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Introduction and Objectives: To identify the current mortality and management of patients admitted for suspected acute coronary syndrome in Spain. The last available registry (2004-2005) reported an in-hospital mortality of 5.7%., Methods: The study included patients consecutively admitted between January and June 2012 at 44 hospitals selected at random. Information was collected on clinical course at admission and on events at 6 months., Results: A total of 2557 patients admitted with suspected acute coronary syndrome were included: 788 (30.8%) with ST-segment elevation, 1602 (62.7%) without ST-segment elevation, and 167 (6.5%) with unclassified acute coronary syndrome. In-hospital mortality was 4.1% (6.6%, 2.4%, and 7.8% respectively), significantly lower than that observed for 2004-2005. Reperfusion treatment (most commonly, primary percutaneous coronary intervention) was administered to 85.7% of patients with ST-segment elevation attended within 12h. The median time from first medical contact to thrombolysis was 40 min and to balloon inflation, 120 min. Among patients without ST-segment elevation, coronary angiography was performed in 80.6%, percutaneous intervention in 52.0%, and surgery was indicated in 6.4%. Secondary prevention treatments at discharge was prescribed more often than in earlier registries. In patients alive at discharge (follow-up available for 97.1%), 6-month mortality was 3.8%., Conclusions: Mortality among patients with acute coronary syndrome in Spain was lower than that reported in the most recent published studies, in parallel with a more frequent use of the main treatments recommended., (Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Cardiac arrest is one of the major current challenges, due to both its high incidence and mortality and the fact that it leads to severe brain dysfunction in over half of the survivors. The so-called coronary origin Bridge Code is presented, based on the international resuscitation recommendations (2005, 2010). In accordance with a series of strict predictive criteria, this code makes it possible to: (1) select refractory CPR patients with a high or very high presumption of underlying coronary cause; (2) evacuate the patient using mechanical chest compressors [LucasTM, Autopulse®], maintaining coronary and brain perfusion pressures; (3) allow coronary revascularization access during resuscitation maneuvering (PTCA during ongoing CPR); (4) induce early hypothermia; and (5) facilitate post-cardiac arrest intensive care. In the case of treatment failure, the quality of hemodynamic support makes it possible to establish a second bridge to non-heart beating organ donation., (Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Objective: Observational studies have reported a paradoxical inverse relationship between the use of an early invasive strategy (EIS) and the risk of events in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS). The study objectives are: 1) to examine the association between baseline risk in patients with NSTE ACS and the use of EIS; and 2) to identify some of the factors independently associated to the use of EIS., Design: Retrospective cohort study., Setting: Intensive care units participating in the SEMICYUC ARIAM Registry., Patients: Consecutive patients admitted with a diagnosis of NSTE-ACS within 48 hours of evolution between the months of April-July 2010., Interventions: None., Main Outcomes: Coronary angiography with or without angioplasty within 72 hours, risk stratification using the GRACE scale., Results: We analyzed 543 patients with NSTE-ACS, of which 194 were of low risk, 170 intermediate risk and 179 high risk. The EIS was used in 62.4% of the patients at low risk, in 60.2% of those with intermediate risk, and in 49.7% of those at high risk (p for tendency 0.0144). The EIS was used preferentially in patients with low severity and comorbidity. In the logistic regression model, EIS was independently associated to the availability of a catheterization laboratory (OR 2.22 [CI 95% 1.55 to 3.19]), the presence of ST changes on ECG (OR 1.80 [1.23 to 2.64]), or the existence of a low risk of bleeding (OR 0.76 [0.66 to 0.88)]. Conversely, EIS was less prevalent in patients with diabetes (OR 0.60 [0.41 to 0.88]) or tachycardia upon admission (OR 0.54 [0 36 to 0.82])., Conclusions: In 2010 there remained a lesser relative use of EIS in patients at high risk, due in part to an increased risk of bleeding in these patients., (Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

This syndrome was described in 1990. It is characterized by chest pain that simulates an acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronary arteries. We present 16 patients admitted in our ICU, who met the criteria of transient left ventricular dysfunction syndrome (TLVDS). All but 1 patient were women, with age in general higher than 55 years. Chest pain was detected in the 75% of them. A total of 43% had emotional stress as 56% had an elevation of the ST segment, essentially anterolateral. The increase of the biomarkers was slight-to-moderate, with the exception of one patient in whom it was especially high. All of them had undergone a coronary arteriogram and ventriculography, and either septal or anterolateral dyskinesia had been detected, with normal ejection fraction. In 75% of the cases the dyskinesia had disappeared between 4 days to 6 weeks., (Copyright © 2010 Elsevier España, S.L. y SEMICYUC. All rights reserved.)

We present a map of 27 indicators to measure the care quality given to patients with acute coronary syndrome attended in the pre- and hospital area. This includes technical process indicators (registration of care intervals, performance of electrocardiogram, monitoring and vein access, assessment of prognostic risk, hemorrhage and in-hospital mortality, use of reperfusion techniques and performance of echocardiograph), pharmacological process indicators (platelet receptors inhibition, anticoagulation, thrombolysis, beta-blockers, angiotensin converting inhibitors and lipid lowering drugs) and outcomes indicators (quality scales of the care given and mortality)., (Copyright © 2010 Elsevier España, S.L. y SEMICYUC. All rights reserved.)

Objective: To compare tolerance of two sources of isocaloric intake (fructose-glucose-xylitol mixture [FGX] versus glucose) in parenteral nutrition for patients with systemic inflammatory response syndrome (SIRS)., Design: Open, prospective, cohort and randomized study., Setting: Intensive Care Unit., Subjects and Methods: Two groups of patients admitted in ICU: acute pneumonia with sepsis, and necro-hemorrhagic pancreatitis. Criteria of exclusion were: diabetes, previous hypertriglyceridemia, renal failure with serum creatinine > 3 mg/dL on admission in ICU, or hyperbilirrubinemia > 2.5 mg/dL. Parenteral nutrition (TPN), consisting of 1.4 g AA + Lipids 1.3 g + carbohydrates 4 g/kg/d, (either glucose or FGX at random) was administered. Basal levels and days 1st, 4th and 10th plasma glucose, triglycerides, cholesterol, uric acid were determined, and blood venous gases as well. Capillary glycemia was measured every 6 hours and insulin given if glucose levels rose above 180 mg/dL., Statistics: Fisher's exact test; Student t-test; Mann-Whitney test. Data as mean and SD., Results and Conclusions: During 48 months, 119 patients admitted in the ICU (72 with pneumonia and 47 with pancreatitis) were included. In pneumonia, tolerance was similar with both intakes; glycemia was kept at the same level in both, but the amount of insulin given was significantly more in those patients fed on glucose (p < 0.05). Nevertheless, resting blood glucose and triglyceride levels were higher in pancreatitic patients, and more insulin was required. Those on FGX had lower triglyceride plasma levels (p < 0.05) and less insulin was given throughout the study. Glycemia was kept lower though no statistical significance was reached (p < 0.1). No hyperuricemia nor lactic acidosis was found.

We studied the behavior of the cholesterol of 118 septic patients on entering Intensive Care and on receiving parenteral nutritional support, to establish its utility as malnutrition and/or monitoring marker. On admission, there was more intensive hypocholesterolemia (104 +/- 39 mg/dl) in those who had developed multi-organ failure (87 +/- 34 mg/dl, p < 0.001). There was no correlation between cholesterol and gravity (APACHE II). Basal cholesterol values were correlated with transferrin (r = 0.58), prealbumin (r = 0.43), retinol-linked protein (r = 0.32) and albumin (r = 0.32) and albumin (r = 0.54). During twelve days' parenteral nutrition, cholesterol and visceral protein levels recovered, and the good correlation was maintained between cholesterol and transferrin while that between cholesterol and prealbumin increased and that between cholesterol and retinol-linked virtually disappeared. There ceased to be a relation between albumin and cholesterol as from day six. In cases where the septic situation was maintained, with clinical deterioration, cholesterol levels did not rise. This, along with the close correlation with transferrin, led us to think that cholesterol is influenced by inflammation mediators, acting as a marker for this more as nutritional parameter. However, in practice, it provides the same information as short-life visceral proteins, and its determination is more accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

Unlabelled: The APACHE II system classified patients on the basis of the severity of their disease, while the groups related with the diagnosis (DRG) are classified according to the consumption of resources. Nonetheless, the relative DRG weight (RWDRG) may be related with severity given that the most severe patients are also usually the most expensive. The aims of the study were: 1) verify the ability of DRG to measure clinical severity and 2) compare the prognostic value of both systems., Methods: A transversal cut off was performed (316 consecutive admissions in intensive care units [ICU] with 23 exclusions due to unclear final evolution) with the patients being classified according to final hospital evolution in survivors and deaths. Each patient was given an APACHE II score corresponding to the first 24 hours in the ICU. Parallelly the cases were grouped in the corresponding DRG in accordance with the CIE-9-MC codification of their discharge report. The comparison of the means was carried out with the Student's t test, with the determination of prognostic values being performed by discriminant analysis., Results: The survivors had an APACHE II score of 9.5 +/- 5.5 and the deaths of 22.5 +/- 7.8 (p < 0.0001). The RWDRG of the survivors was 1.4 +/- 0.9 and that of the deaths of 2.0 +/- 1.0 (p < 0.0001). On inclusion of all the patients the APACHE II prognostic value was 85.3% and the RWDRG 68.9% and both 84.6%. In the group of patients with a RWDRG lower than 1.6 the prognostic value of the APACHE II was of 87.6% and the RGRDW 72.0% and both 90%. In the group with RWDRG greater than 1.6 the prognostic value of the APACHE II was 85.1%, the RWDRG 73.0% and both 83.2%., Conclusions: The system of the groups related with diagnosis indirectly measures clinical severity. APACHE II is significantly superior to the system of groups related with diagnosis with regard to prognostic value. The use of both systems together does not improve the prognostic value of APACHE II.