Acute myocardial infarction incidence, mortality and case fatality in Santa Clara, Cuba, 2007-2008.

INTRODUCTION: Information on acute myocardial infarction incidence and mortality is essential for determining the efficacy of the health system's cardiovascular disease prevention activities; however, in Cuba, sufficient data related to acute myocardial infarction are lacking, particularly at the local level. OBJECTIVE: Describe acute myocardial infarction incidence, mortality and case fatality rates from January 2007 through December 2008 in persons aged 45-74 in the municipality of Santa Clara, Villa Clara Province, Cuba. METHODS: A retrospective descriptive study was conducted. The World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease Project (MONICA) methodology was used, but only in part, since out-of-hospital case fatalities were not investigated, resulting in insufficient data for such cases. Cases of acute myocardial infarction covered under MONICA definition 1 were included (non-fatal definite, fatal definite, fatal possible, and unclassifiable deaths). Hospitalized patients were followed for 28 days. Incidence, mortality and case fatality rates in the population were calculated by age group (45-54, 55-64 and 65-74 years) and sex. Age-standardized incidence and mortality rates were calculated using the direct method, with the world population as a reference. RESULTS: A total of 482 cases of acute myocardial infarction were registered. The percentage of cases of non-fatal definite, fatal definite, fatal possible and fatal with insufficient data were 32%, 18.3%, 26.3% and 13.9% respectively. The cumulative age-standardized incidence per 100,000 population was 433 (95% CI 365-501) in men and 195 (95% CI 152-237) in women, while mortality per 100,000 population was 242 (95% CI 192-292) in men and 120 (95% CI 87-153) in women. Case fatality was 56.4% in men and 62.6% in women. Most fatal cases (65.6%) occurred out of hospital, a trend that was more marked in men (73.9%) than in women (51%). CONCLUSIONS: Case fatality from acute myocardial infarction in Santa Clara residents was high, especially in women. Two thirds of fatalities occurred out of hospital, a higher proportion of these deaths in men. It is recommended that the AMI registry be completed by investigating out-of-hospital case fatalities with insufficient data; expanding it to include the 35-44 age group; and that the supply of cardiac marker enzyme immunoassay test kits in Santa Clara be stabilized.

Ductus arterioso permeable. Resultados del tratamiento quirúrgico en 69 pacientes pediátricos / Patent ductus arteriosus. Surgical treatment results in 69 pediatrics patients

Objetivo: El propósito de este trabajo fue el conocer los resultados del tratamiento quirúrgico de la persistencia del conducto arterioso. Métodos: Se realizó un estudio descriptivo en 69 pacientes pediátricos intervenidos quirúrgicamente por persisstencia del conducto arterioso en el servicio de cirugía cardíaca del Cardiocentro “Ernesto Che Guevara”, de Villa Clara, Cuba, entre octubre de 1997 y agosto de 2004. Resultados: La edad promedio de los pacientes fue de 3.3 años, predominando el sexo femenino, la mayoría de los ductus fueron cerrados con doble ligadura y transfixión (67 pacientes). Las complicaciones más frecuentes fueron las respiratorias y se encontró cortocircuito residual en dos pacientes, los cuales resolvieron espontáneamente en 6 meses. Todos los pacientes mostraron mejoría clínica y ecocardiográfica a los 6 meses de operados. No hubo fallecidos. Conclusión: El cierre quirúrgico de la PCA muestra resultados favorables a corto y mediano plazo en nuestro Cardiocentro

Objective: The aim of this investigate work was to know the patient ductus arterious surgical treatment results. Method: A descriptive study was made in 69 pediatrics patients that underwent surgical closure of patent ductus arteriosus in the cardiac service or “Ernesto Che Guevara” Heart Hospital in Santa Clara, Cuba, between October 1997 to august 2004. Results: The patients age average was 3.3 years olf, and predominant in female sex. The majority of the ductus were closure by double ligature and transfixion (67 patients). The respiratory infections were the complication more frequents and residual shunt was found in two patients, which were resolved spontaneously in the first six months. All patients showed clinic and echocardiography improvement at six months of surgical treatment. We didn´t have dead. Conclusion: The patent ductus arteriosus surgical closure show favourable results in our Heart Hospital

¿Es útil el Euroscore como predictor de mortalidad precoz y de complicaciones mayores en la cirugía coronaria a corazón latiendo? / Is useful Euroscore how predictor of early mortality and greater morbidity in beating heart coronary artery bypass grafting surgery?

Objetivo: el objetivo de este trabajo fue el de investigar la utilidad del Euroscore para predecir la muerte y la presencia de complicaciones mayores en pacientes que fueron sometidos a cirugía coronaria a corazón latiendo. Métodos: Para la realización de esta investigación fueron estudiados los expedientes clínicos de 200 pacientes que fueron revascularizados sin circulación extracorpórea por el servicio de cirugía cardíaca del Cardiocentro Ernesto che Guevara de villa Clara, en el período comprendido de enero a diciembre del año 2004. del total de pacientes 16 fallecieron y en 22 se presentaron complicaciones mayores. A cada uno de los pacientes le fue calculado el valor del Euroscore. La utilidad del Euroscore para predecir la probabilidad de morir, y de presentar complicaciones mayores fue investigada a través del Test Hosmer Lemeshow y por medio de las curvas ROC. Resultados: con el Euroscore se obtuvo un área bajo la curva ROC de 0,84, lo que demuestra que este score tiene un excelente poder discriminante para predecir la muerte en estos pacientes. El test de Hosmer Lemeshow con un valor de 0,71 y en el test de Hosmer Lemeshow con un valor de p< a 0,05 (Euroscore: p00,043) muestra ser menos útil para predecir estos eventos

Objective: The aim of this study was to investigate the utility of Euroscore to predict mortality and greater morbidity in patients that underwent coronary artery bypass grafting surgery without extracorporeal circulation. Method. To make this investigation were studied 200 patients that underwent coronary artery bypass graftings surgery without extracorporeal circulation in the cardiac service of Ernesto che Guevara Institute in Santa Clara, Villa clara, Cuba, between January 1 to December 30, 2004. Sixteen patients dead and twenty two had greater morbidity. For each patients was calculated the value of Euroscore. the utility of Euroscore to predict mortality and greater morbidity was i nvestigated by ROC curves and Hosmer Lemeshow test. Results: The Euroscore show an area under the ROC curve of 0,84 to predict mortality and 0,71 to predict greater morbidity. Conclusion: these results permit us to know that Euroscore is very useful to predict mortality in coronary artery bypass grafting surgery without extracorporeal circulation