Impacto de las características estructurales y organizativas hospitalarias y de urgencias en el resultado evolutivo de la insuficiencia cardiaca aguda / Impact of hospital and emergency department structural and organizational characteristics on outcomes of acute heart failure

Introducción y objetivos: Investigar si diferentes características estructurales/organizativas del hospital y del servicio de urgencias (SU) impactan en los resultados de la insuficiencia cardiaca aguda (ICA). Métodos: Análisis secundario del Registro EAHFE. Se recogieron 6 características hospitalarias y del SU, y se relacionaron con 7 resultados tras el evento índice y tras el alta, ajustados por año de inclusión, características basales y del episodio de ICA y por dichas características estructurales/organizativas. También se relacionó el porcentaje de altas directas desde urgencias (ADU) y resultados, y si había interacción según las características hospitalarias o del SU. Resultados: Cuarenta SU españoles incluyeron 17.974 episodios de ICA. Hubo menos estancias prolongadas en hospitales de alta tecnología, con hospitalización a domicilio y con SU con alta frecuentación, y más estancias prolongadas en hospitales con unidad de insuficiencia cardiaca y área de observación en urgencias. Los hospitales de alta tecnología presentaron menor mortalidad hospitalaria (OR=0,78; IC95%, 0,65-0,94). Respecto a eventos 30 días tras el alta, los hospitales con unidad de corta estancia (UCE) tuvieron más hospitalizaciones (OR=1,19; IC95%, 1,02-1,38); los SU con alta afluencia, menor mortalidad (OR=0,73; IC95%, 0,56-0,96) y eventos combinados (OR=0,87; IC95%, 0,76-0,99), y los hospitales con unidad de insuficiencia cardiaca, menos reconsultas a urgencias (OR=0,83; IC95%, 0,76-0,91), hospitalizaciones (OR=0,85; IC95%, 0,75-0,97) y eventos combinados (OR=0,84; IC95%, 0,77-0,92). A más ADU, menos estancias prolongadas. Entre otras interacciones, el incremento de ADU se asoció con más reconsultas, hospitalizaciones y eventos combinados a los 30 días del alta en hospitales sin UCE, pero no en hospitales con UCE (AU)

Introduction and objectives: To determine whether structural/organizational characteristics of hospitals and emergency departments (EDs) affect acute heart failure (AHF) outcomes. Methods: We performed a secondary analysis of the EAHFE Registry. Six hospital/ED characteristics were collected and were related to 7 postindex events and postdischarge outcomes, adjusted by the period of patient inclusion, baseline patient characteristics, AHF episode features, and hospital and ED characteristics. The relationship between discharge directly from the ED (DDED) and outcomes was assessed, and interaction was analyzed according to the hospital/ED characteristics. Results: We analyzed 17 974 AHF episodes included by 40 Spanish EDs. Prolonged stays were less frequent in high-technology hospitals and those with hospitalization at home and with high-inflow EDs, and were more frequent in hospitals with a heart failure unit (HFU) and an ED observation unit. In-hospital mortality was lower in high-technology hospitals (OR, 0.78; 95%CI, 0.65-0.94). Analysis of 30-day postdischarge outcomes showed that hospitals with a short-stay unit (SSU) had higher hospitalization rates (OR, 1.19; 95%CI, 1.02-1.38), high-inflow EDs had lower mortality (OR, 0.73; 95%CI, 0.56-0.96) and fewer combined events (OR, 0.87; 95%CI, 0.76-0.99), while hospitals with HFU had fewer ED reconsultations (OR, 0.83; 95%CI, 0.76-0.91), hospitalizations (OR, 0.85; 95%CI, 0.75-0.97), and combined events (OR, 0.84; 95%CI, 0.77-0.92). The higher the percentage of DDED, the fewer the prolonged stays. Among other interactions, we found that more frequent DDED was associated with more 30-day postdischarge reconsultations, hospitalizations and combined events in hospitals without SSUs, but not in hospitals with an SSU. Conclusions: AHF outcomes were significantly affected by the structural/organizational characteristics of hospitals and EDs and their aggressiveness in ED management (AU)

Intervención en ancianos frágiles desde urgencias / Intervention in frail elderly patients from emergency care

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Evolución del perfil clínico de los pacientes con insuficiencia cardiaca aguda atendidos en servicios de urgencias españoles / Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments

Objetivo. Analizar los cambios en la epidemiología, en la atención clínica ambulatoria y en urgencias, y la evolución de los pacientes atendidos por insuficiencia cardiaca aguda (ICA) en los servicios de urgencias hospitalarios (SUH) españoles entre 2007 y 2014. Método. Estudio multicéntrico, de cohortes, con inclusión consecutiva de pacientes con ICA diagnosticados en 9SUH durante 4 periodos (2007, 2009, 2011 y 2014). Se analizaron los cambios observados en 20 variables correspondientes a datos basales, de atención ambulatoria y urgente, y evolutivos. Resultados. Se incluyeron 4.845 pacientes. Hubo cambios significativos en 13 variables: aumentaron los pacientes >80años (2007/2014: 45,9/55,4%; p<0,001) pero disminuyó la dependencia funcional grave (28,2/19,7%; p<0,001). Respecto a la atención crónica ambulatoria, aumentó el uso de betabloqueantes (44,6/57,8%; p=0,002) y antialdosterónicos (26,6/37,7%; p<0,05) en pacientes con fracción de eyección disminuida, así como la realización de ecocardiografía (42,8/56,2%; p=0,001), y disminuyó el uso de digoxina (25,4/16,9%; p=0,005). En lo referente a la asistencia en urgencias, se incrementó la solicitud de troponinas (54,6/61,9%; p<0,001), péptidos natriuréticos (7,8/48,5%; p<0,001) y el uso de ventilación no invasiva (3,2/6,9%; p=0,004), y disminuyó la de fármacos en perfusión intravenosa (diuréticos: 21,3/10,4%; p<0,001; nitratos: 21,3/17,5%; p=0,001; vasopresores: 4,2/1,5%; p<0,001). Finalmente, aumentaron las altas directas desde urgencias sin hospitalización (20,0/25,9%; p<0,001) y disminuyeron las reconsultas a urgencias a 30días (27,3/17,6%; p=0,007). La mortalidad intrahospitalaria y a los 30días no se modificaron. Conclusiones. Se detectan cambios evolutivos durante un periodo de 7años en los pacientes con ICA atendidos en el SUH, con una asistencia más ajustada a las guías clínicas, aunque todavía existen áreas de mejora. Destaca un aumento del seguimiento ambulatorio sin ingreso, con una disminución de las reconsultas al SUH (AU)

Objective. To analyse the changes in epidemiology, outpatient and emergency department clinical care, and outcomes of patients treated for acute heart failure (AHF) in Spanish hospital emergency departments (HEDs) between 2007 and 2014. Method. A multicentre cohort study was conducted that consecutively included patients with AHF diagnosed in 9HEDs during 4 periods (2007, 2009, 2011 and 2014). The study analysed the changes observed in 20 variables corresponding to baseline data, outpatient care and emergency care data and outcome data. Results. A total of 4,845 patients were included. There were significant changes in 13 variables: there was an increase in patients older than 80years (2007/2014: 45.9%/55.4%; P<.001) and a decrease in severe functional dependence (28.2%/19.7%; P<.001). In terms of long-term outpatient care, there was an increased use of beta-blockers (44.6%/57.8%; P=.002) and aldosterone antagonists (26.6%/37.7%; P<.05) among patients with reduced ejection fraction and an increase use of echocardiography (42.8%/56.2%; P=.001). The use of digoxin decreased (25.4%/16.9%; P=.005). In terms of emergency care, there was an increase in requests for troponins (54.6%/61.9%; P<.001), natriuretic peptides (7.8%/48.5%; P<.001) and the use of noninvasive ventilation (3.2%/6.9%; P=.004). Requests for endovenous perfusion drugs decreased (diuretics: 21.3%/10.4%; P<.001; nitrates: 21.3%/17.5%; P=.001; vasopressors: 4.2%/1.5%; P<.001). Finally, discharges directly from the emergency department without hospitalization increased (20.0%/25.9%; P<.001), and emergency department readmissions at 30days decreased (27.3%/17.6%; P=.007). Hospital mortality and mortality at 30days did not change. Conclusions. Changes in outcomes were detected during a 7-year period in patients with AHF treated in HEDs, with care that was more in line with the clinical guidelines. There are, however, areas for improvement. There was a noteworthy increase in outpatient follow-up without hospitalisation and a reduction in HED readmissions (AU)

Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments. / Evolución del perfil clínico de los pacientes con insuficiencia cardiaca aguda atendidos en servicios de urgencias españoles.

OBJECTIVE: To analyse the changes in epidemiology, outpatient and emergency department clinical care, and outcomes of patients treated for acute heart failure (AHF) in Spanish hospital emergency departments (HEDs) between 2007 and 2014. METHOD: A multicentre cohort study was conducted that consecutively included patients with AHF diagnosed in 9HEDs during 4 periods (2007, 2009, 2011 and 2014). The study analysed the changes observed in 20 variables corresponding to baseline data, outpatient care and emergency care data and outcome data. RESULTS: A total of 4,845 patients were included. There were significant changes in 13 variables: there was an increase in patients older than 80years (2007/2014: 45.9%/55.4%; P<.001) and a decrease in severe functional dependence (28.2%/19.7%; P<.001). In terms of long-term outpatient care, there was an increased use of beta-blockers (44.6%/57.8%; P=.002) and aldosterone antagonists (26.6%/37.7%; P<.05) among patients with reduced ejection fraction and an increase use of echocardiography (42.8%/56.2%; P=.001). The use of digoxin decreased (25.4%/16.9%; P=.005). In terms of emergency care, there was an increase in requests for troponins (54.6%/61.9%; P<.001), natriuretic peptides (7.8%/48.5%; P<.001) and the use of noninvasive ventilation (3.2%/6.9%; P=.004). Requests for endovenous perfusion drugs decreased (diuretics: 21.3%/10.4%; P<.001; nitrates: 21.3%/17.5%; P=.001; vasopressors: 4.2%/1.5%; P<.001). Finally, discharges directly from the emergency department without hospitalization increased (20.0%/25.9%; P<.001), and emergency department readmissions at 30days decreased (27.3%/17.6%; P=.007). Hospital mortality and mortality at 30days did not change. CONCLUSIONS: Changes in outcomes were detected during a 7-year period in patients with AHF treated in HEDs, with care that was more in line with the clinical guidelines. There are, however, areas for improvement. There was a noteworthy increase in outpatient follow-up without hospitalisation and a reduction in HED readmissions.

Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D / Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale

INTRODUCCIÓN Y OBJETIVOS: Disponer de escalas pronósticas en la insuficiencia cardiaca crónica agudizada para detectar la mortalidad precoz es fundamental. El objetivo de este estudio es crear una escala pronóstica (escala EAHFE-3D) que estratifique el riesgo de muerte a muy corto plazo. PACIENTES Y MÉTODO: Se utilizó el registro EAHFE, multipropósito y multicéntrico, con seguimiento prospectivo que incluye 6.597 pacientes con insuficiencia cardiaca crónica agudizada atendidos en 34 servicios de urgencias españoles entre 2007 y 2014. Se recogieron variables demográficas, antecedentes personales, datos del episodio agudo, destino final y mortalidad a los 3 días. La cohorte de derivación incluye pacientes seleccionados entre 2009 y 2011 en el registro EAHFE (n = 3.640). La variable a estudio fue la mortalidad a los 3 días. Se creó una escala pronóstica (escala EAHFE-3D) con los resultados del estudio multivariante en función del peso de la OR. La escala fue validada utilizando una cohorte de pacientes incluidos en 2014 (n = 2.957). RESULTADOS: Se analizaron 3.640 pacientes (102 muertos a los 3 días, 2,8%) en la cohorte de derivación. La escala final contiene las siguientes variables (máximo 165 puntos): edad≥ 75 años (30 puntos), NYHA basal III-IV (15 puntos), presión arterial sistólica < 110 mmHg (20 puntos), saturación de O2 < 90% (30 puntos), hiponatremia (20 puntos), tratamiento inotropo o vasopresor (30 puntos) y necesidad de ventilación mecánica no invasiva (20 puntos), con un área bajo la curva ROC de 0,80 (IC 95% 0,76-0,84; p < 0,001). La cohorte de validación incluye 2.957 pacientes (66 muertos a los 3 días, 2,2%) y la escala obtiene un área bajo la curva ROC de 0,76 (IC 95% 0,70-0,82; p < 0,001). Los grupos fueron: muy bajo riesgo (0-20 puntos), bajo riesgo (21-40 puntos), riesgo intermedio (41-60 puntos), alto riesgo (61-80 puntos) y muy alto riesgo (> 80 puntos), con una mortalidad (cohorte de derivación/validación) de 0/0,5, 0,8/1,0%, 2,9/2,8, 5,5/5,8 y 12,7/22,4%, respectivamente. CONCLUSIONES: La escala EAHFE-3D puede ser de ayuda para estratificar el pronóstico a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada en 5 grupos de riesgo

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTES AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure < 110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P < .001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P < .001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups

Evaluación de los conocimientos y la percepción de soporte a la enfermedad en los pacientes con insuficiencia cardiaca. Estudio SOPICA EN ESPAÑA / Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN

Objetivo. Conocer la percepción de los pacientes con insuficiencia cardiaca (IC) sobre su enfermedad, tratamiento y soporte, así como los especialistas que intervienen tras una descompensación, y si existe relación entre el tipo de especialista involucrado en el seguimiento y el pronóstico a medio plazo. Método. Estudio de cohortes multicéntrico, prospectivo, con inclusión consecutiva en urgencias de pacientes con IC aguda. Se entrevistaron telefónicamente los pacientes a los 91-180días tras la consulta en urgencias. Se investigó la relación entre el tipo de especialista que hacía el seguimiento y las visitas a urgencias u hospitalizaciones mediante modelos de regresión de Cox con ajuste progresivo por grupos de potenciales confusores de la relación de interés. Resultados. Se entrevistaron 785 pacientes: un 33% (IC95%: 30-36%) consideraron su enfermedad leve, un 64% (60-67%) necesitaban ayuda de terceras personas para sus actividades diarias, un 65% (61-68%) no habían percibido cambios terapéuticos recientemente y un 69% (67-72%) perciben el mismo tratamiento en las agudizaciones. El soporte percibido varió significativamente dependiendo del factor considerado (de mayor a menor: familia, hospital, urgencias, centro de salud, religión y asociaciones de pacientes; p<0,05 en todas las comparaciones). El 39% (36-43%) de pacientes con descompensaciones consultaron directamente a urgencias sin modificaciones previas del tratamiento y, al alta, el médico de cabecera (74%, 71-77%) y el cardiólogo (74%, 70-77%) fueron los más involucrados en el seguimiento, aunque la especialidad no se relacionó con el pronóstico. Conclusión. Existen diversos aspectos de percepción del paciente con IC respecto a su enfermedad susceptibles de futuras intervenciones. El seguimiento del paciente involucra a diferentes especialidades, pero todas consiguen resultados similares a medio plazo (AU)

Objective. To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis. Methods. A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships. Results. We interviewed 785 patients. Thirty-three percent (95%CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p<.05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis. Conclusion. There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term (AU)

Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN.

OBJECTIVE: To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis. METHODS: A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships. RESULTS: We interviewed 785 patients. Thirty-three percent (95%CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p<.05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis. CONCLUSION: There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term.

Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale. / Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D.

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTS AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.

Effects of dietary fibre intake on risk factors for cardiovascular disease in subjects at high risk.

BACKGROUND: Epidemiological studies and feeding trials with supplements suggest that fibre intake is associated with a reduction in cardiovascular risk. However, the effects of changes in dietary fibre on risk factor levels have not been evaluated in free-living individuals. Thus, the effects of changes in dietary fibre intake on cardiovascular risk factors were assessed over 3 months in free-living high-risk subjects. METHODS: 772 high-risk subjects (age 69+/-5 years) were assigned to a low-fat diet or two Mediterranean-style diets. All participants received behavioural and nutritional education, including recommendations for increasing the consumption of vegetables, fruits, and legumes. Changes in food and nutrient intake, body weight, blood pressure, lipid profiles, glucose control and inflammatory markers were evaluated. RESULTS: Most participants increased consumption of vegetable products, but the increase in dietary fibre exhibited wide between-subject variability (6-65 g/day). Body weight, waist circumference, and mean systolic and diastolic blood pressure decreased across quintiles of fibre intake (p<0.005; all). Reductions in fasting glucose and total cholesterol levels, and increments in HDL cholesterol were highest among participants in the upper 20% of fibre intake (p = 0.04 and 0.02 respectively). Plasma concentrations of C-reactive protein, but not those of inflammatory cytokines, decreased in parallel with increasing dietary fibre (p = 0.04). Significant reductions in LDL cholesterol were observed only among participants with the greatest increases in soluble fibre intake (p = 0.04). CONCLUSIONS: Increasing dietary fibre intake with natural foods is associated with reductions in classical and novel cardiovascular risk factors in a high-risk cohort.

Síndrome coronario agudo por intoxicación con monóxido de carbono / Acute coronary syndrome by carbon monoxide intoxication

La intoxicación por monóxido de carbono (CO) es una patología frecuente en los Servicios de Urgencias que muchas veces no se diagnostica debido a la presentación clínica inespecífica, a la baja disponibilidad de co-oxímetros en los Laboratorios de Urgencias y a las características propias del gas (incoloro, inodoro y noirritante). El CO es un gas producido por la combustión incompleta de la materia orgánica, que se une a la hemoglobina, dificultando el transporte de oxígeno a los tejidos, y a la citocromo-oxidasa, generando una disfunción multiorgánica, en particular sobre el SNC. La afectación cardiovascular es menos frecuente y es un riesgo menos conocido entre los sanitarios, por lo que nos parece de interés presentar un caso de síndrome coronario agudo asociado a una intoxicación grave por CO (AU)

Carbon monoxide (CO) poisoning is a frequent pathology in Emergency Departments (ED) that many times it is not diagnosed due to the lack of a specific clinical presentation, and thelack of co-oximeters in the ED as well as the gas ‘own characteristics(odorless, colorless and non irritating). CO is produced by the in complete combustion of organic materia, it binds to hemoglobin, impairing oxygen transport trough out the tissues and the cytocromeoxidase, thus generating a multiorganic disfunction, particularly over the Central Nervous System. Cardiovascular involvement is less frequent and is a less known risk by sanitary personnel, the reason why it is of special interest to present a case of acute coronary syndrome associated to severe CO intoxication (AU)