Showing papers by "Hospital General Universitario Gregorio Marañón published in 1998"

Treatment of AIDS-associated progressive multifocal leukoencephalopathy with highly active antiretroviral therapy

Abstract: Objectives: To evaluate the efficacy of highly active antiretroviral therapy (HAART) in 12 patients with AIDS-associated progressive multifocal leukoencephalopathy (PML). Patients and methods: The diagnosis of PML was established by brain biopsy in six patients and by neuroimaging findings and PCR detection of JC virus in cerebrospinal fluid (CSF) in six patients. We also studied 13 consecutive AIDS patients with biopsy-proven PML cared for in the same institution before HAART was available. Eleven patients of the HAART group and eight patients of the control group received intravenous arabinoside cytosine cycles. Results: With HAART, the median decrease in the HIV viral load was 3.58 log 10 copies/ml and the median increase in the CD4 cell count was 74 × 1 O 6 /l. The median survival time after PML diagnosis was 545 days in the HAART group and 60 days in the control group (P < 0.001, log-rank test). In the HAART group, the neurological deficits improved substantially in six patients and stabilized in six patients. Eleven patients underwent follow-up cranial computed tomography or magnetic resonance scan that showed improvement of PML lesions in 10 patients and stabilization in one patient. Follow-up CSF analysis showed clearance of JC virus in six out of seven patients who had an initial positive result. Conclusions: This study shows that HAART may increase the survival, clinical status and radiological features of AIDS patients with PML. Clearance of JC virus from CSF has been found, suggesting that immune reconstitution can interrupt the JC virus lytic cycle.

Fluorescein-Induced Allergic Reaction

Abstract: Background Adverse reactions following intravenous sodium fluorescein are very unusual and their mechanism is still uncertain. We report the case of a patient who suffered an adverse reaction during a fluorescein ocular angiography. Positive allergy tests to fluorescein suggest an IgE-mediated mechanism. Objective Report the allergy evaluation performed in a patient who suffered an adverse reaction during an intravenous fluorescein administration. Methods We selected the case of a patient who suffered dizziness, diaphoresis, generalized pallor, nausea, sphincter relaxation, hypotension, and intense malaise during a fluorescein ocular angiography and compared the results to other nonreactive subjects. Allergy evaluation: Prick and intradermal skin tests and serial determinations of serum tryptase were performed on the patient and four control subjects who underwent and tolerated the same procedure as well as on a patient who developed an intense vagal reaction during blood extraction. Results Positive skin tests and dramatic increase of serum tryptase (67 U/I) were observed in our patient. The rest of the patients had negative skin tests and did not have any variation in their serum tryptase. Conclusions An IgE-mediated mechanism is suggested as responsible for this adverse reaction. We recommend that a complete allergy evaluation should be performed in all patients who have adverse reactions to fluorescein in order to differentiate true allergic reactions from other types of reactions.

The influence of transoesophageal echocardiography on intra-operative decision making - A European multicentre study

Abstract: The role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operative TOE. To determine the current role of transoesophageal echocardiography and the relative impact of category-based transoesophageal echocardiographic indications the present study investigated its use in seven Western European countries. The study sample was taken from a prospective cohort of 224 patients with acute or chronic haemodynamic disturbances or at risk of myocardial ischaemia. All patients were monitored with two-lead electrocardiography and radial and pulmonary artery catheters, as well as biplane or multiplane transoesophageal echocardiography. A total of 2232 clinical interventions were made in these patients. The most frequently observed intervention was the administration of a fluid bolus (45% of all interventions). Overall, transoesophageal echocardiography was the most important guiding factor in 560 (25%) interventions. It was the most important monitor in guiding the following therapeutic interventions: anti-ischaemic therapy--207 of 372 interventions (56%); fluid administration--275 of 996 (28%) interventions; vasopressor or inotrope administration--56 of 316 (16%) interventions; vasodilator therapy--six of 142 (4%) interventions and depth of anaesthesia--four of 211 (2%) interventions. We found that transoesophageal echocardiography is frequently influential in guiding clinical decision making and is used most frequently for category II indications but category I indications were associated with more frequent change in management.

Mechanisms of Residual Lumen Stenosis After High-Pressure Stent Implantation A Quantitative Coronary Angiography and Intravascular Ultrasound Study

Abstract: Background —Intravascular ultrasound (IVUS) studies have demonstrated that stents are frequently suboptimally expanded despite the use of high pressures for deployment. The purpose of this study was to identify the mechanisms responsible for such residual lumen stenosis. Methods and Results —Fifty-seven lesions from 50 patients treated with high-pressure (median±interquartile range, 14±2 atm) elective (44 de novo, 13 restenotic lesions) stenting were prospectively studied (29 Wiktor, Medtronic; 28 Palmaz-Schatz, Cordis Corp). Balloon subexpansion was calculated as the difference between maximal and minimal balloon cross-sectional areas at peak pressure measured by automatic edge detection; elastic recoil was calculated as the difference between minimal measured balloon size and IVUS-derived minimal lumen area within the stent. Angiographic residual diameter stenosis was 10±13% (reference diameter, 3.1±0.7 mm; balloon to artery ratio, 1.12±0.23) and IVUS-derived stent expansion was 80±28%. However, although balloon nominal size was 9.6±1.3 mm[2][1] and maximal balloon size measured inside the coronary lumen was 12.5±3.2 mm2, final stent minimal lumen area was only 7.1±2.2 mm2. Balloon subexpansion of 4.0±1.8 mm[2][1] (33%) and elastic recoil of 1.6±2.3 mm[2][1] (20%) (both P <0.0001) were the two mechanisms responsible for residual luminal stenosis. Wiktor stent and peak inflation pressure correlated with balloon subexpansion, whereas Wiktor stent, de novo lesion, and minimal lumen area at baseline correlated with elastic recoil. Conclusions —Despite high-pressure deployment, lumen dimensions after stenting are only 57% of maximal achievable. Inadequate balloon expansion and elastic recoil are responsible for residual lumen stenosis, suggesting that plaque characteristics and stent resistance deserve further investigation. [1]: #ref-2

Diagnostic imaging of lipoma arborescens

Abstract: Objective. The imaging characteristics of lipoma arborescens using plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are described. Design and patients. Five patients with a diagnosis of lipoma arborescens are presented. Three had monoarticular involvement of the knee joint. In the remaining two patients both knees and both hips, respectively, were affected. All patients were examined using plain radiographs and MRI. CT was employed in two cases. Results and conclusions. A conclusive diagnosis with exclusion of other synovial pathologies having similar clinical and radiological behaviour can be achieved on the basis of the MRI characteristics of lipoma arborescens. The aetiology of lipoma arborescens remains unknown, but its association with previous pathology of the affected joints in all our patients supports the theory of a non-neoplastic reactive process involving the synovial membrane.

Multicenter Evaluation of the COBAS AMPLICOR HCV Assay, an Integrated PCR System for Rapid Detection of Hepatitis C Virus RNA in the Diagnostic Laboratory

Abstract: The benefits shown by the recent introduction of PCR for the in vitro diagnosis of hepatitis C virus (HCV) infection has prompted the development of standardized, ready-to-use assays that can be implemented in routine clinical laboratories. We have evaluated the clinical performance of COBAS AMPLICOR HCV (COBAS), the first instrument system that allows the automation of HCV RNA amplification and detection, to determine its performance in the routine laboratory setting. More than 2,000 specimens collected at five centers were analyzed in parallel by the COBAS and the manual AMPLICOR HCV (AMPLICOR) tests, and the results were compared with the results for biochemical and serological markers of HCV. In this study the two PCR systems showed the same accuracy, with a concordance rate of 99.8%. As expected, the correlation between serology and PCR was not absolute because the presence of anti-HCV antibodies may be associated with a latent or past infection. On the other hand, if the presence of confirmed anti-HCV antibodies and elevated alanine aminotransferase levels are taken as the “gold standard,” indicating an active, ongoing infection, the COBAS and AMPLICOR tests show high and comparable sensitivities (100%) and specificities (98%), with positive and negative predictive values of 100 and 97%, respectively. During the study no false-positive reactions were detected. The use of an internal control allowed the identification of inhibitory substances that prevented amplification for 0.3 and 0.4% of samples tested by the COBAS and AMPLICOR tests, respectively. Compared to the manual system, the COBAS system allowed a significant reduction of hands-on time and could improve the overall laboratory work flow. In conclusion, these results support the use of the COBAS and AMPLICOR tests for the molecular diagnosis of active HCV infections.

Osteochondritis dissecans of the talus during childhood and adolescence.

Abstract: Between 1985 and 1996, our Service treated 18 cases of osteochondritis dissecans of the talus in children and adolescents. The lesion is more frequent during childhood than previously thought. Different theories about the etiology of the lesion and the various treatments used are discussed. The outcome was satisfactory in most cases. We consider that, with the exception of type IV Berndt and Harty lesions, preliminary treatment should be conservative, which gave good results in our study. Surgical treatment should be reserved for patients with an unsatisfactory evolution with orthopaedic treatment, with lesions with thick sclerotic edges, or for patients with loose intraarticular fragments.

Visceral leishmaniasis (Kala-Azar) in transplant recipients: case report and review.

Abstract: Background. In endemic areas, visceral leishmaniasis has been identified as an opportunistic infection in patients with derangements in their cellular immune system. Methods. We report a renal transplant patient with visceral leishmaniasis. We also reviewed the previously published cases of 17 organ transplant recipients with this parasitic disease. Results. Visceral leishmaniasis occurred a median time of 8 months after transplantation, and the clinical picture was characterized by fever, splenomegaly, and blood cytopenias. Leishmaniae were detected in bone marrow in 16 of 18 patients and diagnostic serology results were found in 8 of 10 tested patients. Pentavalent antimonials were used to treat 16 patients, five of which developed pancreatitis. Five of 18 patients died, including two untreated patients. Relapses of visceral leishmaniasis occurred in 4 of 13 survivors. Conclusions. In endemic areas, visceral leishmaniasis may complicate the clinical course of organ transplantation and can have fatal consequences, particularly when untreated.

Randomized, prospective comparison of four burst pacing algorithms for spontaneous ventricular tachycardia.

Abstract: "Less aggressive" burst stimulation is more effective in terminating spontaneous monomorphic ventricular tachycardia with a lesser acceleration rate. Higher ventricular tachycardia cycle length and use of 91% coupling interval were independent predictors for pacing termination.

Registro de Actividad de la Sección de Hemodinámica y Cardiología Intervencionista del año 1997

Abstract: The results of the Spanish Registry of Hemodynamic and Interventional Cardiology in 1997 are presented. The Registry collects the activity of 83 centers which constitute all the cardiac catheterization laboratories in Spain. The main activity was adult cardiac catheterization in 75 centers and exclusively pediatric cardiac catheterization in 8. A total of 72,370 diagnostic catheterization procedures, 80% coronary angiographies (57,960; 1,462 per million inhabitants), were performed which represents a 13% total increase compared to 1996. Coronary intervention increased by 23% compared to 1996, for a total number of 18,545 procedures. The ratio of coronary interventions per million inhabitants was 468. Success rates of coronary interventions (91.3%) and complications (3.7%) were similar to those registered in previous years. In the specific field of revascularization devices, there has been a dramatic increase in the use of stents. In 1997, coronary stents were employed in 11,417 cases (a 61% increase compared to 1996) which represents 61.5% of all coronary revascularizations procedures. A total of 14,170 prosthesis were implanted, 72% in a elective way, with a low rate of complications (0.95% subacute closure; 1.45% myocardial infarction and 0.75% mortality). Compared to 1996, directional coronary atherectomy (92 procedures) showed a slight decrease, whereas rotational atherectomy (554 procedures) increased by 49% with double the number of centers performing this technique. As in previous years, a slight decrease (7% compared to 1996) in adult valvuloplasties (559 vs 599) was noted. Pediatric interventional procedures decreased by 17% (465 vs 558 procedures) compared to the 1996 Registry.

Inhibition of Phosphodiesterase Type IV Suppresses Human Immunodeficiency Virus Type 1 Replication and Cytokine Production in Primary T Cells: Involvement of NF-κB and NFAT

Abstract: Rolipram, a phosphosdiesterase type IV-specific inhibitor, prevented p24 antigen release from anti-CD3-activated human immunodeficiency virus (HIV)-infected T cells and CD4(+)-cell depletion associated with viral replication in a dose-responsive manner but minimally inhibited T-cell proliferation. Moreover, rolipram reduced the production of tumor necrosis factor alpha (TNF-alpha) and interleukin-10 (IL-10) by HIV-infected T cells. The transcriptional ability of a luciferase reporter gene under control of the HIV long terminal repeat, induced by phorbol myristic acetate plus ionomycin or by TNF-alpha, in primary T and Jurkat cells was also inhibited by rolipram. Rolipram inhibited NF-kappaB and NFAT activation induced by T-cell activation in Jurkat and primary T cells, as measured by transient transfection of reporter genes and electrophoretic mobility shift assays. Exogenous addition of TNF-alpha in the presence of rolipram restored NF-kappaB but not NFAT activation or p24 release. Addition of dibutyryl-cyclic AMP (dBcAMP) mimicked the effects of rolipram on p24 antigen release, NF-kappaB activation, and TNF-alpha secretion, but it did not affect NFAT activation or IL-10 production. The protein kinase A inhibitor KT5720 prevented the inhibition of TNF-alpha secretion but not that of HIV type 1 (HIV-1) replication caused by rolipram. Our data indicate that blockade of phosphodiesterase type IV could be of benefit against HIV-1 disease by modulating cytokine secretion and transcriptional regulation of HIV replication, and they suggest an important role of NFAT in HIV replication in primary T cells. Some of those activities cannot be ascribed solely to its ability to increase cAMP.

A marginal zone pattern may be found in different varieties of non-Hodgkin's lymphoma: the morphology and immunohistology of splenic involvement by B-cell lymphomas simulating splenic marginal zone lymphoma.

Abstract: Aims: Splenic marginal zone lymphoma (SMZL) is characterized by a micronodular infiltrate of the splenic white pulp, centred on pre-existing follicles, with a peripheral rim of ‘marginal’ zone B-cells, always accompanied by a variable degree of red pulp infiltration. These histological features can be closely mimicked by a variety of other small B-cell lymphomas when they involve the spleen, which makes recognition of SMZL difficult. We therefore have compared the histopathological and immunohistochemical features of other non-Hodgkin's lymphoma (NHL) types with those of SMZL. Methods and results We selected cases of splenic involvement by different types of B-cell lymphoma, including mantle cell lymphoma (MCL), follicular lymphoma (FL), immunocytoma (IM) and lymphocytic lymphoma (B-CLL). A micronodular pattern and marginal zone differentiation were both found to be frequently present in FL and MCL, and with lesser frequency in IM and B-CLL. The main morphological feature useful for differential diagnosis was the cytological composition of the white pulp tumoral nodules. SMZL is distinguished by characteristic dimorphic cytology, different from the monomorphic cytology of MCL, and the distinctive mixture of centroblasts and centrocytes which is the rule in FL. B-CLL could also be identified on the basis of the polymorphic cytology including small lymphocytes and prolymphocytes, whereas cases diagnosed as IM show prominent plasmacytic differentiation, lacking the features of the other lymphoma types. Immunohistochemistry was particularly useful for the differential diagnosis. Thus the recognition of MCL was facilitated by the identification of cyclin D1 and CD43 reactivity, while FL could be recognized by the lack of IgD expression or the distinctive pattern of Ki67 staining found in SMZL. B-CLL cells were CD23 + , CD43 +. Conclusion The results of this study provide morphological and immunohistological information useful in the recognition of the different varieties of NHLs when involving the spleen and the differential diagnosis of SMZL.

Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging.

Abstract: Objective. To assess the diagnostic value of the relationship between subcutaneous tumors and the superficial fascia in the characterization of soft-tissue masses. Design. MR studies of 64 soft tissue masses located in the subcutaneous space were reviewed. We established five grades of relationship between tumors and superficial fascia and analyzed the probability of the lesions in each group being malignant. Group 1 tumors did not contact the fascia; group 2 lesions contacted it slightly, with acute angles between the tumor and the fascia; group 3 lesions had wider contact with larger acute or right angles; group 4 tumors had even wider contact with obtuse angles with the fascia; and group 5 was composed of lesions that crossed the superficial fascia. Results. The probability of a subcutaneous lesion that crosses the superficial fascia being malignant was 6.88 times greater than for lesions that did not cross the fascia. For lesions forming obtuse angles with the fascia the probability of malignancy was 6.3 times greater than that of tumors that did not present this sign. All histologically verified fascial infiltrations occurred in malignant lesions of groups 4 and 5. Conclusions. Malignant tumors of the subcutaneous compartment have a higher tendency to develop a close relationship with the fascia than benign lesions. Obtuse angles between superficial fascia and a subcutaneous mass or a lesion crossing the fascia strongly suggest malignancy.

Combined Effect of Age and Right Ventricular Involvement on Acute Inferior Myocardial Infarction Prognosis

Abstract: Background—In patients with acute inferior myocardial infarction (AIMI), right ventricular involvement (RVI) is one of the strongest predictors of in-hospital death. We hypothesized that the impact of RVI on AIMI prognosis depends on the patient’s age. Methods and Results—The in-hospital clinical outcome of 798 consecutive patients admitted to the coronary care unit within 48 hours of symptom onset with AIMI was analyzed according to patient age and to the presence of RVI diagnosed by ECG and/or echocardiographic criteria. The total incidence of RVI was 37%, and it increased as age advanced. Patients with RVI had a significantly higher incidence of major complications (45% versus 19%, P<0.0001) and a higher in-hospital mortality rate (22% versus 6%, P<0.0001). The prognostic effect of RVI was independent of sex, smoking, diabetes, shock on admission, left ventricular ejection fraction, and reperfusion therapy, all age-dependent predictors. A multivariate analysis showed a significant (P=0.03) interaction ...

Rhodococcus equi infection in transplant recipients: case report and review of the literature.

Abstract: Background. Rhodococcus equi is an opportunistic pathogen that usually causes infection in immunocompromised hosts, mainly human immunodeficiency virus-positive patients, yet solid organ transplant recipients may be affected as well. Infections in this group of patients have not been sufficiently analyzed. Methods. We report an R equi pneumonia in a heart transplant recipient and review another 11 cases. Results. Infection appeared a mean of 49 months (range 1-180) after transplantation. Lung was primarily involved in 10 cases (83.3%). The remaining two cases presented with a paravertebral abscess and a purulent pericarditis. Invasive techniques were necessary to reach the diagnosis in nine cases. One patient healed with surgical resection of the lesion; the remaining 11 received antimicrobial agents. Six of them required additional surgical treatment. Three patients died. Conclusions. Clinicians should consider R equi when evaluating a solid organ recipient with an asymptomatic lung nodule. Microbiology laboratories should be alerted in these cases because it could be mistaken for a contaminant diphtheroid and will not respond to the standard empirical therapy.

In Vitro Activity of the New Glycopeptide LY333328 against Multiply Resistant Gram-Positive Clinical Isolates

Abstract: The in vitro activity of LY333328 was compared with those of vancomycin and teicoplanin against 425 gram-positive clinical isolates, including a variety of multiply resistant strains. LY333328 at ≤4 μg/ml inhibited all microorganisms tested, including methicillin- and teicoplanin-resistant staphylococci, glycopeptide-resistant enterococci, penicillin- and multiply resistant pneumococci, and viridans and beta-hemolytic streptococci.

Pulmonary complications following orthotopic liver transplant.

Abstract: Pulmonary complications after orthotopic liver transplant (OLT) are frequent, involving high morbidity and mortality. We have determined the pulmonary complication incidence in 187 patients submitted to OLT at the General University Hospital “Gregorio Maranon” in the last 4 years, analyzing the type of infection, evolution, diagnostic and therapeutic measures and their influence on OLT mortality. A total of 120 patients had pulmonary complications, the most frequent being pleural effusion (61.94 %), pneumonia (43.36 %), and pneumothorax (11.5 %). Serious pulmonary hypertension was diagnosed by invasive methods in two patients at the time of surgery (unidentified before OLT); both died at early post postoperative times. Pleural effusion was noted in 70 patients, 31.42 % of them requiring thoracic tube drainage, complications developing in 22.72 %. Thirteen patients were diagnosed of pneumothorax, the most frequent etiologies being percutaneous liver biopsy, thoracic tube drainage for pleural effusion, and postoperative complications in 41.6, 33.3, and 23.3 %, respectively. Pneumonia was diagnosed in the 1st month after OLT in 45 patients. Tests to diagnose and identify the etiological agent were made in 71.1 % of diagnosed pneumonia patients, identification being obtained in 62.5 %. Telescope catheter culture identified the agent in 48 %, fiber optic bronchoscopy in 50 %, and lung or pleural biopsy in 100 %. Respiratory insufficiency was noted in 64 patients (34.22 % of transplanted patients). Factors involved in their development were pneumonia (42.18 %), graft dysfunction (39.06 %, pleural effusion (34.37 %), sepsis (28.18 %), and poor nutritional status (7.81 %). Fifty patients (41.66 %) died, pulmonary pathology being the determinant factor in 28.8 %. Patient mortality with respiratory insufficiency was greater, especially in those with three factors involved the development of respiratory insufficiency.

Transpyloric enteral feeding in critically ill children.

Abstract: Background: Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated. Methods: A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children. 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF. Results: The mean duration of TEF was 19.5 ± 26.8 days (range, 1-120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF. Conclusions: Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.

Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine.

Abstract: Povidone is a synthetic polymer mainly used as a dispersing or suspending agent for many pharmaceutical products. It is also used as a carrier for iodine. In many countries it is not mandatory its inclusion in drug labels so many adverse effects may be under diagnosed. Povidone-iodine used as a topical antiseptic solution may produce allergic contact dermatitis and irritation. Povidone, when systemically administered may deposit in tissues causing local lesions and pain. Three cases of immediate hypersensitivity to this agent have been reported. We present a patient who developed generalized urticaria and angioedema immediately after the first topical use of Betadine (povidone-iodine) on a right arm wound. The positive skin prick test to Betadine and povidone extract and the demonstration of serum specific IgE to povidone, confirmed an IgE-mediated hypersensitivity.

Resultados de la angioplastia primaria en pacientes con enfermedad multivaso

Abstract: Introduccion Entre los pacientes con infartoagudo de miocardio que son tratados mediante angioplastiaprimaria, aquellos con enfermedad multivasopresentan un peor pronostico. No obstante, noesta claro si este efecto se debe solo a una mayorprevalencia de shock cardiogenico o si la enfermedadmultivaso constituye un factor pronostico independiente. Objetivos Estudiar si la enfermedad multivasoconstituye o no un factor pronostico independienteen los pacientes con infarto agudo de miocardiotratados mediante angioplastia primaria, y en sucaso aclarar los mecanismos por los que la enfermedadmultivaso contribuye a una mayor mortalidaden estos pacientes. Pacientes y metodos Entre agosto de 1991 y octubrede 1996, 312 pacientes con infarto agudo demiocardio fueron tratados mediante angioplastiaprimaria en nuestro centro. La evolucion intrahospitalariade los pacientes con enfermedad multivasose comparo con la de los pacientes con enfermedadde un vaso. Resultados Los pacientes con enfermedad multivaso(n = 158; 51%) tenian mayor edad (64 ± 11frente a 61 ± 13 anos; p = 0,017) y mas frecuenciade diabetes (el 35 frente al 20%; p = 0,007), hipertension(el 54 frente al 39%; p = 0,012), infartoagudo de miocardio previo (el 29 frente al 5%; p Conclusiones En la poblacion de pacientes coninfarto agudo de miocardio tratados con angioplastiaprimaria, la enfermedad multivaso se asocia auna mayor mortalidad intrahospitalaria. Ello sedebe no solo a una mayor frecuencia de insuficienciacardiaca grave, sino que unas caracteristicas basalesde peor pronostico, una mayor incidencia dealgunas complicaciones y una mas frecuente necesidadde nueva revascularizacion pueden contribuir ala mayor mortalidad de estos pacientes.