Risk factors and therapeutic coverage at 6†years in patients with previous myocardial infarction: the CASTUO study.

OBJECTIVES: To determine the degree of risk factor control, the clinical symptoms and the therapeutic management of patients with a history of previous myocardial infarction. METHODS: Cross-sectional study at 6 years of a first episode of acute myocardial infarction between 2000 and 2009, admitted at a hospital in the region of Extremadura (Spain). Of 2177 patients with this diagnosis, 1365 remained alive and therefore were included in the study. RESULTS: We conducted a person-to-person survey in 666 (48.8%) individuals and telephone survey in 437 (31.9%) individuals. The former are analysed. 130 were female (19.5%). The mean age was 67.4 years and the median time since the event was 5.8 (IQR 3.6-8.2) years. Active smokers made up 13.8%, low-density lipoprotein (LDL) cholesterol was ≥70 mg/dL: 82%, blood pressure ≥140/90 mm Hg (≥140/85 in diabetics): 49.8%, fasting glucose ≥126 mg/dL: 26%, heart rate 50-59 bpm: 60.7%, and obesity: 45.9%. Patients reported presenting angina comprised 22.4% and those with dyspnoea, 29.3%. Drug coverage was: 88.0% antiplatelet drugs, 86.5% statins, 75.6% ß-blockers and 65.8% blockers of the renin-angiotensin system. Patients receiving all four types of drugs made up 41.9%, with only 3.0% having jointly controlled cholesterol, blood pressure, heart rate and glycaemia. CONCLUSIONS: LDL cholesterol, heart rate and blood pressure were risk factors with less control. More than 1/5 of patients had angina and more than 1/4, dyspnoea. Risk factor control and the clinical condition were far from optimal, as was drug coverage, although to a lesser degree.

Determinación del índice tobillo-brazo en pacientes con dolor torácico agudo de posible origen coronario / Ankle-brachial index in patients with chest pain and suspected acute coronary syndrome

Fundamento y objetivo: El dolor torácico agudo (DTA) es un síntoma inespecífico que puede ser expresión de cardiopatía isquémica (CI). La arteriosclerosis frecuentemente está presente en más de un territorio vascular. El índice tobillo-brazo (ITB) es una herramienta útil en el diagnóstico de enfermedad arterial periférica (EAP). Nuestro objetivo fue evaluar la utilidad del ITB en pacientes con DTA en los que se sospecha CI. Pacientes y método: Estudio transversal de 94 pacientes consecutivos, con una edad media (DE) de 57,4 (12,2) años, ingresados por DTA con sospecha de CI, en los que se determinó el ITB y se investigó la presencia de CI.Resultados: La CI estuvo presente en 22 pacientes (23,4%) y estuvo ausente en 72 pacientes (76,6%). La EAP asintomática (ITB≤0,9) estuvo presente en 6 pacientes (27,2%) en el grupo con CI y en 7 pacientes (9,7%) en el grupo sin CI. Encontramos diferencias significativas en el ITB según la presencia o no de CI (0,9 [0,23] frente a 1,17 [0,15]; p<0,001). Evaluamos el valor diagnóstico del ITB en la detección de CI: el área bajo la curva ROC (receiver operating characteristic) fue de 0,8 (intervalo de confianza del 95%: 0,70–0,87); el punto de corte óptimo fue de 0,8 (sensibilidad del 22,7% y especificidad del 98,6%). En el análisis multivariante, el ITB fue el mejor predictor independiente de CI (p<0,0001). Conclusiones: El ITB es un método sencillo, barato y eficiente, que complementa los métodos diagnósticos actuales en el reconocimiento del DTA de origen coronario (AU)

Background and objective: Acute chest pain (ACP) is a non-specific symptom that may be the expression of coronary artery disease (CAD). Atherosclerosis is usually present in more than one vascular territory. Ankle-brachial index (ABI) is a useful tool for the diagnosis of peripheral arterial disease (PAD). Our aim was to evaluate the value of ABI in patients with ACP when CAD is suspected. Patients and methods: We performed a cross-sectional study of 94 patients, mean age: 57.4 (12.2), admitted consecutively due to ACP with suspicion of CAD. ABI and presence of CAD were determined. Results: CAD was present in 22 patients (23.4%) and absent in 72 (76.6%). Asymptomatic PAD (ABI≤0.9) was present in 6 patients (27.2%) of CAD group and in 7 patients (9.7%) of the non-CAD group. Significant difference was found in ABI based on the presence or not of CAD [0.95 (0.23) vs 1.17 (0.15), p<0.001]. The diagnostic value of ABI for CAD detection was evaluated: area under the ROC curve was 0.8 (IC 95%: 0.70–0.87) and optimal cut-off point was 0.8 (sensitivity=22.7% and specificity=98.6%). In the multivariate analysis, ABI was the best independent predictor of CAD (p<0.001).Conclusion: ABI is a simple, cheap and efficient method, which complements other conventional diagnostic methods in the recognition of patients with ACP due to CAD (AU)

[Ankle-brachial index in patients with chest pain and suspected acute coronary syndrome]. / Determinación del índice tobillo-brazo en pacientes con dolor torácico agudo de posible origen coronario.

BACKGROUND AND OBJECTIVE: Acute chest pain (ACP) is a non-specific symptom that may be the expression of coronary artery disease (CAD). Atherosclerosis is usually present in more than one vascular territory. Ankle-brachial index (ABI) is a useful tool for the diagnosis of peripheral arterial disease (PAD). Our aim was to evaluate the value of ABI in patients with ACP when CAD is suspected. PATIENTS AND METHODS: We performed a cross-sectional study of 94 patients, mean age: 57.4 (12.2), admitted consecutively due to ACP with suspicion of CAD. ABI and presence of CAD were determined. RESULTS: CAD was present in 22 patients (23.4%) and absent in 72 (76.6%). Asymptomatic PAD (ABI < or = 0.9) was present in 6 patients (27.2%) of CAD group and in 7 patients (9.7%) of the non-CAD group. Significant difference was found in ABI based on the presence or not of CAD [0.95 (0.23) vs 1.17 (0.15), p<0.001]. The diagnostic value of ABI for CAD detection was evaluated: area under the ROC curve was 0.8 (IC 95%: 0.70-0.87) and optimal cut-off point was 0.8 (sensitivity=22.7% and specificity=98.6%). In the multivariate analysis, ABI was the best independent predictor of CAD (p<0.001). CONCLUSION: ABI is a simple, cheap and efficient method, which complements other conventional diagnostic methods in the recognition of patients with ACP due to CAD.