Resumo Fundamento Os limiares de corte para a “relação do ciclo completo de repouso” (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na “zona cinzenta” da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia. Objetivos Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínico-fisiológico: a “RFR Ajustada”, e comparar sua concordância com o FFR. Métodos Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na “zona cinzenta” da RFR (0,86 a 0,92) para construir um índice (“RFR Ajustada”) que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR. Resultados Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a “RFR Ajustada” melhorou a capacidade diagnóstica em comparação com a RFR na “zona cinzenta” (AUC-RFR = 0,651 versus AUC-“RFR Ajustada” = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37). Conclusões Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a “RFR Ajustada” melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos.

Abstract Background Cutoff thresholds for the “resting full-cycle ratio” (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR “grey zone”, requiring the performance of FFR to rule out or confirm ischemia. Objectives To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the “Adjusted RFR”, and compare its agreement with the FFR. Methods Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR “grey zone” (0.86 to 0.92) to construct an index (“Adjusted RFR”) that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR. Results A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the “Adjusted RFR” improved the diagnostic capacity compared to the RFR in the “grey zone” (AUC-RFR = 0.651 versus AUC-“Adjusted RFR” = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37). Conclusions Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the “Adjusted RFR” improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices.

Introduction Acute coronary syndrome registries made by the Argentine Society of Cardiology provide current and comparative information on their evolution, whose analysis allows to know mortality rate and different regional treatment patterns, and to evaluate the relationship between outcomes and demographic variables, clinical characteristics and therapy applied in “real life”. Objectives To analyze the clinical, therapeutic and outcome characteristics of ST segment elevation acute myocardial infarction (STEMI) included in a multicenter registry conducted by the Argentine Society of Cardiology in 2011. Methods Patients diagnosed with STEMI included in the multicenter SCAR (Acute Coronary Syndromes in Argentina) registry were analyzed. Data from centers that participated in the 2005 and 2011 registries were compared. Results The study included 476 patients. Twenty-five percent of patients were women, mean age was 61 ± 12.3 years, and 70% received reperfusion therapy: 20% (n = 92) with thrombolytics and 50% (n = 238) with primary angioplasty. In-hospital mortality rate due to STEMI was 8%. Independent predictors of death were age over 70 years (OR 2, 95% CI 1.2-3.3, p = 0.003), not having received reperfusion therapy (OR 1.72, 95% CI 1.1-2.0, p = 0.01) and cardiogenic shock (OR 37, 95% CI 12-117, p < 0.0001). Comparison of the same centers showed that in 2011 the number of cases that did not receive reperfusion therapy was reduced by 30%, with increased use of primary angioplasty [OR 3.7 (95% CI 1.6-4, p < 0.001)]. A reduction of in-hospital mortality [OR 0.40 (95% CI 0.23-0.83, p = 0.01)] was also identified. Conclusions Seventy percent of patients with STEMI included in the SCAR registry received reperfusion therapy, while mortality rate was 8%. Compared with 2005, an increase of primary angioplasty and decreased in-hospital mortality was found, among other findings.

Introducción Los registros de síndromes coronarios agudos realizados por la Sociedad Argentina de Cardiología aportan información actualizada y comparativa sobre su evolución, cuyo análisis permite conocer la tasa de mortalidad, diferentes patrones de tratamiento regionales y evaluar la relación entre los resultados y variables demográficas, características clínicas y terapéutica aplicada en la “vida real”. Objetivos Analizar las características clínicas, terapéuticas y evolutivas del infarto agudo de miocardio con supradesnivel del segmento ST (IAMST) del registro multicéntrico realizado por la Sociedad Argentina de Cardiología durante 2011. Material y métodos Se analizaron pacientes con diagnóstico de IAMST incluidos en el registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Se compararon datos de centros que participaron en los registros de 2005 y de 2011. Resultados Se incluyeron 476 pacientes. Una cuarta parte fueron mujeres, la edad media fue de 61 ± 12,3 años, el 70% recibió tratamiento de reperfusión: 20% (n = 92) con trombolíticos y 50% (n = 238) con angioplastia primaria. La mortalidad hospitalaria de los IAMST fue del 8%. Fueron predictores independientes de muerte la edad mayor de 70 años (OR 2, IC 95% 1,2-3,3; p = 0,003), no haber recibido tratamiento de reperfusión (OR 1,72, IC 95% 1,1-2,0; p = 0,01) y el shock cardiogénico (OR 37, IC 95% 12-117; p < 0,0001). Comparando los mismos centros, en 2011 se redujo en un 30% el número de casos que no recibieron tratamiento de reperfusión, con un incremento del uso de la angioplastia primaria [OR 3,7 (IC 95% 1,6-4; p < 0,001)]. Se detectó también una reducción de la mortalidad hospitalaria [OR 0,40 (IC 95% 0,23-0,83; p = 0,01)]. Conclusiones El 70% de los pacientes con IAMST del SCAR recibió tratamiento de reperfusión, mientras que la mortalidad fue del 8%. Respecto de 2005 se observó, entre otros hallazgos, un incremento de la angioplastia primaria y una disminución de la mortalidad hospitalaria.

Objective: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. Methods: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. Results: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. Conclusions: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.

Objetivo: Describir la frecuencia de utilización de los servicios de urgencias en las áreas sanitarias de Asturias desde 1994 a 2001 y analizar su variabilidad. Métodos: Se estimó la demanda de urgencias hospitalarias y de atención primaria en las 8 áreas sanitarias de Asturias, y se analizó su evolución y las diferencias entre áreas, usando la estandarización indirecta y estadísticos de variabilidad. Resultados: Entre 1994 y 2001 se realizaron casi 6,5 millones de urgencias (un 43,8% en hospitales), con un crecimiento medio anual del 6,2% (un 7,8% en atención primaria y un 5,1% en hospitales) con gran heterogeneidad entre áreas. La variabilidad fue mayor en atención primaria y disminuyó en el período estudiado (coeficientes de variación: 0,38 y 0,27 para 1994 y 2001 en atención primaria, y 0,14 y 0,11 en hospitales, respectivamente). Conclusiones: La utilización de las urgencias creció en el período estudiado y se observa una gran variabilidad entre áreas sanitarias.

Objective: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. Methods: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. Results: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. Conclusions: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.

Objetivo: Describir la frecuencia de utilización de los servicios de urgencias en las áreas sanitarias de Asturias desde 1994 a 2001 y analizar su variabilidad. Métodos: Se estimó la demanda de urgencias hospitalarias y de atención primaria en las 8 áreas sanitarias de Asturias, y se analizó su evolución y las diferencias entre áreas, usando la estandarización indirecta y estadísticos de variabilidad. Resultados: Entre 1994 y 2001 se realizaron casi 6,5 millones de urgencias (un 43,8% en hospitales), con un crecimiento medio anual del 6,2% (un 7,8% en atención primaria y un 5,1% en hospitales) con gran heterogeneidad entre áreas. La variabilidad fue mayor en atención primaria y disminuyó en el período estudiado (coeficientes de variación: 0,38 y 0,27 para 1994 y 2001 en atención primaria, y 0,14 y 0,11 en hospitales, respectivamente). Conclusiones: La utilización de las urgencias creció en el período estudiado y se observa una gran variabilidad entre áreas sanitarias.