array:26 [
  "pii" => "S2174204918302034"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2018.06.002"
  "estado" => "S300"
  "fechaPublicacion" => "2018-06-01"
  "aid" => "1233"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2018;37:489-90"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1545
    "formatos" => array:3 [
      "EPUB" => 121
      "HTML" => 1123
      "PDF" => 301
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0870255117307941"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2018.03.010"
      "estado" => "S300"
      "fechaPublicacion" => "2018-06-01"
      "aid" => "1223"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2018;37:457-66"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2201
        "formatos" => array:3 [
          "EPUB" => 151
          "HTML" => 1623
          "PDF" => 427
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Awareness of Fabry disease in cardiology&#58; A gap to be filled"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "457"
            "paginaFinal" => "466"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Perce&#231;&#227;o da doen&#231;a de Fabry em cardiologia&#58; uma lacuna a preencher"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => 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" => 1923
                "Ancho" => 2167
                "Tamanyo" => 157891
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of selection of index patients and division into groups for analysis and comparisons&#46; <span class="elsevierStyleSup">a</span> See text for details&#46; <span class="elsevierStyleSup">b</span> Genetic test&#58; positive&#47;negative&#58; identification&#47;non-identification of pathogenic or likely pathogenic mutation&#40;s&#41; in sarcomeric genes encoding beta-myosin heavy chain &#40;<span class="elsevierStyleItalic">MYH7</span>&#41;&#44; myosin-binding protein C &#40;<span class="elsevierStyleItalic">MYBPC3</span>&#41;&#44; cardiac troponin I and T &#40;<span class="elsevierStyleItalic">TNNI3</span> and <span class="elsevierStyleItalic">TNNT2</span>&#41;&#44; tropomyosin alpha-1 chain &#40;<span class="elsevierStyleItalic">TPM1</span>&#41;&#44; myosin light chain 3 &#40;<span class="elsevierStyleItalic">MYL3</span>&#41;&#44; myosin regulatory light chain 2 &#40;<span class="elsevierStyleItalic">MYL2</span>&#41;&#44; alpha cardiac actin &#40;<span class="elsevierStyleItalic">ACTC1</span>&#41;&#44; and muscle LIM protein &#40;<span class="elsevierStyleItalic">CSRP3</span>&#41;&#46; PRo-HCM&#58; Portuguese Registry of Hypertrophic Cardiomyopathy&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Dulce Brito, Nuno Cardim, Lu&#237;s Rocha Lopes, Adriana Belo, Jorge Mimoso, Lino Gon&#231;alves, Hugo Madeira"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Dulce"
                "apellidos" => "Brito"
              ]
              1 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Cardim"
              ]
              2 => array:2 [
                "nombre" => "Lu&#237;s Rocha"
                "apellidos" => "Lopes"
              ]
              3 => array:2 [
                "nombre" => "Adriana"
                "apellidos" => "Belo"
              ]
              4 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Mimoso"
              ]
              5 => array:2 [
                "nombre" => "Lino"
                "apellidos" => "Gon&#231;alves"
              ]
              6 => array:2 [
                "nombre" => "Hugo"
                "apellidos" => "Madeira"
              ]
              7 => array:1 [
                "colaborador" => "on behalf of the Portuguese Registry of Hypertrophic Cardiomyopathy &#40;PRo-HCM&#41; Investigators"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204918302034"
          "doi" => "10.1016/j.repce.2018.06.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302034?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307941?idApp=UINPBA00004E"
      "url" => "/08702551/0000003700000006/v2_201806270452/S0870255117307941/v2_201806270452/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204918302046"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2017.09.021"
    "estado" => "S300"
    "fechaPublicacion" => "2018-06-01"
    "aid" => "1215"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2018;37:491-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1836
      "formatos" => array:3 [
        "EPUB" => 126
        "HTML" => 1395
        "PDF" => 315
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Is the PARADIGM-HF cohort representative of the real-world heart failure patient population&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "491"
          "paginaFinal" => "496"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Ser&#225; a coorte do PARADIGM-HF representativa da popula&#231;&#227;o do mundo real de doentes com insufici&#234;ncia card&#237;aca&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => 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" => 801
              "Ancho" => 2170
              "Tamanyo" => 59969
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to number of unfulfilled eligibility criteria &#40;A&#41; and number of ineligibility criteria present &#40;B&#41; for treatment with sacubitril&#47;valsartan according to PARADIGM-HF&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gustavo Rodrigues, Ant&#243;nio Tralh&#227;o, Carlos Aguiar, Pedro Freitas, Ant&#243;nio Ventosa, Miguel Mendes"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Gustavo"
              "apellidos" => "Rodrigues"
            ]
            1 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Tralh&#227;o"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Aguiar"
            ]
            3 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Freitas"
            ]
            4 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Ventosa"
            ]
            5 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Mendes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255117302068"
        "doi" => "10.1016/j.repc.2017.09.023"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117302068?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302046?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302046/v3_201807150625/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204918302022"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2017.07.012"
    "estado" => "S300"
    "fechaPublicacion" => "2018-06-01"
    "aid" => "1232"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2018;37:481-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2524
      "formatos" => array:3 [
        "EPUB" => 122
        "HTML" => 2055
        "PDF" => 347
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Modified shock index&#58; A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "481"
          "paginaFinal" => "488"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "&#205;ndice de choque modificado&#58; um &#237;ndice cl&#237;nico simples para estratifica&#231;&#227;o de risco nos doentes admitidos com enfarte com supradesnivelamento do segmento ST"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => 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" => 1419
              "Ancho" => 1519
              "Tamanyo" => 101995
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patient selection&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gl&#243;ria Abreu, Pedro Azevedo, Carlos Galv&#227;o Braga, Catarina Vieira, Miguel &#193;lvares Pereira, Juliana Martins, Carina Arantes, Catarina Rodrigues, Alberto Salgado, Jorge Marques"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Gl&#243;ria"
              "apellidos" => "Abreu"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Azevedo"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Galv&#227;o Braga"
            ]
            3 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "Vieira"
            ]
            4 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "&#193;lvares Pereira"
            ]
            5 => array:2 [
              "nombre" => "Juliana"
              "apellidos" => "Martins"
            ]
            6 => array:2 [
              "nombre" => "Carina"
              "apellidos" => "Arantes"
            ]
            7 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "Rodrigues"
            ]
            8 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Salgado"
            ]
            9 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Marques"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255117301993"
        "doi" => "10.1016/j.repc.2017.07.018"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301993?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302022?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302022/v3_201807150625/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S2174204918302022"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2017.07.012"
      "estado" => "S300"
      "fechaPublicacion" => "2018-06-01"
      "aid" => "1232"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2018;37:481-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2524
        "formatos" => array:3 [
          "EPUB" => 122
          "HTML" => 2055
          "PDF" => 347
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Modified shock index&#58; A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "481"
            "paginaFinal" => "488"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "&#205;ndice de choque modificado&#58; um &#237;ndice cl&#237;nico simples para estratifica&#231;&#227;o de risco nos doentes admitidos com enfarte com supradesnivelamento do segmento ST"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => 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" => 1419
                "Ancho" => 1519
                "Tamanyo" => 101995
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patient selection&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Gl&#243;ria Abreu, Pedro Azevedo, Carlos Galv&#227;o Braga, Catarina Vieira, Miguel &#193;lvares Pereira, Juliana Martins, Carina Arantes, Catarina Rodrigues, Alberto Salgado, Jorge Marques"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "Gl&#243;ria"
                "apellidos" => "Abreu"
              ]
              1 => array:2 [
                "nombre" => "Pedro"
                "apellidos" => "Azevedo"
              ]
              2 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Galv&#227;o Braga"
              ]
              3 => array:2 [
                "nombre" => "Catarina"
                "apellidos" => "Vieira"
              ]
              4 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "&#193;lvares Pereira"
              ]
              5 => array:2 [
                "nombre" => "Juliana"
                "apellidos" => "Martins"
              ]
              6 => array:2 [
                "nombre" => "Carina"
                "apellidos" => "Arantes"
              ]
              7 => array:2 [
                "nombre" => "Catarina"
                "apellidos" => "Rodrigues"
              ]
              8 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Salgado"
              ]
              9 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Marques"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255117301993"
          "doi" => "10.1016/j.repc.2017.07.018"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301993?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302022?idApp=UINPBA00004E"
      "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302022/v3_201807150625/en/main.assets"
    ]
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "Cardiogenic shock in acute myocardial infarction&#58; Stratify to prevent"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "489"
        "paginaFinal" => "490"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Ant&#243;nio Jos&#233; Fiarresga"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Ant&#243;nio Jos&#233;"
            "apellidos" => "Fiarresga"
            "email" => array:1 [
              0 => "a&#46;fiarresga&#64;gmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Hospital de Santa Marta&#44; CHLC&#44; Lisboa&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Choque cardiog&#233;nico no enfarte agudo do mioc&#225;rdio&#58; estratificar para prevenir"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiogenic shock &#40;CS&#41; is defined as persistent hypotension &#40;systolic blood pressure &#60;90 mmHg&#41; secondary to myocardial dysfunction&#44; associated with signs of organ hypoperfusion&#46; CS may be present in 10&#37; of patients with ST-segment elevation myocardial infarction &#40;STEMI&#41; and is associated with 30-day mortality of about 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In the majority of STEMI patients&#44; hemodynamic deterioration occurs after hospital admission&#44; which means that there may be room for preventive measures and highlights the importance of early recognition of those most likely to evolve to CS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Scores such as Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications &#40;CADILLAC&#41;&#44; Thrombolysis in Myocardial Infarction &#40;TIMI&#41;&#44; the Global Registry of Acute Coronary Events &#40;GRACE&#41; and the Zwolle risk score are used to stratify patients and enable the adoption of different levels of clinical monitoring&#44; therapeutic care and post-discharge strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; the search for simpler and more accurate scores has continued&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The shock index &#40;SI&#41; is defined as the ratio of heart rate to systolic blood pressure&#44; and was introduced in 1967 by Allgower and Burri to assess the degree of hypovolemia in hemorrhagic or infectious shock states&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The SI&#44; which is easy to calculate&#44; is an objective measure of cardiovascular performance and a marker for predicting the onset of hypotension&#46; Assessment of SI in the context of acute myocardial infarction was only used more recently&#44; and a first meta-analysis&#44; of eight studies enrolling 20<span class="elsevierStyleHsp" style=""></span>404 patients&#44; was published last year&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> A high SI was associated with increased in-hospital mortality and higher risk of short- and long-term adverse outcomes compared to low SI&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">An important limitation of SI is the lack of information about systemic vascular resistance status&#46; Mean arterial pressure &#40;incorporating both systolic and diastolic blood pressure&#41; best represents tissue perfusion status&#46; The modified shock index &#40;MSI&#41;&#44; which is the ratio of heart rate to mean arterial pressure&#44; has been shown to be a better predictor of mortality than heart rate&#44; systolic blood pressure&#44; diastolic blood pressure and SI alone in trauma patients&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Shangguan et al&#46; were the first to assess the predictive value of MSI in the context of STEMI&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In a retrospective study of 160 consecutive patients&#44; they found that MSI &#8805;1&#46;4&#44; assessed in the emergency department&#44; was an independent factor for major adverse cardiac events and seven-day all-cause mortality&#44; with a stronger association than SI&#46; Yu et al&#46; retrospectively studied 1864 STEMI patients undergoing primary coronary angioplasty to assess whether admission age SI &#40;age multiplied by SI&#41; and MSI were useful clinical parameters to predict long-term prognosis&#44; with both showing good prognostic performance&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The cutoff value of MSI for the prediction of all-cause mortality was 0&#46;71&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the Journal&#44; Abreu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> assess the prognostic value of MSI to predict six-month mortality in a large retrospective observational study of 1158 STEMI patients without cardiogenic shock on admission&#46; They found that MSI &#8805;0&#46;93 was present in about a quarter of the patients and was associated with worse in-hospital clinical course&#46; Adverse events&#44; acute heart failure and cardiogenic shock were significantly more frequent in this subgroup&#46; MSI was also an independent predictor of overall six-month mortality&#46; The cutoff of 0&#46;93 identified by the authors is between those in the above studies&#44; which presumably reflects methodological differences&#44; such as population selection and the timing and method for assessing hemodynamic parameters&#46; However&#44; their approach of using MSI in patients with no shock at admission&#44; and assessing heart rate and blood pressure in the hemodynamic laboratory&#44; seems to be the most appropriate and practical way to apply this index in clinical practice&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Their study has limitations&#44; some of which are acknowledged by the authors&#44; including its single-center and retrospective design&#44; the lack of a control group to effectively test their hypothesis&#44; and the lack of comparison with other hemodynamic indices or risk scores&#46; Nevertheless&#44; the authors should be congratulated for their important contribution to an issue that is still poorly defined and that needs further investigation&#44; since a simple risk stratification of these patients remains an unmet clinical need&#46; They have paved the way for future studies that may validate this strategy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ESC Scientific Document Group&#46; 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation&#58; the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology &#40;ESC&#41;"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Ibanez"
                            1 => "S&#46; James"
                            2 => "S&#46; Agewall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi093"
                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15637085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of cardiogenic shock in acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Khalid"
                            1 => "S&#46; Dhakam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2174/157340308783565456"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Cardiol Rev"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "paginaInicial" => "34"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19924275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Tralh&#227;o"
                            1 => "A&#46;M&#46; Ferreira"
                            2 => "S&#46; Madeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2015.04.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "535"
                        "paginaFinal" => "541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26297630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "GRACE&#44; TIMI Zwolle and CADILLAC risk scores &#8211; do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Kozieradzka"
                            1 => "K&#46;A&#46; Kami&#324;ski"
                            2 => "D&#46; Maciorkowska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2009.10.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "148"
                        "paginaInicial" => "70"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19923016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Shock index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Allgower"
                            1 => "C&#46; Burri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0028-1106070"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dtsch Med Wochenschr"
                        "fecha" => "1967"
                        "volumen" => "92"
                        "paginaInicial" => "1947"
                        "paginaFinal" => "1950"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5299769"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prognostic value of shock index for the outcomes of acute myocardial infarction patients&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "X&#46; Zhang"
                            1 => "Z&#46; Wang"
                            2 => "Z&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2017"
                        "volumen" => "96"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation of shock index and modified shock index with the outcome of adult trauma patients&#58; a prospective study of 9860 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Singh"
                            1 => "S&#46; Ali"
                            2 => "A&#46; Agarwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1947-2714.141632"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Am J Med Sci"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "paginaInicial" => "450"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25317389"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modified shock index is a predictor for 7-day outcomes in patients with STEMI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Q&#46; Shangguan"
                            1 => "J&#46;S&#46; Xu"
                            2 => "H&#46; Su"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2015.04.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "1072"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25983270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age shock index is superior to shock index and modified shock index for predicting long-term prognosis in acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Yu"
                            1 => "C&#46; Tian"
                            2 => "J&#46; Song"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SHK.0000000000000892"
                      "Revista" => array:6 [
                        "tituloSerie" => "Shock"
                        "fecha" => "2017"
                        "volumen" => "48"
                        "paginaInicial" => "545"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28481840"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modified shock index&#58; a bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Abreu"
                            1 => "P&#46; Azevedo"
                            2 => "P&#46;G&#46; Braga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2017.07.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2018"
                        "volumen" => "37"
                        "paginaInicial" => "481"
                        "paginaFinal" => "488"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29807676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302034/v3_201807150625/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000006/v3_201807150625/S2174204918302034/v3_201807150625/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302034?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 37. Issue 6.
Pages 489-490 (June 2018)
Share
Share
Download PDF
More article options
Vol. 37. Issue 6.
Pages 489-490 (June 2018)
Editorial comment
Open Access
Cardiogenic shock in acute myocardial infarction: Stratify to prevent
Choque cardiogénico no enfarte agudo do miocárdio: estratificar para prevenir
Visits
4640
António José Fiarresga
Serviço de Cardiologia, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Related content
Glória Abreu, Pedro Azevedo, Carlos Galvão Braga, Catarina Vieira, Miguel Álvares Pereira, Juliana Martins, Carina Arantes, Catarina Rodrigues, Alberto Salgado, Jorge Marques
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

Cardiogenic shock (CS) is defined as persistent hypotension (systolic blood pressure <90 mmHg) secondary to myocardial dysfunction, associated with signs of organ hypoperfusion. CS may be present in 10% of patients with ST-segment elevation myocardial infarction (STEMI) and is associated with 30-day mortality of about 50%.1 In the majority of STEMI patients, hemodynamic deterioration occurs after hospital admission, which means that there may be room for preventive measures and highlights the importance of early recognition of those most likely to evolve to CS.2

Scores such as Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Thrombolysis in Myocardial Infarction (TIMI), the Global Registry of Acute Coronary Events (GRACE) and the Zwolle risk score are used to stratify patients and enable the adoption of different levels of clinical monitoring, therapeutic care and post-discharge strategies.3,4 However, the search for simpler and more accurate scores has continued.

The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure, and was introduced in 1967 by Allgower and Burri to assess the degree of hypovolemia in hemorrhagic or infectious shock states.5 The SI, which is easy to calculate, is an objective measure of cardiovascular performance and a marker for predicting the onset of hypotension. Assessment of SI in the context of acute myocardial infarction was only used more recently, and a first meta-analysis, of eight studies enrolling 20404 patients, was published last year.6 A high SI was associated with increased in-hospital mortality and higher risk of short- and long-term adverse outcomes compared to low SI.

An important limitation of SI is the lack of information about systemic vascular resistance status. Mean arterial pressure (incorporating both systolic and diastolic blood pressure) best represents tissue perfusion status. The modified shock index (MSI), which is the ratio of heart rate to mean arterial pressure, has been shown to be a better predictor of mortality than heart rate, systolic blood pressure, diastolic blood pressure and SI alone in trauma patients.7

Shangguan et al. were the first to assess the predictive value of MSI in the context of STEMI.8 In a retrospective study of 160 consecutive patients, they found that MSI ≥1.4, assessed in the emergency department, was an independent factor for major adverse cardiac events and seven-day all-cause mortality, with a stronger association than SI. Yu et al. retrospectively studied 1864 STEMI patients undergoing primary coronary angioplasty to assess whether admission age SI (age multiplied by SI) and MSI were useful clinical parameters to predict long-term prognosis, with both showing good prognostic performance.9 The cutoff value of MSI for the prediction of all-cause mortality was 0.71.

In this issue of the Journal, Abreu et al.10 assess the prognostic value of MSI to predict six-month mortality in a large retrospective observational study of 1158 STEMI patients without cardiogenic shock on admission. They found that MSI ≥0.93 was present in about a quarter of the patients and was associated with worse in-hospital clinical course. Adverse events, acute heart failure and cardiogenic shock were significantly more frequent in this subgroup. MSI was also an independent predictor of overall six-month mortality. The cutoff of 0.93 identified by the authors is between those in the above studies, which presumably reflects methodological differences, such as population selection and the timing and method for assessing hemodynamic parameters. However, their approach of using MSI in patients with no shock at admission, and assessing heart rate and blood pressure in the hemodynamic laboratory, seems to be the most appropriate and practical way to apply this index in clinical practice.

Their study has limitations, some of which are acknowledged by the authors, including its single-center and retrospective design, the lack of a control group to effectively test their hypothesis, and the lack of comparison with other hemodynamic indices or risk scores. Nevertheless, the authors should be congratulated for their important contribution to an issue that is still poorly defined and that needs further investigation, since a simple risk stratification of these patients remains an unmet clinical need. They have paved the way for future studies that may validate this strategy.

Conflicts of interest

The author has no conflicts of interest to declare.

References
[1]
B. Ibanez, S. James, S. Agewall, ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC), et al.
[2]
L. Khalid, S. Dhakam.
A review of cardiogenic shock in acute myocardial infarction.
Curr Cardiol Rev, 4 (2008), pp. 34-40
[3]
A. Tralhão, A.M. Ferreira, S. Madeira, et al.
Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.
Rev Port Cardiol, 34 (2015), pp. 535-541
[4]
A. Kozieradzka, K.A. Kamiński, D. Maciorkowska, et al.
GRACE, TIMI Zwolle and CADILLAC risk scores – do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively?.
Int J Cardiol, 148 (2011), pp. 70-75
[5]
M. Allgower, C. Burri.
Shock index.
Dtsch Med Wochenschr, 92 (1967), pp. 1947-1950
[6]
X. Zhang, Z. Wang, Z. Wang, et al.
The prognostic value of shock index for the outcomes of acute myocardial infarction patients: a systematic review and meta-analysis.
Medicine (Baltimore), 96 (2017),
[7]
A. Singh, S. Ali, A. Agarwal, et al.
Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients.
N Am J Med Sci, 6 (2014), pp. 450-452
[8]
Q. Shangguan, J.S. Xu, H. Su, et al.
Modified shock index is a predictor for 7-day outcomes in patients with STEMI.
Am J Emerg Med, 33 (2015), pp. 1072-1075
[9]
T. Yu, C. Tian, J. Song, et al.
Age shock index is superior to shock index and modified shock index for predicting long-term prognosis in acute myocardial infarction.
[10]
G. Abreu, P. Azevedo, P.G. Braga.
Modified shock index: a bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation.
Rev Port Cardiol, 37 (2018), pp. 481-488
Copyright © 2018. Sociedade Portuguesa de Cardiologia
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.