Prediction of Acute Myocardial Injury in Noncardiac Surgery in Patients at Risk for Major Adverse Cardiovascular and Cerebrovascular Events: A Multivariable Risk Model.

BACKGROUND: The best use of perioperative cardiac biomarkers assessment is still under discussion. Massive postoperative troponin surveillance can result in untenably high workloads and costs for health care systems and potentially harmful interventions for patients. In a cohort of patients at risk for major adverse cardiovascular and cerebrovascular events (MACCEs), we aimed to (1) determine whether preoperative biomarkers can identify patients at major risk for acute myocardial injury in noncardiac surgery, (2) develop a risk model for acute myocardial injury prediction, and (3) propose an algorithm to optimize postoperative troponin surveillance. METHODS: Prospective, single-center cohort study enrolling consecutive adult patients (≥45 years) at risk for MACCE scheduled for intermediate-to-high-risk noncardiac surgery. Baseline high-sensitivity troponin T (hsTnT) and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), as well as hsTnT on the first 3 postoperative days were obtained. The main outcome was the occurrence of acute myocardial injury. Candidate predictors of acute myocardial injury were baseline concentrations of hsTnT ≥14 ng/L and NT-proBNP ≥300 pg/mL and preoperative and intraoperative variables. A multivariable risk model and a decision curve were constructed. RESULTS: Of 732 patients, 42.1% had elevated hsTnT and 37.3% had elevated NT-proBNP levels at baseline. Acute myocardial injury occurred in 161 patients (22%). Elevated baseline hsTnT, found in 84% of patients with acute myocardial injury, was strongly associated with this outcome: odds ratio (OR), 12.08 (95% confidence interval [CI], 7.78-19.42). Logistic regression identified 6 other independent predictors for acute myocardial injury: age, sex, estimated glomerular filtration rate (eGFR) <45 mL·min -1 ·1.73 m -2 , functional capacity <4 METs or unknown, NT-proBNP ≥300 pg/mL, and estimated intraoperative blood loss. The c -statistic for the risk model was 77% (95% CI, 0.73-0.81). The net benefit of the model began at a risk threshold of 7%. CONCLUSIONS: Baseline determination of cardiac biomarkers in patients at risk for MACCE shortly before intermediate- or high-risk noncardiac surgery helps identify those with the highest risk for acute myocardial injury. A baseline hsTnT ≥14 ng/L indicates the need for postoperative troponin surveillance. In patients with baseline hsTnT <14 ng/L, our 6-predictor model will identify additional patients at risk for acute myocardial injury who may also benefit from postoperative surveillance.

PCSK9 Inhibitors Have Apolipoprotein C-III-Related Anti-Inflammatory Activity, Assessed by 1H-NMR Glycoprotein Profile in Subjects at High or very High Cardiovascular Risk.

Atherosclerosis is a chronic inflammatory disease caused by the accumulation of cholesterol in the intima. Proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9) can reduce low-density lipoprotein (LDL) cholesterol levels by 60%, but there is still no evidence that they can lower markers of systemic inflammation such as high-sensitivity C-reactive protein (hsCRP). Acute-phase serum glycoproteins are upregulated in the liver during systemic inflammation, and their role as inflammatory biomarkers is under clinical evaluation. In this observational study, we evaluate the effects of iPCSK9 on glycoproteins (Glyc) A, B and F. Thirty-nine patients eligible for iPCSK9 therapy were enrolled. One sample before and after one to six months of iPCSK9 therapy with alirocumab was obtained from each patient. Lipids, apolipoproteins, hsCRP and PCSK9 levels were measured by biochemical analyses, and the lipoprotein and glycoprotein profiles were measured by 1H nuclear magnetic resonance (1H-NMR). The PCSK9 inhibitor reduced total (36.27%, p < 0.001), LDL (55.05%, p < 0.001) and non-high-density lipoprotein (HDL) (45.11%, p < 0.001) cholesterol, apolipoprotein (apo) C-III (10%, p < 0.001), triglycerides (9.92%, p < 0.001) and glycoprotein signals GlycA (11.97%, p < 0.001), GlycB (3.83%, p = 0.017) and GlycF (7.26%, p < 0.001). It also increased apoA-I (2.05%, p = 0.043) and HDL cholesterol levels (11.58%, p < 0.001). Circulating PCSK9 levels increased six-fold (626.28%, p < 0.001). The decrease in Glyc signals positively correlated with the decrease in triglycerides and apoC-III. In conclusion, in addition to LDL cholesterol, iPCSK9 therapy also induces a reduction in systemic inflammation measured by 1H-NMR glycoprotein signals, which correlates with a decrease in triglycerides and apoC-III.

Mortality and incidence of cardiovascular events in patients treated with aspirin and statins at one year after myocardial injury in noncardiac surgery: a prospective observational study.

BACKGROUND: Recommendations on the diagnosis and management of myocardial injury in noncardiac surgery (MINS) show remarkable variability. Mortality reports also vary. We aimed to describe mortality and major adverse cardiovascular and cerebrovascular event (MACCE) rates in patients with silent MINS treated with postoperative aspirin-statin therapy and with cardiology follow-up. METHODS: Prospective descriptive cohort study of patients aged 45 years or older scheduled for noncardiac surgery with high risk for cardiovascular complications from May 2017 to April 2019. Aspirin-statin therapy and cardiology follow-up were prescribed for patients with silent (asymptomatic) MINS. The primary outcome was one-year mortality in patients with silent MINS, diagnosed by troponin concentration. Secondary outcomes were mortality in MINS patients with perioperative myocardial infarction (PMI) or chronic myocardial injury (CMI) and MACCE. RESULTS: We identified 766 eligible patients and enrolled 747. MINS occurred in 166 patients (22.2%); 151 (91%) had silent MINS and 15 (9%) had PMI. Thirty-one patients (4.1%) had CMI. One-year mortality was higher in patients with silent MINS (22.5%) than in patients with no MINS (7.8%) (P<0.001). One-year mortality rates in MINS patients with PMI or CMI were 27 and 19%, respectively. MACCE were more frequent in patients with silent MINS at 30 days and one year (18 and 25%) than in patients with no MINS (6 and 12%, respectively). CONCLUSIONS: Rates of mortality and MACCE in patients with silent MINS were high despite aspirin-statin therapy and cardiology follow-up. Further prospective research is needed to assess new postoperative care protocols that might effectively improve outcomes.

An intensive, structured, mobile devices-based healthcare intervention to optimize the lipid-lowering therapy improves lipid control after an acute coronary syndrome.

Aims: Despite the evidence, lipid-lowering treatment (LLT) in secondary prevention remains insufficient, and a low percentage of patients achieve the recommended LDL cholesterol (LDLc) levels by the guidelines. We aimed to evaluate the efficacy of an intensive, mobile devices-based healthcare lipid-lowering intervention after hospital discharge in patients hospitalized for acute coronary syndrome (ACS). Methods and results: Ambiespective register in which a mobile devices-based healthcare intervention including periodic follow-up, serial lipid level controls, and optimization of lipid-lowering therapy, if appropriate, was assessed in terms of serum lipid-level control at 12 weeks after discharge. A total of 497 patients, of which 462 (93%) correctly adhered to the optimization protocol, were included in the analysis. At the end of the optimization period, 327 (70.7%) patients had LDLc levels ≤ 70 mg/dL. 40% of patients in the LDLc ≤ 70 mg/dL group were upgraded to very-high intensity lipid-lowering ability therapy vs. 60.7% in the LDLc > 70 mg/dL group, p < 0.001. Overall, 38.5% of patients had at least a change in their LLT. Side effects were relatively infrequent (10.7%). At 1-year follow-up, LDLc levels were measured by the primary care physician in 342 (68.8%) of the whole cohort of 497 patients. In this group, 71.1% of patients had LDLc levels ≤ 70 mg/dL. Conclusion: An intensive, structured, mobile devices-based healthcare intervention after an ACS is associated with more than 70% of patients reaching the LDLc levels recommended by the clinical guidelines. In patients with LDLc measured at 1-year follow-up, 71.1% had LDLc levels ≤ 70 mg/dL.

Análisis del proceso de prescripción de inhibidores PCSK9 en los servicios de cardiología de los hospitales españoles y propuesta de optimización. Estudio IKIGAI / Analysis of the prescription process of PCSK9 inhibitors in the cardiology departments of Spanish hospitals and optimization proposal. The IKIGAI study

Objetivos: Conocer las tramitaciones y gestiones requeridas en la prescripción del tratamiento con inhibidores PCSK9 en los servicios de cardiología de los hospitales españoles, haciendo propuestas de mejoras para optimizar el proceso de prescripción. Métodos: Una primera fase de recogida de información sobre variables y procedimientos administrativos requeridos en la prescripción de inhibidores PCSK9 y elaboración de un cuestionario específico. Una segunda fase de recogida de datos a través de un cuestionario electrónico autoadministrado. Resultados: Participaron 88 hospitales (número medio de camas 625; número medio de cardiólogos 18 ± 10; 78% hospitales universitarios). Hubo una infrautilización de inhibidores PCSK9 (prescripción real 30 tratamientos/año; prescripción potencial 80), principalmente por no cumplir con informe de posicionamiento terapéutico (52%), con la denegación de solicitud en un 31%. Se requirieron una media de 1,2 ± 0,4 formularios, con un promedio de 8,5 ± 4,2 variables, además de los requisitos del informe de posicionamiento terapéutico. Solo en el 21% de los hospitales no es necesario un proceso de autorización previa, y en el resto es necesaria la aprobación por una comisión. El tiempo acumulado en el proceso de prescripción es de seis semanas. La discontinuación del tratamiento durante el seguimiento es de 9 ± 12%. Conclusiones: Los inhibidores PCSK9 se encuentran claramente infrautilizados en España. Esto se debe a una incorrecta identificación de los pacientes, y a la existencia de complejos procedimientos de tipo administrativo que podrían inhibir/desmotivar su prescripción por parte de los cardiólogos, y consecuentemente, limitar su prescripción. Asimismo, existe un retraso notable desde la aprobación del fármaco hasta su administración.(AU)

Aims: To ascertain the formalities and procedures required for the prescription of PCSK9 inhibitors in the cardiology departments of Spanish hospitals, making proposals for improvement to optimize the prescription process. Methods: A first phase of collecting information about the variables and administrative procedures required for the prescription of PCK9 inhibitors and the elaboration of a specific questionnaire and a second phase of collecting data with an online self-administered questionnaire. Results: A total of 88 hospitals participated in the study (mean number of beds 625; mean number of cardiologists 18 ± 10; 78% university hospitals). There was underuse of PCSK9 inhibitors (real prescription of 30 treatments/year; potential prescription of 80), mainly because of not fulfilling the therapeutic positioning report (52%) and application refusal (31%). Beyond the requirements of the therapeutic positioning report, 1.2 ± 0.4 applications are required with 8.5 ± 4.2 variables. Only 21% of hospitals did not require a previous authorization process and in the remaining hospitals, approval from a committee was necessary. The accumulated time of the prescription process was 6 weeks. Discontinuation rates during follow-up were 9% ± 12%. Conclusions: Treatment with PCSK9 inhibitors is clearly underused in Spain. This is mainly due to both inappropriate identification of patients, and complex administrative procedures that could inhibit/discourage prescription by cardiologists and consequently, limit their use. In addition, there is a substantial delay from drug approval tadministration.(AU)

Analysis of the prescription process of PCSK9 inhibitors in the cardiology departments of Spanish hospitals and optimization proposal. The IKIGAI study. / Análisis del proceso de prescripción de inhibidores PCSK9 en los servicios de cardiología de los hospitales españoles y propuesta de optimización. Estudio IKIGAI.

AIMS: To ascertain the formalities and procedures required for the prescription of PCSK9 inhibitors in the cardiology departments of Spanish hospitals, making proposals for improvement to optimize the prescription process. METHODS: A first phase of collecting information about the variables and administrative procedures required for the prescription of PCK9 inhibitors and the elaboration of a specific questionnaire and a second phase of collecting data with an online self-administered questionnaire. RESULTS: A total of 88 hospitals participated in the study (mean number of beds 625; mean number of cardiologists 18 ± 10; 78% university hospitals). There was underuse of PCSK9 inhibitors (real prescription of 30 treatments/year; potential prescription of 80), mainly because of not fulfilling the therapeutic positioning report (52%) and application refusal (31%). Beyond the requirements of the therapeutic positioning report, 1.2 ± 0.4 applications are required with 8.5 ± 4.2 variables. Only 21% of hospitals did not require a previous authorization process and in the remaining hospitals, approval from a committee was necessary. The accumulated time of the prescription process was 6 weeks. Discontinuation rates during follow-up were 9% ± 12%. CONCLUSIONS: Treatment with PCSK9 inhibitors is clearly underused in Spain. This is mainly due to both inappropriate identification of patients, and complex administrative procedures that could inhibit/discourage prescription by cardiologists and consequently, limit their use. In addition, there is a substantial delay from drug approval tadministration.

Implementation of clinical practices and pathways optimizing ACS patients lipid management: Focus on eight European initiatives.

Post-acute coronary syndrome (ACS) patients are at very high cardiovascular risk. Despite current guidelines strongly recommend to reduce LDL-C levels and initiation of high-intensity statins as early as possible in patients admitted with an ACS, less than half of ACS patients receive a high intensity statin, and a high percentage of has LDL-C well above the goal despite therapy. There are multiple reasons for that, including physician lack of guideline adherence, patient lack of compliance with treatment, and lack of standardized procedures. Furthermore, although the prevalence of familial hypercholesterolemia is higher among patients with ACS, this condition remains poorly estimated. To fill these gaps, some European countries have launched local initiatives for the in-hospital and post-discharge ACS patient lipid management. It appears that ensuring optimal therapy during hospitalization and dedicated follow-up protocols results in a significant improvement of lipid levels in these very high risk patients, which may translate into a reduced risk of recurrent future events.

Una nueva estrategia para alcanzar los niveles objetivos de colesterol LDL tras un síndrome coronario agudo / A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome

Introducción y objetivos: El adecuado control lipídico tras un síndrome coronario agudo (SCA) es una estrategia de prevención secundaria crucial para disminuir el riesgo de reinfarto y muerte cardiovascular. Existen tablas que predicen la dosificación necesaria del tratamiento hipolipidemiante según el colesterol LDL (cLDL) inicial pero no han sido probadas en el SCA. Analizamos los factores asociados al control del cLDL tras un SCA y la utilidad de las tablas de Masana y Plana en este contexto. Métodos: Entre enero de 2015 y mayo de 2016 se incluyeron 326 pacientes con SCA. Se registraron las concentraciones basales de cLDL y el tratamiento hipolipidemiante al alta. Se analizaron las variables asociadas a un adecuado control del cLDL (< 70 mg/dL) en el seguimiento. Resultados: La edad media fue 66 ± 13 años, el 72% varones. El tratamiento hipolipidemiante al alta se ajustó a las recomendaciones de Masana en 196 (60%) pacientes. Tras 122 [66-184] días, en 148 (45%) se alcanzó el objetivo de cLDL, siendo este porcentaje mayor (109/196 -56%- vs. 39/130 -30%- pacientes) cuando el tratamiento fue planificado según las tablas de Masana y Plana (p < 0,001). En el análisis multivariante, el género masculino (p < 0,001), la ausencia de dislipidemia previa (p < 0,001) y la aplicación de las tablas de Masana y Plana (p = 0,007) fueron predictores independientes para alcanzar el cLDL objetivo. Conclusiones: El control lipídico adecuado tras un SCA se alcanza en menos de la mitad de casos. La dosificación de la terapia hipolipidemiante según las tablas de Masanay Plana mejora la consecución de este crucial objetivo terapéutico

Introduction and objectives: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. Methods: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (< 70 mg/dL) control during follow-up. Results: Among our patient population (72% male, age 66 ± 13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P < .001). The male gender (P < .001), the absence of prior history of dyslipemia (P < .001) and the adherence to Masana's recommendations (P = .007) were independent predictors for the achievement of targeted LDLc levels during follow-up. Conclusions: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal

A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome. / Una nueva estrategia para alcanzar los niveles objetivos de colesterol LDL tras un síndrome coronario agudo.

INTRODUCTION AND OBJECTIVES: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. METHODS: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up. RESULTS: Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. CONCLUSIONS: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.

Ceftolozane-tazobactam for the treatment of ventilator-associated infections by colistin-resistant Pseudomonas aeruginosa / Ceftolozano-tazobactam en el tratamiento de infecciones respiratorias asociadas a ventilación mecánica por Pseudomonas aeruginosa resistente a colistina

The use of colistin for the treatment of multiresistant bacteria has led to the emergence of colistin-resistant strains of Gram-negative bacilli. Treatment of infections caused by these pan-drug-resistant bacteria is difficult owing to the paucity of effective antibiotics. We report two cases of ventilator-associated respiratory infection caused by pan-drug-resistant, colistin-resistant Pseudomonas aeruginosa that were successfully treated with ceftolozane-tazobactam (AU)

La utilización de colistina para el tratamiento de bacterias multirresistentes ha favorecido la aparición de cepas de bacilos gramnegativos resistentes a dicho antibiótico. El tratamiento de las infecciones producidas por estas bacterias panresistentes es difícil dada la escasez de antibióticos que se pueden emplear en esta situación. Se presentan dos pacientes con infecciones respiratorias relacionadas con ventilación mecánica producidas por una Pseudomonas aeruginosa panresistente y resistente a colistina que fueron tratadas con ceftolozano/tazobactam con buenos resultados (AU)

El déficit de hierro es un determinante de la capacidad funcional y de la calidad de vida a los 30 días tras un síndrome coronario agudo / Iron deficiency is a determinant of functional capacity and health-related quality of life 30 days after an acute coronary syndrome

Introducción y objetivos: El déficit de hierro (DH) es una condición frecuente en pacientes con cardiopatía isquémica o insuficiencia cardiaca. Pero se desconoce su impacto en la capacidad funcional y la calidad de vida (CdV) tras un síndrome coronario agudo (SCA). Métodos: Se evaluó prospectivamente el impacto del DH en la capacidad funcional y la CdV de 244 pacientes 30 días después de haber sufrido un SCA. La CdV se evaluó mediante el test EuroQol-5 dimensiones, la escala visual analógica y el Heart-QoL. La capacidad funcional se midió mediante ergometría en cinta sin fin o con la prueba de los 6 min de marcha. Se evaluó el impacto del DH en la morbimortalidad cardiovascular. Resultados: Se documentó DH en el 46% de los pacientes. Estos pacientes realizaban ejercicio menos tiempo (366 ± 162 frente a 462 ± 155 s; p < 0,001), presentaban peores tasas metabólicas de consumo (7,9 ± 2,9 frente a 9,3 ± 2,6 equivalentes metabólicos; p = 0,003) y peor CdV, con puntuaciones más bajas en el EuroQol-5 dimensiones (0,76 ± 0,25 frente a 0,84 ± 0,16), la escala visual analógica (66 ± 16 frente a 72 ± 17) y el Heart-QoL (1,9 ± 0,6 frente a 2,2 ± 0,6) (todas, p < 0,05). El DH fue un predictor independiente de peor capacidad funcional (OR = 2,9; IC95%, 1,1-7,6; p = 0,023) y peor CdV (OR = 1,9; IC95%, 1,1-3,3; p < 0,001). No se observó efecto en la morbimortalidad cardiovascular. Conclusiones: El DH implica peor capacidad funcional y peor calidad de vida a medio plazo tras un SCA (AU)

Background and objectives: Iron deficiency (ID) is a prevalent condition in patients with ischemic heart disease and heart failure. Little is known about the impact of ID on exercise capacity and quality of life (QoL) in the recovery phase after an acute coronary syndrome (ACS). Methods: Iron status and its impact on exercise capacity and QoL were prospectively evaluated in 244 patients 30 days after the ACS. QoL was assessed by the standard EuroQoL-5 dimensions, EuroQoL visual analogue scale, and Heart-QoL questionnaires. Exercise capacity was analyzed by treadmill/6-minute walk tests. The effect of ID on cardiovascular mortality and readmission rate was also investigated. Results: A total of 46% of the patients had ID. These patients had lower exercise times (366 ± 162 vs 462 ± 155 seconds; P < .001), metabolic consumption rates (7.9 ± 2.9 vs 9.3 ± 2.6 METS; P = .003), and EuroQoL-5 dimensions (0.76 ± 0.25 vs 0.84 ± 0.16), visual analogue scale (66 ± 16 vs 72 ± 17), and Heart-QoL (1.9 ± 0.6 vs 2.2 ± 0.6) scores (P < .05). ID independently predicted lower exercise times (OR, 2.9; 95%CI, 1.1-7.6; P = .023) and worse QoL (OR, 1.9; 95%CI, 1.1-3.3; P < .001) but had no effect on cardiovascular morbidity or mortality. Conclusions: ID, a prevalent condition in ACS patients, results in a poorer mid-term functional recovery, as measured by exercise capacity and QoL (AU)

Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion.

BACKGROUND: The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. DESIGN AND METHODS: Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. RESULTS: A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. CONCLUSIONS: Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.

Iron Deficiency Is a Determinant of Functional Capacity and Health-related Quality of Life 30 Days After an Acute Coronary Syndrome.

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) is a prevalent condition in patients with ischemic heart disease and heart failure. Little is known about the impact of ID on exercise capacity and quality of life (QoL) in the recovery phase after an acute coronary syndrome (ACS). METHODS: Iron status and its impact on exercise capacity and QoL were prospectively evaluated in 244 patients 30 days after the ACS. QoL was assessed by the standard EuroQoL-5 dimensions, EuroQoL visual analogue scale, and Heart-QoL questionnaires. Exercise capacity was analyzed by treadmill/6-minute walk tests. The effect of ID on cardiovascular mortality and readmission rate was also investigated. RESULTS: A total of 46% of the patients had ID. These patients had lower exercise times (366±162 vs 462±155seconds; P<.001), metabolic consumption rates (7.9±2.9 vs 9.3±2.6 METS; P=.003), and EuroQoL-5 dimensions (0.76±0.25 vs 0.84±0.16), visual analogue scale (66±16 vs 72±17), and Heart-QoL (1.9±0.6 vs 2.2±0.6) scores (P<.05). ID independently predicted lower exercise times (OR, 2.9; 95%CI, 1.1-7.6; P=.023) and worse QoL (OR, 1.9; 95%CI, 1.1-3.3; P<.001) but had no effect on cardiovascular morbidity or mortality. CONCLUSIONS: ID, a prevalent condition in ACS patients, results in a poorer mid-term functional recovery, as measured by exercise capacity and QoL.

Déficit de hierro en pacientes con síndrome coronario agudo: prevalencia y factores predisponentes / Iron deficiency in patients with acute coronary syndrome: Prevalence and predisposing factors

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Infarto de miocardio en inmigrantes del sur de Asia en Cataluña. Resultados del Estudio ASIAM / Myocardial infarction in south asian immigrants in Catalonia. Results from the ASIAM study

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