[Incidence of acute myocardial infarction in Chile between 2008 and 2016]. / Incidencia de infarto agudo de miocardio en Chile, 2008-2016.

BACKGROUND: There is no recent information on the incidence of acute myocardial infarction (AMI) in Chile. AIM: To describe and evaluate the temporal incidence trend of AMI in Chile between 2008 and 2016. MATERIAL AND METHODS: A time series study. We included all AMI cases (ICD10 = I21) that were registered in Chile between 2008 and 2016 in the national hospital discharge and death databases. Rates were stratified according to sex and age group. We calculated crude and standardized rates (direct method). Time trends were evaluated using Prais-Winsten (PW) regression models. RESULTS: There were 132,784 cases of AMI. The mean age of cases was 67 ± 14 years, 67% were men. Crude and standardized rates were 84.4 and 73.1 cases per 100,000 inhabitants, respectively. Standardized incidence increased in total population and women, whose PW coefficients were 0.43 (0.01-0.82; p = 0.045) and 0.26 (0.005-0.47; p = 0.02), respectively. Regarding age, an upward trend was observed in the younger age groups, whose coefficients were 0.20 (0.08 - 0.31; p = 0.004) for cases < 45 years, 1.31 (0.81-1.81; p < 0.01) for cases between 45 and 54 years, and 2.68 (1.31 - 4.04; p = 0.002) for cases between 55 and 64 years. CONCLUSIONS: An increase in the number of cases with AMI was observed, especially in younger age groups. This estimation could be useful for planning and evaluating public policies.

Incidencia de infarto agudo de miocardio en Chile, 2008-2016 / Incidence of acute myocardial infarction in Chile between 2008 and 2016

Background: There is no recent information on the incidence of acute myocardial infarction (AMI) in Chile. Aim: To describe and evaluate the temporal incidence trend of AMI in Chile between 2008 and 2016. Material and Methods: A time series study. We included all AMI cases (ICD10 = I21) that were registered in Chile between 2008 and 2016 in the national hospital discharge and death databases. Rates were stratified according to sex and age group. We calculated crude and standardized rates (direct method). Time trends were evaluated using Prais-Winsten (PW) regression models. Results: There were 132,784 cases of AMI. The mean age of cases was 67 ± 14 years, 67% were men. Crude and standardized rates were 84.4 and 73.1 cases per 100,000 inhabitants, respectively. Standardized incidence increased in total population and women, whose PW coefficients were 0.43 (0.01-0.82; p = 0.045) and 0.26 (0.005-0.47; p = 0.02), respectively. Regarding age, an upward trend was observed in the younger age groups, whose coefficients were 0.20 (0.08 − 0.31; p = 0.004) for cases < 45 years, 1.31 (0.81-1.81; p < 0.01) for cases between 45 and 54 years, and 2.68 (1.31 − 4.04; p = 0.002) for cases between 55 and 64 years. Conclusions: An increase in the number of cases with AMI was observed, especially in younger age groups. This estimation could be useful for planning and evaluating public policies.

Reducing Health Inequalities: Comparison of Survival After Acute Myocardial Infarction According to Health Provider in Chile.

Health inequalities are marked in Chile. To address this situation, a health reform was implemented in 2005 that guarantees acute myocardial infarction (AMI) health care for the entire population. We evaluated if the health reform changed AMI early and long-term survival rates by hospital provider (public/private) using a longitudinal population-based study of patients ≥15 years with a first AMI in Chile between 2002 and 2011. Time trends and early (within 28 days) and long-term (29-365 days) survival by age were assessed. We identified 59,557 patients: median age of 64 years; 68.9% men; 83.2% treated at public hospitals; 74.4% with public insurance. Early and long-term case-fatality was higher at public hospitals (14.6% vs 9.3%; P < .001 and 5.8% vs 3.3%; P < .001, respectively). There was a higher annual increase for early and long-term survival in public hospitals, 0.008 percentage points (95% CI: 0.006, 0.009; P < .0001) and 0.03 (0.002, 0.003; P < .0001), than in private hospitals, 0.0002 (95% CI: -0.0001, 0.005; P = .10) and 0.002 (95% CI: 0.0007, 0.003; P = .004), respectively. Being served at public hospitals affected early and long-term survival, especially in patients <70 years: hazard ratio was 2.01 (95% CI: 1.77, 2.28) and 3.11 (2.41, 4.01), respectively. Therefore, even if inequalities persist, there was a higher increase in early and long-term survival in public versus private hospitals.

Electrocirugía en procedimientos dermatológicos en pacientes portadores de dispositivos eléctricos cardíacos implantables / Electrosurgery in dermatological procedures in patients with implantable cardiac electrical devices

Debido al acelerado envejecimiento de la población, cada vez es mayor la cantidad de usuarios portado-res de dispositivos electrónicos cardíacos implan-tables (DECI). Muchos de estos pacientes se verán enfrentados a procedimientos dermatológicos que con frecuencia utilizan equipos de electrocirugía. Es-tos tienen riesgo potencial de producir interferencias electromagnéticas (IEM), y por lo tanto alterar el fun-cionamiento de estos dispositivos. Si bien no todos los DECI tienen las mismas características, las nuevas tec-nologías de estos dispositivos han disminuido, aunque no eliminado completamente, el riesgo de IEM. Este artículo tiene como propósito revisar el tema y recopilar las recomendaciones generales que todo dermatólogo debe conocer tanto en la fase preoperatoria, intraoperatoria, como postoperatoria al utilizar equipos de electrocirugía en un paciente con DECI.

Due to the accelerated population aging, an increa-sing number of users is carrying cardiac implantable electronic devices (CIEDs). Many of these patients will face dermatological procedures that often use electrosurgical equipment. The latter has the poten-tial to produce electromagnetic interference (EMI), and therefore alter the operation of these devices. While not all CIEDs have the same characteristics, new technologies for these devices have decreased if not eliminated completely the risk of EMI.The purpose of this article is to review CIED topic and compile general recommendations that every dermatologist should be aware of, both in the preoperative, intraoperative, and postoperative phases when using electrosurgery equipment in a patient with CIED.

Variación estacional de las hospitalizaciones por infarto agudo de miocardio según sexo y edad en Chile / Seasonal variation in hospital admissions due to acute myocardial infarction according to sex and age in Chile

Background: The incidence of acute myocardial infarction (AMI) varies according to seasonality, being higher in winter. The effect of sex on this phenomenon is not clear. Aim: To evaluate the effect of seasonality in men and women hospitalized for AMI at different ages. Material and Methods: We included all patients with a primary diagnosis of AMI admitted in public and private hospitals in Chile during 2002-2011 (codes I21-I22, of the tenth international classification of diseases). We obtained data from the National Discharge databases available at the Ministry of Health website. We estimated the number of discharges per month and per seasonality (cold /template), and the Standardized Incidence Ratio (SIR) with the formula: number of observed cases/expected cases (average annual hospitalizations), stratified by sex and age (< 50 years, 50-64 years, 6574 years, ≥ 75 years). We evaluated the effect of sex with binomial regressions for the different age strata. Results: We assessed 59,557 AMI hospitalizations (69% men, with and without ST elevation segment). May, June and July (austral winter) had a SIR of 1.10; 1.12 and 1.10, respectively. Women had a 20% excess of hospitalizations during cold seasons at any age. In men, the excess of hospitalizations increased from 9% in those aged < 50 years to 21% in those ≥ 75 years (p = 0.043). When comparing women and men, women aged < 50 years showed the higher risk of being hospitalized during cold seasons (adjusted risk ratio = 1.06; 95% confidence intervals 1.01-1.13). Conclusions: Women have a stronger seasonal pattern in AMI hospitalizations than men. While this effect increases with age in men, in women it remains constant at all ages.

[Seasonal variation in hospital admissions due to acute myocardial infarction according to sex and age in Chile]. / Variación estacional de las hospitalizaciones por infarto agudo de miocardio según sexo y edad en Chile.

BACKGROUND: The incidence of acute myocardial infarction (AMI) varies according to seasonality, being higher in winter. The effect of sex on this phenomenon is not clear. AIM: To evaluate the effect of seasonality in men and women hospitalized for AMI at different ages. MATERIAL AND METHODS: We included all patients with a primary diagnosis of AMI admitted in public and private hospitals in Chile during 2002-2011 (codes I21-I22, of the tenth international classification of diseases). We obtained data from the National Discharge databases available at the Ministry of Health website. We estimated the number of discharges per month and per seasonality (cold /template), and the Standardized Incidence Ratio (SIR) with the formula: number of observed cases/expected cases (average annual hospitalizations), stratified by sex and age (< 50 years, 50-64 years, 6574 years, ≥ 75 years). We evaluated the effect of sex with binomial regressions for the different age strata. RESULTS: We assessed 59,557 AMI hospitalizations (69% men, with and without ST elevation segment). May, June and July (austral winter) had a SIR of 1.10; 1.12 and 1.10, respectively. Women had a 20% excess of hospitalizations during cold seasons at any age. In men, the excess of hospitalizations increased from 9% in those aged < 50 years to 21% in those ≥ 75 years (p = 0.043). When comparing women and men, women aged < 50 years showed the higher risk of being hospitalized during cold seasons (adjusted risk ratio = 1.06; 95% confidence intervals 1.01-1.13). CONCLUSIONS: Women have a stronger seasonal pattern in AMI hospitalizations than men. While this effect increases with age in men, in women it remains constant at all ages.

[Association between socioeconomic status and survival after a first episode of myocardial infarction]. / Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012.

BACKGROUND: A low socioeconomic status is associated with higher overall mortality rates. AIM: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. MATERIAL AND METHODS: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. RESULTS: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). CONCLUSIONS: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.

Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012 / Association between socioeconomic status and survival after a first episode of myocardial infarction

Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.

Color Doppler Ultrasound Assessment of Activity in Keloids.

BACKGROUND: The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated. OBJECTIVE: To assess the sonographic activity of keloids in comparison with clinical scoring. MATERIALS AND METHODS: A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement). RESULTS: Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU. CONCLUSION: Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.

Manejo médico de la hiperhidrosis / Medical management of hyperhidrosis

La hiperhidrosis es un aumento patológico de la sudoración, que puede asociarse a patologías médicas y fármacos, afectando en forma significativa la calidad de vida. La hiperhidrosis focal primaria es una patología común, cuyo manejo es un desafío. Están disponibles múltiples terapias para el tratamiento de hiperhidrosis, incluyendo productos tópicos, iontoforesis, toxina botulínica, fármacos sistémicos, cirugía y nuevos equipos para destrucción selectiva de las glándulas sudoríparas. El propósito de este artículo es revisar la literatura, enfocándose en las terapias no quirúrgicas y opciones de tratamiento emergentes.

Hyperhidrosis is a pathological excessive sweating. It can be associated with medical conditions or drugs and affect significantly the quality of life. Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. Multiple therapies are available for the treatment of hyperhidrosis, including topical products, iontophoresis, botulinum toxin, systemic medications, surgery and new devices aimed at the destruction of ecrine glands. The purpose of this article is to review the literature, with a focus on non-surgical therapies and emerging treatment options.

Effective universal health coverage and improved 1-year survival after acute myocardial infarction: the Chilean experience.

UNLABELLED: In 2005, Chile implemented a universal system of health guarantees (AUGE) aimed at improving equitable access to quality medical care for priority health conditions, including acute myocardial infarction (MI). OBJECTIVE: To evaluate 1-year survival in MI patients before and after AUGE. METHODS: Retrospective cohorts of patients with MI (with and without ST segment elevation) discharged alive from six public hospitals between January 2001-June 2005 (pre-AUGE) and July 2008-March 2009 (post-AUGE). Chilean national mortality and MI Registry (hospital-based) databases were linked using a unique identification number (ICD-10 codes I00-I99 were used to identify cardiovascular deaths). One-year survival was assessed using Weibull multivariate regression. RESULTS: About 1867 patients were discharged alive pre-AUGE and 534 post-AUGE; 25% were women in both periods. When comparing pre-AUGE and post-AUGE, there was an increase in the use of primary and elective angioplasty (1.7 vs 23.6% and 7.3 vs 20.0%), beta-blockers (62 vs 71%) and statins (40 vs 90%); P < 0.001 all. One-year survival was 92% pre-AUGE (95% CI: 91-93%) and 96% post-AUGE (95% CI: 94-97%) (HR = 0.50, 95% CI: 0.31-0.82; P = 0.003). The post-AUGE improvement persisted after adjusting for variables associated with long-term case-fatality (HR = 0.44, 95% CI: 0.26-0.75). Percutaneous coronary intervention (HR = 0.31, 95% CI: 0.09-0.99) and statins use at discharge (HR = 0.45, 95% CI: 0.31-0.66) had the highest effects associated with lower case-fatality and both treatments increased in the post-AUGE period. CONCLUSIONS: The implementation of AUGE in Chile appears to have contributed to improved treatment of MI in public hospitals and increased 1-year survival, which is consistent with its aim to improve access to quality medical care and to reduce health inequities.

Alarming weight gain in women of a post-transitional country.

OBJECTIVE: In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups. DESIGN: Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire. SETTING: Population-based cohort of low- to middle-income Chilean women. SUBJECTS: Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS). RESULTS: At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05). CONCLUSIONS: In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Suturas: lo usual y lo nuevo / Sutures: the usual and the new

En la actualidad, existen numerosas estrategias para enfrentar el cierre de una herida quirúrgica. Éstas son suturas, corchetes y adhesivos, teniendo cada una de ellas indicaciones precisas. Las suturas constituyen la estrategia más antigua, existiendo en la actualidad una gran variedad de suturas absorbibles y no absorbibles con distintas características. El presente documento hará una breve revisión de las suturas existentes y abordar algunas líneas de desarrollo nuevos métodos de cierre de heridas, orientadas principalmente a reducir la incidencia de complicaciones.

Nowadays, there are numerous strategies to close a surgical wound. These are sutures, staples and adhesive materials. Each one has precise indications. Sutures are the most antique strategy and there are multiple absorbable and non-absorbable sutures with different characteristics. This document will review actual sutures and will discuss some new advances in wound closures in order to reduce complications.

Las mujeres jóvenes en Chile tienen elevado riesgo de muerte intrahospitalaria por infarto de miocardio / Younger women have a higher risk of in-hospital mortality due to acute myocardial infarction in Chile

Introducción y objetivos. La enfermedad coronaria es la segunda causa de muerte de las mujeres chilenas; estas presentan mayor mortalidad, especialmente las más jóvenes. El objetivo es analizar la mortalidad intrahospitalaria por infarto agudo de miocardio según sexo y edad en Chile, evaluando los factores asociados. Métodos. Se seleccionaron todos los casos de infarto agudo de miocardio ocurridos en Chile entre 2001 y 2007 (código I.21) del registro nacional de ingresos hospitalarios y del registro GEMI (registro multicéntrico hospitalario). Se estimaron las odds ratio para mortalidad intrahospitalaria de las mujeres según edad (brutos y ajustados por características clínicas y tratamiento). Resultados. Se registraron 49.287 casos de infarto agudo de miocardio, el 31,3% mujeres, de los que 9.278 ingresaron al registro GEMI (el 27,1% mujeres). La mortalidad intrahospitalaria fue mayor entre las mujeres que entre los varones (nacional, el 20,4 frente al 11,3%; GEMI, el 14,2 frente al 7,3%; p < 0,001 ambos), independiente de la edad. Las menores de 45 años tenían el mayor riesgo estimado de mortalidad intrahospitalaria: nacional, odds ratio = 2,3 (intervalo de confianza del 95%, 1,5-3,3) y GEMI, odds ratio = 2,7 (intervalo de confianza del 95%, 1,1-6,8); en mayores de 74 años, fueron odds ratio = 1,3 (1,2-2,4) y odds ratio = 1,5 (1,2-1,9), respectivamente. Las mujeres jóvenes recibieron menos estatinas, odds ratio = 0,7 (0,6-0,8); ácido acetilsalicílico, odds ratio = 0,4 (0,2-0,6); bloquedores beta, odds ratio = 0,8 (0,6-0,9), y trombolisis, odds ratio = 0,6 (0,5-0,8). Hubo interacción entre la clase Killip y el sexo; en el modelo ajustado, el mayor riesgo sólo se observó en mujeres menores de 55 años en clase Killip I-II e infarto agudo de miocardio con elevación del segmento ST, odds ratio = 4,3 (2,1-8,9). Conclusiones. En el contexto de un país latinoamericano, las mujeres menores de 55 años con infarto agudo de miocardio con elevación del segmento ST en clase Killip I-II tienen un mayor riesgo de muerte por infarto agudo de miocardio que no se explica totalmente por factores conocidos (AU)

Introduction and objectives. Coronary heart disease is the second cause of death in Chilean women, with higher mortality among women, especially at younger ages. The objective was to analyze in-hospital case-fatality by sex and age in patients with acute myocardial infarction in Chile and to evaluate associated factors. Methods. From the nationwide hospital admissions database and the GEMI registry (a multicenter registry), we selected all cases of acute myocardial infarction (code: I.21) that occurred between 2001 and 2007 in Chile. We estimated odds ratios for in-hospital case-fatality in women by age (crude and adjusted for clinical characteristics and treatment). Results. In total, 49 287 cases of acute myocardial infarction were hospitalized, 31.3% of them women; 9278 patients were incorporated in the GEMI registry (27.1% women). In-hospital case-fatality was higher (P<.001) in women than men (national database, 20.4% vs 11.3%; GEMI, 14.2% vs 7.3%, irrespective of age. In-hospital case-fatality risk was higher in women aged<45 years: national odds ratio=2.3 (95% confidence interval, 1.5-3.3) and GEMI, odds ratio=2.7 (1.1-6.8). The estimated risk was lower in women aged 75 or more years in both databases, 1.3 (1.2-2.4) and 1.5 (1.2-1.9), respectively. Younger women less often received statins, odds ratio=0.7 (0.6-0.8); acetylsalicylic acid, odds ratio=0.4 (0.2-0.6); betablockers, odds ratio=0.8 (0.6-0.9), and thrombolytics, odds ratio=0.6 (0.5-0.8). An interaction was found between Killip class and sex. After adjusting for covariates, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II, had the highest risk, odds ratio=4.3 (2.1-8.9). Conclusions. In the context of a Latin American country, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II had a higher risk of death. Known risk factors do not completely explain this excess of risk (AU)

Younger women have a higher risk of in-hospital mortality due to acute myocardial infarction in Chile.

INTRODUCTION AND OBJECTIVES: Coronary heart disease is the second cause of death in Chilean women, with higher mortality among women, especially at younger ages. The objective was to analyze in-hospital case-fatality by sex and age in patients with acute myocardial infarction in Chile and to evaluate associated factors. METHODS: From the nationwide hospital admissions database and the GEMI registry (a multicenter registry), we selected all cases of acute myocardial infarction (code: I.21) that occurred between 2001 and 2007 in Chile. We estimated odds ratios for in-hospital case-fatality in women by age (crude and adjusted for clinical characteristics and treatment). RESULTS: In total, 49,287 cases of acute myocardial infarction were hospitalized, 31.3% of them women; 9278 patients were incorporated in the GEMI registry (27.1% women). In-hospital case-fatality was higher (P<.001) in women than men (national database, 20.4% vs 11.3%; GEMI, 14.2% vs 7.3%, irrespective of age. In-hospital case-fatality risk was higher in women aged<45 years: national odds ratio=2.3 (95% confidence interval, 1.5-3.3) and GEMI, odds ratio=2.7 (1.1-6.8). The estimated risk was lower in women aged 75 or more years in both databases, 1.3 (1.2-2.4) and 1.5 (1.2-1.9), respectively. Younger women less often received statins, odds ratio=0.7 (0.6-0.8); acetylsalicylic acid, odds ratio=0.4 (0.2-0.6); betablockers, odds ratio=0.8 (0.6-0.9), and thrombolytics, odds ratio=0.6 (0.5-0.8). An interaction was found between Killip class and sex. After adjusting for covariates, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II, had the highest risk, odds ratio=4.3 (2.1-8.9). CONCLUSIONS: In the context of a Latin American country, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II had a higher risk of death. Known risk factors do not completely explain this excess of risk.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2) / Clinical characteristics, complications and mortality in 506 patients with infective endocarditis and determinants of survival rate at 10 years

Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

[Clinical characteristics, complications and mortality in 506 patients with infective endocarditis and determinants of survival rate at 10 years]. / Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2).

BACKGROUND: Rates of morbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. AIM: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. MATERIAL AND METHODS: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. RESULTS: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylococcus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% of patients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. CONCLUSIONS: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Incidencia y letalidad por infarto agudo del miocardio en Chile: 2001-2007 / Incidence and case fatality due to acute myocardial infarction in Chile in the period 2001-2007

Background: Acute myocardial infarction (AMI) causes 73.6 percent of coronary heart disease (CHD) deaths in Chile. Aim: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. Material and Methods: A time-series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. Results: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34 percent in individuals < 45 years of age and 9.2 percent in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5 percent (45.4 percent in men and 57.2 percent in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2 percent in men and 0.81 percent in women. In-hospital case fatality was 14.2 percent (11.3 and 20.4 percent in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01 percent in men and women, respectively (p < 0.05). Conclusions: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital.

[Incidence and case fatality due to acute myocardial infarction in Chile in the period 2001-2007]. / Incidencia y letalidad por infarto agudo del miocardio en Chile: 2001-2007.

BACKGROUND: Acute myocardial infarction (AMI) causes 73.6% of coronary heart disease (CHD) deaths in Chile. AIM: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. MATERIAL AND METHODS: A time-series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. RESULTS: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34% in individuals < 45 years of age and 9.2% in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5% (45.4% in men and 57.2% in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2% in men and 0.81% in women. In-hospital case fatality was 14.2% (11.3 and 20.4% in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01% in men and women, respectively (p < 0.05). CONCLUSIONS: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital.