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Ruiz-Bailén M, Romero-Bermejo FJ, Ramos-Cuadra JÁ, Rucabado-Aguilar L, Chibouti-Bouichrat K, Castillo-Rivera AM, Pintor-Mármol A, Expósito-Ruiz M, García MIR, Dolores-Pola-Gallego-de-Guzmán M, Gómez-Jiménez J, Torres-Ruiz JM, Ulecia-Martínez M. Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units. ACTA ACUST UNITED AC 2011; 13:21-9. [PMID: 21244229 DOI: 10.3109/17482941.2010.538697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the frequency and the factors associated with performance of echocardiography in acute coronary syndrome (ACS) patients during their stay in intensive care units or coronary care units (ICU/CCU). METHODS Retrospective cohort study including all patients diagnosed with acute coronary syndrome-unstable angina (UA), acute myocardial infarction (AMI)-included in the 'ARIAM' Spanish multi-centre register. The study period was from June 1996 to December 2005. The follow-up period is limited to the time of stay in the Intensive Care Units or Coronary Care Units (ICUs/CCUs). A univariate analysis was carried out on the patients with UA and AMI according to whether or not echocardiograms were performed during their stay in ICU/CCU. In addition the data was evaluated for any temporal variation in the performance of echocardiography, and two multivariate analyses were carried out to evaluate the factors associated with performance of echocardiography in UA and AMI patients. RESULTS The study period included 45,688 AMI patients and 17,277 UA patients. Echocardiograms were performed in 26.87% AMI patients and 16.75% UA patients. In total, 15,172 echocardiograms were performed in ACS patients (23.6%). The multivariate analysis demonstrated that the variables associated with the performance of echocardiography in UA were: Killip and Kimball class, cigarette smoking, family history of cardiovascular events, cardiogenic shock, uncontrolled angina, mechanical ventilation and treatment with ACE inhibitors, while the presence of previous AMI was associated with fewer echocardiograms being performed. In AMI, the multivariate analysis showed the following variables to be associated with the performance of echocardiography: Killip and Kimball class, Q-AMI, right heart failure, the need for insertion of Swan-Ganz catheter, cardiogenic shock, high-degree AV block and the administration of ACE inhibitors, while age was associated with fewer being performed. Over the 10 years of the study period, there was a discrete but significant increase in the use of echocardiography in patients in ICU/CCU. CONCLUSIONS Echocardiography is not commonly used in ACS patients while in ICU/CCU. UA and AMI patients who did have echocardiograms during their stay in ICU/CCU were chiefly those presenting heart failure and major complications, and represent a subpopulation with poor prognosis. The performance of echocardiography in ACS patients increased slightly over the length of their stay in ICU/CCU.
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Affiliation(s)
- Manuel Ruiz-Bailén
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, Spain
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Ruiz-Nodar JM, Cequier Á, Lozano T, Fernández Vázquez F, Möller I, Abán S, Marqués JT, González Llopis F, Álvarez P, Bethencourt A, Zarauza J, de la Villa BG, Burgos V, Ferreiro JL, García JM, Rodríguez AG, de la Tassa CM. Impacto del tipo de hospital en el tratamiento y evolución de los pacientes con síndrome coronario agudo sin elevación del ST. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70059-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Núñez J, Sanchis J, Bodí V. [Invasive revascularization strategy in non-ST-segment acute coronary syndromes. The debate continues]. Med Clin (Barc) 2009; 133:717-23. [PMID: 19457503 DOI: 10.1016/j.medcli.2008.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 12/16/2008] [Indexed: 10/20/2022]
Abstract
Revascularization strategy in the setting of non-ST-segment acute coronary syndromes remains a controversy. Evidence obtained from clinical trials, generally performed in selected patients, reveals heterogeneous and insufficient results when a routine invasive revascularization strategy and a conservative one are compared. The conflicting results among trials are due to differences in: a) baseline characteristics; b) methodology and protocols applied and; c) objectives and outcomes definitions. Although present guidelines recommend that a routine invasive strategy should be used in high risk non-ST-segment elevation acute coronary syndromes, there is no consistent evidence that supports this approach. In order to reach definitive conclusions, further randomized studies should: a) expand inclusion criteria to highest risk populations and; b) standardize the methodology, objectives and outcome definitions.
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Affiliation(s)
- Julio Núñez
- Servei de Cardiologia, Hospital Clínic i Universitari, Universitat de València, Valencia, España.
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Cequier Á. El registro MASCARA desenmascara la realidad asistencial del manejo de los síndromes coronarios agudos en España. Rev Esp Cardiol 2008. [DOI: 10.1157/13124988] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ferreira-González I, Permanyer-Miralda G, Marrugat J, Heras M, Cuñat J, Civeira E, Arós F, Rodríguez JJ, Sánchez PL, Bueno H. Estudio MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado). Resultados globales. Rev Esp Cardiol 2008. [DOI: 10.1157/13124991] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado) Study. General Findings. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1885-5857(08)60228-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alonso JJ, Sanz G, Guindo J, García-Moll X, Bardají A, Bueno H. Unidades coronarias de cuidados intermedios: base racional, infraestructura, equipamiento e indicaciones de ingreso. Rev Esp Cardiol 2007. [DOI: 10.1157/13101644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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López Menchaca R, Herrero Martínez JM, Suárez Fernández C. [Association of antiagregants: when and how]. Med Clin (Barc) 2007; 128:383-9. [PMID: 17386246 DOI: 10.1157/13099977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aterothrombotic disease (coronary, cerebrovascular and peripheral artery disease) is the most common cause of mortality and disability in the world, antiaggregants representing one of its therapeutic and preventive pillars. We have drugs at present that act at different levels of platelet aggregation (COX inhibitors as well as inhibitors of phosphodiesterase, ADP P2Y12 receptor and IIb/IIIa receptor). We review here the efficacy and safety of the association of antiaggregants in most relevant clinical scenarios, including current clinical recommendations and an analysis of supportive evidence.
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Claver E, Curós A, López-Ayerbe J, Serra J, Mauri J, Fernández-Nofrerias E, Rodríguez-Leor O, Bernal E, Valle V. Variables clínicas predictoras de enfermedad del tronco común en pacientes de alto riesgo con un primer episodio de síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13091883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Heras M, Bueno H, Bardají A, Fernández-Ortiz A, Martí H, Marrugat J. Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry. Heart 2006; 92:1571-6. [PMID: 16644860 PMCID: PMC1861221 DOI: 10.1136/hrt.2005.079673] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To analyse intensity of treatment of high-risk patients with non-ST elevation acute coronary syndromes (NSTEACS) included in the DESCARTES (Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español) registry. PATIENTS AND SETTING Patients with NSTEACS (n = 1877) admitted to 45 randomly selected Spanish hospitals in April and May 2002 were studied. DESIGN Patients with ST segment depression and troponin rise were considered high risk (n = 478) and were compared with non-high risk patients (n = 1399). RESULTS 46.9% of high-risk patients versus 39.5% of non-high-risk patients underwent angiography (p = 0.005), 23.2% versus 18.8% (p = 0.038) underwent percutaneous revascularisation, and 24.9% versus 7.4% (p < 0.001) were given glycoprotein IIb/IIIa inhibitor. In-hospital and six-month mortality were 7.5% versus 1.1% and 17% versus 4.6% (p < 0.001), respectively. A treatment score (> or = 4, 2-3 and < 2) was defined according to the number of class I interventions recommended in clinical guidelines: aspirin, clopidogrel, beta blockers, angiotensin-converting enzyme inhibitors, statins and revascularisation. Independent predictors of six-month mortality were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04 to 1.10, p < 0.001), diabetes (OR 1.92, 95% CI 1.14 to 3.22, p = 0.014), previous cardiovascular disease (OR 4.17, 95% CI 1.63 to 10.68, p = 0.003), high risk (OR 2.20, 95% CI 1.30 to 3.71, p = 0.003) and treatment score < 2 versus > or = 4 (OR 2.87, 95% CI 1.27 to 6.52, p = 0.012). CONCLUSIONS Class I recommended treatments were underused in high-risk patients in the DESCARTES registry. This undertreatment was an independent predictor of death of patients with an acute coronary syndrome.
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Affiliation(s)
- M Heras
- Department of Cardiology of Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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Ferrer Hita JJ, Domínguez Rodríguez A, García González MJ, Abreu González P, Bethencourt Muñoz M, Marrero Rodríguez F. Influencia de la diabetes mellitus en el tratamiento y el pronóstico del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1016/s0300-8932(06)74646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huelmos A, Jiménez J, Guijarro C, Belinchón JC, Puras E, Sánchez C, Casas ML, López-Bescos L. Enfermedad arterial periférica desconocida en pacientes con síndrome coronario agudo: prevalencia y patrón diferencial de los factores de riesgo cardiovascular tradicionales y emergentes. Rev Esp Cardiol 2005. [DOI: 10.1016/s0300-8932(05)74070-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Colmenero Ruiz M, Reina Toral A, Jiménez Quintana M, Aguayo de Hoyos E, Ruiz Bailén M, García Alcántara A, Álvarez Bueno M, Benítez Parejo J. Variabilidad en el manejo del infarto agudo de miocardio en el registro ARIAM en el año 2002. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74277-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Permanyer-Miralda G, Ferreira-González I, Marrugat de la Iglesia J, Bueno-Zamora H. Bases conceptuales y metodológicas del estudio MASCARA: el reto de la efectividad. Med Clin (Barc) 2005; 125:580-4. [PMID: 16277951 DOI: 10.1157/13080652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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García Almagro FJ, Gimeno JR, Villegas M, Muñoz L, Sánchez E, Teruel F, Hurtado J, González J, Antolinos MJ, Pascual D, Valdés M. Use of a Coronary Risk Score (the TIM I Risk Score) in a Non–Selected Patient Population Assessed for Chest Pain at an Emergency Department. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1885-5857(06)60505-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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García Almagro FJ, Gimeno JR, Villegas M, Muñoz L, Sánchez E, Teruel F, Hurtado J, González J, Antolinos MJ, Pascual D, Valdés M. Aplicación de una puntuación de riesgo coronario (TIMI Risk Score) en una población no seleccionada de pacientes que consultan por dolor torácico en un servicio de urgencias. Rev Esp Cardiol 2005. [DOI: 10.1157/13077228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de la Hera JM, Moris C, Barriales V. Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST: ¿hay más de un mundo real? Rev Esp Cardiol (Engl Ed) 2005. [DOI: 10.1157/13073905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zueco Gil J. Importancia de los factores clínicos y anatómicos en el intervencionismo coronario. Rev Esp Cardiol (Engl Ed) 2005. [DOI: 10.1157/13073897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bueno H, Bardají A, Fernández-Ortiz A, Marrugat J, Martí H, Heras M. Manejo del síndrome coronario agudo sin elevación del segmento ST en España. Estudio DESCARTES (Descripción del Estado de los Síndromes Coronarios Agudos en un Registro Temporal ESpañol). Rev Esp Cardiol 2005. [DOI: 10.1157/13072471] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alonso Martín JJ, Curcio Ruigómez A, Cristóbal Varela C, Tarín Vicente MN, Serrano Antolín JM, Talavera Calle P, Graupner Abad C. Indicaciones de revascularización: aspectos clínicos. Rev Esp Cardiol 2005. [DOI: 10.1157/13071894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bodí V, Sanchis J, Llàcer A, Núñez J, Fácila L, Pellicer M, Bertomeu V, Bosch MJ, García D, Chorro FJ. [Sex differences in mortality at one-month and at one-year after an acute coronary syndrome]. Med Clin (Barc) 2004; 122:566-9. [PMID: 15144743 DOI: 10.1016/s0025-7753(04)74310-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE We aimed to delineate the sex differences in short-term (one-month) and long-term (one-year) cardiac death after an acute coronary syndrome. PATIENTS AND METHOD After the publication of the new myocardial infarction definition, we prospectively analyzed 1,324 consecutive patients admitted with a diagnosis of acute coronary syndrome to a tertiary hospital. 483 (37%) of these patients had myocardial infarction with ST-elevation, 439 (33%) had myocardial infarction without ST elevation (troponin I > 1 ng/ml) and 402 (30%) had an unstable angina (troponin I < 1 ng/ml). RESULTS Within 1-year of follow-up, 177 deaths (13.4%) were detected. There was a similar rate of cardiac death in female and male patients with 'non-ST elevation myocardial infarction' (one-month: 9.7% vs 7.1%, p = NS; one-year: 16.7% vs 13.2%, p = NS) and with unstable angina (one-month: 3% vs 1.9%, p = NS; one-year: 3% vs 5.6%, p = NS). Among patients with 'ST-elevation myocardial infarction' women showed a higher rate of cardiac death at one-month (21.5% vs 9.8%; p < 0.0001) and at one-year (28.9% vs 14.1%, p < 0.0001) than men. In the multivariate analysis, independent predictors of cardiac death in 'ST-elevation myocardial infarction' at one-year were age > 70 years (p < 0.0001), Killip class > 1 (p < 0.0001) and lack of reperfusion (p = 0.003) but not having a female sex. CONCLUSIONS Patients with 'non-ST elevation acute coronary syndromes' did not display sex differences with regard to mortality. Women with 'ST-elevation myocardial infarction' had a higher mortality; however, these differences were not independently related to a female sex but to a worse baseline clinical profile and a lesser rate of reperfusion.
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Affiliation(s)
- Vicent Bodí
- Servicio de Cardiología, Hospital Clínic i Universitari, Universitat de Valencia, Spain.
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Bodí V, Sanchís J, Llácer À, Fácila L, Núñez J, Pellicer M, Bertomeu V, Ruiz V, Bosch MJ, Consuegra L, García D, Chorro FJ. Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. De los grandes estudios al mundo real. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77256-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Borja Villegas J, Rigau Comas D, Izquierdo Pulido I. Criterios terapéuticos en el síndrome coronario agudo. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Antoni Gómez-Hospital J, Cequier Á. La realidad de la estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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López-Fernández S, Cequier Á, Iràculis E, Gómez-Hospital JA, Teruel L, Valero J, Beltrán P, García del Blanco B, Jara F, Esplugas E. Las elevaciones importantes de troponina I en el síndrome coronario agudo sin elevación del segmento ST se asocian a estenosis coronarias más complejas. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Páramo Fernández J, Orbe Lopategui J. El sistema hemostático en los síndromes coronarios agudos: implicaciones fisiopatológicas y terapéuticas. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Herrera Carranza M, Sánchez González A, Ortega Zarza P, Díaz Fernández J, García Sánchez M, Pino Moya E, Barba Pichardo R. Síndrome coronario agudo sin elevación del segmento ST por lesión aguda del tronco común de la arteria coronaria izquierda. Presentación de 6 pacientes. Med Intensiva 2004. [DOI: 10.1016/s0210-5691(04)70046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bodí V, Fácila L, Sanchís J, Llàcer A, Ferrero JA, Chorro FJ. [Gender differences in patients with suspected non-ST-segment elevation acute coronary syndromes. Implications for invasive management]. Rev Esp Cardiol 2003; 56:412-6. [PMID: 12689578 DOI: 10.1016/s0300-8932(03)76887-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sex differences have been observed in the clinical profile, prognosis, and treatment of patients with unstable ischemic heart disease. Men tend to receive more invasive management. We assessed these differences in 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation who were seen since our chest pain unit opened. A protocol for the management of unstable ischemic heart disease was followed. Women had a worse baseline clinical profile but men more frequently had a positive exercise stress test. Univariate analysis showed that angiography and revascularization procedures were performed more often in men. However, multivariate analysis did not confirm male sex as an independent predictor of the need for a more invasive strategy. The inauguration of a chest pain unit and application of a protocol for the management of unstable ischemic heart disease has helped to correct case stratification and optimize the application of invasive treatments.
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Affiliation(s)
- Vicent Bodí
- Servei de Cardiologia. Hospital Clínic i Universitari. Universitat de València. España.
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Bosch X, López De Sá E, López Sendón J, Aboal J, Miranda-Guardiola F, Bethencourt A, Rubio R, Moreno R, Martín Jadraque L, Roldán I, Calviño R, Valle V, Malpartida F. [Clinical characteristics, prognosis, and variability in the management of non-ST-segment elevation acute coronary syndromes. Data from the PEPA registry]. Rev Esp Cardiol 2003; 56:346-53. [PMID: 12689568 DOI: 10.1016/s0300-8932(03)76877-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the clinical characteristics and inter-hospital variability in the treatment and prognosis of patients with non-ST-segment elevation acute coronary syndromes. PATIENTS AND METHOD Data from the PEPA study, a prospective registry that enrolled 4,115 patients in 18 Spanish hospitals, were analyzed. RESULTS The mean age of the patients enrolled was 65 years, 33% were women, and 26% had diabetes. Large differences were observed in the clinical profile of patients admitted to different centers, especially relative the history of previous disease, prior coronary revascularization, and co-morbidity. Antiplatelet treatment was used in 93% of patients, heparin in 45%, beta-blockers in 42%, nitrates in 67%, and calcium antagonists in 46%. During hospitalization, exercise stress testing was performed in 37% of patients, coronary angiography in 32%, coronary angioplasty in 9%, and coronary surgery in 4%. Inter-hospital variability was minimal for the use of antiplatelet agents, wide for the use of heparin and beta-blockers, and huge for the use of revascularization procedures. Mortality and the incidence of death or myocardial infarction were 2.6% and 4.4% during hospitalization, and 4.6% and 8% at 3 months, with wide inter-hospital variability. These differences were not significant once adjusted for clinical characteristics and the treatment received at admission. CONCLUSIONS Patients with non-ST-segment elevation acute coronary syndromes represent an heterogeneous group with a high incidence of complications. Pharmacologic and, especially, invasive treatment varies widely in different hospitals. These results underline the importance of correct initial risk stratification and uniform treatment following the recommendations of clinical guidelines.
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Affiliation(s)
- Xavier Bosch
- Servicio de Cardiología. Institut de Malalties Cardiovasculars. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Barcelona. España.
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Arós F, Cuñat J, Loma-Osorio A, Torrado E, Bosch X, Rodríguez JJ, López Bescós L, Ancillo P, Pabón P, Heras M, Marrugat J. Tratamiento del infarto agudo de miocardio en España en el año 2000. El estudio PRIAMHO II. Rev Esp Cardiol 2003; 56:1165-73. [PMID: 14670268 DOI: 10.1016/s0300-8932(03)77034-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hospital registries are useful tools to measure the degree of implementation of new treatments and clinical practice guidelines. PATIENTS AND METHOD The hospital registry described here was developed in the prospective PRIAMHO II study, which involved a random selection of Spanish hospitals with a coronary intensive care unit and external quality control. This study investigated patients admitted to the coronary care unit with acute myocardial infarction. Demographic and clinical characteristics were recorded, as well as the management, clinical course and survival after 28 days and one year. RESULTS From May 15 to December 15 2000 we included in the registry 6,221 patients from the 58 hospitals that complied with the quality control requirements (71.6% of all participating hospitals). Acute mortality was 9.6%; 28-day and one-year mortality were 11.4% and 16.5%, respectively. Of the patients with ST elevation-myocardial infarction of less than 12 hours' duration, 71.6% were reperfused and 89.3% received fibrinolysis with a median door-to-needle time of 48 minutes. Ejection fraction was measured in 81% of the patients, and 43% were tested for inducible ischemia. About nine-tenths (91%) of the patients were discharged on least one antiplatelet drug, 56% on a beta blocker, 45% on an ACE inhibitor, and 45% on a lipid-lowering agent, with a coefficient of variation between hospitals greater than 25% for the last three drugs. CONCLUSIONS The percentage of patients with ST elevation treated with reperfusion should increase, as it probably will thanks to the increasing use of primary angioplasty. The door-to-needle time was longer than the recommended interval. In-hospital risk stratification was good but nonsystematic for the evaluation of ejection fraction, and unsatisfactory for inducible ischemia testing. At discharge the percentages of patients receiving beta blockers, ACE inhibitors and statins were not optimal, and there were wide variations in prescribing practices between hospitals.
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Affiliation(s)
- Fernando Arós
- Area de Cardiología y Críticos. Hospital Txagorritxu. Vitoria. España.
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Carlos Kaski J, Cruz-Fernández JM, Fernández-Bergés D, García-Moll X, Martín Jadraque L, Mostaza J, López García-Aranda V, Ramón González Juanatey J, Castro Beiras A, Martín Luengo C, Alonso García Á, López-Bescós L, Marcos Gómez G. Marcadores de inflamación y estratificación de riesgo en pacientes con síndrome coronario agudo: diseño del estudio SIESTA (Systemic Inflammation Evaluation in patients with non-ST segment elevation Acute coronary syndromes). Rev Esp Cardiol (Engl Ed) 2003. [DOI: 10.1016/s0300-8932(03)76883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Criterios terapéuticos en el síndrome coronario agudo. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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López-Sendón J. [Troponin and other markers of cardiac damage. Myths and realities]. Rev Esp Cardiol 2003; 56:16-9. [PMID: 12549994 DOI: 10.1016/s0300-8932(03)76815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Valentín Segura V. [Indications of treatment with clopidogrel in the guidelines of the Spanish Society of Cardiology for unstable angina/non-ST-segment elevation acute myocardial infarction]. Rev Esp Cardiol 2002; 55:1217-8; author reply 1218. [PMID: 12423582 DOI: 10.1016/s0300-8932(02)76788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
In the past few years, several clinical trials with low-molecular-weight heparins in acute coronary syndromes without ST-segment elevation have been published. In the acute phase of treatment, enoxaparin obtained better results than unfractionated heparin, but dalteparin and nadroparin did not. Enoxaparin also obtained better results than tinzaparin. From these results, it can be assumed that the efficacy of enoxaparin is higher than that of dalteparin and nadroparin. However, because low-molecular-weight heparins have not been compared head to head (except in the case of enoxaparin and tinzaparin), and given the differences between studies in patient selection criteria, design, treatment strategies, and efficacy variables, it cannot be concluded that one low-molecular-weight heparin is superior to another in the acute phase of treatment. Prolonged dalteparin treatment suggests a benefit, particularly for patients at high risk (defined as those with high troponin levels), and it can also be useful in patients waiting for invasive procedures.
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Affiliation(s)
- Javier Borja
- Pharmacia Spain, S.A., Medical Department, Carretera de Rubí, 90-100, 08190 Sant Cugat del Vallés, Barcelona, Spain.
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López Bescós L, Arós F. Respuesta. Rev Esp Cardiol (Engl Ed) 2002. [DOI: 10.1016/s0300-8932(02)76789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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