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en las mujeres&#44; sobre todo en pacientes de bajo riesgo<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> ya que no reduce la tasa de mortalidad o el infarto de miocardio en comparaci&#243;n con una estrategia invasiva selectiva&#44; a diferencia de lo que ocurre en los varones<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Esta recomendaci&#243;n se basa en el an&#225;lisis de subgrupos de ensayos realizados hace una d&#233;cada<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> donde el exceso de riesgo se concentraba sobre todo en la necesidad de revascularizaci&#243;n quir&#250;rgica tras el diagn&#243;stico y no en la estrategia de revascularizaci&#243;n percut&#225;nea precoz<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los estudios que analizan desigualdades en la utilizaci&#243;n de procedimientos diagn&#243;sticos o terap&#233;uticos en el SCA analizan a las mujeres en su conjunto<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;11&#44;16&#44;17</span></a>&#46; Sin embargo&#44; se ha prestado una menor atenci&#243;n a los subgrupos de mujeres en los que se concentra el mayor o menor esfuerzo terap&#233;utico&#44; en concreto respecto al intervencionismo coronario&#46; La identificaci&#243;n de estos subgrupos con diferente probabilidad de ser sometidas a intervencionismo coronario precoz permitir&#237;a un an&#225;lisis desagregado del problema de las desigualdades de esfuerzo terap&#233;utico en mujeres&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es identificar alguno de los determinantes de la realizaci&#243;n de la EIP en mujeres con SCASEST a partir de los datos del registro ARIAM-SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de cohortes retrospectivo&#46; Se incluyeron en el an&#225;lisis 440 mujeres con SCASEST de menos de 48<span class="elsevierStyleHsp" style=""></span>h de evoluci&#243;n&#46; Se excluyeron 58 pacientes a las que les fue realizada una coronariograf&#237;a electiva &#40;&#62;<span class="elsevierStyleHsp" style=""></span>72<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Diecis&#233;is pacientes fueron excluidas para el an&#225;lisis por falta de datos analizables respecto a la estrategia recibida&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El desenlace principal del an&#225;lisis fue la ejecuci&#243;n de una EIP definida como la realizaci&#243;n de una angiograf&#237;a coronaria seguida o no de revascularizaci&#243;n dentro de las primeras 72<span class="elsevierStyleHsp" style=""></span>h de ingreso&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las variables incluidas como posibles predictores asociadas a la realizaci&#243;n de la EIP incluyen factores demogr&#225;ficos como la edad&#44; 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y electrocardiogr&#225;ficas del episodio&#46; Se consideraron como cambios electrocardiogr&#225;ficos de alto riesgo aquellos sugestivos de afectaci&#243;n del tronco de coronaria izquierda&#44; el descenso de ST de m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>mm en m&#225;s de 2 derivaciones&#44; la elevaci&#243;n transitoria de ST&#44; la FV primaria y el bloqueo AV de alto grado al ingreso<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Se opt&#243; por categorizar los valores de troponina de forma binaria de modo que la variable &#171;troponina elevada&#187; incluye cualquier valor de troponina distinto al rango normal&#46; Se escogieron estas variables al ser aquellas que se manejan de forma habitual en el momento de decidir el tipo de estrategia a adoptar en cada caso&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Tambi&#233;n se consider&#243; si los casos fueron atendidos en centros con disponibilidad de realizar un cateterismo&#46; Se valor&#243; el riesgo isqu&#233;mico basal tanto mediante los diferentes niveles de estratificaci&#243;n de riesgo GRACE como con la escala TIMI&#46; Los puntos de corte de riesgo considerados en la escala GRACE fueron los establecidos para estimar mortalidad intrahospitalaria<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;10&#44;20</span></a> para estimar riesgo bajo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>108&#41;&#44; intermedio &#40;109-140&#41; y alto &#40;&#62;<span class="elsevierStyleHsp" style=""></span>140&#41;&#46; Respecto a la escala TIMI&#44; se consider&#243; riesgo aumentado con puntuaciones a partir de 4<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;21</span></a>&#46; El riesgo hemorr&#225;gico se cuantific&#243; mediante un &#237;ndice ad hoc basado en el n&#250;mero de predictores independientes de hemorragias mayores del registro GRACE<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Se consider&#243; que todas las pacientes incluidas presentaban&#44; de manera basal&#44; al menos un factor de riesgo hemorr&#225;gico ya que el sexo femenino es uno de los predictores independientes de hemorragias mayores del registro GRACE&#46; Las otras variables consideradas fueron la edad avanzada&#44; los antecedentes de hemorragias&#44; los valores basales de hemoglobina&#47;hematocrito&#44; la presi&#243;n arterial media y la disfunci&#243;n renal medida por la concentraci&#243;n de creatinina s&#233;rica o bien por la tasa de filtraci&#243;n glomerular calculada por la ecuaci&#243;n de Cockcroft-Gault<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;23</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En el an&#225;lisis estad&#237;stico-descriptivo se calcularon las proporciones para las variables categ&#243;ricas y las medianas con percentiles 25 y 75 en el caso de variables continuas&#46; Los contrastes de hip&#243;tesis sobre proporciones se realizaron mediante el test Ji-cuadrado&#46; Las variables cuantitativas se contrastaron mediante pruebas no param&#233;tricas &#40;test de Mann-Whitney&#41;&#46; Los contrastes fueron bilaterales con un nivel de significaci&#243;n alfa del 5&#37;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para determinar los factores predictores independientes del cateterismo precoz aquellas variables asociadas en el an&#225;lisis univariante a la realizaci&#243;n de una EIP con una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;10 se incluyeron en un modelo de regresi&#243;n log&#237;stica binaria que se analiz&#243; mediante una estrategia hacia atr&#225;s&#44; elimin&#225;ndose en cada paso la variable menos significativa&#46; El efecto de la asociaci&#243;n entre la edad y la realizaci&#243;n de una EIP se analiz&#243; de forma gr&#225;fica&#46; Dicha asociaci&#243;n no era lineal sino de tipo &#171;m&#237;nimo umbral&#187;&#46; Por ello&#44; se opt&#243; por categorizar la edad como variable binaria con el punto de corte a nivel de dicho umbral &#40;80 a&#241;os&#41; y como tal se introdujo en el modelo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La eliminaci&#243;n de variables no dependi&#243; solamente de su nivel de significaci&#243;n&#44; sino tambi&#233;n de su impacto en las odds ratios &#40;OR&#41; ajustadas de las dem&#225;s variables&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre las variables predictoras y la realizaci&#243;n de una EIP se estim&#243; mediante el c&#225;lculo de las OR ajustadas y de sus intervalos de confianza &#40;IC&#41; de 95&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los an&#225;lisis se realizaron con el programa estad&#237;stico Statistical Package for Social Sciences&#44; versi&#243;n 19&#46;0 &#40;SPSS&#44; Chicago&#44; Illinois&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Durante el periodo de 2010 participaron 43 centros que aumentaron a 56 en 2011 &#40;anexo&#41;&#46; En 2010 se reclutaron 187 mujeres con SCASEST &#40;27&#44;7&#37; del total de pacientes con SCASEST&#41; y durante 2011&#44; 253 pacientes &#40;27&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; De las 440 pacientes analizadas&#44; 220 pacientes &#40;60&#44;1&#37;&#41; fueron sometidas a una EIP y 146 &#40;39&#44;9&#37;&#41; recibieron tratamiento conservador&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En el an&#225;lisis univariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; los factores que se asociaron significativamente a la EIP en las mujeres fueron el tabaquismo&#44; la disponibilidad de la Unidad de Hemodin&#225;mica en el centro donde se atiende el caso y los trazados electrocardiogr&#225;ficos de alto riesgo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Por el contrario&#44; la edad &#40;mayor de 80 a&#241;os&#41;&#44; la presencia de diabetes mellitus&#44; la insuficiencia cardiaca y el alto riesgo isqu&#233;mico basal &#40;estratificado seg&#250;n el sistema de puntuaci&#243;n GRACE&#41; se asociaron parad&#243;jicamente con la estrategia conservadora&#46; La presencia de lesiones coronarias conocidas&#44; la fibrilaci&#243;n auricular&#44; el tratamiento previo con acenocumarol y el riesgo hemorr&#225;gico elevado tambi&#233;n se asociaron significativamente con la estrategia conservadora &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El an&#225;lisis de regresi&#243;n log&#237;stica &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; identific&#243; como variables predictoras independientes asociadas al uso de una estrategia invasiva el electrocardiograma de alto riesgo &#40;OR ajustada&#58; 2&#44;96&#59; IC 95&#37;&#58; 1&#44;72-4&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y el tabaquismo &#40;OR ajustada&#58; 2&#44;50&#59; IC 95&#37;&#58; 1&#44;20-5&#44;19&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46; La disponibilidad de la Unidad de Hemodin&#225;mica no se asoci&#243; de forma independiente a la EIP&#46; De las variables que se asociaron con la estrategia conservadora en el an&#225;lisis univariante&#44; la edad avanzada &#40;OR ajustada&#58; 0&#44;48&#59; IC 95&#37;&#58; 0&#44;27-0&#44;82&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; la existencia de lesiones coronarias conocidas &#40;OR ajustada&#58; 0&#44;47&#59; IC 95&#37;&#58; 0&#44;26-0&#44;84&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41; y la frecuencia cardiaca &#40;OR ajustada&#58; 0&#44;98&#59; IC 95&#37;&#58; 0&#44;97-0&#44;99&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; se confirmaron como variables predictoras independientes asociadas a la estrategia conservadora&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El porcentaje de pacientes fumadoras fue de 12&#44;5&#37; &#40;53 pacientes&#41;&#44; de las cuales el 60&#44;4&#37; &#40;32&#37;&#41; eran fumadoras activas&#46; El riesgo isqu&#233;mico de estas pacientes fue significativamente menor &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En el an&#225;lisis desagregado de los determinantes del score GRACE las pacientes fumadoras se caracterizaron por ser significativamente m&#225;s j&#243;venes y presentar menos insuficiencia cardiaca al ingreso &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Para confirmar la validez de los resultados se realiz&#243; un an&#225;lisis de sensibilidad consistente en la exclusi&#243;n del an&#225;lisis de los pacientes que fallecen en las primeras 24<span class="elsevierStyleHsp" style=""></span>h &#40;10 pacientes&#44; 2&#44;5&#37;&#41;&#46; Tras excluir las muertes precoces del an&#225;lisis&#44; el an&#225;lisis multivariante tuvo resultados similares &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">En el presente estudio el grupo de mujeres tratadas con una EIP fueron significativamente m&#225;s j&#243;venes&#44; con menor riesgo isqu&#233;mico y hemorr&#225;gico&#44; con mayor porcentaje de pacientes fumadoras&#44; con cambios electrocardiogr&#225;ficos de alto riesgo y atendidas en centros con disponibilidad de realizar estudios hemodin&#225;micos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Por el contrario&#44; el grupo de pacientes tratadas de forma conservadora se caracteriz&#243; por una mayor edad&#44; mayor porcentaje de pacientes diab&#233;ticas&#44; tratadas cr&#243;nicamente con dicumar&#237;nicos y mayor gravedad al ingreso &#40;mayor prevalencia de insuficiencia cardiaca&#44; mayor riesgo isqu&#233;mico basal&#41;&#44; confirmando la relaci&#243;n inversa entre el riesgo isqu&#233;mico y la realizaci&#243;n de la estrategia invasiva ya descrita en la poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;24</span></a>&#46; No se encontraron diferencias significativas en cuanto a comorbilidad &#40;EPOC&#44; obesidad&#44; insuficiencia renal cr&#243;nica&#41;&#46; El subgrupo tratado de forma conservadora presentaba tambi&#233;n mayor riesgo hemorr&#225;gico&#44; lo que apoyar&#237;a la asociaci&#243;n dosis-respuesta entre riesgo hemorr&#225;gico y uso de la EIP que constituye un importante hallazgo de recientes estudios<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> y sugiere que la menor utilizaci&#243;n de una EIP en los pacientes de alto riesgo puede deberse al mayor riesgo hemorr&#225;gico de estos pacientes&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante muestra que la probabilidad de recibir una EIP aumenta en el subgrupo de pacientes fumadoras y con cambios electrocardiogr&#225;ficos indicadores de lesiones graves al ingreso&#46; De estos 2 factores&#44; la relaci&#243;n de los cambios electrocardiogr&#225;ficos de riesgo y la actitud intervencionista no plantea problemas de interpretaci&#243;n y corresponde a la aplicaci&#243;n de las gu&#237;as vigentes de pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a>&#46; El efecto observado del tabaquismo sobre el tipo de estrategia adoptada reproduce los resultados de otros an&#225;lisis<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Este efecto result&#243; independiente de la edad en el an&#225;lisis de regresi&#243;n&#44; lo que sugiere un efecto espec&#237;fico de este factor de riesgo sobre el tratamiento y la evoluci&#243;n de los SCA&#46; De hecho&#44; se ha descrito un efecto parad&#243;jico consistente con mejor pron&#243;stico en los pacientes fumadores con IAM y angina inestable e IAM que no se explica &#250;nicamente por covariables cl&#237;nicas como la edad&#44; el sexo o el tratamiento recibido<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; En el estudio de Poon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> la infraestimaci&#243;n del riesgo isqu&#233;mico real de las pacientes fue el motivo m&#225;s com&#250;n para adoptar una estrategia conservadora&#46; Una posible hip&#243;tesis que explicar&#237;a nuestros resultados ser&#237;a la sobreestimaci&#243;n del riesgo de estas pacientes&#46; No podemos excluir la posibilidad de que otros factores&#44; como una menor percepci&#243;n del riesgo hemorr&#225;gico de estas pacientes&#44; influyan en la decisi&#243;n sobre el tipo de estrategia a adoptar&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Respecto a los factores asociados de modo independiente a la estrategia conservadora&#44; la existencia de lesiones coronarias conocidas previamente puede sugerir tanto la existencia de lesiones no revascularizables ya conocidas como la ausencia de las mismas&#46; El 87&#37; de las pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; con lesiones coronarias previas hab&#237;an sido sometidas a cateterismo con anterioridad&#44; de las cuales el 52&#37; &#40;12&#47;23&#41; ten&#237;an antecedentes de intervencionismo coronario y 12&#37; &#40;3&#47;23&#41; de revascularizaci&#243;n quir&#250;rgica&#46; Una limitaci&#243;n de este estudio es la ausencia de datos en el registro para explorar las caracter&#237;sticas de estas lesiones ya que un factor de riesgo conocido es la IPC previa&#46; La edad avanzada &#40;&#62;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os&#41; fue tambi&#233;n una variable predictora asociada a la estrategia conservadora&#44; coincidiendo as&#237; con otros estudios que indican que el binomio g&#233;nero femenino&#47;edad avanzada disminuye el uso de la revascularizaci&#243;n en el SCASEST<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; La mayor frecuencia cardiaca al ingreso tambi&#233;n se asoci&#243; de modo independiente con la estrategia conservadora&#46; Este dato coincide con an&#225;lisis similares<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; La relaci&#243;n entre el incremento de la frecuencia cardiaca y la mortalidad cardiovascular es bien conocida&#46; El aumento de la frecuencia cardiaca es un dato predictivo de mayor mortalidad a corto y largo plazo en pacientes con SCA<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> y tambi&#233;n se interpreta como dato del uso contradictorio de la estrategia conservadora en los pacientes m&#225;s graves<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; En estudios recientes la infraestimaci&#243;n del riesgo isqu&#233;mico real de las pacientes fue el motivo m&#225;s com&#250;n para adoptar una estrategia conservadora<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Este es un dato relevante que sugiere la necesidad de replantear una correcta valoraci&#243;n del riesgo y el beneficio en la toma de decisiones sobre el diagn&#243;stico y el tratamiento precoz de los SCASEST en mujeres&#44; teniendo en cuenta adem&#225;s que los riesgos de la EIP se basan en datos probablemente obsoletos y que no est&#225;n directamente en relaci&#243;n con la t&#233;cnica percut&#225;nea<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Un aspecto considerado en el an&#225;lisis fue la posibilidad de que los pacientes m&#225;s graves&#44; que fallecen pocas horas tras el ingreso sin tiempo a realizar la coronariograf&#237;a&#44; estuvieran influyendo en el resultado al ser analizados en el mismo grupo que las pacientes tratadas de forma conservadora&#46; Sin embargo&#44; los resultados fueron similares tras la exclusi&#243;n de las pacientes fallecidas en las primeras 24<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La validez de estos resultados debe ser tomada con cautela ya que proceden de un registro observacional de cohortes cuya principal limitaci&#243;n es su vulnerabilidad al efecto de los factores de confusi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;25</span></a>&#46; Otra limitaci&#243;n est&#225; en un posible sesgo de selecci&#243;n en los pacientes ya que solo se estudian los pacientes que ingresan en las unidades coronarias que voluntariamente participan en el proyecto ARIAM-SEMICYUC&#46; Una tercera limitaci&#243;n del an&#225;lisis de este tipo de registros podr&#237;a deberse a que el uso sistem&#225;tico de las escalas de valoraci&#243;n de riesgo y sus diferentes puntos de corte pueden no ser herramientas utilizadas en la cl&#237;nica habitual&#44; sino datos cumplimentados a posteriori en el registro&#46; Sin embargo&#44; s&#237; son de uso cl&#237;nico habitual los determinantes individuales que constituyen dichas escalas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; en este estudio el tabaquismo y el electrocardiograma de alto riesgo al ingreso identifican un subgrupo de mujeres con SCASEST con mayor probabilidad de ser sometidas a intervencionismo precoz de modo independiente&#46; La existencia de lesiones coronarias previas&#44; la edad avanzada y el incremento de la frecuencia cardiaca son factores independientes para el tratamiento conservador&#46; Ser&#237;an necesarias nuevas herramientas de an&#225;lisis de decisiones respecto al intervencionismo coronario en la poblaci&#243;n femenina&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">El registro ARIAM es un proyecto financiado por la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar los determinantes asociados a la estrategia invasiva precoz &#40;EIP&#41; en mujeres con s&#237;ndrome coronario agudo sin elevaci&#243;n de ST &#40;SCASEST&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo&#46; An&#225;lisis crudo y ajustado de la realizaci&#243;n de EIP mediante regresi&#243;n log&#237;stica no condicional&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Unidades coronarias participantes en 2010-2011 en el registro ARIAM-SEMICYUC&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cuatrocientas cuarenta mujeres con SCASEST&#46; Se excluyeron 16 por datos insuficientes y 58 con coronariograf&#237;a electiva &#40;&#62;<span class="elsevierStyleHsp" style=""></span>72<span class="elsevierStyleHsp" style=""></span>h&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Variables analizadas</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Demogr&#225;ficas&#44; factores de riesgo coronario&#44; medicaci&#243;n previa&#44; comorbilidad&#46; Caracter&#237;sticas cl&#237;nicas&#44; anal&#237;ticas&#44; hemodin&#225;micas y electrocardiogr&#225;ficas del episodio&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las mujeres tratadas conservadoramente presentaban mayor edad&#44; mayor prevalencia de anticoagulaci&#243;n oral&#44; diabetes&#44; lesiones coronarias previas e insuficiencia cardiaca &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; mayor riesgo hemorr&#225;gico e isqu&#233;mico basal &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y mayor frecuencia cardiaca al ingreso &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Tras el ajuste solo la edad mayor de 80 a&#241;os &#40;OR&#58; 0&#44;48&#59; IC 95&#37;&#58; 0&#44;27-0&#44;82&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; las lesiones coronarias conocidas &#40;OR&#58; 0&#44;47&#59; IC 95&#37;&#58; 0&#44;26-0&#44;84&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41; y la frecuencia cardiaca &#40;OR&#58; 0&#44;98&#59; IC 95&#37;&#58; 0&#44;97-0&#44;99&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; se asociaron de forma independiente al tratamiento conservador&#46; El tabaquismo &#40;OR&#58; 2&#44;50&#59; IC 95&#37;&#58; 1&#44;20-5&#44;19&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41; y el electrocardiograma de alto riesgo &#40;OR&#58; 2&#44;96&#59; IC 95&#37;&#58; 1&#44; 72-4&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron a la EIP&#46; La exclusi&#243;n de muertes precoces &#40;&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#41; no alter&#243; estos resultados&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En mujeres con SCASEST el tabaquismo y el electrocardiograma de alto riesgo al ingreso son factores independientes asociados a la EIP&#46; Las lesiones coronarias previas conocidas&#44; la edad &#62;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os y el aumento de la frecuencia cardiaca son factores independientes asociados al tratamiento conservador&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation &#40;NSTE-ACS&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was made&#46; Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A total of 440 women with NSTE-ACS were studied&#46; Sixteen patients were excluded due to insufficient data&#44; together with 58 patients subjected to elective coronary angiography &#40;&#62; 72<span class="elsevierStyleHsp" style=""></span>h&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Variables analyzed</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic parameters&#44; coronary risk factors&#44; previous medication&#44; comorbidity&#46; Clinical&#44; laboratory&#44; hemodynamic and electrocardiographic data of the episode&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Women treated conservatively were of older age&#44; had oral anticoagulation&#44; diabetes&#44; previous coronary lesions&#44; and heart failure &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; increased baseline bleeding and ischemic risk &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; and a higher heart rate upon admission &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; After adjustment&#44; only age &#62; 80 years &#40;OR 0&#44;48&#44; 95&#37; CI 0&#44;27 to 0&#44;82&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; known coronary lesions &#40;OR 0&#44;47&#44; 95&#37; CI 0&#44;26-0&#44;84&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#44; and heart rate &#40;OR 0&#44;98&#44; 95&#37; CI 0&#44;97-0&#44;99&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; were independently associated to conservative treatment&#46; Smoking &#40;OR 2&#46;50&#44; 95&#37; CI 1&#46;20 to 5&#46;19&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41; and high-risk electrocardiogram &#40;OR 2&#46;96&#44; 95&#37; CI 1&#46;72 to 4&#46;97&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; were associated to the early invasive strategy&#46; The exclusion of early deaths &#40;&#60;24<span class="elsevierStyleHsp" style=""></span>h&#41; did not alter these results&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">In women with NSTE ACS&#44; smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy&#46; Previous coronary lesions&#44; age &#62; 80 years and increased heart rate were independent factors associated to conservative treatment&#46;</p>"
      ]
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        "nota" => "<p class="elsevierStyleNotepara">Grupo ARIAM-SEMICYUC&#58; varios hospitales &#40;<a class="elsevierStyleCrossRef" href="#sec0035">Anexo 1</a>&#41;&#46;</p>"
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            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Andaluc&#237;a&#58;</span> Hospital Nuestra Se&#241;ora de Valme &#40;Sevilla&#41;&#58; Dolores Herrera Rojas&#44; Ana Loza V&#225;zquez&#44; Antonio Campanario Garc&#237;a&#44; Jos&#233; Antonio S&#225;nchez Rom&#225;n&#44; Mar&#237;a Mar&#237;n Herrero y Alejandro &#218;beda Iglesias&#46; <span class="elsevierStyleBold">Andorra&#58;</span> Hospital de Nuestra Se&#241;ora de Meritxell &#40;Andorra la Vella&#41;&#58; Antonio Margarit Ribas&#46; <span class="elsevierStyleBold">Arag&#243;n&#58;</span> Hospital General San Jorge &#40;Huesca&#41;&#58; Juan Carlos L&#243;pez Claver&#44; Lorenzo Labarta Monz&#243;n&#44; Jes&#250;s Escos Orta&#44; Ar&#225;nzazu Lander Azcona&#44; Carlos Ser&#243;n Arbeloa&#44; Isabel Garrido Ram&#237;rez de Arellano y Mar&#237;a Isabel Marquina Lacueva&#59; Hospital Cl&#237;nico Universitario Lozano Blesa &#40;Zaragoza&#41;&#58; Emilia Civeira Murillo&#44; Luis Mariano Giner Smith y Luis Mart&#237;n Vill&#233;n&#59; Hospital Maz &#40;Zaragoza&#41;&#58; Isabel Yuste Serrano&#44; Pedro Bernad&#44; Santiago Temi&#241;o&#44; Victoria Rull&#44; Raquel Valero y Noelia Artesero&#59; Hospital Universitario Miguel Servet &#40;Zaragoza&#41;&#58; Joaqu&#237;n Joven Lafont&#44; Jos&#233; Luis Ib&#225;&#241;ez Langa&#44; Alejandra Mor&#243;n&#44; Jose Luis Iba&#241;ez Langa&#44; Javier Mu&#241;oz Marco&#44; Jes&#250;s Lorente Cort&#233;s&#44; Teresa Sanz&#44; Agust&#237;n Nebra&#44; Antonio Luis Ruiz&#44; Ignacio Gonz&#225;lez y Antonio Luis Aguilar&#46; <span class="elsevierStyleBold">Comunidad Foral de Navarra&#58;</span> Hospital Virgen del Camino &#40;Pamplona&#47;Iru&#241;a&#41;&#58; Jos&#233; Ramos Castro&#46; <span class="elsevierStyleBold">Castilla y Le&#243;n&#58;</span> Complejo Asistencial de Palencia &#40;Palencia&#41;&#58; Jose <span class="elsevierStyleSmallCaps">I</span>&#46; Alonso Fern&#225;ndez&#44; Houssein Bouchotrouch y Maite Ortega S&#225;ez&#59; Hospital El Bierzo &#40;Ponferrada&#41;&#58; Juli&#225;n J&#46; Sandoval Garz&#243;n&#59; Hospital General de Segovia &#40;Segovia&#41;&#58; Pablo Ancillo Garc&#237;a y Antonio Jos&#233; Mont&#243;n Rodr&#237;guez&#59; Hospital General Yag&#252;e &#40;Burgos&#41;&#58; Oliverio L&#243;pez Gimeno&#59; Hospital Santa B&#225;rbara &#40;Soria&#41;&#58; Christian J&#46; Salas&#59; Hospital Felipe <span class="elsevierStyleSmallCaps">II</span> &#40;Valladolid&#41;&#58; Juan Jos&#233; Sanz Hern&#225;n&#59; Hospital Universitario del R&#237;o Hortega &#40;Valladolid&#41;&#58; Marta Garc&#237;a Garc&#237;a&#44; Ana Mar&#237;a Prieto y Rub&#233;n Herr&#225;n Monge&#59; Hospital Virgen de la Concha &#40;Zamora&#41;&#58; Ana carolina Caballero Zirena&#46; <span class="elsevierStyleBold">Castilla-La Mancha&#58;</span> Hospital General de Ciudad Real &#40;Ciudad Real&#41;&#58; Carmen Mart&#237;n Rodr&#237;guez&#44; Mariana Portilla Botelho y Alfonso Ambros Checa&#59; Hospital Universitario de Guadalajara &#40;Guadalajara&#41;&#58; Elena Y&#225;&#241;ez Parareda&#59; Hospital Santa B&#225;rbara &#40;Puertollano&#41;&#58; Francisca Prieto Valderrey y Emilio Moreno Mill&#225;n&#46; <span class="elsevierStyleBold">Catalunya&#58;</span> Hospital General de L&#8217;Hospitalet &#40;L&#8217;Hospitalet de Llobregat&#41;&#58; Jos&#233; Juli&#225;n Berrade Zubiri&#59; Hospital de Sabadell &#40;Sabadell&#41;&#58; Consuelo Gu&#237;a Rambla y Xaime Garc&#237;a Nogales&#59; Hospital de Sant Boi &#40;Sant Boi de Llobregat&#41;&#58; Alejandra Fern&#225;ndez Trujillo&#59; Hospital General de Catalunya &#40;Sant Cugat del Vall&#232;s&#41;&#58; Elisabet Manero Caballero y Roc&#237;o Toledo&#59; Hospital de Terrassa &#40;Terrassa&#41;&#58; Joaqu&#237;n Amador Amerigo&#59; Hospital de Sant Pau y Santa Tecla &#40;Tarragona&#41;&#58; Yolanda del Castillo&#59; Hospital de Sant Joan de D&#233;u &#40;Manresa&#41;&#58; Josep M&#46; Alcoverro Pedrola&#46; <span class="elsevierStyleBold">Comunidad Valenciana&#58;</span> Hospital General Universitario de Alicante &#40;Alicante&#41;&#58; Jos&#233; C&#225;novas Robles&#44; M&#243;nica D&#237;az Barranco&#44; Victoria Ortol&#225; Vercher y Francisco &#193;ngel Jaime S&#225;nchez&#59; Hospital Universitario de la Ribera &#40;Alzira&#41;&#58; Lucia Arias Portaceli&#44; Ana Abalos Garc&#237;a&#44; Mart&#237;n Parejo Montell y Juan Fern&#225;ndez Cabrera&#59; Hospital General de Castell&#243; &#40;Castell&#243;n de la Plana&#41;&#58; Laura Albert Rodrigo&#44; Patricia Casero Roig&#44; Susana Altaba Tena y Amparo Ferr&#225;ndiz&#59; Consorcio Hospitalario Provincial de Castell&#243;n &#40;Castell&#243;n&#41;&#58; Javier Madero&#59; Hospital de la Plana &#40;Vila-Real&#41;&#58; Elena Porcar Rodado&#59; Hospital de Villajoyosa &#40;Villajoyosa&#41;&#58; Pedro Manzano Hinojosa&#59; Hospital General de Elche &#40;Elche&#41;&#58; Jaime Latour P&#233;rez&#44; Eva de Miguel Balsa&#44; Karel Pino Izquierdo y Francisco Javier Coves Orts&#59; Hospital Torrevieja Salud UTE &#40;Torrevieja&#41;&#58; Eugenio Herrrero Guti&#233;rrez&#59; Hospital Dr&#46; Peset Aleixandre &#40;Valencia&#41;&#58; Luis Garc&#237;a Ochando y Luisa F&#46; Mart&#237;n Osorio&#59; Hospital de Manises &#40;Manises&#41;&#58; M&#243;nica Talavera Peregrina y Concha Cort&#233;s Naval&#243;n&#59; Hospital Vega Baja &#40;Orihuela&#41;&#58; Cristina Portillo Requena y Fadoua Laghzaoui&#59; Hospital de Requena &#40;Valencia&#41;&#58; Carlos Jos&#233; Folgado Bisbal&#59; Hospital de Sagunto &#40;Sagunto&#41;&#58; Regina Calvo Embuena&#59; Hospital del Vinalop&#243; &#40;Elche&#41;&#58; David Mart&#237;n Langerwerf&#59; Hospital Universitario de San Juan de Alicante &#40;San Juan de Alicante&#41;&#58; Cristina Molla Jim&#233;nez&#59; Cl&#237;nica Quir&#243;n de Valencia &#40;Valencia&#41;&#58; Javier Tornero L&#243;pez&#59; Hospital Arnau de Vilanova &#40;Valencia&#41;&#58; Mois&#233;s Rico Sala&#44; Mercedes Garc&#237;a Sanz y Eugenia de la Fuente O&#8217;Connor&#59; Hospital Cl&#237;nico Universitario &#40;Valencia&#41;&#58; Ricardo Oltra Chord&#225;&#59; Hospital Universitario La Fe &#40;Valencia&#41;&#58; Mar&#237;a Paz Fuset Cabanes&#44; Isabel Madrid L&#243;pez&#44; Karla Vacacela Cordova y Esther Villarreal Tello&#59; Hospital de Vinaros &#40;Vinar&#242;s&#41;&#58; Mar&#237;a Desamparados Oliva Gimeno&#46; <span class="elsevierStyleBold">Extremadura</span>&#58; Hospital San Pedro de Alc&#225;ntara &#40;C&#225;ceres&#41;&#58; Eduardo Corchero&#44; Elena Gallego Curto&#44; Alberto Fern&#225;ndez Zapata y Abilio Arrasqueta Llanes&#59; Hospital Don Benito &#40;Villanueva de la Serena&#41;&#58; Juan Diego Jim&#233;nez Delgado&#59; Hospital de M&#233;rida &#40;M&#233;rida&#41;&#58; Marcelo P&#233;rez Arriaga&#44; Fernando V&#225;zquez Fuentes&#44; Mercedes Antona D&#237;ez y Guadalupe Borge Rodr&#237;guez&#59; Hospital Virgen del Puerto &#40;Plasencia&#41;&#58; Eva Guerra Nevado y Anton Arana Llanderal&#59; Hospital de Zafra &#40;Zafra&#41;&#58; Miguel Gonz&#225;lez Lar e Hilario Badiola Villa&#46; <span class="elsevierStyleBold">Galicia&#58;</span> Hospital Xeral de Lugo &#40;Lugo&#41;&#58; Mar&#237;a Luisa Mart&#237;nez Rodr&#237;guez y Rebeca &#193;lvarez-Lata&#59; Complejo Hospitalario de Ourense &#40;Ourense&#41;&#58; Mar&#237;a Jos&#233; de la Torre y Rom&#225;n Rodr&#237;guez &#193;lvarez-Granada&#59; Hospital Miguel Dom&#237;nguez &#40;Pontevedra&#41;&#58; Ra&#250;l Jos&#233; Gonz&#225;lez Gonz&#225;lez&#59; Hospital Arquitecto Marcide &#40;Ferrol&#41;&#58; Carmen J&#46; Fern&#225;ndez Gonz&#225;lez&#46; <span class="elsevierStyleBold">La Rioja&#58;</span> Hospital San Pedro &#40;Logro&#241;o&#41;&#58; Mar&#237;a de la Concepci&#243;n Pav&#237;a Pesquera&#44; Ver&#243;nica D&#237;az de Anto&#241;ana y Lidia Mart&#237;nez Camarero&#46; <span class="elsevierStyleBold">Madrid&#58;</span> Hospital Universitario Pr&#237;ncipe de Asturias &#40;Alcal&#225; Henares&#41;&#58; Jos&#233; Andr&#233;s Cambronero Galache y Cristina Mart&#237;nez&#59; Hospital del Henares &#40;Coslada&#41;&#58; In&#233;s Torrej&#243;n P&#233;rez&#59; Hospital de Fuenlabrada &#40;Fuenlabrada&#41;&#58; Mercedes Rubio Regidor&#44; Marialving Fuentes Salazar y Febechi Afamefule Afamefule&#59; Hospital Severo Ochoa &#40;Legan&#233;s&#41;&#58; Frutos del Nogal S&#225;ez&#59; Hospital La Moraleja &#40;Madrid&#41;&#58; Miguel &#193;ngel Palma Gamiz&#59; Hospital del Tajo &#40;Aranjuez&#41;&#58; Miriam Chana Garc&#237;a&#59; Hospital Infanta Leonor &#40;Madrid&#41;&#58; Paloma Rico Cepeda&#46; <span class="elsevierStyleBold">Pa&#237;s Vasco&#58;</span> Hospital de Cruces &#40;Barakaldo&#41;&#58; Katherine Garc&#237;a Castillo y Victoria Boado Varela&#46; <span class="elsevierStyleBold">Principado de Asturias&#58;</span> Hospital San Agust&#237;n &#40;Avil&#233;s&#41;&#58; Josefa Rengel Jim&#233;nez&#46; <span class="elsevierStyleBold">Murcia&#58;</span> Hospital Rafael M&#233;ndez &#40;Lorca&#41;&#58; Carlos Luis Albacete Moreno&#59; Hospital General Universitario Reina Sof&#237;a &#40;Murcia&#41;&#58; Francisco Felices Abad&#44; Isabel Cremades Naval&#243;n&#44; Lisa Ort&#237;n Katnich&#44; F&#225;tima Mart&#237;nez-Lozano Aranaga&#44; Jos&#233; L&#46; Espinosa Berenguel&#44; Blanca Gallego P&#233;rez y Mart&#237;n Vigil Velis&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Hospitales participantes en el registro ARIAM-SEMICYUC en los cortes 2010-2011"
            "identificador" => "sec0035"
          ]
        ]
      ]
    ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AAS&#58; &#225;cido acetilsalic&#237;lico&#59; Ant&#46; familiares&#58; antecedentes familiares&#59; ARA <span class="elsevierStyleSmallCaps">II</span>&#58; antagonistas de los receptores de la angiotensina <span class="elsevierStyleSmallCaps">ii</span>&#59; CCV&#58; cirug&#237;a cardiovascular&#59; DM&#58; diabetes mellitus&#59; ECG&#58; electrocardiograma&#59; EIP&#58; estrategia invasiva precoz&#59; FA&#58; fibrilaci&#243;n auricular&#59; FC &#40;lpm&#41;&#58; frecuencia cardiaca &#40;lat&#47;min&#41;&#59; GRACE&#58; Global Registry of Acute Coronary Events&#59; HTA&#58; hipertensi&#243;n arterial&#59; ICC&#58; insuficiencia cardiaca congestiva&#59; IECAs&#58; inhibidores de la enzima convertidora de angiotensina&#59; IPC&#58; intervencionismo percut&#225;neo coronario&#59; Les&#46; coronarias previas&#58; lesiones coronarias previas&#59; mmHg&#58; mil&#237;metros de mercurio&#59; TAD&#58; tensi&#243;n arterial dist&#243;lica&#59; TAS&#58; tensi&#243;n arterial sist&#243;lica&#59; TIMI&#58; thrombolysis in myocardial infarction&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mediana &#40;p25-p75&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Factores de riesgo coronario</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Antecedentes patol&#243;gicos</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infarto de miocardio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;842&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Angina</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;19&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Les&#46; coronarias previas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;15&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ACV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;6&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;711&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">EPOC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;5&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;6&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;598&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia renal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;4&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Procedimientos diagn&#243;sticos y terap&#233;uticos</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Coronariograf&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;17&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;17&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;914&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">IPC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;701&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CCV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;449&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Forma de presentaci&#243;n</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dolor en reposo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;6&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;380&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20 &#40;9&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;19&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TAS inicial &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">140&#40;120-161&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">140&#40;120-160&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;918&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TAD inicial &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;64-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;65-85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FC inicial &#40;lpm&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;69-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;68-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Killip inicial&#58;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Casos atendidos en centros con Unidad de Hemodin&#225;mica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Factores riesgo hemorr&#225;gico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">54 &#40;49-60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FC &#40;lpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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