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Objective: The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA)., Design and Scope: Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA., Patients: Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women., Main Variables of Interest: In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model., Results: The women were older (70+/-8 versus 65+/-11; p=0.02) and had greater prevalence of diabetes (37% versus 18%; p=0.002) and hypertension (58% versus 37%; p<0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p=0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p=0.01) and in-hospital mortality (17% versus 8%; p=0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality., Conclusions: In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA.

Objective: To assess the incidence, clinical profile and influence on outcome of systemic inflammatory response syndrome (SIRS) in patients with acute myocardial infarction (AMI) treated with primary angioplasty (PA)., Design: Prospective observational study., Scope: A 12-beds coronary care unit at a university hospital., Patients and Methods: Patients with AMI treated with PA, admitted in 2004 were studied. PRINCIPAL VARIABLES OF INTEREST: Age, gender, anterior localization of AMI, smoking, arterial hypertension, diabetes mellitus, troponin Ic levels, time delays until PA, heart failure, left ventricular ejection fraction (LVEF), in-hospital length of stay and mortality., Results: Ninety patients were included. SIRS was diagnosed in 15 patients (16.6%), who were older (72 +/- 7 vs 66 +/- 9 years; p = 0,01). These patients had a greater frequency of diabetes mellitus (42% vs 17%; p = 0.01), higher troponin Ic levels (80 +/- 12 vs 68 +/- 19 ng/ml; p = 0.02), lower LVEF (41 +/- 8% vs 51 +/- 12%; p = 0.002), longer in-hospital length of stay (18 +/- 5 vs 7 +/- 3 days, p = 0.001), and higher in-hospital mortality (10 vs 3%, p = 0.03) compared with patients without SIRS. Diabetes mellitus (OR: 1.7; 95% CI: 1.2-1.9) and lower ejection fraction (OR: 2.3; 95% CI: 1.5-3.1) were the independent predictors of the presence of systemic inflammatory response syndrome. In multivariant analysis SIRS was an independent predictor of mortality in AMI patients treated with PA (OR: 3.3; 95% CI: 1.3-6)., Conclusions: Systemic inflammatory response syndrome may be present in AMI patients treated with PA and its presence is associated to a worse outcome and longer in-hospital stay.

The presence of diabetes mellitus worsens prognosis in acute coronary syndromes. The aim of our study was to analyze retrospectively the influence of diabetes mellitus on the management and prognosis of patients with non-ST-segment elevation acute coronary syndrome. We compared the baseline clinical characteristics of 273 patients (93 diabetic and 180 non-diabetic) admitted consecutively to our department with the diagnosis of non-ST-segment elevation acute coronary syndrome. In both groups, we assessed the medical treatment given during hospitalization and the use of coronary angiography, percutaneous coronary intervention, and coronary artery bypass grafting. Finally, we determined the incidence of heart failure during hospitalization and mortality at 28 days and 6 months in both groups. Multifactorial analysis revealed that diabetes was an independent risk factor for mortality during the study period. Data from our registry indicate that these findings were not associated with more extensive use of interventions in diabetic patients.