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El tratamiento de reperfusión del infarto ha disminuido considerablemente la mortalidad por esa causa. La angioplastia coronaria y la trombolisis son métodos efectivos para lograrlo. De la controversia sobre cuál de los dos es el mejor método, se ha pasado a la búsqueda de la forma más rápida y efectiva para lograr la reperfusión, dado el papel trascendente que tiene el tiempo para el rescate del miocardio. Así, se han implementado estrategias fármaco-invasivas, trombolisis prehospitalaria y sistemas de traslado acordes. Existe universalmente un porcentaje de pacientes que no recibe tratamiento de reperfusión por múltiples razones, una muy importante es la demora. Latinoamérica sigue las mismas tendencias que el resto del mundo, con un mayor uso progresivo de la angioplastia con respecto a la trombolisis, y con una cantidad significativa de pacientes que no acceden al tratamiento. Hay registros que muestran una mortalidad algo más elevada que en Europa y Estados Unidos. Existen múltiples razones para ello, entre otras, la demora en la consulta, la falta de acceso a centros equipados correctamente por desigualdades sociales, etc. Las sociedades científicas tienen un papel ineludible en la difusión de las normas de diagnóstico temprano y tratamiento precoz frente a la comunidad médica, las autoridades sanitarias y la sociedad.

The relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, casecontrol study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy‐two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self‐report, when admitted to the medical center.
The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08–3.19). The odds ratio was 2.42 (95% confidence interval, 1.88–3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87–5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90–3.24) and to 4.12 (95% confidence interval, 2.83–5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was ≥140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96–3.41), and it was 3.42 (95% confidence interval, 2.40–4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was ≤90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91–3.22), and if it was >90 mm Hg, it increased nearly four‐fold (odds ratio=3.72; 95% confidence interval, 2.33–5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present.
In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients.

OBJECTIVES

Objectives. This study sought to determine whether the response to amrinone in patients with severe baseline left ventricular dysfunction can predict improvement in left ventricular ejection fraction after coronary artery bypass graft surgery.

The purpose of this study was to report the 3-year follow-up results of the ERACI trial (Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease).

With the purpose of investigating the pathophysiology of changes in the R wave after exercise and its relationship with left ventricular function, we studied 44 patients with coronary heart disease. They were classified into the following three groups: group A, 11 patients with angina pectoris and no prior myocardial infarction; group B, 18 patients with angina pectoris and prior myocardial infarction; and group C, 15 patients with prior myocardial infarction but no angina. All patients performed two exercise tests; one was a control test, and the other was performed after the sublingual administration of 5 mg of isosorbide dinitrate. In group A, variations in the R-wave voltage in control test and in the test after isosorbide dinitrate were 1.5 ± 0.8 mm and –1.2 ± 0.9 mm (P < 0.05), respectively. In group B, results were 1.2 ± 0.7 mm on the control test and –0.7 ± 0.6 mm after isosorbide dinitrate (P < 0.002), and in group C were –1.6 ± 1.2 mm on the control test and –0.7 ± 0.7 mm after isosorbide dinitrate (not significant). Thus, the two groups of patients with angina showed an increase of the R-wave after exercise in the control test but a decrease after the administration of nitrates, whereas the patients without angina showed a reduced R-wave after exercise both before and after the administration of nitrates (like normal subjects). This study suggests that ischemic ventricular dysfunction with exercise results in an increase in the R-wave, while exercise after nitrates results in a decrease in the R-wave consistent with less or no ventricular dysfunction due to nitrate therapy.

The role of Percutaneous Transluminal Angioplasty (PTA) in the revascularization of carotid arteries is not well established. The aim of this study was to asses the efficacy of PTA in revascularizing patients with carotid arterial stenosis. Thirteen consecutive patients (mean age 68±7.7 years) underwent 13 PTA procedures in the carotid arteries during September 1992 to March 1994. The indication for revascularization was recurrent ischemic attacks with severe (>50%) carotid stenosis in the 13 cases. Time between symptoms onset to PTA was more than one month in all cases. The lesions were located in the internal carotid arteries (first extracraneal segment) in nine patients and in the common carotid arteries in four. This group included one patient treated by severe internal carotid stenosis with complete occlussion in the contralateral internal carotid vessel. PTA was performed using conventional technique. The balloon/artery ratio was 0.8–0.9/1 in all cases (Mean balloon size 5.3±0.5mm).