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      Frecuencia de factores de riesgo coronarios en pacientes con infarto agudo de miocardio en el Servicio de Cardiología del Hospital de Clínicas Translated title: Frequency of coronary risk factors in patients with acute myocardial infarction in the Cardiology Service of the Hospital de Clínicas

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          Abstract

          RESUMEN Introducción: el infarto agudo de miocardio es una complicación grave de la enfermedad cardiovascular y se conocen varios factores de riesgo coronarios. Objetivo: determinar la frecuencia de factores de riesgo coronarios en pacientes con infarto agudo de miocardio en el Servicio de Cardiología del Hospital de Clínicas. Material y método: diseño observacional, descriptivo, retrospectivo de corte transversal, que incluyó a pacientes adultos con diagnóstico de infarto agudo de miocardio del Servicio de Cardiología del Hospital de Clínicas desde enero de 2015 a marzo de 2018. Se determinaron las variables demográficas, motivo de consulta, antecedentes familiares de cardiopatía isquémica y la presencia de factores de riesgo coronario. Resultados: se incluyeron 231 sujetos, la edad media fue 63±1 años, 138 (60%) fueron varones. El motivo de consulta más frecuente fue el dolor precordial (71%). La mayoría presentó infarto sin elevación del segmento ST (63,6%). Los factores de riesgo coronario más frecuentes fueron la hipertensión arterial (89%), el sedentarismo (60%) y el consumo de tabaco (55,4%) sobre todo en los pacientes mayores de 65 años. Conclusión: los factores de riesgo coronario más frecuentes fueron la hipertensión arterial, el sedentarismo y el tabaquismo, predominando en mayores de 60 años.

          Translated abstract

          ABSTRACT Introduction: Acute myocardial infarction is a serious complication of cardiovascular disease and several coronary risk factors are known. Objective: To determine the frequency of coronary risk factors in patients with acute myocardial infarction in the Cardiology Service of the Hospital de Clínicas. Material and method: Observational, descriptive, retrospective cross-sectional design which included adult patients diagnosed with acute myocardial infarction from the Cardiology Service of the Hospital de Clínicas from January 2015 to March 2018. Demographic variables, reason of consultation, family history of ischemic heart disease and the presence of coronary risk factors were determined. Results: Two hundred thirty-one subjects were included, the mean age was 63±1 years, and 138 (60%) were male. The most frequent reason for consultation was precordial pain (71%). The majority presented infarction without elevation of the ST segment (63.6%). The most frequent coronary risk factors were arterial hypertension (89%), sedentary lifestyle (60%) and tobacco consumption (55.4%), especially in patients older than 65 years. Conclusion: The most frequent coronary risk factors were arterial hypertension, sedentary lifestyle and smoking, predominating in people over 60 years of age.

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          Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006.

          Although ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (AMI) have been the focus of intense clinical investigation, limited information exists on characteristics and hospital mortality of patients not enrolled in clinical trials. Previous large databases have reported declining mortality of patients with STEMI but have not noted substantial mortality change among those with NSTEMI. The National Registry of Myocardial Infarction enrolled 2,515,106 patients at 2,157 US hospitals from 1990 to 2006. Of these, we evaluated 1,950,561 with diagnoses reflecting acute myocardial ischemia on admission. From 1990 to 2006, the proportion of NSTEMI increased from 14.2% to 59.1% (P < .0001), whereas the proportion of STEMI decreased. Mean age increased (from 64.1 to 66.4 years, P < .0001) as did the proportion of females (from 32.4% to 37.0%, P < .0001). Patients were less likely to report prior angina, prior AMI, or family history of coronary artery disease but more likely to report history of diabetes, hypertension, current smoking, heart failure, prior revascularization, stroke, and hyperlipidemia. From 1994 to 2006, hospital mortality fell among all patients (10.4% to 6.3%), STEMI (11.5% to 8.0%), and NSTEMI (7.1% to 5.2%), (all P < .0001). After adjustment for baseline covariates, hospital mortality fell among all patients by 23.6% (odds ratio [OR] 0.764, 95% CI 0.744-0.785), STEMI by 24.2% (OR 0.758, 0.732-0.784), and NSTEMI by 22.6% (OR 0.774, 0.741-0.809), all P < .001. This large, observational database from 1990 to 2006 shows increasing prevalence of NSTEMI and, despite higher risk profile on presentation, falling risk-adjusted hospital mortality in patients with either STEMI or NSTEMI.
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            Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.

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              Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial Infarction

              Objectives The aim of this study was to mechanistically investigate associations among cigarette smoking, microvascular pathology, and longer term health outcomes in patients with acute ST-segment elevation myocardial infarction (MI). Background The pathophysiology of myocardial reperfusion injury and prognosis in smokers with acute ST-segment elevation MI is incompletely understood. Methods Patients were prospectively enrolled during emergency percutaneous coronary intervention. Microvascular function in the culprit artery was measured invasively. Contrast-enhanced magnetic resonance imaging (1.5-T) was performed 2 days and 6 months post-MI. Infarct size and microvascular obstruction were assessed using late gadolinium enhancement imaging. Myocardial hemorrhage was assessed with T2* mapping. Pre-specified endpoints included: 1) all-cause death or first heart failure hospitalization; and 2) cardiac death, nonfatal MI, or urgent coronary revascularization (major adverse cardiovascular events). Binary logistic regression (odds ratio [OR] with 95% confidence interval [CI]) with smoking status was used. Results In total, 324 patients with ST-segment elevation MI were enrolled (mean age 59 years, 73% men, 60% current smokers). Current smokers were younger (age 55 ± 11 years vs. 65 ± 10 years, p < 0.001), with fewer patients with hypertension (52 ± 27% vs. 53 ± 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In Myocardial Infarction) flow grade (≥2 vs. ≤1, p = 0.024) and ST-segment resolution (none vs. partial vs. complete, p = 0.010) post–percutaneous coronary intervention. On day 1, smokers had higher circulating C-reactive protein, neutrophil, and monocyte levels. Two days post-MI, smoking independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to 5.37; p = 0.003). After a median follow-up period of 4 years, smoking independently predicted all-cause death or heart failure events (OR: 2.20; 95% CI: 1.07 to 4.54) and major adverse cardiovascular events (OR: 2.79; 95% CI: 2.30 to 5.99). Conclusions Smoking is associated with enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and longer term adverse cardiac outcomes. Inflammation and irreversible myocardial hemorrhage post-MI represent mechanistic drivers for adverse long-term prognosis in smokers. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction. [BHF MR-MI]; NCT02072850)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                spmi
                Revista Virtual de la Sociedad Paraguaya de Medicina Interna
                Rev. virtual Soc. Parag. Med. Int.
                Sociedad Paraguaya de Medicina Interna (Asunción, , Paraguay )
                2312-3893
                September 2019
                : 6
                : 2
                : 57-63
                Affiliations
                [1] San Lorenzo Asunción orgnameUniversidad Nacional de Asunción orgdiv1Facultad de Ciencias Médicas orgdiv2Hospital de Clínicas Paraguay
                Article
                S2312-38932019000200057
                10.18004/rvspmi/2312-3893/2019.06.02.57-063
                ee789581-6369-4b15-84a3-7d8168642e5b

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 July 2019
                : 17 June 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 7
                Product

                SciELO Paraguay

                Categories
                Artículos Originales

                myocardial infarction,hypertension,tobacco smoking,dyslipidemias,exercise,diabetes mellitus,sedentary behavior,infarto del miocardio,hipertensión,fumar tabaco,dislipidemias,ejercicio,conducta sedentaria

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