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Bosch D.,Hospital Universitari Dr Josep Trueta | Masia R.,Hospital Universitari Dr Josep Trueta | Sala J.,Hospital Universitari Dr Josep Trueta | Vila J.,Institute Municipal dInvestigacio Mdica IMIM | And 11 more authors.
Revista Espanola de Cardiologia | Year: 2011

Introduction and objectives: To determine the effect of opening an on-site diagnostic catheterization facility on 30-day and 2-year mortality rates in patients with myocardial infarction (MI). Methods: The study included 1539 consecutive MI patients aged 25-74 years who were recruited before and after the catheterization laboratory opened in 1998: during 1995-1997 and 1999-2003, respectively. Results: The 641 consecutive MI patients recruited in 1995-1997 had worse 30-day mortality than the 898 recruited between 1999-2003 (11.2% versus 6.35%, respectively; P = .001). The number of coronary angiographies and percutaneous coronary interventions carried out was greater in the second period (19.4% versus 3.3%, and 54.8% versus 23.0%, respectively; P < .001). Two-year survival curves were significantly better in the second period for all-cause and cardiovascular death. The adjusted odds ratio for death at 30 days was 0.58 (95% confidence interval [CI] 0.36-0.95) for the second period compared with the first and the adjusted hazard ratio for cardiovascular death at 2 years for patients still alive at 30 days was 0.62 (95%CI 0.39-0.99). After adjustment for the prescription of statins, angiotensin-converting enzyme inhibitors, beta-blockers and antiplatelet drugs at discharge, the effect observed at 2 years was no longer significant. Conclusions: Opening a new on-site diagnostic catheterization unit significantly increased the 30-day survival of MI patients. However, the increase in 2-year survival of 30-day survivors observed was largely explained by the implementation of better secondary prevention. © 2010 Sociedad Española de Cardiología.

Marrugat J.,Institute Municipal dInvestigacio Mdica IMIM | Sala J.,Institute Municipal dInvestigacio Mdica IMIM | Elosua R.,Institute Municipal dInvestigacio Mdica IMIM | Ramos R.,Institute Municipal dInvestigacio Mdica IMIM | Baena-Diez J.M.,Institute Municipal dInvestigacio Mdica IMIM
Revista Espanola de Cardiologia | Year: 2010

This article describes the limitations of the currently available screening modalities used for determining cardiovascular risk in the general population. In addition, it contains an analysis of the potential ways in which the predictive and classificatory abilities of the cardiovascular risk charts used in primary care can be improved to enable them to function more effectively. Also included are discussions of existing opportunities for improving current strategies for screening and cardiovascular prevention, of the value of measuring new biomarkers in individual patients, including genetic predisposition to coronary heart disease, and of some of the clinical measures used in practice, such as the ankle-brachial index and the carotid intima-media thickness. In addition, the most important subgroups of individuals at a high cardiovascular risk, as judged by their size and the number of cardiovascular events experienced at 10 years, are described. Finally, there is a brief review of the potential role that image modalities currently being developed could play in particular subgroups of asymptomatic individuals with an elevated disease risk.

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