RESUMEN
OBJECTIVE: The aim of this study was to examine the association between accessibility to cardiovascular emergency centers and cardiovascular mortality in Japan. DESIGN: A semi-ecological study. SETTING: Three databases were generated: accessibility to emergency cardiovascular centers, population records and death records. MAIN OUTCOME MEASURES: The standardized mortality ratio (SMR) for cardiovascular disease was adjusted by age and sex. Accessibility was represented by transfer time, number of cardiovascular emergency hospitals, and the proportion of habitable areas. Combinations of the three were divided into Categories 1-8 from the worst to the best, and the association with SMR was analyzed. RESULTS: There were 1998 cardiovascular emergency hospitals. The median of crude mortality was 0.16%. The median SMR of the reference Category 8 (transfer time <30 min and habitable area ≥50% with cardiovascular emergency hospitals) was 0.96, but that of the low accessibility Category 1 (transfer time ≥30 min and habitable area <50% without cardiovascular emergency hospitals) was 1.10. The SMR of accessibility Category 1 : Category 8 was 1.18 (95% confidence interval: 1.14-1.21). CONCLUSIONS: Decreased accessibility to cardiovascular emergency hospitals was associated with increased SMR. Areas with less accessibility and higher cardiovascular mortality were characterized by geographical variability in Japan.
Asunto(s)
Instituciones Cardiológicas/estadística & datos numéricos , Enfermedades Cardiovasculares/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Daño por Reperfusión Miocárdica/prevención & control , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
A cor triatriatum is a congenital malformation of the heart which, in almost all cases, is diagnosed in childhood, whereas adult cases are very rare. The hemodynamics of the cor triatriatum is similar to that of mitral stenosis, which sometimes, but rarely, causes embolism. We present a case of multiple cerebral infarctions accompanied with a cor triatriatum. A 57-year-old female suddenly displayed impaired consciousness and hemiparesis immediately after cranioplasty for another disease, and was diagnosed by a diffusion weighted MRI as having multiple infarctions. A transesophageal echocardiography detected a membrane-like, echo-dense structure across the left atrium, suggesting a cor triatriatum. We suspect that her multiple infarctions were caused by embolism due to a cor triatriatum. Here, we discuss the relationship between her embolic stroke and the cor triatriatum, with references to literature on the subject.