In Peru, ST elevation myocardial infarction most frequently affects men between 60-70 years. The most frequent initial reperfusion treatment is fibrinolysis, followed by primary angioplasty, and pharmaco-invasive strategy. The main reason for the lack of administration of reperfusion treatment was the delay from symptoms onset to first medical contact. The most common cause of in-hospital death was cardiogenic shock.

Background: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. Conclusions: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

Antecedentes. El infarto de miocardio con elevación del segmento ST (IMCEST), es una de las principales causas de morbimortalidad a nivel global, la reperfusión adecuada del miocardio consigue disminuir las complicaciones de esta entidad. El objetivo del estudio fue describir las características clínicas y terapéuticas del IMCEST en el Perú y la relación de la reperfusión exitosa con los eventos adversos intrahospitalarios. Materiales y métodos. Cohorte prospectiva, multicéntrica de pacientes con IMCEST atendidos durante el año 2020 en hospitales públicos del Perú. Se evaluaron las características clínicas, terapéuticas y eventos adversos intrahospitalarios, además de la relación entre la reperfusión exitosa del infarto y los eventos adversos. Resultados. Se incluyeron 374 pacientes, 69,5% en Lima y Callao. La fibrinólisis fue usada en 37% de casos (farmacoinvasiva 26% y sola 11%), angioplastia primaria con < 12 h de evolución en 20%, angioplastia tardía en 9% y 34% no accedieron a terapias de reperfusión adecuadas, principalmente por presentación tardía. El tiempo de isquemia fue mayor en pacientes con angioplastia primaria en comparación a fibrinólisis (mediana 7,7 h [RIQ 5-10] y 4 h [RIQ 2,3-5,5] respectivamente). La mortalidad fue de 8,5%, la incidencia de insuficiencia cardiaca posinfarto fue de 27,8% y de choque cardiogénico de 11,5%. El éxito de la reperfusión se asoció con menor mortalidad cardiovascular (RR: 0,28; IC95%: 0,12-0,66, p=0,003) y menor incidencia de insuficiencia cardiaca (RR: 0,61; IC95%: 0,43-0,85, p=0,004). Conclusiones. La fibrinólisis sigue siendo la terapia de reperfusión más frecuente en hospitales públicos del Perú. El menor tiempo de isquemia a reperfusión se asoció con el éxito de esta y, a su vez, a menores eventos adversos intrahospitalarios.

To determine the association between altitude and the Framingham risk score in the Peruvian population, we performed a cross-sectional analytical study of data collected by the 2017–2018 Food and Nutrition Surveillance by Life Stages survey. The outcome of this study was the Framingham 10-year cardiovascular disease event risk prediction, which is composed of six modifiable and non-modifiable coronary risk factors. A generalized linear model (GLM) of the gamma family and log link function was used to report the crude and adjusted β coefficients. Several sensitivity analyses were performed to assess the association of interest. Data from a total of 833 surveyed participants were included. After adjusting for educational level, poverty level, alcohol consumption, physical activity level, the presence of any limitation, obesity, and area of residence, it was observed that altitude ≥ 2500 m above sea level (β = −0.42 [95% CI: −0.69 to −0.16]) was negatively and significantly associated with a decrease in the Framingham 10-year risk score. High altitude was significantly and negatively associated with Framingham 10-year risk scores. Our results will allow prevention strategies considering modifiable risk factors to avoid the development of cardiovascular diseases, especially in people living at low altitudes.

Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Background Myocardial infarction (MI) is the most prevalent cardiovascular disease globally and is considered a public health problem. In Peru, MI is the second leading cause of death at the national level, with a mortality rate that exceeds 10% in the hospital setting. The study aims to determine the clinical and epidemiological characteristics of ST-segment elevation myocardial infarction (STEMI) in tertiary care facilities belonging to the Peruvian public health system. Methods and analysis This will be a prospective, observational, multicenter study, with baseline and two follow-up assessments: at admission to the health service, and 30 days and 12 months after admission. This multicenter study will be conducted in 27 hospitals located in the main cities of Peru. The patients included in the study will be over 18 years of age, of either sex, and will have been admitted to the health facility with a diagnosis of acute coronary syndrome with ST-segment elevation. The Kaplan-Meier method will be used to estimate the cumulative in-hospital mortality of patients at 30 days and 12 months of follow-up, and the log-rank test will be used to evaluate the differences between the survival curves between reperfused and non-reperfused patients. Subsequently, to evaluate the risk factors for successful reperfusion and cardiovascular adverse events, generalized linear models of the binomial family with log link function will be used to estimate the bivariate and multivariate relative risk (RR) with their respective 95% confidence intervals. This project was approved by the Ethics and Research Committee of the National Cardiovascular Institute (Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo”—INCOR [in Spanish]; Approval report 21/2019-CEI). Discussion Among the strengths, the observational design will allow the inclusion of a large sample of patients, which will significantly contribute to the knowledge base on STEMI in Peru. It should be noted that this study is the first to examine the clinical-epidemiological characteristics of STEMI in high-resolution hospital centers in Peru with follow-up one year after the event, providing knowledge of these observable characteristics in daily clinical routine. Likewise, the multicenter nature of the study will increase the external validity of the findings. In terms of limitations, the observational design of the study can only describe associations and not causality. Furthermore, since data from medical records will be used, there could be imprecision in the data.

Background. Concurrent evidence about cardiogenic shock (CS) characteristics, treatment and outcome does not represent a global spectrum of patients and is therefore limited. The aim of this study was to investigate these regional differences. Methods. To investigate regional differences in presentation characteristics, treatments and outcomes of patients treated with all types of cardiogenic shock (CS) in a single calendar year on a multi-national level. Consecutive patients from 19 tertiary care hospitals in 13 countries with CS who were treated between January 1, 2018 and December 31, 2018 were enrolled in this study. Results. In total, 699 cardiogenic shock patients were included in this study. Of these patients, 440 patients (63%) were treated in European hospitals and 259 (37%) were treated in Non-European hospitals. Female patients (P<0.01) and patients with a previous myocardial infarction (P=0.02) were more likely to present at Non-European hospitals; whereas older patients (P=0.01) and patients with cardiogenic shock due to acute heart failure (P<0.01) were more likely to present at European hospitals. Vasopressor use was more likely in Non-European hospitals (P=0.04), whereas use of mechanical circulatory support (MCS) was more likely in European hospitals (P<0.01). Despite adjustment for relevant confounders, 30-day in-hospital mortality risk was comparably high in CS patients treated in European vs. Non-European hospitals (hazard ratio 1.08, 95% CI 0.84-1.39, P=0.56). Conclusion.Despite marked heterogeneity in characteristics and treatment of CS patients, including fewer use of MCS but more frequent use of vasopressors in Non-European hospitals, 30-day in-hospital mortality did not differ between regions.

Objetivo. Conocer las características clínicas y determinar los factores relacionados a mayor mortalidad en pacientes con choque cardiogénico (CC) por infarto de miocardio en un hospital de referencia peruano. Materiales y métodos. Cohorte única prospectiva donde se evaluó la presentación, tratamiento y complicaciones de pacientes con CC por infarto de miocardio atendidos entre marzo 2019 a agosto 2020 en el Instituto Nacional Cardiovascular - INCOR. Se evaluaron los factores relacionados con mayor mortalidad hospitalaria y en el seguimiento, además del uso del score IABP shock II en la población de estudio. Resultados. Cuarenta pacientes fueron incluidos, el 75% con CC por disfunción ventricular izquierda, la mayoría varones con edad de 75 (69-82) años. Un 50% de casos presentaron CC luego del ingreso a emergencia. Los pacientes estratificados mediante el score IABP shock II como bajo, intermedio y alto riesgo, tuvieron una mortalidad intrahospitalaria de 37,5; 71;4 y 91,6% respectivamente. La mortalidad intrahospitalaria fue 70%, mayor en mujeres, mayores de 75 años y en los que desarrollaron el CC durante la hospitalización. En el análisis univariado, el lactato sérico > 4 mmol/L al ingreso se relacionó con mayor mortalidad (HR:2,8; IC:1,6-3,6, p=0,009). La sobrevida hasta el término del estudio fue de 12,8%. Conclusiones. EL CC por infarto de miocardio representa una entidad clínica de elevada mortalidad a pesar de la revascularización y el tratamiento disponible en nuestra realidad. El mayor predictor de mortalidad fue el valor de lactato sérico mayor a 4 mmol/L al ingreso. El score IABP shock II demostró ser un buen parámetro para estratificar el riesgo de muerte en nuestra población.