Risk factors for three-vessel coronary artery disease in patients of Northwest Mexico

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Peña-Duque, Daniel Coutiño-Castelán, Eduardo Arias-Sánchez, Arturo Abundes-Velasco, Oscar Castro-Alvarado, Franklyn A. Colon-Arias, Carlos Alvarenga-Fajardo, César Hernández-Fonseca, Erika Rodríguez-Barriga, Adolfo Hernández-Padilla" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Piero" "apellidos" => "Custodio-Sánchez" ] 1 => array:2 [ "nombre" => "Félix" "apellidos" => "Damas-De Los Santos" ] 2 => array:2 [ "nombre" => "Marco A." "apellidos" => "Peña-Duque" ] 3 => array:2 [ "nombre" => "Daniel" "apellidos" => "Coutiño-Castelán" ] 4 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Arias-Sánchez" ] 5 => array:2 [ "nombre" => "Arturo" "apellidos" => "Abundes-Velasco" ] 6 => array:2 [ "nombre" => "Oscar" "apellidos" => "Castro-Alvarado" ] 7 => array:2 [ "nombre" => "Franklyn A." "apellidos" => "Colon-Arias" ] 8 => array:2 [ "nombre" => "Carlos" "apellidos" => "Alvarenga-Fajardo" ] 9 => array:2 [ "nombre" => "César" "apellidos" => "Hernández-Fonseca" ] 10 => array:2 [ "nombre" => "Erika" "apellidos" => "Rodríguez-Barriga" ] 11 => array:2 [ "nombre" => "Adolfo" "apellidos" => "Hernández-Padilla" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1405994018300326?idApp=UINPBA00004N" "url" => "/14059940/0000008800000005/v1_201812250612/S1405994018300326/v1_201812250612/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1405994018300028" "issn" => "14059940" "doi" => "10.1016/j.acmx.2018.01.001" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "414" "copyright" => "Instituto Nacional de Cardiología Ignacio Chávez" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Arch Cardiol Mex. 2018;88:413-22" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1710 "formatos" => array:3 [ "EPUB" => 66 "HTML" => 1150 "PDF" => 494 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical Research" "titulo" => "Multicomponent exercise decreases blood pressure, heart rate and double product in normotensive and hypertensive older patients with high blood pressure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "413" "paginaFinal" => "422" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El ejercicio multicomponente disminuye los parámetros hemodinámicos en pacientes ancianos normotensos e hipertensos no controlados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3336 "Ancho" => 2018 "Tamanyo" => 483543 ] ] "descripcion" => array:1 [ "en" => "Some examples of the physical exercises performed during the MCEP. (a), (c), (d) and (f) show the functional exercises to lower limbs that mimic the activities of daily living. In turn, (b), (e) and (g) are the same exercises; however, with examples of approaches used to increase the load. Classical resistance exercises used in the MCEP for upper limbs are demonstrated in the (h), (i) and (j). Moreover, (k) and (l) show the balance exercises performed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hélio José Coelho-Júnior, Ricardo Yukio Asano, Ivan de Oliveira Gonçalvez, Cayque Brietzke, Flávio Oliveira Pires, Samuel da Silva Aguiar, Daniele Jardim Feriani, Erico Chagas Caperuto, Marco Carlos Uchida, Bruno Rodrigues" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Hélio José" "apellidos" => "Coelho-Júnior" ] 1 => array:2 [ "nombre" => "Ricardo Yukio" "apellidos" => "Asano" ] 2 => array:2 [ "nombre" => "Ivan de Oliveira" "apellidos" => "Gonçalvez" ] 3 => array:2 [ "nombre" => "Cayque" "apellidos" => "Brietzke" ] 4 => array:2 [ "nombre" => "Flávio Oliveira" "apellidos" => "Pires" ] 5 => array:2 [ "nombre" => "Samuel da Silva" "apellidos" => "Aguiar" ] 6 => array:2 [ "nombre" => "Daniele Jardim" "apellidos" => "Feriani" ] 7 => array:2 [ "nombre" => "Erico Chagas" "apellidos" => "Caperuto" ] 8 => array:2 [ "nombre" => "Marco Carlos" "apellidos" => "Uchida" ] 9 => array:2 [ "nombre" => "Bruno" "apellidos" => "Rodrigues" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1405994018300028?idApp=UINPBA00004N" "url" => "/14059940/0000008800000005/v1_201812250612/S1405994018300028/v1_201812250612/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Clinic Research" "titulo" => "Risk factors for three-vessel coronary artery disease in patients of Northwest Mexico" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "431" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cuitlahuac Arroyo-Rodríguez, Olga Rosa Brito-Zurita, Santiago Sandoval-Navarrete, Rogelio Solis-Vásquez, José Manuel Ornelas-Aguirre, Celestino Olea-Hernández, César Vásquez-Serna, Amanda Marcela Castelan-Ojeda" "autores" => array:8 [ 0 => array:3 [ "nombre" => "Cuitlahuac" "apellidos" => "Arroyo-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Olga Rosa" "apellidos" => "Brito-Zurita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Santiago" "apellidos" => "Sandoval-Navarrete" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Rogelio" "apellidos" => "Solis-Vásquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "José Manuel" "apellidos" => "Ornelas-Aguirre" "email" => array:1 [ 0 => "jose.ornelasa@imss.gob.mx" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 5 => array:3 [ "nombre" => "Celestino" "apellidos" => "Olea-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "César" "apellidos" => "Vásquez-Serna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Amanda Marcela" "apellidos" => "Castelan-Ojeda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Cardiology Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medical Center of the South of Sonora at Ciudad Obregón, Sonora, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hemodinamic Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Research and Education Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Health Sciences Department, University of Sonora at Ciudad Obregón, Sonora, Mexico" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author. at: 2106 Paseo del Jardín, El Paraiso, Ciudad Obregón, Sonora, Mexico, Tel.: +52 64 4462 0471." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores de riesgo para la enfermedad arterial coronaria de tres vasos en pacientes del noroeste de México" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2341 "Ancho" => 2891 "Tamanyo" => 367719 ] ] "descripcion" => array:1 [ "en" => "Ankle-Brachial Index values according to gender. Ankle-Brachial Index was normal if it was between 1.00 and 1.39. Ankle-Brachial Index was abnormal if it was <1 or ≥1.4. Peripheral arterial disease was diagnosed if Ankle-Brachial Index was ≤0.9. Borderline arterial disease was diagnosed if Ankle-Brachial Index was between 0.91 and 0.99." ] ] ] "textoCompleto" => "IntroductionCardiovascular disease is the main cause of death in the world.<a class="elsevierStyleCrossRef" href="#bib0260">1</a> Mechanism beyond coronary artery disease is atherosclerosis<a class="elsevierStyleCrossRef" href="#bib0265">2</a> and risk factors to develop it were described for the first time by Framingham and are: arterial systemic hypertension (ASH), diabetes mellitus (DM), hypercholesterolemia and smoking.<a class="elsevierStyleCrossRef" href="#bib0270">3</a>Smoking, sedentarism, atherogenic diet, arterial systemic hypertension, diabetes mellitus, obesity, dyslipidemia and metabolic syndrome are considered modifiable risk factors. Instead; masculine gender, chronic kidney disease, postmenopausal state, advanced age and coronary disease family background are non-modifiable factors.<a class="elsevierStyleCrossRefs" href="#bib0275">4–6</a> Also, considered as emergent coronary risk factors are: high sensibility to C reactive protein (HS-CRP), hyperhomocysteinemia, glycemic fast concentrations, leukocyte counting as well as coronary calcium score measured by computed tomography, Ankle-Brachial Index (ABI), periodontal disease, lipoprotein levels and carotid artery intima media thickness.<a class="elsevierStyleCrossRef" href="#bib0290">7</a> However current evidence does not sustain a routinely measurement for vascular risk stratification.<a class="elsevierStyleCrossRef" href="#bib0295">8</a>On the other side, three-vessel coronary artery disease (TVCAD) is an atherosclerosis advanced manifestation and it is defined as a stenosis ≥70% in each major epicardial coronary artery.<a class="elsevierStyleCrossRef" href="#bib0300">9</a> Most of these patients should require a revascularization strategy (surgical or percutaneous) to ameliorate their symptoms and life hope.<a class="elsevierStyleCrossRef" href="#bib0305">10</a> Syntax score is an angiographic tool grading coronary lesions complexity and which allows obtaining evidence based on clinical practice guides and select the best revascularization techniques.<a class="elsevierStyleCrossRefs" href="#bib0310">11,12</a> This score is also used to analyze coronary anatomy, when an elevated value, a complex coronary anatomy associated to atherosclerotic damage is revealed.<a class="elsevierStyleCrossRefs" href="#bib0310">11,13</a> Studies in Mexican population reported high frequency of coronary risk factors (CRF) as obesity, diabetes mellitus, dyslipidemia, smoking, saturated fat intake.<a class="elsevierStyleCrossRefs" href="#bib0325">14,15</a> Nevertheless, there is no literature report about coronary risk factors in patients with three-vessel coronary artery disease. The objective of this study was to describe demographic, clinic, anthropometric, angiographic and biochemical characteristics in a group of patients with three-vessel coronary artery disease in Northwest México.MethodsAn observational and descriptive study was performed from May 2015 to February 2016 in a third level hospital at Instituto Mexicano del Seguro Social (IMSS) in ciudad Obregon, Sonora México. This is the regional referral hospital for four states in the northwest of Mexico (Sonora, Sinaloa, Baja California and Baja California Sur).Mestizo population, older than 18 years were studied, all of them with three-vessel coronary disease diagnostic<a class="elsevierStyleCrossRef" href="#bib0335">16</a> (stenosis ≥70% in each epicardial major coronary arteries). A convenience sampling of a hundred consecutive patients was obtained from May 2015 to February 2016. An analysis with the Kolmogorov–Smirnov test was performed to know the normality of the population prior to the analysis of results. Local Research Ethics Committee approved the protocol. Written informed consent for each patient was asked during hospital stay when three-vessel coronary disease was assessed by coronariographic study. Anthropometric measurements as weight, length/height for age, body mass and fat index (BMI) were obtained with light clothes, no shoes and using a Tanita TBF-215 body composition analyzer. Abdominal circumference ratio was assessed with the World Health Organization's recommendations<a class="elsevierStyleCrossRef" href="#bib0340">17</a> and BMI calculated with Quetelet formula.<a class="elsevierStyleCrossRef" href="#bib0345">18</a> Ankle-Brachial Index (ABI) was evaluated with a Sonotrax Edan 8Hz catheter and to interpret it, method measurements and abnormal definitions from the American Heart Association's scientific consensus were taken.<a class="elsevierStyleCrossRef" href="#bib0350">19</a>After a 12h fast, blood samples were taken to qualify lipid, glucose, blood urea nitrogen (BUN), urea, creatinine, uric acid. All laboratory tests were performed with a AU680 Analyzer-Beckman Coultier, Inc equipment with clinical chemistry standardization methods. Glycosylated hemoglobin A1c fraction (HbA1c) was performed with a DCA Vantage Analyzer, SIEMENS (NGSP approved).Syntax score was done by an interventional cardiologist who remained blind to patient's risk factors and got help from Syntax calculator version 2.11.<a class="elsevierStyleCrossRef" href="#bib0320">13</a> Left ventricular ejection fraction (LVEF) as well as other clinical parameters were obtained from the clinical records, American Society for Echocardiography recommendations for LVEF were considered.<a class="elsevierStyleCrossRef" href="#bib0355">20</a>Left main coronary artery disease was defined with ≥50% luminal stenosis by visual estimation during coronariography; systemic arterial hypertension with blood pressure ≥140/90mmHg or if users of antihypertensive treatment. Criteria for diabetes mellitus or metabolic syndrome were the ones recommended by American Diabetes Association (ADA) and International Diabetes Federation (IDF).<a class="elsevierStyleCrossRefs" href="#bib0360">21,22</a> Familiar background for cardiovascular disease was considered when one or more first grade family members have undergone acute myocardial infarction, cerebrovascular accident or cardiovascular death; in women, younger than 65 or in men younger than 55 years old.<a class="elsevierStyleCrossRef" href="#bib0290">7</a> Sedentary lifestyle was set when patient had physical activity less than 30min, 5 days a week,<a class="elsevierStyleCrossRef" href="#bib0370">23</a> smoking with intake > 100 cigarettes in patient's whole life, active smoking with an intake of at least a part of a cigarette in the last 30 days,<a class="elsevierStyleCrossRef" href="#bib0375">24</a> to estimate packages/year: multiply smoking years by smoked packages of cigarettes daily. Hyperuricemia was diagnosed when uric acid was ≥7mg/dL and chronic renal disease when glomerular filtration rate (GFR) was <60mL/min.<a class="elsevierStyleCrossRef" href="#bib0380">25</a>Dyslipidaemia was assessed with cholesterol values ≥200mg/dL, high-density lipoproteins (HDL-C) ≥40mg/dL, low-density lipoproteins (LDL-C) ≥100mg/dL or triglycerides level ≥150mg/dL. Stable or unstable angina, silent ischemia, acute myocardial infarction with or without ST-segment elevation (AMI with STSE or AMI without STSE) were classified according to the European Society of Cardiology and American Heart Association practice guidelines.<a class="elsevierStyleCrossRefs" href="#bib0385">26–28</a>SPSS program version 20 for Windows® was used for statistical analysis. Numerical variables were expressed as frequencies and percentages. Kolmogorov–Smirnov test was used to analyze the distribution of the data. To show differences among numerical variables with normal distribution and independent samples, a Student t test was used. Qualitative values were assessed with a Pearson–Fisher chi square test. A p≤0.05 was considered as a statistically significant difference.ResultsFrom the 25 women and 75 men studied, women had a higher average age than men when diagnosed (69±9.0 years old, p=0.002). A higher prevalence of metabolic syndrome was associated with feminine gender (88%), instead in males was 65% (p=0.03). On the opposite, 76% of men had smoking habit while there were just 44% of smoking women (p=0.003). In addition, previous cocaine use was present in 11% of men (p=0.09).Related to chronic diseases, diabetes mellitus was found in 80% of women compared to 51% of men (p=0.01). No meaningful differences in arterial hypertension (p=0.74), cardiovascular disease (p=0.64) neither chronic renal disease (p=0.62) were found (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A noticeable difference in body fat was evident, being higher in women compared to men (40.3% versus 29.5%, p<0.001). Glycemic control was achieved in less than a 30% of both genders, with no differences between them (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The most common clinical presentation of cardiovascular disease was stable angina (45%), and masculine group the most affected (51%). Whereas women group showed a higher frequency of unstable angina (48%), 3 cases in the masculine group got silent ischemia and a 28% acute infarction prevalence where most of the cases were AMI with STSE. Optimal medical therapy was established in 26% of males and 43% of females presenting as stable angina (p=0.78) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).Ankle-Brachial Index was abnormal in 58% of the patients (ABI <1 or ≥1.4); 28% men and 44% women were diagnosed with peripheral arterial disease (ABI ≤0.9; p=0.14) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Within the patients having peripheral artery disease 65% of males and 67% of females were diabetic (p=0.94). About Syntax score, no significative differences associated to gender were observed (p=0.56). No meaningful differences in left main coronary artery disease, as well as low, intermediate or high Syntax score (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Finally, 51% of patients got a left ventricular ejection fraction (LVEF) abnormally low. Thirty three percent of men and forty percent of women, got a left ventricular ejection fraction (LVEF), slightly abnormal. On the other hand, 6.7% of men and 12% of women showed a left ventricular ejection fraction, moderately abnormal (31–40%). And 9.3% of men and 4% of women resulted with a left ventricular ejection fraction, severely abnormal – equal to or less than 30% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionThree-vessel coronary artery disease is an advanced manifestation of atherosclerosis,<a class="elsevierStyleCrossRef" href="#bib0400">29</a> thus, most patients with this disease require a surgical or percutaneous strategy to improve their symptoms and prognostic. As it was also important to describe cardiovascular risk factors (CRF), in the present study; demographic, anthropometric, biochemical, angiographic and Ankle-Brachial Index are considered in a sample with three-vessel coronary artery disease in Northwest México.Important to mention that diet and lifestyle changes in this people also affect .<a class="elsevierStyleCrossRef" href="#bib0405">30</a> However, our study did not evaluate diet habits as a coronary risk factor which could be a limitation to suggest a relation with TVCAD. A high consumption of a diet rich in simple carbohydrates is very common and, fruit and vegetables are rarely eaten.<a class="elsevierStyleCrossRef" href="#bib0410">31</a> Nevertheless, this does not fully explain the differences that some authors have suggested in relation to feeding as an independent cardiovascular risk factor, but it does take into account the presence of genetic factors identified in the Mexican population that could confer a greater risk as has been suggested.<a class="elsevierStyleCrossRefs" href="#bib0415">32,33</a>Traditional diet in this Mexican area includes saturated lipids in grilled meat, fresh cheese and tamales.<a class="elsevierStyleCrossRef" href="#bib0405">30</a> Consequently, there is a high prevalence of diabetes mellitus, dyslipidemia, saturated lipids intake and smoking.<a class="elsevierStyleCrossRefs" href="#bib0325">14,15</a> The effects of cocaine are well-known, such as increased inotropic and chronotropic, vasoconstriction, pro thrombotic state, endothelial dysfunction and accelerated atherosclerosis.<a class="elsevierStyleCrossRefs" href="#bib0425">34,35</a> A finding of our study was that an 8% of the patients with TVCAD had been occasionally cocaine users. However, we did not find that this could have an association with the current clinical picture due to the age of presentation that is higher in these patients than described in people affected by cocaine use.High prevalence of diabetes mellitus and metabolic syndrome is remarkable in the studied sample. Other researches in patients with three-vessel coronary artery disease like Syntax score, report a prevalence of just 25% for diabetes mellitus and 45% for metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bib0310">11</a> “CREDO Kyoto PCI/CABG registry cohort-2”, a Japanese study, reports diabetic with three-vessel coronary artery disease in only 50% of their population.<a class="elsevierStyleCrossRef" href="#bib0435">36</a>Besides, another possible explanation for the differences found, could be the cut-off point to define a significative coronary stenosis. In Syntax study and “CREDO Kyoto PCI/CABG registry cohort-2” approaches, a 50% cutting point was the reference for a significative stenosis, whereas in our approach a 70% cutting point was used. This 70% was considered due to the discrepancies between the 50% cut-off point and the coronary blood flow (CBF) reserve ≤0.8 (considering the gold standard to diagnose a coronary stenosis ischemic potential). To use a 70% cut-off point improves angiographic specificity to detect ischemic potential in a coronary stenosis, even when it decreases its sensibility.<a class="elsevierStyleCrossRef" href="#bib0440">37</a> A limitation of our study was the fact of taking only the evaluation of a single interventional cardiologist but who nevertheless had extensive experience and professional certification to do so.Sociocultural and ethnical differences might also be involved in a higher risk profile in our sample, which could determine do not follow indicated treatment neither special diet as reduce salt consumption or improve physical activity, have a hypertensive control, etc.<a class="elsevierStyleCrossRef" href="#bib0445">38</a> For instance, glycemic control was good enough just in 29% of the diabetic people. Considering diabetic and pre-diabetic subjects together, 81.36% of men and 88% of women had an abnormal glucose metabolism; alarming data due to the high morbidity and mortality in this group of patients.<a class="elsevierStyleCrossRef" href="#bib0450">39</a>Dyslipidemia was the most common risk factor, despite the use of hypolipemiant drugs 100% of the sample registered any other lipid parameter away from target. Probably due to a lack of adjusting to therapeutic instructions or even more, to hereditary lipid disease with specific genomic mutations not measured in the present study.<a class="elsevierStyleCrossRef" href="#bib0455">40</a> Therefore, sedentary lifestyle, atherogenic diet and tobacco consumption are essential factors that influence dyslipidemia in Northwest Mexican population.<a class="elsevierStyleCrossRef" href="#bib0460">41</a>Ankle braquial index (ABI) ≤0.9 is associated with a higher mortality frequency as well as cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0465">42</a> ABI ≥1.4 is related with acute myocardial infarction but not with an increase in mortality,<a class="elsevierStyleCrossRef" href="#bib0470">43</a> and ABI limit value (0.91–0.99) is associated with endothelial dysfunction.<a class="elsevierStyleCrossRef" href="#bib0475">44</a> Based on these and in accordance with the American Heart Association's scientific consensus to measure and interpret ABI, all values out of range from 1.00 to 1.39, are considered as abnormal,<a class="elsevierStyleCrossRef" href="#bib0350">19</a> so it was found that 58% of studied sample had an abnormal ABI, higher in the right side and lower in theft side in men and abnormally low in both sides in women. Differences which might be due to a higher risk profile in women than men (women were older, with a higher diabetes load, metabolic syndrome and several types of dyslipidemia). Higher ABI mainly in the right side, has been associated with blood pressure measurement in 4 limbs (it usually starts in the right side, when patient could get an anxiety transitory rise in blood pressure, mitigated effect during blood pressure measurement in the rest of the limbs).<a class="elsevierStyleCrossRef" href="#bib0350">19</a>Other possible explanations for this fact might be: muscular mass (most of the people is right-handed), embryologic development and anatomic preference atherosclerotic plaques formation in specific sites.<a class="elsevierStyleCrossRefs" href="#bib0480">45–47</a>Because of difficult coronary lesions in the studied sample, Syntax score was high in most patients (37±11.6). Compared with FREEDOM study, where Syntax score was 26.2±8.4 (a diabetic sample with 82.8% of patients with TVCAD)<a class="elsevierStyleCrossRef" href="#bib0495">48</a>; in Syntax study, the average was 28.8±11.5. Differences which could probably be explained for an adverse risk profile in our studied cases, but mainly, by using a ≥70% cut-off point (instead of a >50%) to define a meaningful coronary stenosis. It has been recently demonstrated that considering ≥70% cut-off point to indicate revascularization, decreases adverse events rate in a year and the number of stents used, also providing a much better functionality in revascularization strategy.<a class="elsevierStyleCrossRef" href="#bib0500">49</a>Finally, a high prevalence of coronary risk factors and complex coronary anatomy (High Syntax scores) might lead to a worse prognosis than the reported from other researchers.<a class="elsevierStyleCrossRefs" href="#bib0305">10,39</a> SYNTAX II is score which combines coronary anatomy and clinical variables (age, renal function, left ventricular ejection fraction, gender, chronic obstructive pulmonary disease and peripheral artery disease), this recently developed score substantially increased the accuracy of identifying low (and high) risk patients compared to the anatomical SYNTAX score alone.<a class="elsevierStyleCrossRefs" href="#bib0505">50,51</a>ConclusionsOur study found a significant prevalence of diabetes mellitus, smoking and metabolic syndrome associated for three-vessel coronary artery disease at our studied sample. These might lead to complex coronary lesions and probably a worse prognostic.Most patients showed an abnormal Ankle-Brachial Index sighting toward a generalized atherosclerosis.FundingWe certify that no funding has been received for the conduct of this study and/or preparation of this manuscript.Authors’ contributionThis author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.Arroyo-Rodríguez A. Cuitláhuac: Acquisition, analysis, interpretation of data for the work, drafting the work and revising it critically for important intellectual content and approval of the version to be published.Brito-Zurita Olga Rosa: Analysis, interpretation of data for the work, drafting the work and revising it critically for important intellectual content.Sandoval-Navarrete Santiago: Drafting the work and revising it critically for important intellectual content and approval of the version to be published.Solís-Vásquez Rogelio: Drafting the work and revising it critically for important intellectual content and approval of the version to be published.Ornelas-Aguirre José Manuel: Analysis, interpretation of data for the work, drafting the work and revising it critically for important intellectual content and approval of the version to be published.Olea-Hernández Celestino: Drafting the work and revising it critically for important intellectual content and approval of the version to be published.Vásquez-Serna César: Drafting the work and revising it critically for important intellectual content and approval of the version to be published.Castelan-Ojeda Amanda Marcela: Drafting the work and revising it critically for important intellectual content and approval of the version to be published.Conflict of interestWe certify that all financial and material support for the conduct of this study and/or preparation of this manuscript was done by research group only." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1131042" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1063859" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1131043" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1063858" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors’ contribution" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack385046" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-26" "fechaAceptado" => "2018-02-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1063859" "palabras" => array:6 [ 0 => "Coronary artery disease" 1 => "Atherosclerosis" 2 => "Risk factors" 3 => "Syntax score" 4 => "Ankle-Brachial Index" 5 => "Mexico" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1063858" "palabras" => array:6 [ 0 => "Enfermedad arterial coronaria" 1 => "Aterosclerosis" 2 => "Factores de riesgo" 3 => "Puntaje Syntax" 4 => "Índice tobillo-brazo" 5 => "México" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThree-vessel coronary artery disease is an advanced manifestation of atherosclerosis, with high prevalence in Mexico. ObjectiveThe aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico. MethodsA cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016. The disease was defined when ≥70% stenosis was present in each major epicardial coronary artery. Anthropometric and biochemical parameters were measured in each patient. Ankle-Brachial Index was measured with vascular ultrasound, and Syntax score calculation with an on-line application. Statistical analysis for qualitative differences was performed using Pearson X2 test, with p<0.05 being considered as significant. ResultsThe study included 100 patients, of whom 75 were male (mean age 63±9 years) and 25 female (mean age 69±9 years). The coronary risk factors observed were diabetes (58%), hypertension (86%), smoking (68%), dyslipidaemia (100%), metabolic syndrome (71%), and obesity/overweight (75%). Diabetes and metabolic syndrome prevalence was higher in women (p=0.03), but smoking was higher in men (76%, p=0.003). Ankle-Brachial Index was abnormal in 58% of patients, the mean Syntax score was in 36.9±11.5, and the prevalence of left main coronary heart disease was 36%. ConclusionsThis group of patients with complex coronary lesions has a high prevalence of coronary risk factors, which could represent a worse prognosis." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa enfermedad coronaria de tres vasos (ECTV) es una manifestación avanzada de aterosclerosis, con alta prevalencia en el noroeste de México. ObjetivoDescribir los factores de riesgo coronario (FRC) en un grupo de enfermos con ECTV en el noroeste de México. MétodosDe mayo de 2015 a febrero de 2016 se realizó un estudio transversal en una población del noroeste de México diagnosticada con ECTV. Se definió ECTV cuando existía estenosis ≥70% en cada una de las arterias coronarias epicárdicas mayores. Se midieron parámetros antropométricos y bioquímicos en cada paciente. Los parámetros para el índice tobillo-brazo (ITB) se obtuvieron con ultrasonido vascular (Edan SonoTrax 8Hz) y un cálculo de puntaje Syntax con una aplicación en línea. Análisis estadístico con χ2 de Pearson para diferencias cualitativas Se consideró significativo cuando p≤0.05. ResultadosSe estudiaron 25 mujeres (edad 69±9 años) y 75 varones (edad 63±9 años). Los FRC observados fueron diabetes (58%), hipertensión (86%), antecedente de tabaquismo (68%), dislipidemia (100%), síndrome metabólico (71%) y sobrepeso/obesidad (75%). En las mujeres la prevalencia de diabetes y síndrome metabólico fue mayor que en los varones (p=0.03), pero el tabaquismo fue más prevalente en los varones (76%, p=0.003). El ITB se encontró anormal en el 58% de los pacientes, el puntaje Syntax promedio fue de 36.9±11.5 y la prevalencia de la enfermedad del tronco de la arteria coronaria izquierda fue del 36%. ConclusiónEn este grupo de estudio con lesiones coronarias complejas existe alta prevalencia de FRC que se refleja en y posiblemente un peor pronóstico." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2341 "Ancho" => 2891 "Tamanyo" => 367719 ] ] "descripcion" => array:1 [ "en" => "Ankle-Brachial Index values according to gender. Ankle-Brachial Index was normal if it was between 1.00 and 1.39. Ankle-Brachial Index was abnormal if it was <1 or ≥1.4. Peripheral arterial disease was diagnosed if Ankle-Brachial Index was ≤0.9. Borderline arterial disease was diagnosed if Ankle-Brachial Index was between 0.91 and 0.99." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1156 "Ancho" => 1523 "Tamanyo" => 76581 ] ] "descripcion" => array:1 [ "en" => "Left ventricular ejection fraction according to gender. Normal: LVEF 52–72 for males and 54–74 for females. Slightly abnormal: LFEF 41–51 for males and 41–53 for females. Moderately abnormal: LVEF 30–40 for both genders. Severely abnormal: LVEF <30. LVEF: left ventricular ejection fraction %." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men n (%) n=75 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women n (%) n=25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0040">*</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63±9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69±9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0045">§</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidaemia<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperuricemia<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedentary lifestyle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metabolic syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prediabetes<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Toxicomany</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cocaine<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Diseases</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular disease<a class="elsevierStyleCrossRef" href="#tblfn0025">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic renal disease<a class="elsevierStyleCrossRef" href="#tblfn0030">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral artery disease<a class="elsevierStyleCrossRef" href="#tblfn0035">g</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">With diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Without diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1929777.png" ] ] ] "notaPie" => array:9 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Defined as total cholesterol ≥200mg/dL, HDL-C ≤40mg/dL, triglyceride ≥150 or LDL-C ≥100mg/dL." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Acid levels ≥7mg/dL. Obtained in 68 from 75 men and 23 from 25 women." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "A1C 5.7–6.4." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "Defined as previous use of cocaine at least once." ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "Defined as previous background of acute coronary syndrome, coronary angioplasty, revascularization surgery or vascular cerebral event." ] 5 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "f" "nota" => "Defined as glomerular filtration rate <60mL/min." ] 6 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "g" "nota" => "Ankle-Brachial Index ≤0.9." ] 7 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "*" "nota" => "p value with Pearson X2." ] 8 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "§" "nota" => "p value with Student t test." ] ] ] "descripcion" => array:1 [ "en" => "Coronary risk factors in the studied population." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BMI=Body Mass Index.STSE: ST segment elevation.OMT: Optimal medical therapy (defined as the combination of at least one antiplatelet drug, statin, beta-blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker).AIT: Anti-ischemic therapy (defined as the combination of two or more antianginal drugs and at least one antiplatelet drug)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men n (%) n=75 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women n (%) n=25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0065">§</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Anthropometry</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.70±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.52±8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71<a class="elsevierStyleCrossRef" href="#tblfn0070">Ω</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.36±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.16±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30<a class="elsevierStyleCrossRef" href="#tblfn0070">Ω</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body fat (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0070">Ω</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Clinical laboratory tests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin A1C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.01±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.58±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18<a class="elsevierStyleCrossRef" href="#tblfn0070">Ω</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proper glycemic control<a class="elsevierStyleCrossRef" href="#tblfn0050">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77<a class="elsevierStyleCrossRef" href="#tblfn0070">Ω</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Angina</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OMT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unstable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OMT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Silent ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OMT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AMI with STSE<a class="elsevierStyleCrossRef" href="#tblfn0055">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OMT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AMI without STSE<a class="elsevierStyleCrossRef" href="#tblfn0060">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OMT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIT+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1929775.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "a" "nota" => "A1C (glycated hemoglobin) <7%." ] 1 => array:3 [ "identificador" => "tblfn0055" "etiqueta" => "*" "nota" => "Acute myocardial infarction with ST segment elevation." ] 2 => array:3 [ "identificador" => "tblfn0060" "etiqueta" => "**" "nota" => "Acute myocardial infarction without ST segment elevation." ] 3 => array:3 [ "identificador" => "tblfn0065" "etiqueta" => "§" "nota" => "p value with X2 test." ] 4 => array:3 [ "identificador" => "tblfn0070" "etiqueta" => "Ω" "nota" => "p value calculated using Student t test." ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric measures, glycemic control evaluation and clinical presentation of cardiovascular disease according to gender." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "S.D.=standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men n (%) n=75 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women n (%) n=25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average SYNTAX score±S.D.<a class="elsevierStyleCrossRef" href="#tblfn0075">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.3±11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.7±11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left main coronary heart disease, n<a class="elsevierStyleCrossRef" href="#tblfn0080">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low SYNTAX score, n<a class="elsevierStyleCrossRef" href="#tblfn0085">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intermediate SYNTAX score, n<a class="elsevierStyleCrossRef" href="#tblfn0090">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High SYNTAX score, n<a class="elsevierStyleCrossRef" href="#tblfn0095">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1929776.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0075" "etiqueta" => "a" "nota" => "t Student test was used to compare differences between genders." ] 1 => array:3 [ "identificador" => "tblfn0080" "etiqueta" => "b" "nota" => "X2 test was used to calculate differences between genders." ] 2 => array:3 [ "identificador" => "tblfn0085" "etiqueta" => "c" "nota" => "SYNTAX score ≤22." ] 3 => array:3 [ "identificador" => "tblfn0090" "etiqueta" => "d" "nota" => "SYNTAX score 23–32." ] 4 => array:3 [ "identificador" => "tblfn0095" "etiqueta" => "e" "nota" => "SYNTAX score ≥33." ] ] ] "descripcion" => array:1 [ "en" => "SYNTAX score and left main coronary heart disease." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:51 [ 0 => array:3 [ "identificador" => "bib0260" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available at: <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.sciencedirect.com/science/article/pii/S0140673612617280">http://www.sciencedirect.com/science/article/pii/S0140673612617280</a>" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/14059940/0000008800000005/v1_201812250612/S1405994018300132/v1_201812250612/en/main.assets" "Apartado" => array:4 [ "identificador" => "14592" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Investigación clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/14059940/0000008800000005/v1_201812250612/S1405994018300132/v1_201812250612/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1405994018300132?idApp=UINPBA00004N"]

Statistics

Clinic Research

Factores de riesgo para la enfermedad arterial coronaria de tres vasos en pacientes del noroeste de México

Cuitlahuac Arroyo-Rodrígueza, Olga Rosa Brito-Zuritab, Santiago Sandoval-Navarretec, Rogelio Solis-Vásqueza, José Manuel Ornelas-Aguirred,e,

Corresponding author

jose.ornelasa@imss.gob.mx

Corresponding author. at: 2106 Paseo del Jardín, El Paraiso, Ciudad Obregón, Sonora, Mexico, Tel.: +52 64 4462 0471.

, Celestino Olea-Hernándeza, César Vásquez-Sernaa, Amanda Marcela Castelan-Ojedaa

a Cardiology Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico

b Medical Center of the South of Sonora at Ciudad Obregón, Sonora, Mexico

c Hemodinamic Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico

d Research and Education Department, Hospital Number 2, High Specialty Medical Unit, Northwest National Medical Center of the Instituto Mexicano del Seguro Social at Ciudad Obregón, Sonora, Mexico

e Health Sciences Department, University of Sonora at Ciudad Obregón, Sonora, Mexico

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index values according to gender&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index was normal if it was between 1&#46;00 and 1&#46;39&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index was abnormal if it was &#60;1 or &#8805;1&#46;4&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Peripheral arterial disease was diagnosed if Ankle-Brachial Index was &#8804;0&#46;9&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Borderline arterial disease was diagnosed if Ankle-Brachial Index was between 0&#46;91 and 0&#46;99&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease is the main cause of death in the world&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">1</span></a> Mechanism beyond coronary artery disease is atherosclerosis<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a> and risk factors to develop it were described for the first time by Framingham and are&#58; arterial systemic hypertension &#40;ASH&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; hypercholesterolemia and smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Smoking&#44; sedentarism&#44; atherogenic diet&#44; arterial systemic hypertension&#44; diabetes mellitus&#44; obesity&#44; dyslipidemia and metabolic syndrome are considered modifiable risk factors&#46; Instead&#59; masculine gender&#44; chronic kidney disease&#44; postmenopausal state&#44; advanced age and coronary disease family background are non-modifiable factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">4&#8211;6</span></a> Also&#44; considered as emergent coronary risk factors are&#58; high sensibility to C reactive protein &#40;HS-CRP&#41;&#44; hyperhomocysteinemia&#44; glycemic fast concentrations&#44; leukocyte counting as well as coronary calcium score measured by computed tomography&#44; Ankle-Brachial Index &#40;ABI&#41;&#44; periodontal disease&#44; lipoprotein levels and carotid artery intima media thickness&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">7</span></a> However current evidence does not sustain a routinely measurement for vascular risk stratification&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other side&#44; three-vessel coronary artery disease &#40;TVCAD&#41; is an atherosclerosis advanced manifestation and it is defined as a stenosis &#8805;70&#37; in each major epicardial coronary artery&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Most of these patients should require a revascularization strategy &#40;surgical or percutaneous&#41; to ameliorate their symptoms and life hope&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">10</span></a> Syntax score is an angiographic tool grading coronary lesions complexity and which allows obtaining evidence based on clinical practice guides and select the best revascularization techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;12</span></a> This score is also used to analyze coronary anatomy&#44; when an elevated value&#44; a complex coronary anatomy associated to atherosclerotic damage is revealed&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13</span></a> Studies in Mexican population reported high frequency of coronary risk factors &#40;CRF&#41; as obesity&#44; diabetes mellitus&#44; dyslipidemia&#44; smoking&#44; saturated fat intake&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#44;15</span></a> Nevertheless&#44; there is no literature report about coronary risk factors in patients with three-vessel coronary artery disease&#46; The objective of this study was to describe demographic&#44; clinic&#44; anthropometric&#44; angiographic and biochemical characteristics in a group of patients with three-vessel coronary artery disease in Northwest M&#233;xico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational and descriptive study was performed from May 2015 to February 2016 in a third level hospital at Instituto Mexicano del Seguro Social &#40;IMSS&#41; in ciudad Obregon&#44; Sonora M&#233;xico&#46; This is the regional referral hospital for four states in the northwest of Mexico &#40;Sonora&#44; Sinaloa&#44; Baja California and Baja California Sur&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mestizo population&#44; older than 18 years were studied&#44; all of them with three-vessel coronary disease diagnostic<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> &#40;stenosis &#8805;70&#37; in each epicardial major coronary arteries&#41;&#46; A convenience sampling of a hundred consecutive patients was obtained from May 2015 to February 2016&#46; An analysis with the Kolmogorov&#8211;Smirnov test was performed to know the normality of the population prior to the analysis of results&#46; Local Research Ethics Committee approved the protocol&#46; Written informed consent for each patient was asked during hospital stay when three-vessel coronary disease was assessed by coronariographic study&#46; Anthropometric measurements as weight&#44; length&#47;height for age&#44; body mass and fat index &#40;BMI&#41; were obtained with light clothes&#44; no shoes and using a Tanita TBF-215 body composition analyzer&#46; Abdominal circumference ratio was assessed with the World Health Organization&#39;s recommendations<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a> and BMI calculated with Quetelet formula&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">18</span></a> Ankle-Brachial Index &#40;ABI&#41; was evaluated with a Sonotrax Edan 8<span class="elsevierStyleHsp" style=""></span>Hz catheter and to interpret it&#44; method measurements and abnormal definitions from the American Heart Association&#39;s scientific consensus were taken&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">After a 12<span class="elsevierStyleHsp" style=""></span>h fast&#44; blood samples were taken to qualify lipid&#44; glucose&#44; blood urea nitrogen &#40;BUN&#41;&#44; urea&#44; creatinine&#44; uric acid&#46; All laboratory tests were performed with a AU680 Analyzer-Beckman Coultier&#44; Inc equipment with clinical chemistry standardization methods&#46; Glycosylated hemoglobin A1c fraction &#40;HbA1c&#41; was performed with a DCA Vantage Analyzer&#44; SIEMENS &#40;NGSP approved&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Syntax score was done by an interventional cardiologist who remained blind to patient&#39;s risk factors and got help from Syntax calculator version 2&#46;11&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">13</span></a> Left ventricular ejection fraction &#40;LVEF&#41; as well as other clinical parameters were obtained from the clinical records&#44; American Society for Echocardiography recommendations for LVEF were considered&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Left main coronary artery disease was defined with &#8805;50&#37; luminal stenosis by visual estimation during coronariography&#59; systemic arterial hypertension with blood pressure &#8805;140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg or if users of antihypertensive treatment&#46; Criteria for diabetes mellitus or metabolic syndrome were the ones recommended by American Diabetes Association &#40;ADA&#41; and International Diabetes Federation &#40;IDF&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">21&#44;22</span></a> Familiar background for cardiovascular disease was considered when one or more first grade family members have undergone acute myocardial infarction&#44; cerebrovascular accident or cardiovascular death&#59; in women&#44; younger than 65 or in men younger than 55 years old&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">7</span></a> Sedentary lifestyle was set when patient had physical activity less than 30<span class="elsevierStyleHsp" style=""></span>min&#44; 5 days a week&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a> smoking with intake &#62; 100 cigarettes in patient&#39;s whole life&#44; active smoking with an intake of at least a part of a cigarette in the last 30 days&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> to estimate packages&#47;year&#58; multiply smoking years by smoked packages of cigarettes daily&#46; Hyperuricemia was diagnosed when uric acid was &#8805;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and chronic renal disease when glomerular filtration rate &#40;GFR&#41; was &#60;60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">25</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Dyslipidaemia was assessed with cholesterol values &#8805;200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; high-density lipoproteins &#40;HDL-C&#41; &#8805;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; low-density lipoproteins &#40;LDL-C&#41; &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL or triglycerides level &#8805;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Stable or unstable angina&#44; silent ischemia&#44; acute myocardial infarction with or without ST-segment elevation &#40;AMI with STSE or AMI without STSE&#41; were classified according to the European Society of Cardiology and American Heart Association practice guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">26&#8211;28</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">SPSS program version 20 for Windows<span class="elsevierStyleSup">&#174;</span> was used for statistical analysis&#46; Numerical variables were expressed as frequencies and percentages&#46; Kolmogorov&#8211;Smirnov test was used to analyze the distribution of the data&#46; To show differences among numerical variables with normal distribution and independent samples&#44; a Student <span class="elsevierStyleItalic">t</span> test was used&#46; Qualitative values were assessed with a Pearson&#8211;Fisher chi square test&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered as a statistically significant difference&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">From the 25 women and 75 men studied&#44; women had a higher average age than men when diagnosed &#40;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;0 years old&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; A higher prevalence of metabolic syndrome was associated with feminine gender &#40;88&#37;&#41;&#44; instead in males was 65&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; On the opposite&#44; 76&#37; of men had smoking habit while there were just 44&#37; of smoking women &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; In addition&#44; previous cocaine use was present in 11&#37; of men &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Related to chronic diseases&#44; diabetes mellitus was found in 80&#37; of women compared to 51&#37; of men &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; No meaningful differences in arterial hypertension &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;74&#41;&#44; cardiovascular disease &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#41; neither chronic renal disease &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#41; were found &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A noticeable difference in body fat was evident&#44; being higher in women compared to men &#40;40&#46;3&#37; versus 29&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Glycemic control was achieved in less than a 30&#37; of both genders&#44; with no differences between them &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The most common clinical presentation of cardiovascular disease was stable angina &#40;45&#37;&#41;&#44; and masculine group the most affected &#40;51&#37;&#41;&#46; Whereas women group showed a higher frequency of unstable angina &#40;48&#37;&#41;&#44; 3 cases in the masculine group got silent ischemia and a 28&#37; acute infarction prevalence where most of the cases were AMI with STSE&#46; Optimal medical therapy was established in 26&#37; of males and 43&#37; of females presenting as stable angina &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;78&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Ankle-Brachial Index was abnormal in 58&#37; of the patients &#40;ABI &#60;1 or &#8805;1&#46;4&#41;&#59; 28&#37; men and 44&#37; women were diagnosed with peripheral arterial disease &#40;ABI &#8804;0&#46;9&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;14&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Within the patients having peripheral artery disease 65&#37; of males and 67&#37; of females were diabetic &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#41;&#46; About Syntax score&#44; no significative differences associated to gender were observed &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#41;&#46; No meaningful differences in left main coronary artery disease&#44; as well as low&#44; intermediate or high Syntax score &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Finally&#44; 51&#37; of patients got a left ventricular ejection fraction &#40;LVEF&#41; abnormally low&#46; Thirty three percent of men and forty percent of women&#44; got a left ventricular ejection fraction &#40;LVEF&#41;&#44; slightly abnormal&#46; On the other hand&#44; 6&#46;7&#37; of men and 12&#37; of women showed a left ventricular ejection fraction&#44; moderately abnormal &#40;31&#8211;40&#37;&#41;&#46; And 9&#46;3&#37; of men and 4&#37; of women resulted with a left ventricular ejection fraction&#44; severely abnormal &#8211; equal to or less than 30&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">29</span></a> thus&#44; most patients with this disease require a surgical or percutaneous strategy to improve their symptoms and prognostic&#46; As it was also important to describe cardiovascular risk factors &#40;CRF&#41;&#44; in the present study&#59; demographic&#44; anthropometric&#44; biochemical&#44; angiographic and Ankle-Brachial Index are considered in a sample with three-vessel coronary artery disease in Northwest M&#233;xico&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Important to mention that diet and lifestyle changes in this people also affect &#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">30</span></a> However&#44; our study did not evaluate diet habits as a coronary risk factor which could be a limitation to suggest a relation with TVCAD&#46; A high consumption of a diet rich in simple carbohydrates is very common and&#44; fruit and vegetables are rarely eaten&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">31</span></a> Nevertheless&#44; this does not fully explain the differences that some authors have suggested in relation to feeding as an independent cardiovascular risk factor&#44; but it does take into account the presence of genetic factors identified in the Mexican population that could confer a greater risk as has been suggested&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Traditional diet in this Mexican area includes saturated lipids in grilled meat&#44; fresh cheese and tamales&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">30</span></a> Consequently&#44; there is a high prevalence of diabetes mellitus&#44; dyslipidemia&#44; saturated lipids intake and smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#44;15</span></a> The effects of cocaine are well-known&#44; such as increased inotropic and chronotropic&#44; vasoconstriction&#44; pro thrombotic state&#44; endothelial dysfunction and accelerated atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">34&#44;35</span></a> A finding of our study was that an 8&#37; of the patients with TVCAD had been occasionally cocaine users&#46; However&#44; we did not find that this could have an association with the current clinical picture due to the age of presentation that is higher in these patients than described in people affected by cocaine use&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">High prevalence of diabetes mellitus and metabolic syndrome is remarkable in the studied sample&#46; Other researches in patients with three-vessel coronary artery disease like Syntax score&#44; report a prevalence of just 25&#37; for diabetes mellitus and 45&#37; for metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> &#8220;CREDO Kyoto PCI&#47;CABG registry cohort-2&#8221;&#44; a Japanese study&#44; reports diabetic with three-vessel coronary artery disease in only 50&#37; of their population&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">36</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Besides&#44; another possible explanation for the differences found&#44; could be the cut-off point to define a significative coronary stenosis&#46; In Syntax study and &#8220;CREDO Kyoto PCI&#47;CABG registry cohort-2&#8221; approaches&#44; a 50&#37; cutting point was the reference for a significative stenosis&#44; whereas in our approach a 70&#37; cutting point was used&#46; This 70&#37; was considered due to the discrepancies between the 50&#37; cut-off point and the coronary blood flow &#40;CBF&#41; reserve &#8804;0&#46;8 &#40;considering the gold standard to diagnose a coronary stenosis ischemic potential&#41;&#46; To use a 70&#37; cut-off point improves angiographic specificity to detect ischemic potential in a coronary stenosis&#44; even when it decreases its sensibility&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">37</span></a> A limitation of our study was the fact of taking only the evaluation of a single interventional cardiologist but who nevertheless had extensive experience and professional certification to do so&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Sociocultural and ethnical differences might also be involved in a higher risk profile in our sample&#44; which could determine do not follow indicated treatment neither special diet as reduce salt consumption or improve physical activity&#44; have a hypertensive control&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">38</span></a> For instance&#44; glycemic control was good enough just in 29&#37; of the diabetic people&#46; Considering diabetic and pre-diabetic subjects together&#44; 81&#46;36&#37; of men and 88&#37; of women had an abnormal glucose metabolism&#59; alarming data due to the high morbidity and mortality in this group of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">39</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Dyslipidemia was the most common risk factor&#44; despite the use of hypolipemiant drugs 100&#37; of the sample registered any other lipid parameter away from target&#46; Probably due to a lack of adjusting to therapeutic instructions or even more&#44; to hereditary lipid disease with specific genomic mutations not measured in the present study&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> Therefore&#44; sedentary lifestyle&#44; atherogenic diet and tobacco consumption are essential factors that influence dyslipidemia in Northwest Mexican population&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">41</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Ankle braquial index &#40;ABI&#41; &#8804;0&#46;9 is associated with a higher mortality frequency as well as cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">42</span></a> ABI &#8805;1&#46;4 is related with acute myocardial infarction but not with an increase in mortality&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">43</span></a> and ABI limit value &#40;0&#46;91&#8211;0&#46;99&#41; is associated with endothelial dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">44</span></a> Based on these and in accordance with the American Heart Association&#39;s scientific consensus to measure and interpret ABI&#44; all values out of range from 1&#46;00 to 1&#46;39&#44; are considered as abnormal&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> so it was found that 58&#37; of studied sample had an abnormal ABI&#44; higher in the right side and lower in theft side in men and abnormally low in both sides in women&#46; Differences which might be due to a higher risk profile in women than men &#40;women were older&#44; with a higher diabetes load&#44; metabolic syndrome and several types of dyslipidemia&#41;&#46; Higher ABI mainly in the right side&#44; has been associated with blood pressure measurement in 4 limbs &#40;it usually starts in the right side&#44; when patient could get an anxiety transitory rise in blood pressure&#44; mitigated effect during blood pressure measurement in the rest of the limbs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Other possible explanations for this fact might be&#58; muscular mass &#40;most of the people is right-handed&#41;&#44; embryologic development and anatomic preference atherosclerotic plaques formation in specific sites&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">45&#8211;47</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Because of difficult coronary lesions in the studied sample&#44; Syntax score was high in most patients &#40;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;6&#41;&#46; Compared with FREEDOM study&#44; where Syntax score was 26&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4 &#40;a diabetic sample with 82&#46;8&#37; of patients with TVCAD&#41;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">48</span></a>&#59; in Syntax study&#44; the average was 28&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#46; Differences which could probably be explained for an adverse risk profile in our studied cases&#44; but mainly&#44; by using a &#8805;70&#37; cut-off point &#40;instead of a &#62;50&#37;&#41; to define a meaningful coronary stenosis&#46; It has been recently demonstrated that considering &#8805;70&#37; cut-off point to indicate revascularization&#44; decreases adverse events rate in a year and the number of stents used&#44; also providing a much better functionality in revascularization strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">49</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally&#44; a high prevalence of coronary risk factors and complex coronary anatomy &#40;High Syntax scores&#41; might lead to a worse prognosis than the reported from other researchers&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">10&#44;39</span></a> SYNTAX II is score which combines coronary anatomy and clinical variables &#40;age&#44; renal function&#44; left ventricular ejection fraction&#44; gender&#44; chronic obstructive pulmonary disease and peripheral artery disease&#41;&#44; this recently developed score substantially increased the accuracy of identifying low &#40;and high&#41; risk patients compared to the anatomical SYNTAX score alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">50&#44;51</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">Our study found a significant prevalence of diabetes mellitus&#44; smoking and metabolic syndrome associated for three-vessel coronary artery disease at our studied sample&#46; These might lead to complex coronary lesions and probably a worse prognostic&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Most patients showed an abnormal Ankle-Brachial Index sighting toward a generalized atherosclerosis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">We certify that no funding has been received for the conduct of this study and&#47;or preparation of this manuscript&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authors&#8217; contribution</span><p id="par0150" class="elsevierStylePara elsevierViewall">This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Arroyo-Rodr&#237;guez A&#46; Cuitl&#225;huac&#58; Acquisition&#44; analysis&#44; interpretation of data for the work&#44; drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Brito-Zurita Olga Rosa&#58; Analysis&#44; interpretation of data for the work&#44; drafting the work and revising it critically for important intellectual content&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Sandoval-Navarrete Santiago&#58; Drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Sol&#237;s-V&#225;squez Rogelio&#58; Drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Ornelas-Aguirre Jos&#233; Manuel&#58; Analysis&#44; interpretation of data for the work&#44; drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Olea-Hern&#225;ndez Celestino&#58; Drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">V&#225;squez-Serna C&#233;sar&#58; Drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Castelan-Ojeda Amanda Marcela&#58; Drafting the work and revising it critically for important intellectual content and approval of the version to be published&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">We certify that all financial and material support for the conduct of this study and&#47;or preparation of this manuscript was done by research group only&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Introduction"
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              "titulo" => "Introducci&#243;n"
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            1 => array:2 [
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              "titulo" => "Objetivo"
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              "titulo" => "Resultados"
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              "titulo" => "Conclusi&#243;n"
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          "titulo" => "Palabras clave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:2 [
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          "identificador" => "sec0030"
          "titulo" => "Funding"
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          "identificador" => "sec0035"
          "titulo" => "Authors&#8217; contribution"
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          "identificador" => "sec0040"
          "titulo" => "Conflict of interest"
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          "identificador" => "xack385046"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2017-06-26"
    "fechaAceptado" => "2018-02-22"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1063859"
          "palabras" => array:6 [
            0 => "Coronary artery disease"
            1 => "Atherosclerosis"
            2 => "Risk factors"
            3 => "Syntax score"
            4 => "Ankle-Brachial Index"
            5 => "Mexico"
          ]
        ]
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Enfermedad arterial coronaria"
            1 => "Aterosclerosis"
            2 => "Factores de riesgo"
            3 => "Puntaje Syntax"
            4 => "&#205;ndice tobillo-brazo"
            5 => "M&#233;xico"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis&#44; with high prevalence in Mexico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016&#46; The disease was defined when &#8805;70&#37; stenosis was present in each major epicardial coronary artery&#46; Anthropometric and biochemical parameters were measured in each patient&#46; Ankle-Brachial Index was measured with vascular ultrasound&#44; and Syntax score calculation with an on-line application&#46; Statistical analysis for qualitative differences was performed using Pearson <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span> test&#44; with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 being considered as significant&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 100 patients&#44; of whom 75 were male &#40;mean age 63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 years&#41; and 25 female &#40;mean age 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 years&#41;&#46; The coronary risk factors observed were diabetes &#40;58&#37;&#41;&#44; hypertension &#40;86&#37;&#41;&#44; smoking &#40;68&#37;&#41;&#44; dyslipidaemia &#40;100&#37;&#41;&#44; metabolic syndrome &#40;71&#37;&#41;&#44; and obesity&#47;overweight &#40;75&#37;&#41;&#46; Diabetes and metabolic syndrome prevalence was higher in women &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; but smoking was higher in men &#40;76&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; Ankle-Brachial Index was abnormal in 58&#37; of patients&#44; the mean Syntax score was in 36&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#44; and the prevalence of left main coronary heart disease was 36&#37;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This group of patients with complex coronary lesions has a high prevalence of coronary risk factors&#44; which could represent a worse prognosis&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
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          2 => array:2 [
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            "titulo" => "Methods"
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad coronaria de tres vasos &#40;ECTV&#41; es una manifestaci&#243;n avanzada de aterosclerosis&#44; con alta prevalencia en el noroeste de M&#233;xico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir los factores de riesgo coronario &#40;FRC&#41; en un grupo de enfermos con ECTV en el noroeste de M&#233;xico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De mayo de 2015 a febrero de 2016 se realiz&#243; un estudio transversal en una poblaci&#243;n del noroeste de M&#233;xico diagnosticada con ECTV&#46; Se defini&#243; ECTV cuando exist&#237;a estenosis &#8805;70&#37; en cada una de las arterias coronarias epic&#225;rdicas mayores&#46; Se midieron par&#225;metros antropom&#233;tricos y bioqu&#237;micos en cada paciente&#46; Los par&#225;metros para el &#237;ndice tobillo-brazo &#40;ITB&#41; se obtuvieron con ultrasonido vascular &#40;Edan SonoTrax 8<span class="elsevierStyleHsp" style=""></span>Hz&#41; y un c&#225;lculo de puntaje Syntax con una aplicaci&#243;n en l&#237;nea&#46; An&#225;lisis estad&#237;stico con <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> de Pearson para diferencias cualitativas Se consider&#243; significativo cuando <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 25 mujeres &#40;edad 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 a&#241;os&#41; y 75 varones &#40;edad 63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 a&#241;os&#41;&#46; Los FRC observados fueron diabetes &#40;58&#37;&#41;&#44; hipertensi&#243;n &#40;86&#37;&#41;&#44; antecedente de tabaquismo &#40;68&#37;&#41;&#44; dislipidemia &#40;100&#37;&#41;&#44; s&#237;ndrome metab&#243;lico &#40;71&#37;&#41; y sobrepeso&#47;obesidad &#40;75&#37;&#41;&#46; En las mujeres la prevalencia de diabetes y s&#237;ndrome metab&#243;lico fue mayor que en los varones &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; pero el tabaquismo fue m&#225;s prevalente en los varones &#40;76&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; El ITB se encontr&#243; anormal en el 58&#37; de los pacientes&#44; el puntaje Syntax promedio fue de 36&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5 y la prevalencia de la enfermedad del tronco de la arteria coronaria izquierda fue del 36&#37;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En este grupo de estudio con lesiones coronarias complejas existe alta prevalencia de FRC que se refleja en y posiblemente un peor pron&#243;stico&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Objetivo"
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            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusi&#243;n"
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index values according to gender&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index was normal if it was between 1&#46;00 and 1&#46;39&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Ankle-Brachial Index was abnormal if it was &#60;1 or &#8805;1&#46;4&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Peripheral arterial disease was diagnosed if Ankle-Brachial Index was &#8804;0&#46;9&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Borderline arterial disease was diagnosed if Ankle-Brachial Index was between 0&#46;91 and 0&#46;99&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Left ventricular ejection fraction according to gender&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Normal&#58; LVEF 52&#8211;72 for males and 54&#8211;74 for females&#46;</p> <p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Slightly abnormal&#58; LFEF 41&#8211;51 for males and 41&#8211;53 for females&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Moderately abnormal&#58; LVEF 30&#8211;40 for both genders&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Severely abnormal&#58; LVEF &#60;30&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">LVEF&#58; left ventricular ejection fraction &#37;&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">&#167;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dyslipidaemia</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hyperuricemia</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sedentary lifestyle</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Metabolic syndrome</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prediabetes</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Toxicomany</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Smoking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cocaine</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Diseases</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Arterial hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiovascular disease</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chronic renal disease</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Peripheral artery disease</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>With diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Without diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1929777.png"
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            ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Defined as total cholesterol &#8805;200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; HDL-C &#8804;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; triglyceride &#8805;150 or LDL-C &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Acid levels &#8805;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Obtained in 68 from 75 men and 23 from 25 women&#46;</p>"
            ]
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              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">A1C 5&#46;7&#8211;6&#46;4&#46;</p>"
            ]
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              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Defined as previous use of cocaine at least once&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Defined as previous background of acute coronary syndrome&#44; coronary angioplasty&#44; revascularization surgery or vascular cerebral event&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Defined as glomerular filtration rate &#60;60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46;</p>"
            ]
            6 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "g"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Ankle-Brachial Index &#8804;0&#46;9&#46;</p>"
            ]
            7 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040"><span class="elsevierStyleItalic">p</span> value with Pearson <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span>&#46;</p>"
            ]
            8 => array:3 [
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              "etiqueta" => "&#167;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">p value with Student <span class="elsevierStyleItalic">t</span> test&#46;</p>"
            ]
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        ]
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Body Mass Index&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">STSE&#58; ST segment elevation&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">OMT&#58; Optimal medical therapy &#40;defined as the combination of at least one antiplatelet drug&#44; statin&#44; beta-blocker and angiotensin converting enzyme inhibitor&#47;angiotensin receptor blocker&#41;&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">AIT&#58; Anti-ischemic therapy &#40;defined as the combination of two or more antianginal drugs and at least one antiplatelet drug&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">&#167;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Anthropometry</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Abdominal circumference</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;71<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#937;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#937;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Body fat &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#937;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Clinical laboratory tests</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemoglobin A1C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#937;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proper glycemic control</span><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;77<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#937;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Angina</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stable</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>OMT&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>AIT&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unstable</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>OMT&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>AIT&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Silent ischemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">OMT&#43;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">SYNTAX score and left main coronary heart disease&#46;</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "1"
              "referencia" => array:1 [
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                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.sciencedirect.com/science/article/pii/S0140673612617280">http&#58;&#47;&#47;www&#46;sciencedirect&#46;com&#47;science&#47;article&#47;pii&#47;S0140673612617280</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
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                            0 => "R&#46; Lozano"
                            1 => "M&#46; Naghavi"
                            2 => "K&#46; Foreman"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(12)61728-0"
                      "Revista" => array:6 [
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                            "web" => "Medline"
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            1 => array:3 [
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              "etiqueta" => "2"
              "referencia" => array:1 [
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                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://www.nejm.org/doi/full/10.1056/NEJMra1216063">http&#58;&#47;&#47;www&#46;nejm&#46;org&#47;doi&#47;full&#47;10&#46;1056&#47;NEJMra1216063</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of acute coronary syndromes and their implications for therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1216063"
                      "Revista" => array:6 [
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                        "volumen" => "368"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://academic.oup.com/ije/article/44/6/1767/2572749/II-Coronary-Heart-Disease-in-the-Framingham-Study">https&#58;&#47;&#47;academic&#46;oup&#46;com&#47;ije&#47;article&#47;44&#47;6&#47;1767&#47;2572749&#47;II-Coronary-Heart-Disease-in-the-Framingham-Study</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary heart disease in the Framingham study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;R&#46; Dawber"
                            1 => "F&#46;E&#46; Moore"
                            2 => "G&#46;V&#46; Mann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ije/dyv346"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Epidemiol"
                        "fecha" => "2015"
                        "volumen" => "44"
                        "paginaInicial" => "1767"
                        "paginaFinal" => "1780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26705414"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global burden of cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;A&#46; Gaziano"
                            1 => "D&#46; Prabhakaran"
                            2 => "J&#46;M&#46; Gaziano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:7 [
                        "edicion" => "10th ed&#46;"
                        "titulo" => "Braunwald&#39;s heart disease&#58; a textbook of cardiovascular medicine"
                        "fecha" => "2015"
                        "paginaInicial" => "9"
                        "paginaFinal" => "16"
                        "editorial" => "Elsevier&#47;Saunders"
                        "editorialLocalizacion" => "Philadelphia&#44; USA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="https://doi.org/10.1016/S0140-6736(13)60595-4">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;S0140-6736&#40;13&#41;60595-4</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic kidney disease and cardiovascular risk&#58; epidemiology&#44; mechanisms&#44; and prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0200" class="elsevierStylePara elsevierViewall">Authors thank MSD M&#233;xico for supplying necessary material to obtain HbA1c as well as Dr&#46; Enrique Sabag-Ru&#237;z advice for statistical analysis&#46;</p>"
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Article information

ISSN: 14059940
Original language: English

DOI:10.1016/j.acmx.2018.02.009

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Year/Month	Html	Pdf	Total

2024 October	243	6	249
2024 September	423	13	436
2024 August	431	12	443
2024 July	773	28	801
2024 June	473	17	490
2024 May	517	21	538
2024 April	459	19	478
2024 March	367	25	392
2024 February	391	13	404
2024 January	489	21	510
2023 December	372	16	388
2023 November	384	20	404
2023 October	452	20	472
2023 September	491	4	495
2023 August	519	13	532
2023 July	598	13	611
2023 June	377	11	388
2023 May	638	13	651
2023 April	527	2	529
2023 March	480	7	487
2023 February	392	8	400
2023 January	297	7	304
2022 December	324	19	343
2022 November	388	30	418
2022 October	360	24	384
2022 September	364	19	383
2022 August	435	20	455
2022 July	334	11	345
2022 June	358	38	396
2022 May	294	32	326
2022 April	315	19	334
2022 March	300	24	324
2022 February	302	26	328
2022 January	280	25	305
2021 December	266	32	298
2021 November	331	20	351
2021 October	475	21	496
2021 September	381	40	421
2021 August	301	41	342
2021 July	226	50	276
2021 June	217	44	261
2021 May	215	45	260
2021 April	484	96	580
2021 March	258	45	303
2021 February	183	52	235
2021 January	277	84	361
2020 December	162	74	236
2020 November	134	46	180
2020 October	158	85	243
2020 September	252	190	442
2020 August	215	88	303
2020 July	196	75	271
2020 June	129	71	200
2020 May	111	27	138
2020 April	128	20	148
2020 March	249	27	276
2020 February	133	10	143
2020 January	166	16	182
2019 December	205	34	239
2019 November	122	30	152
2019 October	160	15	175
2019 September	169	27	196
2019 August	103	17	120
2019 July	160	22	182
2019 June	90	47	137
2019 May	244	48	292
2019 April	129	43	172
2019 March	56	20	76
2019 February	60	17	77
2019 January	41	24	65
2018 December	21	16	37
2018 November	18	10	28
2018 October	22	37	59
2018 September	28	5	33
2018 August	2	5	7
2018 July	0	8	8
2018 June	1	10	11
2018 May	6	16	22
2018 April	4	14	18
2018 March	0	12	12

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