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Solà-Muñoz S, Jorge M, Jiménez-Fàbrega X, Jiménez-Delgado S, Azeli Y, Marsal JR, Jordán S, Mauri J, Jacob J. Prehospital stratification and prioritisation of non-ST-segment elevation acute coronary syndrome patients (NSTEACS): the MARIACHI scale. Intern Emerg Med 2023; 18:1317-1327. [PMID: 37131092 DOI: 10.1007/s11739-023-03274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this study was to develop and validate a risk scale (MARIACHI) for patients classified as non-ST-segment elevation acute coronary syndrome (NSTEACS) in a prehospital setting with the ability to identify patients at an increased risk of mortality at an early stage. METHODS A retrospective observational study conducted in Catalonia over two periods: 2015-2017 (development and internal validation cohort) and Aug 2018-Jan 2019 (external validation cohort). We included patients classified as prehospital NSTEACS, assisted by an advanced life support unit and requiring hospital admission. The primary outcome was in-hospital mortality. Cohorts were compared using logistic regression and a predictive model was created using bootstrapping techniques. RESULTS The development and internal validation cohort included 519 patients. The model is composed of five variables associated with hospital mortality: age, systolic blood pressure, heart rate > 95 bpm, Killip-Kimball III-IV and ST depression ≥ 0.5 mm. The model showed good overall performance (Brier = 0.043) and consistency in discrimination (AUC 0.88, 95% CI 0.83-0.92) and calibration (slope = 0.91; 95% CI 0.89-0.93). We included 1316 patients for the external validation sample. There was no difference in discrimination (AUC 0.83, 95% CI 0.78-0.87; DeLong Test p = 0.071), but there was in calibration (p < 0.001), so it was recalibrated. The finally model obtained was stratified and scored into three groups according to the predicted risk of patient in-hospital mortality: low risk: < 1% (-8 to 0 points), moderate risk: 1-5% (+ 1 to + 5 points) and high risk: > 5% (6-12 points). CONCLUSION The MARIACHI scale showed correct discrimination and calibration to predict high-risk NSTEACS. Identification of high-risk patients may help with treatment and low referral decisions at the prehospital level.
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Affiliation(s)
| | - Morales Jorge
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Spain
| | | | - Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Emergency Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
- Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain
| | - J Ramon Marsal
- RTI Health Solutions, Research Triangle Park, Spain
- Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sara Jordán
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Josepa Mauri
- Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Pla Director de Malalties Cardiovasculars (PDMCV), Health Department of the Government of Catalonia, Catalonia, Spain
| | - Javier Jacob
- Universitat de Barcelona, Barcelona, Spain
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL, L'Hospitalet de Llobregat, Spain
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Cordero A, Bertomeu-González V, Moreno-Arribas J, Marco A, Sánchez A, Pomares A, Torroba G, Martínez Rey-Rañal E, Moreno MJ, Quiles J, Valero R, Bertomeu-Martínez V. Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rccl.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Llaó I, Gómez-Hospital JA, Aboal J, Garcia C, Montero S, Sambola A, Ortiz J, Tomás C, Bonet G, Viñas D, Oliveras T, Sans-Roselló J, Cantalapiedra J, Andrea R, Hernández I, Pérez-Rodriguez M, Gual M, Cequier A, Ariza-Solé A. Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units. Med Intensiva 2019; 44:475-484. [PMID: 31362838 DOI: 10.1016/j.medin.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN A prospective cohort study was carried out. SETTING The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES Mortality or readmission at 6 months. RESULTS A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.
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Affiliation(s)
- I Llaó
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - J A Gómez-Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - J Aboal
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - C Garcia
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - S Montero
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - A Sambola
- Unidad de Cuidados Intensivos cardiológicos. Hospital Universitari de la Vall d'Hebron, Barcelona, España
| | - J Ortiz
- Unidad de Cuidados Intensivos cardiológicos. Hospital Clínic i Provincial, Barcelona, España
| | - C Tomás
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - G Bonet
- Unidad de Cuidados Intensivos cardiológicos. Hospital Joan XXIII, Tarragona, España
| | - D Viñas
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - T Oliveras
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - J Sans-Roselló
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - J Cantalapiedra
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - R Andrea
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - I Hernández
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - M Pérez-Rodriguez
- Unidad de Cuidados Intensivos cardiológicos. Hospital Joan XXIII, Tarragona, España
| | - M Gual
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A Cequier
- Servicio de Cardiología. Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A Ariza-Solé
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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Cordero A, Bertomeu Martínez V. Causes of Higher In-hospital Mortality Due to ACS in the Canary Islands and Possible Solutions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:443-444. [PMID: 30862428 DOI: 10.1016/j.rec.2018.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Vicente Bertomeu Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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Cordero A, Bertomeu Martínez V. Causas de la mayor mortalidad hospitalaria por IAM en Canarias y sus posibles soluciones. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impacto en la mortalidad de diferentes sistemas de asistencia en red para el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia de España. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience. ACTA ACUST UNITED AC 2016; 70:155-161. [PMID: 27600863 DOI: 10.1016/j.rec.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality. METHODS From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130). RESULTS Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001). CONCLUSIONS From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality.
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Affiliation(s)
- Ángel Cequier
- Sociedad Española de Cardiología, Madrid, Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Albert Ariza-Solé
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco J Elola
- Sociedad Española de Cardiología, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | - José L Bernal
- Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
| | - José V Segura
- Centro de Investigación Operativa, Instituto Universitario de Investigación (IUI), Universidad Miguel Hernández, Alicante, Spain
| | - Andrés Iñiguez
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Álvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Vicente Bertomeu
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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Cambios en el tratamiento y el pronóstico del síndrome coronario agudo con la implantación del código infarto en un hospital con unidad de hemodinámica. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Tendencias en factores de riesgo y tratamientos de pacientes con cardiopatía isquémica estable atendidos en consultas de cardiología entre 2006 y 2014. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cordero A, López-Palop R, Carrillo P, Frutos A, Miralles S, Gunturiz C, García-Carrilero M, Bertomeu-Martínez V. Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit. ACTA ACUST UNITED AC 2016; 69:754-9. [PMID: 26979766 DOI: 10.1016/j.rec.2015.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. METHODS A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. RESULTS The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. CONCLUSIONS After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
| | - Ramón López-Palop
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Pilar Carrillo
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Araceli Frutos
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Sandra Miralles
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Clara Gunturiz
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - María García-Carrilero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Vicente Bertomeu-Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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Ferreira-González I, Carrillo X, Martín V, de la Torre Hernández JM, Baz JA, Navarro Manchón J, Masotti M, Cequier Á, Cárdenas M, Alfonso Manterola F. Variabilidad interhospitalaria en la prescripción tras un síndrome coronario agudo: hallazgos del estudio ACDC. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ferreira-González I, Carrillo X, Martín V, de la Torre Hernández JM, Baz JA, Navarro Manchón J, Masotti M, Cequier Á, Cárdenas M, Alfonso Manterola F. Interhospital Variability in Drug Prescription After Acute Coronary Syndrome: Insights From the ACDC Study. ACTA ACUST UNITED AC 2016; 69:117-24. [DOI: 10.1016/j.rec.2015.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/20/2015] [Indexed: 11/24/2022]
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Trends in Risk Factors and Treatments in Patients With Stable Ischemic Heart Disease Seen at Cardiology Clinics Between 2006 and 2014. ACTA ACUST UNITED AC 2015; 69:401-7. [PMID: 26631917 DOI: 10.1016/j.rec.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic ischemic heart disease is the most prevalent of all cardiovascular diseases. Patients are at high risk of complications. In recent decades, changes may have occurred in the clinical characteristics of the disease, its treatment and control of risk factors. METHODS A direct comparison of 2 national registries of patients with chronic ischemic heart disease carried out in 2006 (n=1583) and 2014 (n=1110). RESULTS We observed statistically significant differences between the 2 registries, with a higher percentage of men and smokers in the 2014 registry, but a lower prevalence of diabetes mellitus and hypertension. Heart failure and stroke were more prevalent in the 2006 registry. Patients in the 2014 registry had better results for lipid profile, blood glucose, creatinine, and glomerular filtration rate. We observed higher use of recommended drugs for secondary prevention and an increased percentage of patients receiving optimal medical therapy, from 32.5% to 49.5% (P<.01). Use of high-intensity statin doses also increased from 10.5% to 42.8% (P<.01). We found better control of some risk factors (improved dyslipidemia, heart rate, and blood glucose in patients with diabetes) but worse blood pressure control. CONCLUSIONS The clinical profile of patients with chronic ischemic heart disease is similar in the 2 registries. There has been an improvement in patients' medical therapy and dyslipidemia control, blood glucose, and heart rate, but there is still much room for improvement in the control of other cardiovascular risk factors.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
| | - Enrique Galve
- Departamento de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Vicente Bertomeu-Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Héctor Bueno
- Departamento de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Lorenzo Fácila
- Departamento de Cardiología, Hospital General de Valencia, Valencia, Spain
| | - Eduardo Alegría
- Departamento de Cardiología, Policlínica Gipuzkoa, San Sebastián, Guipúzcoa, Spain
| | - Ángel Cequier
- Departamento de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Ruiz
- Departamento Médico, Laboratorios Ferrer, Barcelona, Spain
| | - José Ramón González-Juanatey
- Departamento de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Redondo-Diéguez A. Comments on the Long-term Prognosis of Patients With Non-ST-segment Elevation Acute Myocardial Infarction and Coronary Arteries Without Significant Stenosis. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:821-822. [PMID: 26162673 DOI: 10.1016/j.rec.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
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Lozano Palencia T, Ruiz-Nodar JM, Cequier-Fillat Á, Morís de la Tassa C. Comments on the Long-term Prognosis of Patients With Non-ST-segment Elevation Acute Myocardial Infarction and Coronary Arteries Without Significant Stenosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:820-821. [PMID: 26026804 DOI: 10.1016/j.rec.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | - Juan M Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Ángel Cequier-Fillat
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - César Morís de la Tassa
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Redondo-Diéguez A. Comentarios al pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa. Respuesta. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lozano Palencia T, Ruiz-Nodar JM, Cequier-Fillat Á, Morís de la Tassa C. Comentarios al pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cequier Á, García-Altés A. Transparencia y comparación de resultados para la sostenibilidad del sistema sanitario. Med Clin (Barc) 2015; 144:449-51. [DOI: 10.1016/j.medcli.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/18/2015] [Accepted: 01/21/2015] [Indexed: 01/15/2023]
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Fernández-Bergés D, Félix-Redondo F, Consuegra-Sánchez L, Lozano-Mera L, Miranda Díaz I, Durán Guerrero M, Benítez de Castro F, Polanco García J, López-Mínguez J. Infarto de miocardio en mayores de 75 años: una población en aumento. Estudio CASTUO. Rev Clin Esp 2015; 215:195-203. [DOI: 10.1016/j.rce.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/26/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
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Bertomeu V, Cequier Á, Bernal JL, Alfonso F, Anguita MP, Muñiz J, Barrabés JA, García-Dorado D, Goicolea J, Elola FJ. Mortalidad intrahospitalaria por infarto agudo de miocardio. Relevancia del tipo de hospital y la atención dispensada. Estudio RECALCAR. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.06.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bertomeu V, Cequier Á, Bernal JL, Alfonso F, Anguita MP, Muñiz J, Barrabés JA, García-Dorado D, Goicolea J, Elola FJ. In-hospital mortality due to acute myocardial infarction. relevance of type of hospital and care provided. RECALCAR study. ACTA ACUST UNITED AC 2013; 66:935-42. [PMID: 24774106 DOI: 10.1016/j.rec.2013.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/07/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided. METHODS Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States). RESULTS Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed. CONCLUSIONS The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction.
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Affiliation(s)
- Vicente Bertomeu
- Servicio de Cardiología, Hospital San Juan, Universidad Miguel Hernández, Alicante, Spain
| | - Ángel Cequier
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José L Bernal
- Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Alfonso
- Departamento de Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Javier Muñiz
- Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - David García-Dorado
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Goicolea
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Ruiz-Nodar JM, Marín F, Lip GY. Tratamiento antitrombótico y tipo de stent en pacientes con fibrilación auricular a los que se practica una intervención coronaria percutánea. Rev Esp Cardiol 2013; 66:12-6. [DOI: 10.1016/j.recesp.2012.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/08/2012] [Indexed: 01/23/2023]
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Cordero A, Moreno-Arribas J, Bertomeu-González V, Agudo P, Miralles B, Masiá MD, López-Palop R, Bertomeu-Martínez V. Low levels of high-density lipoproteins cholesterol are independently associated with acute coronary heart disease in patients hospitalized for chest pain. Rev Esp Cardiol 2011; 65:319-25. [PMID: 22112390 DOI: 10.1016/j.recesp.2011.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 07/26/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The role of high-density lipoproteins in the context of acute chest pain has not been well characterized. The objective of this study was to determine the relative contribution of lipid profile to the risk of acute coronary syndrome in patients admitted to a cardiology ward for chest pain. METHODS We included all consecutive admissions in a single cardiology department over a period of 10 months and 1-year follow-up was performed. RESULTS In total, 959 patients were included: 457 (47.7%) were diagnosed with non-ischemic chest pain, 355 (37%) with non-ST-elevation acute coronary syndrome, and 147 (15.3%) with ST-elevation acute coronary syndrome. Prevalence of high-density lipoproteins <40 mg/dL was 54.6%, and was higher in patients with acute coronary syndrome (69.4% vs 30.6%; P<.01). The prevalence of acute coronary syndrome increased with reductions in mean high-density lipoproteins. Age, active smoking, diabetes, fasting glucose >100 mg/dL, and high-density lipoproteins <40 mg/dL were independently associated with acute coronary syndrome, and low high-density lipoproteins was the main associated factor (odds ratio, 4.11; 95% confidence interval, 2.87-5.96). Survival analysis determined that, compared with non-ischemic chest pain, the presence of acute coronary syndrome was associated with significantly greater risk of all-cause and cardiovascular mortality. CONCLUSIONS Low levels of high-density lipoproteins cholesterol (≤40 mg/dL) were independently associated with a diagnosis of acute coronary syndrome in patients hospitalized for chest pain, with an inverse relationship between lower levels of high-density lipoproteins and prevalence of acute coronary syndrome.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
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Barrabés JA, Bodí V, Jiménez-Candil J, Fernández-Ortiz A. Actualización en cardiopatía isquémica. Rev Esp Cardiol 2011; 64 Suppl 1:50-8. [DOI: 10.1016/s0300-8932(11)70007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sanchis J, Bodí V, Núñez J, Núñez E. Conservative, true selective invasive, and routine invasive strategies in non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol 2010; 56:1609; author reply 1609-10. [PMID: 21029879 DOI: 10.1016/j.jacc.2010.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 11/30/2022]
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Jiménez-Navarro MF, Muñoz-García AJ, Cabrera-Bueno F, de Teresa-Galván E. Disparity between best scientific evidence and cardiovascular events. Rev Esp Cardiol 2010; 63:1214-1216. [PMID: 20875367 DOI: 10.1016/s1885-5857(10)70241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Jiménez-Navarro MF, Muñoz-García AJ, Cabrera-Bueno F, de Teresa-Galván E. Disparidad entre la mejor evidencia científica y los eventos cardiovasculares. Rev Esp Cardiol (Engl Ed) 2010. [DOI: 10.1016/s0300-8932(10)70259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Del estudio a las normas de calidad y a los sistemas de asistencia: necesidad continuada de aumentar la aplicación de la evidencia. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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