Characteristics and Outcomes of Patients Hospitalized With Suspected Acute Coronary Syndrome in Whom the Diagnosis is not Confirmed
Patients admitted with suspected acute coronary syndrome (ACS) in whom the diagnosis is not confirmed are poorly characterized. In a contemporary registry of consecutive patients hospitalized with suspected ACS as the primary diagnosis, we assessed characteristics on admission and in-hospital and 6-month mortality of patients discharged with other diagnoses and compared this subgroup with true ACS patients. Of 2557 patients included, 9.0% were discharged with a non-ACS diagnosis such as nonspecific chest pain, myopericarditis, stress cardiomyopathy, hemodynamic disturbances, heart failure, myocardial, pulmonary or valvular disease, or others. Compared with true ACS patients, those with othe…
Evidencias de la revascularización en el infarto agudo de miocardio
Resumen La reperfusion precoz es la clave en el manejo de los pacientes con sindrome coronario agudo con elevacion del ST. Cuanto antes se consiga la reperfusion coronaria, mejor es el pronostico. Segun la evidencia cientifica, la intervencion coronaria percutanea primaria es superior a la fibrinolisis en cuanto a morbilidad y mortalidad y es el tratamiento de eleccion siempre que el retraso a la intervencion coronaria no vaya a superar los 90–120 min. Cuando el retraso a la reperfusion con intervencion coronaria percutanea va a ser largo (> 120 min), se recomienda iniciar el tratamiento con fibrinolisis. Por lo tanto, una limitacion muy importante para la adecuada implementacion de la inte…
Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction.
Abstract Background Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. Methods Randomized multicenter study, including 106 patients (January 2012–March 2014) with non-STEMI, over 70 years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia. Patients were randomized to invasive (routine coronary angiogram, n = 52) or conservative (coronar…
Los niveles en sangre de PGC-1α predice miocardio salvado y remodelado ventricular tras infarto agudo de miocardio con elevación del segmento ST
et al.
Fracción aminoterminal del propéptido natriurético cerebral y troponina ultrasensible en el dolor torácico agudo de origen incierto. Un subestudio del estudio PITAGORAS
Resumen Introduccion y objetivos La troponina ultrasensible ha mejorado el diagnostico del sindrome coronario agudo en los pacientes que se presentan con dolor toracico y troponina convencional normal. Nuestro objetivo es analizar si la fraccion aminoterminal del propeptido natriuretico cerebral aporta informacion adicional. Metodos Se estudio a 398 pacientes, incluidos en el estudio PITAGORAS, que acudieron a urgencias por dolor toracico con troponina convencional normal en dos muestras seriadas (a la llegada y a las 6-8 h). Se midio de forma centralizada la troponina T ultrasensible en las dos muestras y la fraccion aminoterminal del propeptido natriuretico cerebral en la segunda. Los obj…
Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction
Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI >= 75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI >= 75 years. Methods We included 979 patients with STEMI >= 75 years, from the ATencion HOspitalaria del Sindrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-P…
Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo
Introduction and objectives: To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Methods: This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. Results: In total, 1090 patients (15%) died. Th…
Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p <
Update on Ischemic Heart Disease and Critical Care Cardiology
This article summarizes the main developments reported in 2013 on ischemic heart disease, together with the most important innovations in the management of acute cardiac patients. 3.792 JCR (2014) Q2, 34/123 Cardiac & cardiovascular systems UEM
Actualización en cardiopatía isquémica y cuidados críticos cardiológicos
This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients. Full English text available from: www.revespcardiol.org/en.
Pronóstico y manejo del síndrome coronario agudo en España en 2012: estudio DIOCLES
Resumen Introduccion y objetivos Conocer la mortalidad y el manejo actuales de los pacientes ingresados por sospecha de sindrome coronario agudo en Espana. El ultimo registro disponible (2004-2005) reporto una mortalidad hospitalaria del 5,7%. Metodos Se incluyo a los pacientes ingresados consecutivamente de enero a junio de 2012 en 44 hospitales seleccionados al azar. Se recogio la evolucion en el ingreso y los eventos a 6 meses. Resultados Se incluyo a 2.557 pacientes ingresados con sospecha de sindrome coronario agudo: 788 (30,8%) con elevacion del segmento ST, 1.602 (62,7%) sin elevacion del segmento ST y 167 (6,5%) con sindrome coronario agudo inclasificable. La mortalidad hospitalaria…
Prognostic Value of Strain by Tissue Tracking Cardiac Magnetic Resonance After ST-Segment Elevation Myocardial Infarction
The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI).The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown.The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvasc…
Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage
Although high-sensitivity troponins allow early diagnosis of acute myocardial infarction, their role for identification of acute coronary syndrome in patients with normal conventional troponin remains unclear.A total of 446 patients presenting to the emergency department with chest pain and normal troponin (common practice assays) in 2 serial samples were included. Both samples were also centrally analyzed for high-sensitivity troponin T (hs-TnT) (Roche Diagnostics, Basel, Switzerland). Detection (3 ng/L) and 99th percentile (≥ 14 ng/L) cutoffs of the maximum hs-TnT levels (hs-TnTmax) were considered. The end points were acute coronary syndrome diagnosis and the composite of in-hospital rev…
Actualización en cardiopatía isquémica
This article contains a review of the main developments reported in 2011 on the pathophysiology, prevention, prognosis and treatment of chronic coronary artery disease and acute coronary syndrome, with or without ST-segment elevation. It also discusses the recommendations of the latest clinical practice guidelines.
La concentración sanguínea de PGC-1a predice miocardio salvado y remodelado ventricular tras infarto agudo de miocardio con elevación del segmento ST
et al.
Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo
Resumen Introduccion y objetivos El objetivo es evaluar la interaccion entre carga de comorbilidad y beneficio de la revascularizacion en ancianos con sindrome coronario agudo sin elevacion del ST (SCASEST). Metodos Estudio retrospectivo que incluyo a 7.211 pacientes de edad ≥ 70 anos y procedentes de 11 registros de SCASEST espanoles. Se evaluaron 6 comorbilidades (diabetes mellitus, arteriopatia periferica, enfermedad cerebrovascular, enfermedad pulmonar cronica, insuficiencia renal y anemia). Se calculo una puntuacion de propension para comparar el efecto de la revascularizacion frente al tratamiento conservador. El objetivo fue la mortalidad a 1 ano. Resultados Al ano habian fallecido 1…
N-terminal Pro-brain Natriuretic Peptide and High-sensitivity Troponin in the Evaluation of Acute Chest Pain of Uncertain Etiology. A PITAGORAS Substudy
Abstract Introduction and objectives High-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients. Methods A total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8 h later) were studied. The samples were also analyzed in a central laboratory for high-sensi…