Gender differences in clinical outcome after coronary stenting

OBJECTIVE: The purpose of this study was to determine the effect of gender differences in the clinical outcome of women and men submitted to coronary stenting at our institution. BACKGROUND: Studies regarding gender differences in outcome after invasive coronary interventions have revealed conflicting data regarding risk for complications. Some studies have pointed to female gender as a predictor of mortality and complications after those procedures. To our knowledge no such evaluation has been performed in our country. METHODS: We reviewed the medical records, cardiac catheterization and procedural data of 205 men and 122 women referred to our section that underwent coronary stenting at the Cardiovascular Center of Puerto Rico and the Caribbean from July 1, 1998 to March 30, 1999. The clinical and procedural characteristics and the immediate procedure-related complications were analyzed. Clinical events during the six-month period after the procedure were evaluated in patients that returned for follow-up to the section. Student's t-test or Mann-Whitney-Wilcoxon, when appropriate, was used to compare continuous data. The chi-square test or Fisher's exact test, was employed to compare categorical data. RESULTS: The initial procedural success and the frequency of early complications were comparable to those informed in the medical literature and not statistically significant between genders. The only statistically significant gender differences in outcome occurred in men who had higher re-hospitalization and re-intervention rates in the six-month period after the procedure. A lower mean ejection fraction and higher previous history of myocardial infarction and cigarette smoking in this group could have been related to the higher complication rate. CONCLUSION: Although the sample examined is small, its findings point to the need of a larger prospective study to further explore the possibility that the previously reported differences in outcome in men and women submitted to interventional procedures would have a stronger relation to clinical factors than to the direct effect of gender.

Surgical versus interventional procedures in patients with multivessel coronary artery disease

OBJECTIVE: This study examined the clinical characteristics, risk factors, indications and post-intervention complications of patients with multivessel coronary artery disease (CAD) submitted to either percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement versus isolated coronary artery bypass grafting (CABG). BACKGROUND: Several studies have examined the relative safety and outcome of patients submitted to those interventional procedures compared to CABG. Limited information is available regarding that subject in Puerto Rico. METHODS: We performed a retrospective analysis of the clinical, angiographic, operative, interventional, post-operative and post-interventional data of patients submitted to those procedures in our institution from January 1998 to August 1998. There were 53 patients in the interventional group and 206 patients in the CAGB group. Comparison of quantitative variables by procedure was based on Student t test or Mann-Whitney-Wilcoxon test; categorical variables were compared using Pearson's chi-square or Fisher's exact test. RESULTS: There were no significant differences in age, body surface area, or cardiac risk factors. The most common pre-existing cardiovascular diagnosis was unstable angina. Three-vessel disease was the most common angiographic finding among CABG patients (61.7 percent). Two-vessel disease without left anterior descending coronary artery obstruction was significantly more common in the PTCA/Stent patients (58.5 percent). The vast majority (97.6 percent) of patients in the PTCA/Stent group and 52.4 percent of the CABG group had two-vessel intervention. A significantly higher frequency of complications occurred in the CABG group. However, the incidence of major complications, in both groups was not statistically different. Atrial arrhythmias were significantly more frequent in the CABG group. CONCLUSION: A larger prospective study should be conducted in order to corroborate these preliminary findings and seek effective solution to any identifiable problem.

Dilated cardiomyopathy: a clinical review of patients evaluated at a Tertiary Care Center in Puerto Rico

OBJECTIVES. The purpose of this study was to determine the causes, epidemiologic baseline data and clinical characteristics of a group of patients referred to a tertiary care center in Puerto Rico with the diagnosis of dilated cardiomyopathy.METHODS. The medical records of 91 new patients with the diagnosis of dilated cardiomyopathy were analyzed. Data was recopilated regarding initial medical history and physical examination, basic blood chemistry, electrocardiograms, chest films and other cardiac studies including echocardiogram, radionuclear ventriculography, cardiac catheterization, contrast ventriculography and coronary angiography. After reviewing the records the etiology for dilated cardiomyopathy was identified in each patient following the World Health Organization Task Forcecriteria. RESULTS. Ischemic cardiomyopathy was identified as the most common the reviewed patient population; an idiopathic etiology was found cause of dilated cardiomyopathy, representing 37 percent of in 22 percent of the patients and valvular heart disease in 14 percent. DISCUSSION. A comparison with previously described series in the medical literature regarding this subject is presented, along with the most prominent clinical characteristics of the studied population. It is felt that the findings presented will require further study of the underlying causes and clinical course of this condition in a larger patient sample and a longer follow-up period

Immunological aspects in various forms of shock

Se presenta un repaso sobre los aspectos inmunológicos en tres formas del síndrome clínico de shock: anafiláctico, séptico y cardiogénico. Se hace una discusión de la participación de los derivados del ácido araquidónico, de la activación del sistema de complemento y de los efectos de los mediadores producidos por diferentes células que explican el origen de varias de las manifestaciones clínicas de estas tres entidades