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Martínez-Guisado A, Cepas-Guillén P, Díez-Villanueva P, López Lluva MT, Jurado-Román A, Bazal-Chacón P, Negreira-Caamaño M, Olavarri-Miguel I, Elorriaga A, Rivera-López R, Escribano D, Salinas P, Vaquero-Luna J, Prieto A, Pérez-Cebey L, Carrasquer A, Llaó I, Torres Mezcúa FJ, Giralt-Borrell T, Matute-Blanco L, Fernández-Cordón C, González C, Arbas-Redondo E, Aritza-Conty D, Díez-Delhoyo F. Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction. Emergencias 2024; 36:123-130. [PMID: 38597619 DOI: 10.55633/s3me/016.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Pablo Bazal-Chacón
- Servicio de Cardiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - Iván Olavarri-Miguel
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, España
| | - Ane Elorriaga
- Servicio de Cardiología, Hospital Universitario de Basurto, Bilbao, Vizcaya, España
| | | | - David Escribano
- Servicio de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, España
| | - Pablo Salinas
- Servicio de Cardiología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | | | - Alicia Prieto
- Servicio de Cardiología, Hospital Universitario de Albacete, Albacete, España
| | - Lucía Pérez-Cebey
- Servicio de Cardiología, Hospital Universitario de A Coruña, A Coruña, España
| | - Anna Carrasquer
- Servicio de Cardiología, Hospital Joan XXIII, Tarragona, España
| | - Isaac Llaó
- Servicio de Cardiología, Hospital de Bellvitge, L´Hospitalet de Llobregat, Barcelona, España
| | | | | | - Lucía Matute-Blanco
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España
| | | | - Clea González
- Servicio de Cardiología, Hospital Universitario de León, León, España
| | | | - David Aritza-Conty
- Servicio de Cardiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Aboal J, Ramos R, Loma-Osorio P, Núñez M, Comas-Cufi M, Iglesies J, Moral S, Bosch D, Martí-Lluch R, Alves-Cabratosa L, Brugada R. Time from electrocardiographic diagnosis of ST-elevation myocardial infarction to guidewire crossing in patients transferred to a hospital for primary angioplasty: factors associated with delay. Emergencias 2021; 33:195-202. [PMID: 33978333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To identify predictors of primary angioplasty delay in patients with ST-elevation myocardial infarction (STEMI) transported from out-of-hospital sites or from hospitals without percutaneous coronary intervention (PCI) suites. MATERIAL AND METHODS Retrospective cohort study of cases between 2008 and 2018 in a university hospital receiving patients diagnosed with STEMI who required a PCI. We performed linear and multivariate regression analyses to identify factors that predicted delay in interpreting a diagnostic electrocardiogram (ECG) until the guidewire passed the lesion (diagnosis-guidewire-crossing time). RESULTS A total of 1039 cases were studied; 296 patients (28.4%) had delays of more than 120 minutes between STEMI diagnosis and guidewire crossing. Factors associated with PCI delay were advanced age (odds ratio [OR] = 1.02; 95% CI, 1.01-1.04]), severe heart failure on admission (OR = 2.28; 95% CI, 1.23-4.22), history of cardiac bypass surgery (OR = 10.01; 95% CI, 2.60-41.81), out-of-hospital cardiac arrest (OR = 4.34; 95% CI, 1.84-10.32), lateral ischemia (OR, 1.64; 95% CI, 1.06-2.51), first medical attention in a hospital without a PCI suite (OR = 1.52; 95% CI, 1.05-2.21), first medical attention outside regular working hours (OR = 1.46; 95% CI, 1.06-2.02), and distance in kilometers to a PCI suite (OR = 1.04; 95% CI, 1.03-1.05). CONCLUSION Patients with STEMI who required transport to a hospital with a PCI suite experienced primary angioplasty delays. Delays were related to logistical and clinical factors as well as to infarction characteristics.
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Affiliation(s)
- Jaime Aboal
- Hospital Universitario Josep Trueta, Girona, España
| | - Rafel Ramos
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España
| | - Pablo Loma-Osorio
- Hospital Universitario Josep Trueta, Girona, España. Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España
| | - Maria Núñez
- Hospital Universitario Josep Trueta, Girona, España
| | - Marc Comas-Cufi
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España
| | | | - Sergio Moral
- Hospital Universitario Josep Trueta, Girona, España
| | - Daniel Bosch
- Hospital Universitario Josep Trueta, Girona, España
| | - Ruth Martí-Lluch
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España
| | - Lia Alves-Cabratosa
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España
| | - Ramon Brugada
- Hospital Universitario Josep Trueta, Girona, España. Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España. Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER CV), España
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Mao CY, Lu HB, Kong N, Li JY, Liu M, Yang CY, Yang P. Levocarnitine protects H9c2 rat cardiomyocytes from H2O2-induced mitochondrial dysfunction and apoptosis. Int J Med Sci 2014; 11:1107-15. [PMID: 25170293 PMCID: PMC4147636 DOI: 10.7150/ijms.9153] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the protective effects of levocarnitine in patients with ischemic heart disease are related to the attenuation of oxidative stress injury, the exact mechanisms involved have yet to be fully understood. Our aim was to investigate the potential protective effects of levocarnitine pretreatment against oxidative stress in rat H9c2 cardiomyocytes. METHODS Cardiomyocytes were exposed to H2O2 to create an oxidative stress model. The cells were pretreated with 50, 100, or 200 μM levocarnitine for 1 hour before H2O2 exposure. RESULTS H2O2 exposure led to significant activation of oxidative stress in the cells, characterized by reduced viability, increased intracellular reactive oxygen species, lipid peroxidation, and reduced intracellular antioxidant activity. Mitochondrial dysfunction was also observed following H2O2 exposure, reflected by the loss of mitochondrial transmembrane potential and intracellular adenosine triphosphate. These pathophysiological processes led to cardiomyocyte apoptosis through activation of the intrinsic apoptotic pathway. More importantly, the levocarnitine pretreatment attenuated the H2O2-induced oxidative injury significantly, preserved mitochondrial function, and partially prevented cardiomyocyte apoptosis during the oxidative stress reaction. Western blotting analyses suggested that levocarnitine pretreatment increased plasma protein levels of Bcl-2, reduced Bax, and attenuated cytochrome C leakage from the mitochondria in the cells. CONCLUSION Our in vitro study indicated that levocarnitine pretreatment may protect cardiomyocytes from oxidative stress-related damage.
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Affiliation(s)
- Cui-Ying Mao
- 1. Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Hai-Bin Lu
- 2. College of Pharmacy, Jilin University, Changchun, China
| | - Ning Kong
- 2. College of Pharmacy, Jilin University, Changchun, China
| | - Jia-Yu Li
- 1. Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Miao Liu
- 1. Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Chun-Yan Yang
- 1. Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Ping Yang
- 1. Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, China
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