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Data de publicació electrònica: 20-01-2023 Introduction and objectives: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. Methods: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. Results: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P

Background. The patients who attend a hospital without a hemodynamic laboratory may have differences in health outcomes, treatment, reperfusion times, the rate of cardiovascular complications, hospital stay, mortality or costs may be affected. The study aimed to analyze the prognostic of patients with STEMI treated in the Emergency Department (ED) and the impact prognostic of the delayed reperfusion time in a Hospital General without hemodynamic laboratory. Methods. After ethics review board approval, this retrospective observational cohort study of patients included acute coronary syndrome with ST elevation of ≤ 24 h in the Illes Balears infarction code registry (CI-IB) between May 2008 and December 2018. The information recorded were age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty (PA). Cardiovascular Event (CE) was defined the combined variable: Killip class progression, malignant arrhythmias, Re-infarction, cerebrovascular disease and mortality. Results.605 patients were analyzed. The reperfusion treatment was 83,1% (80,8% with PA). 19% presented some CE. Hospital and monthly mortality was 6.8% and 7.8% respectively. The main differences between patients with and without CE were: age (66 vs 59 years); Chronic obstructive pulmonary disease (COPD); previous infarction; anterior location; Door-To-Needle Time and FPC-PA time. The risk factors of CE were: age, COPD, anterior location, fibrinolysis and patients without reperfusion treatment. In the group with PA, the risk of mortality was higher in COPD (p=0.012), Symptom start –FPC time with (p = 0,084) and FPC-PA time > 90 minutes (p= 0.107). FCM-AP> 90 minutes had a higher mortality (10 vs 4.4%;HR 1,79; IC 95% 1,15-2,78; log-rank:p=0,013)Conclussions. In our cohort, most patients received reperfusion treatment and were performed within the recommended time. In ED, the pacients with a FCM-PA time longer than recommended in the guidelines and COPD had higher CE y mortality.

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-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older., Supported by: MARATO TV3 (081630), de AGAUR (2014SGR240); del Instituto de Salud Carlos III: Red de Investigacion Cardiovascular RD12/0042 (Programa HERACLES); Red RedIAPP RD06/0018; CP12/03287; CIBER Epidemiologia y Salud Publica; CIBERCV de enfermedades Cardiovasculares, Fondo Europeo de Desarrollo Regional (FEDER) (European Regional Development Funds - ERDF-); FIS CP12/03287, FIS 14/00449, FIS PI081327, FIS INTRASALUD PI1101801.

Uno de los objetivos criticos de la estrategia de salud en la cardiopatia isquemica es la atencion urgente del infarto agudo de miocardio con elevacion del ST (IAMCEST) y mas concretamente del sindrome coronario agudo con elevacion del ST, en los que el tiempo asistencial es critico. Esta inmediatez del tratamiento (ya sea mecanica o farmacologica) se deberia reflejar en los resultados de morbimortalidad. En 2003, tras la evidencia cientifica de la necesidad de una revascularizacion mecanica (intervencion coronaria percutanea primaria) en el infarto agudo de miocardio con elevacion del segmento ST, se establecio esta opcion terapeutica en el hospital de referencia de nuestra comunidad (programa de intervencion coronaria percutanea primaria). En marzo de 2008, tras multiples reuniones con diferentes estamentos y centros, se puso en marcha el Registro Comunitario de la Asistencia al Sindrome Coronario Agudo con Elevacion del ST (Registro Codigo Infarto de las Illes Balears). Se realiza: a) deteccion y documentacion de todos los casos diagnosticados de IAMCEST en la comunidad autonoma; b) evaluacion sistematica de los resultados asistenciales del IAMCEST y su ajuste a los objetivos asistenciales (tiempos, morbimortalidad, complicaciones, tratamientos, etc.); c) identificacion y abordaje de las desviaciones respecto a los objetivos; d) conocimiento exhaustivo e implicacion en el proyecto de todos los dispositivos asistenciales, y e) seguimiento al mes, a los 6 meses y al ano del alta hospitalaria tras el proceso agudo del IAMCEST

Myocardial stunning has been poorly described in patients with cerebrovascular accidents. We present a patient in whom severe anteroapical wall motion abnormalities and extensive anterior ST-segment elevation developed after subarachnoid hemorrhage. Total recovery ensued within 2 days. Coronary vasospasm induced by stroke-related sympathetic surge might be the determinant factor of this cardiac event.

The type of acute coronary syndrome may account for different prognoses between men and women after myocardial infarction. This study assessed gender differences in 28-day mortality rates for first or recurrent Q-wave and non–Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8% women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.