Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo / Tako-tsubo syndrome: analysis of 37 cases

Background: Tako-tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and Methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up were analyzed. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4,433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

Validación del puntaje de riesgo TIMI como predictor de mortalidad en pacientes chilenos con infarto agudo al miocardio con supradesnivel de ST / Prediction of hospital mortality of ST elevation myocardial infarction using TIMI score

Background: Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). Aim: To evaluate the predictive capacity for hospital mortality of TIMI-RS. Material and Methods: Patients with ≤ 12-hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. Results: We analyzed 1125 consecutive patients aged 61 ± 13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ≤ 5 points and only 3.6% had scores ≥ 10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. Conclusions: TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated.

Disección coronaria espontánea posterior a ejercicio: presentación de un caso y revisión bibliográfica / Spontaneous Coronary Artery Dissection after to exercise: a case report and literature review

Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome (ACS) in patients with no risk factors, usually described in young women within delivery period. The test of choice to approach diagnosis is coronary angiography, which could result therapeutic as it achieves myocardial revascularization though angioplasty. Occasionally, complementary radiologic techniques are required for diagnosis, as well as other treatments such as coronary bypass surgery (CBS). The prognosis of successfully revascularized patients is favorable, generally with no recurrence. We report the case of a 25 year-old woman, with no medical records, who experienced two episodes of ACS; first after exercise and two days later while she was at rest,revascularized in our hospital due to a double SCD that required CBS with a propitious evolution and remaining asymptomatic trough a six-year follow up...

Disección coronaria espontánea posterior a ejercicio: presentación de un caso y revisión bibliográfica / Spontaneous coronary artery dissection posterior to exercise: presentation of a case and bibliographic review

Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome (ACS) in patients with no risk factors, usually described in young women within delivery period. The test of choice to approach diagnosis is coronary angiography, which could result therapeutic as it achieves myocardial revascularization though angioplasty. Occasionally, complementary radiologic techniques are required for diagnosis, as well as other treatments such as coronary bypass surgery (CBS). The prognosis of successfully revascularized patients is favorable, generally with no recurrence. We report the case of a 25 year-old woman, with no medical records, who experienced two episodes of ACS; first after exercise and two days later while she was at rest,revascularized in our hospital due to a double SCD that required CBS with a propitious evolution and remaining asymptomatic trough a six-year follow up. (AU)