ABSTRACT
OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.
Subject(s)
Acute Coronary Syndrome/therapy , Coronary Angiography , Kidney Diseases/complications , Myocardial Revascularization , Non-ST Elevated Myocardial Infarction/therapy , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnostic imaging , Aged , Aged, 80 and over , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/complications , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Propensity Score , Recurrence , Registries , Retrospective Studies , Risk , Severity of Illness Index , Spain/epidemiology , Treatment OutcomeABSTRACT
OBJECTIVES: To measure accessibility to health care among diabetic patients and analyze whether differences in delay explain differences in hospital mortality. METHODS: A retrospective cohort study was conducted in diabetic patients with acute coronary syndrome with ST-segment elevation included in the ARIAM-SEMICYUC registry (2010-2013). Crude and adjusted analyses were performed using unconditional logistic regression. RESULTS: A total of 4817 patients were analyzed, of whom 1070 (22.2%) were diabetics. No differences were found in access to health care between diabetic and non-diabetic patients. Diabetic patients presented with longer patient delay (90 min vs. 75 min; p=.004) and prehospital delay (150 min vs. 130 min; p=.002). Once the health system was contacted, diabetic patients had a lower reperfusion rate (50% vs. 57.7%; p<.001), but no longer delay in treatment was observed compared with the non-diabetic individuals. Diabetic patients have greater in-hospital mortality (12.5 vs. 6%; p <.001), though neither patient delay nor prehospital delay were identified as independent predictors of in-hospital mortality. CONCLUSIONS: Diabetic patients had a longer delay in access to health care, though such delay was not independently related to increased mortality.
Subject(s)
Acute Coronary Syndrome/therapy , Diabetes Mellitus , Health Services Accessibility , Cohort Studies , Electrocardiography , Hospital Mortality , Humans , Myocardial Infarction , Retrospective StudiesABSTRACT
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Subject(s)
Humans , Abdominal Wall , Hematoma/prevention & control , Heparin, Low-Molecular-Weight/adverse effects , Muscular Diseases/prevention & control , Hematoma/chemically induced , Muscular Diseases/chemically inducedSubject(s)
Abdominal Wall , Anticoagulants/adverse effects , Hematoma/chemically induced , Hemoperitoneum/chemically induced , Heparin, Low-Molecular-Weight/adverse effects , Aged , Anticoagulants/administration & dosage , Fatal Outcome , Female , Heparin, Low-Molecular-Weight/administration & dosage , HumansABSTRACT
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Subject(s)
Female , Aged , Humans , Anticoagulants/adverse effects , Hematoma/chemically induced , Abdominal Wall/pathology , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/therapeutic use , Abdominal MusclesSubject(s)
Airway Obstruction/chemically induced , Angioedema/chemically induced , Fibrinolytic Agents/adverse effects , Respiratory Insufficiency/chemically induced , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/adverse effects , Aged , Airway Obstruction/drug therapy , Angioedema/drug therapy , Anti-Allergic Agents/therapeutic use , Fibrinolytic Agents/administration & dosage , Humans , Male , Myocardial Infarction/complications , Myocardial Infarction/drug therapy , Respiratory Insufficiency/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Treatment OutcomeABSTRACT
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Subject(s)
Aged , Male , Humans , Thrombolytic Therapy , Treatment Outcome , Anti-Allergic Agents , Myocardial Infarction , Tissue Plasminogen Activator , Respiratory Insufficiency , Angioedema , Airway Obstruction , Fibrinolytic AgentsABSTRACT
We discuss a case of a 68 years old man with an acute myocardial infarction and a cardiopulmonary arrest that 3 days after his admission developed a continuous abdominal pain and findings of peritoneal inflammation. The mesenteric angiographical study was normal. A laparotomy was practised and disclosed a local peritonitis and a colonic infarction without mesenteric vascular occlusion. This picture is very unusual in patients with acute myocardial infarction or cardiopulmonary arrest.
Subject(s)
Colitis, Ischemic/etiology , Myocardial Infarction/complications , Abdominal Pain/etiology , Aged , Colitis, Ischemic/diagnosis , Colon/blood supply , Humans , Infarction/diagnosis , Infarction/etiology , MaleABSTRACT
Se presenta el caso de un paciente de 68 años que sufrió un infarto agudo de miocardio con parada cardiaca reanimada y que al 3º día de su ingreso desarrolló un cuadro de abdomen agudo y rectorragia. Se realizó angiografía mesentérica que fue normal. Fue intervenido quirúrgicamente evidenciándose peritonitis local y una necrosis en colon ascendente secundaria a una colitis isquémica de origen no oclusivo, cuadro clínico extremadamente infrecuente en este tipo de pacientes (AU)
