title: Risk factors, therapeutic approaches, and in-hospital outcomes in Mexicans with ST-elevation acute myocardial infarction: the RENASICA II multicenter registry.
abstract: BACKGROUND
  Ischemic heart disease is a growing health problem in Latin America. We aimed to analyze risk factors, acute management, and short-term outcome of Mexicans with ST-elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  Modifiable risk factors are associated with the occurrence of STEMI in Mexicans, and potentially preventable acute complications are responsible for most short-term deaths.
  
  
  METHODS
  Among 8600 patients enrolled in Registro Nacional de los Síndromes Coronarios Agudos II (RENASICA II) with a suspected acute coronary syndrome, we analyzed 4555 patients (56%; age 21-100 y) with confirmed STEMI who presented within 24 hours from symptoms' onset.
  
  
  RESULTS
  Smoking (66%), hypertension (50%), and diabetes (43%) were the main risk factors. Most patients (74%) presented with Killip class I (class IV in 4%). Anterior-located STEMI occurred in 56% of cases, and posterior-inferior in 40% of cases. Significant Q waves were present in 43%, right bundle branch block in 7%, left bundle branch block in 5%, first-degree atrioventricular block in 2%, and high-degree atrioventricular block in 2%. A total of 1685 (37%) patients received fibrinolytic therapy (streptokinase, 82%; alteplase, 17%; tenecteplase, 1%), with 31% of patients receiving therapy in <2 hours, 36% in 2-4 hours, 19% in 4-6 hours, and 15% in >6 hours. Thirty percent of patients received either percutaneous coronary intervention or coronary artery bypass grafting during hospitalization. Major adverse cardiovascular events were recurrent ischemia (12%), reinfarction (4%), cardiogenic shock (4%), and stroke (1%). The main predictors of 30-day mortality (10%) in multivariate analysis were age ≥65 years (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.94-3.13), Killip class IV (OR: 10.60, 95% CI: 6.09-18.40), and cardiogenic shock (OR: 18.76, 95% CI: 10.60-33.20).
  
  
  CONCLUSIONS
  Largely modifiable risk factors and preventable short-term complications are responsible for most STEMI cases and outcomes in this Mexican population.
authors.affiliation: Coronary Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico. ujuarez@webmedica.com.mx
authors.forename: Úrsulo
authors.initials: Ú
authors.lastname: Juárez-Herrera
authors.forename: Carlos
authors.initials: C
authors.lastname: Jerjes-Sánchez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006327:Heart Block / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy; D020521:Stroke / Q000401:mortality / Q000628:therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult