Factores pronósticos de enfermedad coronaria en diabéticos asintomáticos para inclusión en lista de trasplante renal. Despistaje con coronariografía / Prognostic factors of coronary heart disease in asymptomatic diabetics for inclusion on the kidney transplant waiting list. Screening with coronary angiography

Introducción y objetivos: La enfermedad arterial coronaria es una de las principales causas de morbilidad y mortalidad en pacientes diabéticos candidatos para trasplante renal. La alta prevalencia de enfermedad coronaria en pacientes asintomáticos obliga a hacer despistaje de coronariopatía significativa. Nuestro objetivo es conocer la prevalencia y los factores pronósticos asociados a enfermedad coronaria en este grupo de pacientes en nuestro medio. Métodos: Estudio observacional, descriptivo y retrospectivo de los aspectos epidemiológicos y clínicos de los pacientes diabéticos con enfermedad renal crónica candidatos a trasplante renal entre enero de 2007 y octubre de 2011. Resultados: Se analiza una cohorte de 36 pacientes. El 65% (13) con diabetes mellitus tipo 1 y el 81,3% (13) con diabetes mellitus tipo 2 presentan enfermedad coronaria significativa. En el análisis multivariado de regresión logística, se asociaron significativamente con enfermedad coronaria el tabaquismo (odds ratio [OR] = 8,3, p = 0,048) y los niveles de hemoglobina glicosilada (OR = 9,525, p = 0,006). Factores que no se asociaron significativamente a enfermedad coronaria incluyen: edad, sexo, tipo de diabetes mellitus, duración de diabetes mellitus (años) e hipertensión arterial. Conclusión: Los pacientes diabéticos sin clínica anginosa con enfermedad renal crónica candidatos a inclusión en lista de trasplante renal presentan una alta prevalencia de enfermedad arterial coronaria significativa. El tabaquismo y los niveles de hemoglobina glicosilada se asocian de forma independiente con la presencia de enfermedad arterial coronaria (AU)

Introduction and objectives: Coronary artery disease is a major cause of morbidity and mortality in diabetic kidney transplant candidates. The high prevalence of coronary disease in asymptomatic patients creates the need for major coronary artery disease screening. Our goal was to determine the prevalence and prognostic factors associated with coronary disease in this patient group. Method: A retrospective study of a cohort of 36 asymptomatic patients with diabetes mellitus type 1 and 2 and chronic renal failure that were candidates for renal transplantation between January 2007 and October 2011. Results: We followed a cohort of 36 patients. Significant coronary disease was found in 65% (13) of patients with type 1 diabetes mellitus and 81.3% (13) with type 2 diabetes mellitus. In the multivariate logistic regression analysis, smoking (OR=8.3, P=.048) and glycosylated haemoglobin levels (OR=9.525, P=.006) were significantly associated with coronary artery disease. Factors not significantly associated with coronary artery disease included: age, sex, type of diabetes mellitus, duration of diabetes mellitus (years) and hypertension. Conclusion: Diabetic patients without clinical angina and chronic renal failure who were candidates for inclusion in the kidney transplant waiting list have a high prevalence of significant coronary artery disease. Smoking and glycosylated haemoglobin levels were independently associated with the presence of coronary artery disease (AU)

Prognostic factors of coronary heart disease in asymptomatic diabetics for inclusion on the kidney transplant waiting list. Screening with coronary angiography.

INTRODUCTION AND OBJECTIVES: Coronary artery disease is a major cause of morbidity and mortality in diabetic kidney transplant candidates. The high prevalence of coronary disease in asymptomatic patients creates the need for major coronary artery disease screening. Our goal was to determine the prevalence and prognostic factors associated with coronary disease in this patient group. METHOD: A retrospective study of a cohort of 36 asymptomatic patients with diabetes mellitus type 1 and 2 and chronic renal failure that were candidates for renal transplantation between January 2007 and October 2011. RESULTS: We followed a cohort of 36 patients. Significant coronary disease was found in 65% (13) of patients with type 1 diabetes mellitus and 81.3% (13) with type 2 diabetes mellitus. In the multivariate logistic regression analysis, smoking (OR=8.3, P=.048) and glycosylated haemoglobin levels (OR=9.525, P=.006) were significantly associated with coronary artery disease. Factors not significantly associated with coronary artery disease included: age, sex, type of diabetes mellitus, duration of diabetes mellitus (years) and hypertension. CONCLUSION: Diabetic patients without clinical angina and chronic renal failure who were candidates for inclusion in the kidney transplant waiting list have a high prevalence of significant coronary artery disease. Smoking and glycosylated haemoglobin levels were independently associated with the presence of coronary artery disease.

Modelo de intervención coronaria percutánea primaria en la Comunidad de Castilla-La Mancha / The primary percutaneous coronary intervention program in Castile-La Mancha

La cardiopatía isquémica, y en particular el infarto agudo de miocardio, es la primera causa de muerte en nuestro país y supera a las enfermedades tumorales. La intervención coronaria percutánea primaria, cuando está disponible, es el tratamiento de elección para los pacientes con infarto agudo de miocardio de menos de 12 h de evolución. La universalización del tratamiento de revascularización percutánea a todos los pacientes con infarto de miocardio implica la creación de redes bien organizadas. La participación de los profesionales y su coordinación con los responsables sanitarios locales es imprescindible. En este artículo se describe el protocolo del Código de Reperfusión en Castilla-La Mancha (CORECAM), que resume la iniciativa de Castilla-La Mancha para el abordaje de los pacientes con infarto agudo de miocardio (AU)

Coronary heart disease, and acute myocardial infarction in particular, is the primary cause of death in Spain, resulting in more deaths than cancer. Where available, primary percutaneous coronary intervention is the treatment of choice in the first 12 hours after an acute myocardial infarction. The universalization of percutaneous revascularization to all patients with myocardial infarctions necessitates the creation of well-organized networks. The participation of health-care professionals and coordination with local health-care authorities are essential. This article describes the CORECAM protocol of the primary percutaneous coronary intervention program in Castile-La Mancha, Spain, thereby providing a summary of the treatment initiative for patients with acute myocardial infarction (AU)