disease Working Group (RISCI) of the Spanish Society of Cardiology]. / Manejo del infarto de miiocardio en España (1995-99). Datos del registro de infartos de la sección de cardiopatía Isquémica y unidades coronarias (RISCI) de la Sociedad Española de Cardiología.

INTRODUCTION AND OBJECTIVES: Limited information is available on how patients with myocardial infarction are treated in Spain. In order to make up for this deficiency, in October 1994, the Ischaemic Heart Disease Working Group of the Spanish Society of Cardiology initiated a myocardial infarction registry, which is currently active. METHODS: Patients are recruited from hospitals with intensive coronary care facilities. Demographic characteristics coronary risk factors and previous conditions are collected, as well as clinical events, and diagnostic and therapeutic procedures performed during the stay in the coronary care unit. RESULTS: From 1995 to 1999, 28,357 patients were registered. During this period the mean age increased slightly (from 64.4 +/- 12.2 to 65.2 +/- 12.7; p < 0.001), although the male proportion remained stable (from 76.7% to 77.1%). The median "onset of symptoms-hospital arrival for 1st emergency" time fell from 135 min to 120 min, and the median "onset of symptoms-needle" time from 180 to 175 (NS). The use of thrombolytic therapy did not change (from 42.4 to 43.9%), but the use of aspirin (from 87.4 to 91.7%), beta-blockers (from 32.7 to 39.6%) and angiotensin-converting inhibitors (from 27.9 to 34.8%) increased significantly (p < 0.001). The Swan-Ganz catheter and the intra-aortic balloon counterpulsation were rarely placed during the five years (4.2% and 1.2% respectively in 1999). Both early mortality (11.4 to 9.3%) and the median duration of intensive coronary care stay declined, in these 5 years. CONCLUSIONS: In Spain, during the 1995-1999 period, the use of aspirin, beta-blockers, and angiotensin-converting inhibitors increased significantly during the acute phase of infarction in the coronary care unit. However, both the usage of thrombolytic therapy and the delay between the onset of symptoms and therapy initiation remained unchanged. At the same time, the length of stay in the coronary care unit and early mortality declined, although the clinical profile of the patients did not improve.

[Recurrent pericarditis: our experience with colchicine]. / Pericarditis recurrente: nuestra experiencia con colchicina.

To prove the efficacy of colchicine in the prevention of recurrences of acute pericarditis, 5 patients, age 24 to 64 years (mean 36), were treated during 18 months with 1 milligram daily. Previous treatment with steroids and/or non steroid antiinflammatory agents did not prevent 2-3 recurrences per patient, and was discontinued after entry into the study. There where no further recurrences of acute pericardial episodes during the 24 months of follow-up, and no side effects related to the treatment with colchicine were reported. We conclude that colchicine is effective in preventing the recurrences of acute idiopathic pericarditis.

[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 progression of a postinfarct interventricular communication: an echocardiographic follow-up]. / Progresión de una comunicación interventricular postinfarto: seguimiento ecocardiográfico.

An 80-year-old female patient presented rupture of the interventricular septum as complication of acute anteroseptal myocardial infarction. Serial echocardiographic studies documented progressive increase in size of the apical defect over 16 hours. This observation highlights a potential hazard if surgical repair is deferred to "stabilize" hemodynamically the patient before the intervention.

[Primary coronary angioplasty in acute anterior myocardial infarction: immediate results]. / Angioplastia primaria en el infarto agudo de miocardio de localización anterior: resultados inmediatos.

BACKGROUND: Some reports have indicated that primary angioplasty not contaminated by previous intravenous infusion of thrombolytic agents represents an efficient approach to the treatment of acute myocardial infarction. PATIENTS AND METHODS: As a part of a more ambitious protocol aiming to compare primary angioplasty and intravenous recombinant tissue plasminogen activator, we performed direct coronary angioplasty in 33 patients (18 randomized to angioplasty and 15 because of contraindication to thrombolysis) that were admitted to our hospital with acute myocardial infarction with less than 5 hours elapsed from the onset of pain and with clear electrocardiographic criteria of anterior infarction. RESULTS: In 30 of the 33 patients (90.9%) the left anterior descending artery was recanalized and TIMI 2 flow in 17 and 3 in 13 was obtained. The average time elapsed from the onset of pain to the opening of the artery was 228 +/- 70 (120-390) minutes and from the time of admission to the coronary care unit to complete reperfusion 91 +/- 43 minutes (33-120). Thirty one patients (93.9%) were discharged from the hospital and two (6.1%) died. There was only one hemorrhagic complication without sequelae. CONCLUSIONS: Primary coronary angioplasty in acute anterior myocardial infarction is an efficient, safe and not so difficult therapeutic strategy. Even though it requires a complex around the clock on call set up it is specially useful in specific subsets of patients.

[Drug treatment of angina pectoris. Study Group on Angina Pectoris of the Ischemic Cardiopathy and Coronary Units Section of the Spanish Society of Cardiology]. / Tratamiento médico de la angina de pecho. Grupo de Estudio de Angina de Pecho de la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología.

Medical treatment in angina pectoris is supported by: 1) slowing in coronary artery disease progression; 2) control of the angina episodes and the enhanced of the functional status, and, 3) prognosis improvement. The authors describe in this review, inside the own experience and the large body of evidence, the general measures and pharmacological treatment of both stable and unstable angina. There are included some therapeutic options in associated clinical conditions.

[Basis for a hospital registry of acute myocardial infarction in Spain. The PRIAMO study. Project of a Hospital Registry of Acute Myocardial Infarction]. / Bases para un registro hospitalario de infartos agudos de miocardio en España. El estudio PRIAMHO. Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario.

BACKGROUND AND OBJECTIVES: Information on the management of myocardial infarction in Spain in scarce. PRIAMHO (Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario) study is aimed at developing standardized methods to allow the registration of characteristics and management of patients discharged with a diagnosis of myocardial infarction. Methods and results of the pilot study are presented. METHODS: In the present collaborative study with one-year follow-up, all patients diagnosed with myocardial infarction discharged from 33 Spanish hospitals are registered for one year including their demographic, clinical and outcome characteristics, as well as details on their management when admitted to a coronary care unit. Standardized definitions of diagnosis and measurements are used. Confidentiality of patients' identity and anonymous participation of each center are also warranted. RESULTS: The 33 participant coronary care units, covering some 10,000,000 people, admitted on average 83.9% of myocardial infarction patients of their hospital. In 16 participating centers there is a laboratory of hemodynamics and in 11 coronary surgery. During the pilot study, 606 patients were discharged from the participating coronary care units where the case-fatality, rate was 10.3%. While 19.8% of patients developed left heart failure, 44.1% received thrombolytic therapy. The delay between onset of symptoms and first monitoring was approximately 6 hours, and thereafter admission to the coronary unit about 3 hours. CONCLUSION: PRIAMHO study will allow to establish of the fundamentals for developing a nation-wide myocardial infarction register and will provide an accurate perspective of the characteristics and management of this disease in Spain.

[The performance of coronary angioplasties at centers without cardiac surgery. The recommendations of the Sociedad Española de Cardiología]. / Realización de angioplastias coronarias en centros sin cirugía cardíaca. Recomendaciones de la Sociedad Española de Cardiología.

During the early years of coronary interventions a rigorous on-site surgical stand-by was mandatory. The increased experience in coronary angioplasty both on total number of procedures and the experience gained by each operator, together with the technical improvements, namely since the introduction of stents has induced an evolution in the stand-by strategy, with new concepts such as "next available operating room" or coronary interventions "without on site" surgical facilities, are gaining widespread acceptance. With the aim of defining the requirements to perform coronary interventions at hospitals without coronary surgery, the following aspects are reviewed: a) complications following coronary angioplasty that require coronary surgery; b) the current status of coronary angioplasty without surgical stand-by in different countries. All this information allows us to advance some recommendations concerning the performance of coronary interventions at hospitals without on-site cardiac surgery. Different issues including hospital characteristics, operator and cardiac catheterization laboratory requirements, as well as lesion characteristics and the type of informed consent, should be taken into account.

[The prevalence of angina and cardiovascular risk factors in the different autonomous communities of Spain: the PANES Study. Prevalencia de Angina en España]. / Prevalencia de angina y factores de riesgo cardiovascular en las diferentes comunidades autónomas de España: estudio PANES.

INTRODUCTION AND OBJECTIVE: The study of angina prevalence has received little attention in the analysis of the dimension of coronary heart disease. The aim of this study was to determine the prevalence of angina and cardiovascular risk factors in the 45- to 74-year-old population of the different autonomous regions of Spain. METHODS: A sample of 10,248 subjects was recruited. Sampling was stratified by gender and age groups (45-54, 55-64 and 65 to 74 years), and proportional to the population distribution of the different autonomous regions. A multistage sampling was performed, firstly 200 villages were randomly selected, secondly three different socio-economic household were chosen. Sample unit was neighbouring households. Rose questionnaire of angina and a structured questionnaire to collect socio-demographic and risk factor variables were administered. RESULTS: Angina prevalence in the 45- to 74-year-old Spanish population was 7.5%. The autonomous regions with the higher and lower prevalence were Baleares (11.4%) and Basque Country (3.1%), respectively. The Pearson correlation coefficient between angina prevalence and ischemic heart disease or cardiovascular disease mortality in men and women was 0.52 and 0.55, and 0.31 and 0.44, respectively. The self reported prevalence of hypertension, dyslipemia, diabetes and smoking was 31.1%, 24.2%, 14.3% and 34.6% respectively. CONCLUSIONS: Angina prevalence in Spain is similar to that of developed countries although significant differences were observed among the autonomous regions of Spain. These differences correlate with those observed in ischemic heart disease or cardiovascular mortality among them and are associated with the cardiovascular risk factors prevalence which also varies among communities.

[Clinical practice guidelines of the Spanish Society of Cardiology on unstable angina/infarction without ST elevation]. / Guías de práctica clínica de la Sociedad Española de Cardiología en la angina inestable/infarto sin elevación ST.

This paper up-dates the Clinical Guidelines for Unstable Angina/Non Q wave Myocardial Infarction of the Spanish Society of Cardiology. Due to the increased efficacy of adequate management in the early phases, it has been considered necessary to include recommendations for the pre Hospital and Emergency department phase. Prehospital management. Patients with thoracic pain compatible with myocardial ischemia should be transferred to Hospital as quickly as possible and an ECG tracing performed. Initial management includes rest, sublingual nitroglycerin and aspirin. In the Emergency department. Immediate clinical attention and accessibility to a defibrillator should be available. If ECG tracing discloses ST elevation reperfusion strategy is to be implemented immediately. If no ST elevation is present, the probability of myocardial ischemia and risk factor evaluation is essential for adequate management. A simplified risk stratification classification is presented, that also determines the most adequate site for admission: Coronary Care Unit if high risk factors are present, Cardiology ward for the intermediate risk patient and ambulatory treatment if low risk. Management in Coronary Care Unit. Includes routine ECG monitoring and analgesia. Antithrombotic and anti ischemic treatment include new indication for GP IIb-IIIa and Low molecular weight heparins. Coronary arteriography and revascularisation are recommended, if refractory or recurrent angina, left ventricles dysfunction or other complications are present. Management in the ward is based on adequate chronic medical treatment, risk stratification, and secondary prevention strategy. Coronary arteriography before discharge must be considered in the light of the result of non-invasive tests.