Héctor Ugalde

Nacimiento anómalo de las arterias coronarias en 10.000 pacientes adultos sometidos a coronariografía

Background: Between 0.3 and 1.3% of coronary arteries, have anomalous origins. Circumflex artery has the higher frequency of anomalies. Aim: To study the frequency of congenital anomalous origins of coronary arteries among adult patients subjected to a coronary angiography. Material and Methods: Analysis of reports of 10,000 coronary angiographies performed in a clinical hospital. Patients with congenital heart disease were excluded. Results: One hundred twenty nine patients (1.3%), aged 59 ± 12years (70% males) had congenital anomalies in the origin of coronary arteries. The most common anomaly was the origin of right coronary artery from the left coronary sinus in 75%, followed from the origin of circumflex artery from the right side in 20%o. No association between origin anomalies and atherosclerosis or aortic valve disease, was observed. Conclusions: In this series of patients, origin anomalies of coronary arteries were not associated with aortic valve disease or atherosclerosis, differing from other published reports. Right coronary artery had the highest frequency of anomalies.

Infarto agudo al miocardio en pacientes de 80 y más años. Evolución hospitalaria y seguimiento

Of a totalof 1200 patients, 83 (7%) were aged 80 years or older. Among these, 59% were male and 22%were diabetic. The mean lapse between onset of symptoms and admission was 11 hours and 59%were admitted with less than 6 hours of evolution. Sixty three percent had a history of a previousinfarction and 24% had a Killip IV classification on admission. Reperfusion therapy was done in19% and 70% had heart failure during evolution. A coronary angiography was done in 22% and6% were subjected to revascularization. Mortality was 34%, specially due to cardiogenic shock orventricular rupture. Of 55 patients discharged from the hospital, 31% died within one year and64% within five years, mainly due to cardiac causes.

Terapia de reperfusión en infarto agudo al miocardio: Comparación entre trombolisis endovenosa y angioplastía coronaria

BACKGROUND Primary angioplasty is superior to intravenous thrombolysis as reperfusion therapy for acute myocardial infarction. AIM To compare the results of available reperfusion strategies for initial management of acute myocardial infarction during hospitalization and 5 years follow up. PATIENTS AND METHODS Historical cohort study from a prospective registry of patients admitted with acute myocardial infarction to our center. Patients treated with primary angioplasty were identified and were then matched by age, sex and date of event with patients treated with throm-bolysis. The clinical outcomes were compared including hospitalization and 5-years follow-up. RESULTS From March 1993 to August 2001, 98 patients were treated with primary angioplasty and matched with 98 thrombolyzed patients. The groups were comparable. Compared to thrombolysis, angioplasty had a higher success rate (68 and 91% respectively), resulted in less complications and reduced mortality (11 and 2% respectively), required less revascularization procedures and shorter hospital stay (17 and 13 days, respectively). During the follow-up of survivors, no differences in events or additional mortality were detected at 1 or 5 years. CONCLUSIONS Primary angioplasty is superior as treatment in terms of achieving success and reducing mortality during hospitalization. Evolution after hospitalization is independent of initial therapy.

Angioplastía primaria en infarto agudo al miocardio en arteria coronaria derecha con origen anómalo: Caso clínico

Anomalous origin of coronary arteries is a rare anatomical defect and its association with acute myocardial infarction is unusual. We report a 58-year-old male with ST-Segment elevation. Myocardial infarction of the inferior wall caused by a total occlusion on the proximal third of an anomalous right coronary artery, that was effectively treated with primary angioplasty with stent placement. The patient had a favorable outcome and is asymptomatic after five years of follow up.

Síndrome de Tako-Tsubo, caracterización clínica y evolución a un año plazo.

Background: Tako-Tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up are reported. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

Validación del puntaje de riesgo TIMI como predictor de mortalidad en pacientes chilenos con infarto agudo al miocardio con supradesnivel de ST

BACKGROUND Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). AIM To evaluate the predictive capacity for hospital mortality of TIMI-RS. MATERIAL AND METHODS Patients with ≤ 12-hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. RESULTS We analyzed 1125 consecutive patients aged 61 ± 13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ≤ 5 points and only 3.6% had scores ≥ 10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. CONCLUSIONS TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated.Background: Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). Aim: To evaluate the predictive capacity for hospital mortality of TIMI-RS. Material and methods: Patients with ? 12-hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. Results: We analyzed 1125 consecutive patients aged 61±13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ?5 points and only 3.6% had scores ?10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. Conclusions: TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated.

Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo: Caso clínico

Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up.

Infarto agudo al miocardio en el adulto mayor: Características clínicas, evolución hospitalaria y a 5 años plazo

Background: Among aged patients, acute myocardial infarction has more complications and there is a tendency to underuse proven treatments. Aim: To report the features of acute myocardial infarction among aged patients. Material and methods: Analysis of a registry of patients with acute myocardial infarction admitted to a coronary unit. For the purposes of analysis, patients aged 65 years or more were selected. Follow up was made consulting medical records, calling patients by telephone or consulting death records at the National Identification Service. Results: A total of 1358 patients were admitted in the study period with a diagnosis of acute myocardial infarction and 580 (43%) were aged 65 years or more. On admission, this age group had a higher frequency of hemodynamic instability and anterior wall infarctions. Reperfusion therapy and beta blockers were used less commonly in this group. Hospital mortality among patients younger or older than 65 year was 8 and 25%, respectively (p< 0.01). Among aged patients, five years mortality was 33%. Conclusions: Among aged patients, acute myocardial infarction has a higher risk profile on admission, is usually undertreated and had a higher mortality than in younger subjects.

Angiografía coronaria: indicación, resultados y complicaciones en 5.000 pacientes consecutivos

Background: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere. Aim: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines. Material and methods: Prospective registry of 5.000 patients aged 60±11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications. Results: The indications for 80% of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62%, mainly one vessel disease. These were two deaths due to the procedure (0.04%), three patients (0.06%) had an acute myocardial infarction or a stroke. These figures are lower than referential values. Conclusions: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values