Subject(s)
Clinical Decision-Making , Intensive Care Units , Life Support Care , Patient Admission , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Refusal to TreatABSTRACT
OBJECTIVE: To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS). DESIGN: A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression. SETTING: Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. PATIENTS: A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72 h). VARIABLES ANALYZED: Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode. RESULTS: Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p<0.005), increased baseline bleeding and ischemic risk (p=0.05) and a higher heart rate upon admission (p<0.05). After adjustment, only age > 80 years (OR 0.48, 95% CI 0.27 to 0.82, p=0.009), known coronary lesions (OR 0.47, 95% CI 0.26-0.84, p=0.011), and heart rate (OR 0.98, 95% CI 0.97-0.99, p=0.003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p=0.013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p<0.001) were associated to the early invasive strategy. The exclusion of early deaths (<24 h) did not alter these results. CONCLUSIONS: In women with NSTE ACS, smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy. Previous coronary lesions, age > 80 years and increased heart rate were independent factors associated to conservative treatment.
Subject(s)
Myocardial Revascularization/statistics & numerical data , Non-ST Elevated Myocardial Infarction/therapy , Age Factors , Aged , Aged, 80 and over , Comorbidity , Coronary Disease/epidemiology , Diabetes Mellitus/epidemiology , Electrocardiography , Female , Heart Failure/epidemiology , Heart Rate , Humans , Middle Aged , Non-ST Elevated Myocardial Infarction/epidemiology , Registries , Retrospective Studies , Risk Factors , Smoking/epidemiology , Time Factors , Treatment OutcomeABSTRACT
MAIN OBJECTIVE: Evaluate effectiveness of our cardiac arrest (CA) system. SPECIFIC OBJECTIVES: To know the clinical and demographical characteristics of patients who undergo cardiopulmonary resuscitation (CPR). To know the action time of the CA team, immediate survival, hospital discharge and at one year, cerebral functional category of cardiorespiratory arrest survivors. MATERIAL AND METHODS: Retrospective descriptive study on CA received in the Hospital San Millan of Logoroño. SUBJECTS: In-hospital cardiac arrest adults except for those in the Intensive Care Unit (ICU) and Emergency Department. PERIOD: From January 1, 2003 to December 31, 2006. Survival study until December 31, 2007. Data was collected from the Utstein Style Registry of the in-hospital CPR. Descriptive statistic analysis and bivariant analysis was performed with the Chi2 test and odds ratio (OR). RESULT: CPR was performed in 90 patients. Average arrival time was 1 minute. Origin was non-cardiac 56%, cardiac 34.4%. Initial rhythm was non-shockable 76.7%, shockable 22.2%. Survival at hospital discharge: 20%. Cerebral Performance Category 1: 89%. Survival after one year 16.7%. Survival: cardiac etiology (P=0.05; OR 0.20; 95% CI 0.06-0.65). Initial rhythm shockable (P=0.0001; OR 0.18; 95% CI 0.05-0.56) CONCLUSIONS: Our CA system is effective. We achieve a survival and cerebral performance categories on hospital discharge that is similar to other studies although the rate of patients with shockable rhythm and cardiac etiology in our series is less than others published.
