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Manuel Ruiz-Bailén,
María Dolores Pola Gallego de Guzmán,
Luis Rucabado-Aguilar,
Manuela Expósito-Ruiz, Eduardo Aguayo de Hoyos,
Ana María Castillo-Rivera,
Rosell Quirós-Barrera,
Silvia Galindo-Rodríguez,
Juan Miguel Torres-Ruiz,
Rafael Vázquez-García,
José Angel Ramos-Cuadra,
Ziad Issa-Khozouz
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ABSTRACT: The aim of this study was to investigate patients with unstable angina (UA) and the predictive factors of these arrhythmias and to determine whether this complication behaves as an independent variable with regard to mortality, increased length of stay in an ICU/CCU, and the performance of percutaneous coronary intervention (PCI).
The retrospective cohort study included all patients diagnosed with UA and included in the Spanish "ARIAM" database between June 1996 and December 2005. Univariate and multivariate analyses were performed to evaluate the factors associated with these arrhythmias. 17,616 patients were included.
Sustained ventricular tachycardia (SVT) occurred in 0.5%. The factors associated with its development were age, cardiogenic shock, and non-sustained ventricular tachycardia. SVT was associated with mortality (adjusted OR: 9.836, 95%CI: 1.81-53.33). Ventricular fibrillation (VF) occurred in 1%. In the multivariate study the variables that persistently associated independently with the development of VF were gender, Killip class, and high degree atrioventricular block (HDAVB). VF was associated with higher mortality (27.1% vs. 0.9%). Nevertheless, VF was not seen to be a variable independently associated with mortality in UA patients. Only VF was an independent variable in length of stay (adjusted OR: 2.059, 95%CI: 1.175-3.609). Neither SVT nor VF were independent variables associated with PCI.
Patients with UA complicated by SVT or VF represent a special high-risk subgroup with poor prognosis, which could lead to their being stratified towards a poor prognosis subgroup.
Medical science monitor: international medical journal of experimental and clinical research 07/2009; 15(6):CR280-9. · 1.70 Impact Factor
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ABSTRACT: The study objectives were to assess any gender differences in the application of diagnostic and therapeutic procedures and their impact on outcome in patients with acute myocardial infarction (AMI).
Prospective cohort study of patients in the PRIAMHO II registry. 58 randomly selected public hospitals in Spain included 6209 patients with AMI admitted to Coronary/Critical Care Unit from May 15 to December 15 2000 with 1-year follow-up. Data were gathered on use of coronary angiography and reperfusion procedures, on a combined outcome variable (including death, reinfarction, postinfarction angina, and stroke during hospital stay), and on 28-day and 1-year mortality rates.
4641 (74.75%) of the patients were male and 1568 (25.5%) female. No gender differences in coronary angiography or reperfusion therapy use were found. However, female sex alongside age, use of reperfusion therapy, diabetes mellitus, previous revascularization, previous AMI, and higher Killip class were predictors of the combined outcome variable, with an adjusted OR of 1.21 (CI 95% 1.02-1.42).
No association was observed between the gender of patients with AMI and the application of diagnostic or therapeutic procedures. Nevertheless, female sex behaved as an independent adverse short-term prognostic factor.
International journal of cardiology 05/2007; 116(3):389-95. · 7.08 Impact Factor
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ABSTRACT: Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease.
Descriptive study of a case series.
The intensive care unit (ICU) of a provincial hospital.
The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study.
Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24h after admission, during the first week, during the second or third week, after 1 month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24--76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12--0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time.
After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.
Resuscitation 09/2005; 66(2):175-81. · 3.60 Impact Factor
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Manuel Ruiz-Bailén,
Juan Francisco Brea-Salvago, Eduardo Aguayo de Hoyos,
Luis Rucabado-Aguilar,
Guillermo García Escudero,
Sergio Martínez-Escobar,
Fernando Rossel-Ortiz,
José Francisco Mellado-Vergel,
Francisco Ruiz-Ferrón,
Antonia Morante-Valle,
Francisco Javier Gómez-Jiménez,
Manuel Colmenero-Ruiz
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ABSTRACT: Our objective was to investigate the predisposing factors in patients with acute myocardial infarction (AMI) treated with thrombolysis and complicated by intracranial hemorrhage (ICH), as well as the factors associated with death for patients whose conditions were complicated by ICH.
A retrospective study.
An intensive care/critical care unit.
All patients with AMI listed in the Spanish ARIAM register.
None.
The study period was from June 1996 to December 2003. The follow-up period was limited to the time spent in the intensive care unit/coronary care unit. Associations with the development of ICH were studied by univariate analysis. Another univariate analysis was used to evaluate the differences between patients affected by AMI complicated by ICH who died and those who survived. Two multivariate analyses were also used: one to evaluate the factors related to the development of ICH and the other to evaluate the factors associated with the death of patients with ICH. A total of 17,111 patients with AMI were included in the study. ICH occurred in 151 (0.9%) of these patients during their stay in the intensive care unit/coronary care unit. The multivariate analysis showed that the variables associated with ICH development were smoking (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.478-0.979); oral b-blockers (OR, 0.488; CI, 0.337-0.706); angiotensin-converting enzyme (ACE) inhibitors (OR, 0.480; CI, 0.340-0.678); arterial hypertension (OR, 4.900; CI, 2.758-8.705); age of 55-64 yrs (OR, 2.253; CI, 1.117-4.546); age of 65-74 yrs (OR, 4.240; CI, 2.276-7.901); age of 75-84 yrs (OR, 4.450; CI, 2.319-8.539); and age of >84 yrs (OR, 2.997; CI, 1.039-8.647). The mortality rate among patients with ICH was 48.3%, vs. 8.3% among patients without ICH. The multivariate study showed that the mortality rate among patients with ICH was associated with age (OR, 1.086; CI, 1.033-1.143), arterial hypertension cardiovascular risk factor (OR, 2.773; CI, 1.216-6.324), and the need for mechanical ventilation (OR, 4.324; CI, 1.665-11.230) or cardiopulmonary resuscitation (OR, 12.258; CI, 1.268-118.523). However, the administration of b-blockers (OR, 0.369; CI, 0.136-0.997) or ACE inhibitors (OR, 0.367; CI, 0.149-0.902) was associated with a reduction in the mortality rate.
Factors associated with the development of ICH in our population were age and arterial hypertension, whereas smoking and the administration of b-blockers or ACE inhibitors were associated with a reduction in incidence. Among patients with AMI complicated by ICH, mortality was associated with age, arterial hypertension, cardiopulmonary resuscitation, and the use of mechanical ventilation, whereas the administration of oral b-blockers and ACE inhibitors could be associated with a reduction in mortality.
Critical Care Medicine 08/2005; 33(8):1829-38. · 6.33 Impact Factor
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ABSTRACT: The paradoxical effect of smoking after acute myocardial infarction (AMI) is a phenomenon consisting of a reduction in the mortality of smokers compared to nonsmokers. However, it is not known whether the benefit of this reduction in mortality is due to smoking itself or to other covariables. Despite acceptance of the paradoxical effect of smoking in AMI, it is not known whether a similar phenomenon occurs in unstable angina. The objective of this study was to investigate the paradoxical effect of smoking in AMI and unstable angina, and to study specifically whether smoking is an independent prognostic variable.
The study population was selected from the multicentric ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio [analysis of delay in AMI]) Register, a register of 29,532 patients with a diagnosis of unstable angina or AMI. Tobacco smokers were younger, presented fewer cardiovascular risk factors such as diabetes or hypertension, fewer previous infarcts, a lower Killip and Kimball class, and a lower crude and adjusted mortality in AMI (odds ratio, 0.774; 95% confidence interval, 0.660 to 0.909; p = 0.002). Smokers with unstable angina were younger, with less hypertension or diabetes. In the multivariate analysis, no statistically significant difference in mortality was found.
The reduced mortality observed in smokers with AMI during their stay in the ICU cannot be explained solely by clinical covariables such as age, sex, other cardiovascular factors, Killip and Kimball class, or treatment received. Therefore, smoking may have a direct beneficial effect on reduced mortality in the AMI population. The lower mortality rates found in smokers with unstable angina are not supported by the multivariate analysis. In this case, the difference in mortality can be explained by the other covariables.
Chest 04/2004; 125(3):831-40. · 5.25 Impact Factor
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ABSTRACT: Reversible myocardial dysfunction or myocardial stunning is frequently described in patients with episodes of acute coronary syndrome and has recently been reported in critically ill patients without ischaemic heart disease. This article presents a study and description of the possible existence of myocardial dysfunction in critically ill patients in our setting who present no acute episode or history of cardiovascular disease.
Prospective, descriptive study.
The intensive care unit of a district hospital.
The study included all patients admitted to the intensive care unit between March 1998 and March 2001 for noncardiac causes and with no history of heart disease, and who underwent echocardiographic examination for electrocardiographic changes, signs of cardiac insufficiency, persistent arrhythmias, or any other indication. Patients with sepsis or other critical illness known to be associated with myocardial dysfunction were excluded from the study. The study was carried out on those selected patients who developed myocardial dysfunction.
Transthoracic and transoesophageal echocardiography were carried out to assess the left ventricular ejection fraction and any segmental contractility disturbances. These investigations were carried out within 24 hours of admission, during the first week, during the second or third week, after one month and after three to 6 months. The electrocardiogram was assessed on admission and the changes over time were studied. Thirty-three patients were included in the study after detecting myocardial dysfunction; the median age of these patients was 63 years [range, 23-82 years]. Seven patients died. The median initial left ventricular ejection fraction was 0.34 [range, 0.16-0.48] and improved with time. Segmental contractility disturbances were detected initially in all patients and also normalized with time. All patients presented electrocardiogram changes that normalised in line with the echocardiographic changes.
Reversible myocardial dysfunction can be develop in critically ill patients without primary heart disease. This syndrome is associated with systolic dysfunction, segmental contractility disturbances and electrocardiographic changes.
Journal of Critical Care 01/2004; 18(4):245-52. · 2.13 Impact Factor
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ABSTRACT: The aim of this study has been to investigate the factors predisposing to primary or secondary ventricular fibrillation (VF) and the prognosis in Spanish patients with acute myocardial infarction (AMI) during their admission to the intensive care unit or the coronary care unit.
A retrospective, observational study.
The intensive care units and coronary care units of 119 Spanish hospitals.
A retrospective cohort study including all the AMI patients listed in the ARIAM registry (Analysis of Delay in Acute Myocardial Infarction), a Spanish multicenter study. The study period was January 1995 to January 2001.
Factors associated with the onset of VF were studied by univariate analysis. Multivariate analysis was used to evaluate the independent factors for the onset of VF and for mortality. A total of 17,761 patients with AMI were included in the study; 964 (5.4%) developed VF (primary in 735 patients, secondary in 229). In multivariate analysis, the variables that continued to show an association with the development of VF were the Killip and Kimball class, peak creatine kinase, APACHE II score, age, and time from the onset of symptoms to the initiation of thrombolysis. The mortality in the patients with any VF was 31.8% (27.8% in patients with primary VF and 49.1% in patients with secondary VF). The development of VF is an independent predictive factor for mortality in patients with AMI, with a crude odds ratio of 5.12 (95% confidence interval, 4.41-5.95) and an adjusted odds ratio of 2.73 (95% confidence interval, 2.12-3.51).
Despite the considerable improvement in the treatment of AMI in recent years, the onset of either primary or secondary VF is associated with a poor prognosis. It is usually accompanied by extensive necrosis.
Critical Care Medicine 09/2003; 31(8):2144-51. · 6.33 Impact Factor
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Manuel Ruiz-Bailén, Eduardo Aguayo de Hoyos,
José Angel Ramos-Cuadra,
Miguel Angel Díaz-Castellanos,
Ziad Issa-Khozouz,
Antonio Reina-Toral,
Asunción López-Martínez,
Jesús Calatrava-López,
Francisco Laynez-Bretones,
Juan Carlos Castillo-Parra,
María Victoria De La Torre-Prados
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ABSTRACT: To assess age-related differences in cardiovascular risk factors, clinical course and management of patients with acute myocardial infarction (AMI) in intensive care (ICU) or coronary care units (CCU).
A retrospective cohort study was conducted of all AMI patients listed in the ARIAM register (Analysis of Delay in AMI), a multi-centre register in which 119 Spanish hospitals participated. The study period was from January 1995 to January 2001. A univariate analysis was carried out to evaluate differences between different age groups. Multivariate analysis was used to assess whether age difference was an independent predisposing factor for mortality and for differences in patient management.
17,761 patients were admitted to the ICUs/CCUs with a diagnosis of AMI. The distribution by ages was: <55 years, 3,954 patients (22.3%); 55-64 years, 3,593 (22.2%); 65-74 years, 5,924 (33.4%); 75-84 years, 3,686 (20.8%); and >84 years, 604 (3.4%) (P<0.0001); 24.6% of the patients were female, and the relative proportion of females increased with age. There were clear differences in risk factors between the different age groups, with a predominance of tobacco, cholesterol and family history of heart disease in the younger patients. The incidence of complications, including haemorrhagic complications, increased significantly with age. The older age groups had a lower rate of thrombolysis and less use of revascularisation techniques. The mortality of the above groups was 2.6, 5.4, 10.7, 17.7 and 25.8%, respectively. Age difference was an independent predictive variable for mortality and the administration of thrombolysis.
The distinct age groups differed in cardiovascular risk factors, management and mortality. Age is a significant independent predictive variable for mortality and for the administration of thrombolysis.
International Journal of Cardiology 11/2002; 85(2-3):285-96. · 7.08 Impact Factor
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ABSTRACT: The purpose of our study was to compare the efficacy and safety of alteplase in acute myocardial infarction (AMI), when administered in a double bolus regimen or an accelerated regimen during admission to an intensive care or coronary care unit (ICU/CCU).
A retrospective cohort study including all the AMI patients treated with alteplase recorded in the ARIAM register (Analysis of Delay in AMI), a multi-center register in which 77 Spanish hospitals participate. The study period was from January 1995 to January 2000.
4,615 AMI patients were studied. The accelerated regimen (Group I) was administered to 57.51% (2,654 patients) and the remaining 42.49% (1,961 patients) received the double bolus regimen (Group II). There were no differences in mortality or in the incidence of hemorrhagic stroke between the groups. The mortality was 7.15% in Group I versus 6.43% in Group II (not significant). The incidence of hemorrhagic stroke was 1.09% in Group I versus 1.22% in Group II (not significant). Fewer coronary angiographies were required in Group I (6.28% vs. 8.99%; p<0.001) and fewer rescue angioplasties (10.67% vs. 21.88%, p=0.03). Group I also showed a smaller requirement for stent insertion (2.45% vs. 4.77%; p<0.0001) and for assistance using intra-aortic balloon contrapulsation (0.47% vs. 1.36%; p=0.02).
The two regimens appear to be similar in efficacy and safety. Nevertheless, from these results it may be hypothesized that further revascularization techniques are required after double bolus administration.
Medical science monitor: international medical journal of experimental and clinical research 10/2002; 8(10):PI85-92. · 1.70 Impact Factor
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ABSTRACT: The purpose of this study was to assess the incidence, clinical course, prognosis and mean length of stay in acute myocardial infarction (AMI) complicated by high-grade atrioventricular block (HAVB).
A retrospective cohort study including all AMI patients listed from January 1995 to September 2000 in the ARIAM multi-center register. Univariate analysis was carried out to study the factors associated with the development of HAVB, the mortality rate, and the mean length of stay, and multivariate logistic regression analysis to study whether HAVB is an independent predictive variable for mortality or prolongation of stay.
Of the 14,181 AMI patients included in the register, 837 (5.9%) presented with HAVB, which was associated with age, female sex, increased severity, diabetes, inferior and Q-wave AMIs, and a higher peak creatine phosphokinase (CPK) level. The HAVB patients developed more complications, required more diagnostic-therapeutic resources, and showed significantly higher mortality (p<0.0001) and increased mean length of stay (p<0.0001). The independent risk factors for HAVB were age, maximum peak CPK, inferior or combined localization of the AMI, Q-wave AMI, diabetes, a Killip and Kimball score > 1, and thrombolysis. HAVB was found to be an independent predictive variable for mortality and increased mean length of stay.
AMI patients with HAVB, despite thrombolytic treatment, are at risk for complications, mortality and longer mean admissions. Further study is needed on the outcome of a more active reperfusion policy, such as direct, rescue angioplasty etc.
Medical science monitor: international medical journal of experimental and clinical research 03/2002; 8(3):CR138-47. · 1.70 Impact Factor
