[In-hospital and long-term mortality in women with acute myocardial infarction treated by primary angioplasty]. / Mortalidad a corto y largo plazo en mujeres con infarto de miocardio tratado con angioplastia primaria.

INTRODUCTION AND OBJECTIVES: Mortality and morbidity after ST-elevation myocardial infarction (STEMI) are higher in women than men. It is not clear whether reperfusion by elective treatment with primary angioplasty can improve the poor prognosis in women with this condition. The objective of this study was to determine the effect of sex on clinical characteristics, and on in-hospital and long-term outcomes in patients with STEMI undergoing reperfusion by primary angioplasty. METHODS: A prospective observational study was performed in 838 consecutive patients with STEMI treated by primary angioplasty at a single hospital. Of these, 183 (22%) were women. RESULTS: Women were older (70 years vs 62 years; P<.01), were less frequently smokers (8% vs 53%; P<.01), more frequently had diabetes (45% vs 27%; P<.01) or hypertension (59% vs 36%; P<.01), presented later for angioplasty (4.1 h vs 3.6 h; P=.05), and experienced cardiogenic shock more frequently during the procedure (21% vs 12%; P<.01). There were no differences in the culprit vessel most often responsible for the infarction, in the procedural success rate, or in stent or glycoprotein IIb/IIIa inhibitor use. The total in-hospital mortality rate was higher in women (22% vs 9%; P<.01), as was the adjusted in-hospital rate (odds ratio 2.5, 95% confidence interval 1.2-5.2). During long-term follow-up after discharge (median 35.4 months), there was no significant difference in age-adjusted survival rate (relative risk 1.2, 95% confidence interval 0.7-1.9). CONCLUSIONS: Despite recent advances in the treatment of STEMI, women experience greater in-hospital mortality, even after adjustment for baseline clinical characteristics. However, the long-term age-adjusted mortality rate in women discharged from hospital was similar to that in men.

Mortalidad a corto y largo plazo en mujeres con infarto de miocardio tratado con angioplastia primaria / In-hospital and long-term mortality in women with acute myocardial infarction treated by primary angioplasty

Introducción y objetivos. Las mujeres presentan, con respecto a los varones, una mayor mortalidad y morbilidad tras un infarto agudo de miocardio con elevación del segmento ST (IAMEST). Hay controversia sobre si la angioplastia primaria (ACTPp) como tratamiento de elección logra contrarrestar el peor pronóstico de las mujeres en esta situación. El objetivo fue determinar la influencia del sexo en las características clínicas y en el pronóstico intrahospitalario y a largo plazo de un grupo de pacientes con IAMEST tratados con ACTPp como método de reperfusión. Métodos. Estudio observacional prospectivo de una cohorte de 838 pacientes consecutivos, de ellos 183 (22%) mujeres, con IAMEST tratados con ACTPp en un único centro. Resultados. Las mujeres fueron mayores (70 frente a 62 años; p < 0,01), menos fumadoras (el 53 frente al 8%; p < 0,01), más diabéticas (el 45 frente al 27%; p < 0,01), hipertensas (el 59 frente al 36%; p < 0,01), se presentaron con mayor retraso (el 4,1 frente al 3,6 h; p = 0,05) y más shock cardiogénico durante el procedimiento (del 21 frente al 12%; p = 0,01). No hubo diferencias en la arteria causante del IAM, en el éxito angiográfico o en el uso de stents o inhibidores de la glucoproteína IIb/IIIa. La mortalidad intrahospitalaria fue mayor en las mujeres, tanto en el análisis bruto (el 22 frente al 9%; p < 0,01) como en el multivariable (odds ratio = 2,5; intervalo de confianza [IC] del 95%, 1,2-5,2). En el seguimiento clínico a largo plazo (mediana de 35,4 meses) no hubo diferencias en los supervivientes tras el alta tras ajustar por la edad (riesgo relativo = 1,2; IC del 95%, 0,7-1,9). Conclusiones. A pesar de los recientes avances en el tratamiento del IAMEST, las mujeres presentan una mayor mortalidad hospitalaria ajustada por características basales. Las mujeres supervivientes tras el alta hospitalaria tuvieron una similar mortalidad a largo plazo cuando se ajustó por la edad

Introduction and objectives. Mortality and morbidity after ST-elevation myocardial infarction (STEMI) are higher in women than men. It is not clear whether reperfusion by elective treatment with primary angioplasty can improve the poor prognosis in women with this condition. The objective of this study was to determine the effect of sex on clinical characteristics, and on in-hospital and long-term outcomes in patients with STEMI undergoing reperfusion by primary angioplasty. Methods. A prospective observational study was performed in 838 consecutive patients with STEMI treated by primary angioplasty at a single hospital. Of these, 183 (22%) were women. Results. Women were older (70 years vs 62 years; P<.01), were less frequently smokers (8% vs 53%; P<.01), more frequently had diabetes (45% vs 27%; P<.01) or hypertension (59% vs 36%; P<.01), presented later for angioplasty (4.1 h vs 3.6 h; P=.05), and experienced cardiogenic shock more frequently during the procedure (21% vs 12%; P<.01). There were no differences in the culprit vessel most often responsible for the infarction, in the procedural success rate, or in stent or glycoprotein IIb/IIIa inhibitor use. The total in-hospital mortality rate was higher in women (22% vs 9%; P<.01), as was the adjusted in-hospital rate (odds ratio 2.5, 95% confidence interval 1.2-5.2). During long-term follow-up after discharge (median 35.4 months), there was no significant difference in age-adjusted survival rate (relative risk 1.2, 95% confidence interval 0.7-1.9). Conclusions. Despite recent advances in the treatment of STEMI, women experience greater in-hospital mortality, even after adjustment for baseline clinical characteristics. However, the long-term age-adjusted mortality rate in women discharged from hospital was similar to that in men

Noninvasive assessment of coronary flow velocity reserve in left anterior descending artery adds diagnostic value to both clinical variables and dobutamine echocardiography: a study based on clinical practice.

AIMS: Our objective was to evaluate, in clinical practice, whether noninvasive assessment of coronary flow velocity reserve in left anterior coronary artery adds diagnostic information to both clinical variables and wall motion abnormalities derived from dobutamine stress echocardiography. METHODS AND RESULTS: We studied 130 patients who were scheduled for coronary angiography after undergoing dobutamine stress echocardiography. The same day, flow in left anterior descending artery was detected by transthoracic Doppler echocardiography. A Doppler signal of left anterior descending artery was detected in 110 patients (85%). We identified significant left anterior descending artery stenosis (>50% diameter stenosis) in 42 patients. Sensitivity and specificity of abnormal coronary flow velocity reserve (<2) to detect left anterior descending artery stenosis were 86% and 57%, respectively. Wall motion abnormalities had a sensitivity and specificity of 52% and 82%. After forcing the clinical and dobutamine stress echo variables into a regression model with three modeling steps, an abnormal coronary flow velocity reserve provided incremental information in predicting significant left anterior descending artery stenosis. CONCLUSION: An abnormal coronary flow velocity reserve by transthoracic Doppler echocardiography adds diagnostic value to both clinical data and variables derived from dobutamine stress echo to detect significant left anterior descending artery stenosis.