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Introduction and objectives Despite evidence of a reduction in the incidence and mortality of acute coronary syndrome (ACS), some studies have highlighted differences in outcomes between men and women. We aimed to explore sex differences in the management and treatment of patients with ACS in Spain. Methods This ecological cross-sectional study combined ACS data from 10 Spanish registries (54 centres). Meta-regression analysis was performed using aggregated data of baseline characteristics, interventional procedures, treatments, and events that occurred during hospitalization and one-year follow-up. Results Aggregated data from 34 605 patients (75.1% men) was included. ST-segment elevation myocardial infarction was the most frequent diagnosis (58.9%) and almost 80% of patients were Killip Class I. Compared to men, women were older (mean age: 71.0 vs 63.3 years) and presented higher rates of hypertension (68.1% vs 51.7%) and diabetes (37.7% vs 26.5%). Women were also less likely to undergo percutaneous coronary interventions, revascularization surgery, and to receive drug-eluting stents during hospitalization. Regarding to antiplatelet therapy, even though indicated, 23.1% of women were not treated with P2Y12 inhibitors (vs 14.2% of men; P 60%). Significantly higher in-hospital (5.4% vs 3.7%) and 1-year (8.2% vs 4.9%) mortality was observed among women compared to men, which was mainly attributed to cardiovascular causes. Conclusions Despite older age and unfavourable risk profile, female ACS patients seem to be suboptimally treated with P2Y12 inhibitors. To reduce mortality associated with ACS, improved prevention and optimized therapeutic approaches are needed.

Objetivos. Existe cierta controversia sobre la validez de la ergometria en la evaluacion de pacientes que han sufrido un infarto agudo de miocardio tratado con fibrinoliticos. Ademas, la influencia en el pronostico de la permeabilidad de la arteria responsable del infarto no ha sido establecida clara-mente. Nuestros objetivos fueron determinar la vigencia de la ergometria y la influencia de la permeabilidad de la arteria en el pronostico tras un infarto. Material y metodos. Se estudiaron 99 pacientes con un primer infarto tratado con fibrinoliticos y no complicado. Se realizaron ergometria y cateterismo cardiaco en el primer mes. Se hizo un seguimiento de los pacientes durante 2 anos, regis-trandose los eventos mayores (reinfarto o fallecimiento) y menores (angina clase II o superior, disnea grado II o superior o taquicardia ventricular sostenida). Resultados. En el analisis multivariante median-te regresion de Cox se observo como predictor independiente de eventos mayores: no alcanzar 4 METS en la ergometria (RR = 5,6; IC del 95%, 1,68–19). Las variables predictoras de eventos menores fueron: enfermedad multivaso (RR = 3,36; IC del 95%, 1,56–7,24), localizacion anterior del infarto (RR = 3,15; IC del 95%, 1,3–7,6), ergometria anormal (RR = 2,98; IC del 95%, 1,46–6,09) y fraccion de eyeccion £ 40% (RR = 2,48; IC del 95%, 1,07–5,74). La oclusion de la arteria responsable del infarto no predijo la incidencia de eventos. Conclusiones. La ergometria es valida para establecer el pronostico en los pacientes tratados con trombolisis. La oclusion de la arteria relacionada con el infarto no resulta predictora de eventos tras dos anos de seguimiento.

The presence of a congenital anomaly in coronary arteries can be the cause of a defective coronary flow and ischaemic symptoms. Although they are rare, we must suspect them in the presence of major cardiac events in young people. A single coronary artery is present if the entire coronary system arises from a solitary ostium. Its presence is regarded as having little clinical significance and it is usually a fortuitous finding on coronary angiography. We report the case of a patient with effort anginal symptoms, with a single coronary artery arising from the right sinus of Valsalva without obstructive atherosclerotic lesions.

A patient with a remitting non-microcytic pulmonary carcinoma was subjected to Doppler-echocardiography. The detection of a pericardial effusion with compression of the pulmonary artery due to an extrinsic mass indicated that the disease was progressing. The Doppler technique was used to evaluate the degree of arterial stenosis by determining the pressure gradient caused by it (49 mmHg) and to calculate the right ventricle pressure (75 mmHg). Tumor infiltration of mediastinal structures was posteriorly confirmed by computed tomography.