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Por otro lado&#44; un 2-10&#37; de los casos con SCA son enviados a domicilio al considerarse que el DTA no era coronario&#44; siendo su pron&#243;stico peor que el de los identificados precozmente<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El reto diagn&#243;stico del DTA estriba en que su presentaci&#243;n&#44; exploraci&#243;n f&#237;sica y pruebas complementarias &#40;electrocardiograma &#91;ECG&#93; y biomarcadores s&#233;ricos&#41; son insuficientes para discernir si su origen es coronario&#46; Por ello se ha intentado obtener herramientas de predicci&#243;n cl&#237;nica basadas en escalas de puntuaci&#243;n que ayuden a reducir los errores diagn&#243;sticos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La mayor parte de las escalas&#44; como la <span class="elsevierStyleItalic">Thrombolysis in Myocardial Infarction</span> &#8211;TIMI&#8211; <span class="elsevierStyleItalic">score</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a>&#44; la <span class="elsevierStyleItalic">HEART score</span><a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a>&#44; la <span class="elsevierStyleItalic">Global Registry of Acute Coronary Events</span> &#8211;GRACE&#8211;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">8</span></a>&#44; la <span class="elsevierStyleItalic">Banach Score</span><a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">9</span></a> y la <span class="elsevierStyleItalic">Emergency Department Assessment of Chest Pain Score-Accelerated Diagnostic Protocol</span> &#40;EDACS-ADP&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">10</span></a>&#44; han sido dise&#241;adas para la estratificaci&#243;n del riesgo&#44; la predicci&#243;n de eventos cardiovasculares adversos y mortalidad&#44; o para decidir estrategias terap&#233;uticas iniciales en pacientes con SCA&#44; pero no se han validado como m&#233;todos diagn&#243;sticos&#46; Geleijnse et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a> &#40;anexo 1&#44; disponible en la web&#41; y&#44; m&#225;s recientemente&#44; Boubaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> investigaron nuevas escalas como ayuda cl&#237;nica para dilucidar el origen coronario o no coronario de un DTA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En nuestro pa&#237;s&#44; destacan los trabajos de Sanchis et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">13&#8211;16</span></a> sobre la valoraci&#243;n pron&#243;stica del riesgo coronario a largo plazo&#44; pero tampoco se dise&#241;aron para determinar la probabilidad de padecer un SCA en pacientes con DTA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo principal de este estudio fue obtener una escala de puntuaci&#243;n basada en variables cl&#237;nicas&#44; predictiva para el diagn&#243;stico de SCA y aplicable en pacientes que se presentan en el SUH con un DTA&#44; cuyo ECG y valores de troponina no confirmen el diagn&#243;stico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Dise&#241;o y poblaci&#243;n del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio de cohortes prospectivo sobre pacientes que acudieron a un SUH por DTA entre junio de 2013 y mayo de 2014&#46; Su selecci&#243;n se realiz&#243; mediante muestreo por lotes&#46; Cada lote incluy&#243; a todos los que de forma consecutiva consultaron por DTA &#40;excepto los traum&#225;ticos&#41; durante la jornada laboral de los investigadores participantes&#46; De estos&#44; se incluyeron aquellos con niveles de troponina normales y ECG no diagn&#243;stico &#40;trazado normal&#44; descenso de ST menor de 0&#44;5<span class="elsevierStyleHsp" style=""></span>mm o inversi&#243;n de la onda T asim&#233;trica en menos de 2 derivaciones contiguas&#41;&#46; Se excluyeron los pacientes que no dieron consentimiento&#44; aquellos con elevaci&#243;n de troponina seriada a las 0&#44; 6 y 12<span class="elsevierStyleHsp" style=""></span>h del inicio del dolor y los que ten&#237;an un ECG diagn&#243;stico &#40;elevaci&#243;n del ST en 2 o m&#225;s derivaciones contiguas&#44; bloqueo completo de rama izquierda desconocido&#44; descenso del segmento ST o inversi&#243;n din&#225;mica de la onda T<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">17</span></a>&#41;&#46; Se analizaron todos los ECG realizados a cada paciente&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables del estudio y definiciones b&#225;sicas</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables cl&#237;nicas incluidas en el estudio se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; a las que hay que a&#241;adir el resultado de la coronariograf&#237;a &#40;normal&#47;patol&#243;gica&#41;&#44; el pico m&#225;ximo de troponina <span class="elsevierStyleSmallCaps">I</span> convencional s&#233;rica a las 0&#44; 6 y 12<span class="elsevierStyleHsp" style=""></span>h del inicio del dolor &#40;negativa&#47;positiva&#41;&#44; la angiograf&#237;a coronaria por tomograf&#237;a computarizada &#40;angio-TC&#41; &#40;normal&#47;patol&#243;gica&#41;&#44; el grupo diagn&#243;stico final &#40;SCA&#47;no-SCA&#41; y el diagn&#243;stico etiol&#243;gico&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Los signos gestuales considerados correspond&#237;an a los 3 m&#225;s descritos<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">18&#44;19</span></a> asociados al DTA coronario&#44; aunque en estudios previos han mostrado una limitada validez diagn&#243;stica<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">20</span></a> para el diagn&#243;stico de SCA&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La variable cuantitativa &#171;edad&#187; fue recategorizada en funci&#243;n de la mediana de su distribuci&#243;n de datos&#46; La variable &#171;escala de Geleijnse&#187; fue categorizada en funci&#243;n del punto de corte establecido originalmente<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a>&#46; Los factores de riesgo cardiovascular se exponen en el anexo 2 &#40;disponible en la web&#41; y se consideraron seg&#250;n los est&#225;ndares internacionalmente establecidos<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">21&#8211;24</span></a>&#46; La coronariograf&#237;a se consider&#243; patol&#243;gica cuando se hall&#243; una lesi&#243;n obstructiva mayor del 50&#37; de la luz en vasos epic&#225;rdicos mayores de 2<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La troponina <span class="elsevierStyleSmallCaps">I</span> s&#233;rica se determin&#243; por quimioluminiscencia&#44; consider&#225;ndose positivo un valor mayor de 0&#44;30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;correspondiente al valor por encima del percentil 99 del l&#237;mite superior de referencia&#41;&#46; La angio-TC de arterias coronarias se realiz&#243; mediante una TC multidetector de 64 cortes utilizando contraste con Iopromida 370&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sistem&#225;tica de recogida de datos</span><p id="par0055" class="elsevierStylePara elsevierViewall">La recogida de variables cl&#237;nicas se llev&#243; a cabo por 5 m&#233;dicos del SUH en el primer contacto con el paciente&#46; Previamente fueron entrenados mediante series de concordancia sobre los mismos casos hasta que se consigui&#243; que el &#237;ndice Kappa fuera de al menos el 80&#37;&#46; Posteriormente&#44; 2 investigadores analizaron las pruebas complementarias para asignar el grupo diagn&#243;stico&#59; en caso de discrepancia&#44; un cardi&#243;logo experto decidi&#243; el diagn&#243;stico final&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La escala de Geleijnse<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a> la calcul&#243; un investigador independiente que desconoc&#237;a la base de datos del estudio&#46; El estudio fue aprobado por el Comit&#233; &#201;tico del centro hospitalario &#40;referencia 2221&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protocolo de estudio y seguimiento de los pacientes</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los pacientes fueron asignados a 2 grupos diagn&#243;sticos&#58; grupo SCA cuando se confirm&#243; el origen coronario y grupo no-SCA cuando se demostr&#243; otro origen&#46; La clasificaci&#243;n en origen coronario y la adscripci&#243;n a alguna de sus categor&#237;as &#40;angor estable&#47;inestable o infarto agudo de miocardio&#41; se realiz&#243; siguiendo los criterios vigentes basados en la cl&#237;nica&#44; el valor de troponina&#44; el ECG y los estudios de imagen &#40;angio-TC y coronariograf&#237;a&#41;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">26&#8211;31</span></a>&#46; El diagn&#243;stico de SCA fue definido por 2 m&#233;dicos de Urgencias y refrendado por un cardi&#243;logo experto&#44; en caso de discrepancia&#46; Los pacientes diagnosticados de angor hemodin&#225;mico se encuadraron en el grupo no-SCA&#44; salvo que hubiera evidencia de lesi&#243;n coronaria en las t&#233;cnicas de imagen&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se calcul&#243; el tama&#241;o muestral&#44; para la estimaci&#243;n de una proporci&#243;n en una poblaci&#243;n finita&#44; considerando que el 5&#37; de los pacientes asistidos en un SUH lo hacen por dolor tor&#225;cico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;250 en nuestro caso&#44; correspondiente a 125&#46;000 urgencias&#47;a&#241;o&#41; y que la proporci&#243;n de cardiopat&#237;a isqu&#233;mica en casos de dolor tor&#225;cico es del 10&#37;&#44; con una m&#225;xima imprecisi&#243;n aceptable de<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#37; y con un nivel de confianza en la estimaci&#243;n del 95&#37;&#46; El tama&#241;o muestral m&#237;nimo obtenido fue de 362 casos&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables se introdujeron en la aplicaci&#243;n inform&#225;tica <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> 17&#46;0 para Windows &#40;IBM SPSS Software&#41;&#46; Se realiz&#243; un estudio univariante utilizando una distribuci&#243;n de frecuencias absolutas y relativas para las variables cualitativas&#46; Las variables continuas se expresaron con la media aritm&#233;tica&#44; acompa&#241;adas de los intervalos de confianza del 95&#37; &#40;IC 95&#37;&#41;&#44; y se compararon mediante el test de la t de Student&#46; Para analizar la asociaci&#243;n de las variables cualitativas respecto a la variable dependiente &#171;grupo diagn&#243;stico final&#187; se utiliz&#243; la prueba de la chi<span class="elsevierStyleSup">2</span>&#44; de significaci&#243;n bilateral&#44; con prueba exacta de Fisher en su caso&#44; consider&#225;ndose significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Aquellas variables que en el estudio bivariante&#44; respecto a la variable dependiente &#171;grupo diagn&#243;stico final &#40;SCA&#47;no-SCA&#41;&#187;&#44; mostraron asociaci&#243;n estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; o casi significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41; y en las que&#44; adem&#225;s&#44; el sentido de la asociaci&#243;n ten&#237;a significaci&#243;n cl&#237;nica&#44; se introdujeron en un modelo de regresi&#243;n log&#237;stica para poder hallar los predictores independientes del diagn&#243;stico de SCA&#46; Las variables indicadoras <span class="elsevierStyleItalic">&#40;dummies&#41;</span> fueron construidas seg&#250;n el m&#233;todo parcial&#44; considerando como categor&#237;a de referencia aquella con menor asociaci&#243;n con la presencia de SCA&#46; La variable &#171;tipo de gesto&#187; realizado por el paciente con sus manos fue forzada a entrar en el modelo inicial porque se quer&#237;a explorar su influencia en el modelo multivariante&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El an&#225;lisis de regresi&#243;n log&#237;stica m&#250;ltiple se realiz&#243; inicialmente mediante el m&#233;todo &#171;paso a paso&#187; hacia delante <span class="elsevierStyleItalic">&#40;stepwise-forward&#41;</span> y posteriormente mediante el m&#233;todo de selecci&#243;n met&#243;dica <span class="elsevierStyleItalic">&#40;enter&#41;</span>&#44; determin&#225;ndose la posible existencia de variables de confusi&#243;n y las interacciones&#46; Se utiliz&#243; una probabilidad de entrada del modelo de 0&#44;25 y de salida de 0&#44;80&#46; La bondad de ajuste del modelo de regresi&#243;n log&#237;stica&#44; es decir&#44; la comparaci&#243;n entre los efectos observados y los predichos por el modelo predictivo hallado&#44; se valor&#243; mediante el test de Hosmer-Lemeshow&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Tras identificar los predictivos independientes del diagn&#243;stico de SCA&#44; se asign&#243; una puntuaci&#243;n a cada factor predictivo dividiendo el coeficiente de cada uno &#40;a partir del an&#225;lisis de regresi&#243;n log&#237;stica&#41; por el coeficiente de valor m&#225;s peque&#241;o&#59; despu&#233;s&#44; se redonde&#243; cada cociente al n&#250;mero entero m&#225;s cercano&#46; Finalmente&#44; sumando el n&#250;mero de puntos&#44; se calcul&#243; una puntuaci&#243;n de predicci&#243;n para cada paciente&#46; La validez diagn&#243;stica se midi&#243; mediante el c&#225;lculo de la sensibilidad&#44; la especificidad&#44; el valor predictivo positivo&#44; el valor predictivo negativo&#44; los cocientes de probabilidad o <span class="elsevierStyleItalic">likelihood ratio</span> positivo y negativo y el valor diagn&#243;stico global<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">32</span></a>&#44; con sus respectivos IC 95&#37;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Se calcul&#243; el &#225;rea bajo la curva <span class="elsevierStyleItalic">receiver operating characteristics</span>&#44; con sus correspondientes IC 95&#37;&#44; para valorar si la predicci&#243;n del modelo era mejor que la debida al puro azar y para la comparaci&#243;n entre modelos&#46; La comparaci&#243;n del &#225;rea bajo la curva ROC de cada grupo se realiz&#243; mediante el programa MedCalc Software versi&#243;n 17 &#40;Ostende&#44; B&#233;lgica&#41; por el m&#233;todo de DeLong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">34</span></a>&#44; y considerando un nivel de significaci&#243;n de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se considera un buen resultado cuando esta &#225;rea es de al menos el 80&#37;&#59; es decir&#44; que el 80&#37; de las parejas de casos as&#237; escogidas ser&#225;n correctamente clasificadas por el modelo<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">34</span></a>&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Fueron considerados inicialmente para el estudio 383 pacientes&#46; Las causas de exclusi&#243;n fueron&#58; troponina elevada &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#44; ECG anormal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; troponina elevada y ECG anormal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; y casos perdidos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La muestra final fue de 286 casos&#46; El diagn&#243;stico de SCA se confirm&#243; en 103 &#40;36&#37;&#41; casos &#40;27 catalogados como angor estable&#44; 66 inestables y 10 angor hemodin&#225;mico con lesiones coronarias demostradas&#41;&#44; constituyendo el grupo SCA&#59; y se descart&#243; en 183 &#40;64&#37;&#41;&#44; que conformaron el grupo no-SCA &#40;15 casos de origen cardiaco no coronario&#44; 19 de causa pulmonar&#44; 5 de etiolog&#237;a digestiva&#44; 24 musculoesquel&#233;tica&#44; 11 psic&#243;gena&#44; uno otorrinolaringol&#243;gica y 108 indeterminados&#41;&#46; La edad media global fue de 64&#44;15 a&#241;os &#40;IC 95&#37; 62&#44;43-65&#44;88&#41;&#59; de 70 a&#241;os &#40;IC 95&#37; 67&#44;7-72&#44;2&#41; en el grupo SCA y de 61 a&#241;os en el grupo no-SCA &#40;IC 95&#37; 58&#44;63-63&#44;16&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La mediana de edad de la muestra fue de 65 a&#241;os&#44; con un rango intercuart&#237;lico de 23&#46; La distribuci&#243;n de casos en funci&#243;n de las distintas variables &#40;global y por grupos diagn&#243;sticos&#41; se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; as&#237; como la significaci&#243;n estad&#237;stica del an&#225;lisis bivariante&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados del modelo final de regresi&#243;n log&#237;stica m&#250;ltiple obtenido se exponen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El an&#225;lisis multivariante identific&#243; los siguientes predictores independientes diagn&#243;sticos de SCA&#58; antecedentes personales de enfermedad coronaria&#44; dislipidemia y una puntuaci&#243;n en la escala de Geleijnse<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 puntos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; No hubo evidencia de falta de ajuste del modelo &#40;la bondad de ajuste medida por el estad&#237;stico chi<span class="elsevierStyleSup">2</span> de Pearson obtuvo una p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;29&#41;&#46; Seg&#250;n los coeficientes de regresi&#243;n log&#237;stica&#44; se asign&#243; la puntuaci&#243;n correspondiente a cada una de las variables que finalmente configuraron el modelo&#44; como se describi&#243; previamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Tras examinar las distintas puntuaciones de predicci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; el punto de corte &#243;ptimo fue de 5 puntos o superior para el modelo final&#44; debido a su mayor valor diagn&#243;stico global o precisi&#243;n diagn&#243;stica&#46; El &#225;rea bajo la curva ROC del modelo resultante fue de 0&#44;89 &#40;IC 95&#37; 0&#44;85-0&#44;93&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#41;&#46; Considerando independientemente la escala de Geleijnse como predictora &#250;nica de diagn&#243;stico de SCA&#44; su &#225;rea bajo la curva ROC fue de 0&#44;60 &#40;IC 95&#37; 0&#44;53-0&#44;66&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#41;&#46; Se observaron diferencias estad&#237;sticamente significativas al comparar ambas curvas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">El presente estudio propone una escala de valoraci&#243;n cl&#237;nica con un cociente de probabilidad positivo que permite su empleo en los SUH como ayuda diagn&#243;stica en pacientes que se presentan con DTA y con biomarcadores y ECG no concluyentes&#44; hecho que puede ocurrir hasta en un 33&#37; de los casos de SCA<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a>&#46; Uno de sus integrantes es la escala de Geleijnse<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a>&#44; a la que se a&#241;ade la presencia de antecedentes personales de coronariopat&#237;a y dislipidemia&#46; Estos 2 factores de riesgo son los que m&#225;s significaci&#243;n estad&#237;stica presentaron&#44; por encima de otros como el tabaquismo&#44; la diabetes o la hipertensi&#243;n arterial&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La validez diagn&#243;stica de la escala propuesta&#44; seg&#250;n el &#225;rea bajo la curva ROC&#44; fue superior a la escala de Geleijnse aislada &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#41;&#46; El punto de corte de 5 puntos en la escala que proponemos obtuvo un rendimiento suficiente para discernir si un paciente con DTA tiene o no un SCA &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; destacando una especificidad del 91&#44;8&#37; &#40;IC 95&#37; 87-95&#41; y un cociente de probabilidad positivo de 9&#44;36 &#40;IC 95&#37; 5&#44;70-15&#44;4&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La mayor parte de las escalas actuales tienen como objetivo la cuantificaci&#243;n del riesgo y la predicci&#243;n de eventos cardiovasculares adversos y mortalidad<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">6&#8211;10</span></a>&#44; y aunque su uso est&#225; consolidado en pacientes ya diagnosticados de SCA&#44; son menos los estudios que han investigado su utilidad para ayudar al cl&#237;nico a diferenciar si un DTA es o no un SCA<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">36&#8211;39</span></a>&#46; Adem&#225;s&#44; sus resultados no han sido validados o han demostrado una validez diagn&#243;stica insuficiente<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a>&#46; Recientemente&#44; Boubaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> exploraron este aspecto elaborando una escala de puntuaci&#243;n consistente en la suma de las puntuaciones de otras 2 escalas&#58; la TIMI <span class="elsevierStyleItalic">score</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a> y la de Geleijnse<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a>&#46; Obtuvieron un &#225;rea bajo la curva ROC de 0&#44;85 &#40;IC 95&#37; 0&#44;60-0&#44;90&#41;&#44; mientras que las &#225;reas bajo la curva ROC de las escalas originarias&#44; consideradas independientemente&#44; fueron de 0&#44;74 &#40;IC 95&#37; 0&#44;67-0&#44;81&#41; y de 0&#44;79 &#40;IC 95&#37; 0&#44;74-0&#44;84&#41;&#44; respectivamente&#46; La escala conjunta de Boubaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> obtuvo una sensibilidad del 92&#37;&#44; una especificidad del 62&#37; y un valor predictivo positivo del 23&#37;&#46; En comparaci&#243;n con nuestro estudio&#44; los resultados de estos autores son inferiores en cuanto a validez diagn&#243;stica&#44; a lo que se une la mayor complejidad derivada de la suma de 2 escalas diferentes<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La escala de Geleijnse<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">11</span></a> se basa exclusivamente en las caracter&#237;sticas del DTA sin considerar otros datos&#44; lo que limita su utilidad como instrumento diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a>&#46; Esto podr&#237;a explicar el bajo poder discriminativo que present&#243; en el estudio de Boubaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> y en el nuestro&#46; La mejora de la capacidad diagn&#243;stica en nuestro estudio puede explicarse por la inclusi&#243;n de elementos adicionales a las caracter&#237;sticas del DTA&#44; como los antecedentes personales de coronariopat&#237;a y dislipidemia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Con respecto a la escala HEART<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a>&#44; hay varios estudios que apoyan su utilizaci&#243;n en la toma de decisiones sobre pacientes con DTA en los SUH&#46; No obstante&#44; se trata de un sistema de puntuaci&#243;n que utiliza 5 &#237;tems m&#225;s complejos&#44; incluyendo biomarcadores de lesi&#243;n mioc&#225;rdica y alteraciones electrocardiogr&#225;ficas&#46; A pesar de ello&#44; no se comporta como una herramienta diagn&#243;stica&#44; ya que los pacientes siguen ingresando a pesar de obtener puntuaciones clasificadas como de bajo riesgo<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro estudio presenta algunas limitaciones&#46; Es unic&#233;ntrico&#44; realizado en un solo SUH y con un tama&#241;o muestral peque&#241;o &#40;menor del estimado como &#243;ptimo&#41;&#46; El muestreo por lotes probablemente deja fuera a pacientes elegibles que podr&#237;an o no tener el mismo perfil que los seleccionados en el estudio&#46; Otro posible sesgo es la asignaci&#243;n a grupos diagn&#243;sticos&#44; si bien el hecho de ser revisada por un cardi&#243;logo experto siguiendo los criterios definidos por las sociedades cient&#237;ficas minimiza el posible error&#46; Es posible que la recodificaci&#243;n de las variables usadas para construir el modelo predictivo haya influido en su capacidad predictiva de SCA&#44; sobreestimando algunos par&#225;metros&#44; aunque pensamos que ello no altera significativamente las conclusiones&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La escala de puntuaci&#243;n propuesta es superior a la escala de Geleijnse y m&#225;s f&#225;cil de aplicar que la de Boubaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a>&#44; si bien&#44; como en esta &#250;ltima&#44; se hace precisa una validaci&#243;n externa en una muestra diferente y procedente de diferentes centros para comprobar su aplicabilidad cl&#237;nica&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Si se considera que muchos pacientes con DTA y sospecha de SCA son ingresados en el hospital para la realizaci&#243;n de pruebas diagn&#243;sticas y que en otras ocasiones son remitidos indebidamente a su domicilio&#44; no hay duda de que una herramienta cl&#237;nica que disminuya estos riesgos ser&#237;a &#250;til en los SUH&#46; La escala propuesta contiene variables f&#225;ciles de adquirir en el momento de la consulta&#44; lo que es una condici&#243;n esencial para su aplicabilidad en la cl&#237;nica diaria&#46; Evidentemente&#44; estas herramientas son necesarias mientras en los SUH no se disponga de procedimientos diagn&#243;sticos m&#225;s innovadores&#44; como la angio-TC coronaria o la troponina ultrasensible&#44; que podr&#237;an ayudar a estratificar mejor el riesgo coronario en el futuro<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; se propone un modelo predictivo de SCA&#44; basado en variables puramente cl&#237;nicas&#44; con una validez diagn&#243;stica aceptable para decidir si un paciente con DTA que acude a un SUH con ECG y troponina s&#233;rica no concluyentes presenta un SCA&#46; Es obvio que su interpretaci&#243;n debe integrarse en el conjunto de datos de la historia cl&#237;nica&#44; sin desestimar otras escalas previas de riesgo ya contrastadas para la estimaci&#243;n pron&#243;stica&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Justificaci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome coronario agudo &#40;SCA&#41; requiere una mejora de la precisi&#243;n diagn&#243;stica mediante herramientas &#250;tiles&#44; seguras y f&#225;cilmente aplicables&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Obtener una escala de valoraci&#243;n para el diagn&#243;stico de SCA en pacientes con dolor tor&#225;cico y electrocardiograma y concentraciones de troponina no diagn&#243;sticas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo que incluy&#243; 286 pacientes atendidos en Urgencias por dolor tor&#225;cico&#44; con electrocardiograma y troponina normales&#46; Mediante regresi&#243;n log&#237;stica m&#250;ltiple se obtuvieron las variables independientes predictoras del diagn&#243;stico de SCA&#46; El poder discriminativo de la escala de valoraci&#243;n se evalu&#243; mediante el &#225;rea bajo la curva ROC&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El diagn&#243;stico de SCA se confirm&#243; en 103 pacientes &#40;36&#37;&#41;&#46; El modelo predictivo final incluy&#243; 3 variables&#58; antecedentes personales de enfermedad coronaria&#44; hiperlipidemia y una puntuaci&#243;n en la escala de Geleijnse<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 puntos&#46; El &#225;rea bajo la curva ROC para el modelo obtenido fue de 0&#44;90 &#40;intervalo de confianza al 95&#37; &#91;IC 95&#37;&#93; 0&#44;85-0&#44;93&#41;&#46; Un umbral de 5 puntos obtuvo una sensibilidad del 76&#44;7&#37; &#40;IC 95&#37; 68-84&#41;&#44; una especificidad del 91&#44;8&#37; &#40;IC 95&#37; 87-95&#41;&#44; un cociente de probabilidad positivo de 9&#44;36 &#40;IC 95&#37; 5&#44;70-15&#44;40&#41;&#44; un cociente de probabilidad negativo de 0&#44;25 &#40;18&#44;00-36&#44;00&#41; y una precisi&#243;n diagn&#243;stica global del 86&#44;4&#37; &#40;IC 95&#37; 82-90&#41;&#46;El modelo predictivo fue superior a la escala de Geleijnse aislada&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La escala de puntuaci&#243;n obtenida mostr&#243; una buena capacidad discriminativa para el diagn&#243;stico de SCA&#44; por lo que podr&#237;a ser de inter&#233;s para identificar el SCA en los servicios de Urgencias&#46; No obstante&#44; se precisa su validaci&#243;n mediante estudios multic&#233;ntricos m&#225;s amplios&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Rationale</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Acute coronary syndrome &#40;ACS&#41; requires improved diagnostic accuracy through useful&#44; safe and easy-to-apply tools&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To obtain an assessment scale for the diagnosis of ACS in patients with chest pain and nondiagnostic electrocardiogram and troponin concentrations&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study included 286 patients treated in the emergency department for chest pain&#44; with normal electrocardiogram and troponin levels&#46; Using multiple logistic regression&#44; we obtained the independent predictors for the diagnosis of ACS&#46; The assessment scale&#39;s discriminative power was assessed with the area under the ROC curve&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The diagnosis of ACS was confirmed in 103 patients &#40;36&#37;&#41;&#46; The final predictive model included 3 endpoints&#58; a history of coronary artery disease&#44; hyperlipidaemia and a score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 points on the Geleijnse scale&#46; The area under the ROC curve for the final model was 0&#46;90 &#40;95&#37; confidence interval &#91;95&#37; CI&#93; 0&#46;85-0&#46;93&#41;&#46; A threshold of 5 points achieved a sensitivity of 76&#46;7&#37; &#40;95&#37; CI 68-84&#41;&#44; a specificity of 91&#46;8&#37; &#40;95&#37; CI 87-95&#41;&#44; a positive likelihood ratio of 9&#46;36 &#40;95&#37; CI 5&#46;70-15&#46;40&#41;&#44; a negative likelihood ratio of 0&#46;25 &#40;95&#37; CI 18&#46;00-36&#46;00&#41; and an overall diagnostic accuracy of 86&#46;4&#37; &#40;95&#37; CI 82-90&#41;&#46; The predictive model was superior to the Geleijnse scale alone&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The final scale showed good discriminative capacity for diagnosing ACS and could therefore be of interest for identifying ACS in emergency departments&#46; Nevertheless&#44; the scale needs to be validated in larger multicentre studies&#46;</p></span>"
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                  <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="left" valign="top" scope="col">Variables&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">Pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grupos diagn&#243;sticos</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>286&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">SCA<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&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">No SCA<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>183&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">p&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  " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">145 &#40;50&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;36&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;58&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141 &#40;49&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;63&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;41&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sexo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132 &#40;46&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;43&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;47&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154 &#40;53&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;56&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;52&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes personales de cardiopat&#237;a isqu&#233;mica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;33&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;76&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;8&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes familiares de cardiopat&#237;a isqu&#233;mica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;18&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;26&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;14&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sobrepeso &#40;IMC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">25&#41; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">198 &#40;81&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;83&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126 &#40;80&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hipertensi&#243;n arterial &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">187 &#40;65&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;81&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">103 &#40;56&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes mellitus &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;25&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;35&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;19&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dislipidemia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152 &#40;53&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;76&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;39&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo activo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;24&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;19&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;27&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo pasivo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;13&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;11&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;15&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sedentarismo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;33&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;39&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;30&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;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  " align="left" valign="top"><span class="elsevierStyleItalic">Dolor tor&#225;cico presente en el momento de la entrevista &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99 &#40;34&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;18&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;43&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Primer episodio de dolor tor&#225;cico en su vida &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;38&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;8&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102 &#40;55&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de episodios &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Uno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">249 &#40;87&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 &#40;82&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#40;89&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>M&#225;s de uno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;12&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;17&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;10&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Forma de aparici&#243;n del dolor tor&#225;cico &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Reposo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250 &#40;87&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;84&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">163 &#40;89&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ejercicio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;12&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;10&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Expresi&#243;n verbal del dolor &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aplastante&#47;opresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">230 &#40;80&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86 &#40;83&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134 &#40;78&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;19&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;16&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;21&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Localizaci&#243;n del dolor &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Centrotor&#225;cico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">218 &#40;76&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;84&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">131 &#40;71&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otras localizaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;23&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;28&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Irradiaci&#243;n del dolor &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">163 &#40;57&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;59&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102 &#40;55&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Localizaci&#243;n de la irradiaci&#243;n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MSI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;26&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;26&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;26&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros o no irradiado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">211 &#40;73&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;73&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135 &#40;73&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Intensidad del dolor por EVA &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leve &#40;1-4 puntos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;20&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;20&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;20&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderado &#40;5-7 puntos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134 &#40;46&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;45&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;47&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intenso &#40;8-10 puntos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;32&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;34&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;32&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Presencia de s&#237;ntomas acompa&#241;antes &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;68&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;73&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119 &#40;65&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudoraci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114 &#40;39&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;53&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;32&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;ncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;1&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;29&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;32&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;27&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#225;useas o v&#243;mitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;24&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;29&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;21&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Escala de Geleijnse &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5 puntos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;19&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;6&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;26&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 puntos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">231 &#40;80&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;93&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135 &#40;73&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gestos de las manos &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gesto 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;11&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;12&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;10&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gesto 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171 &#40;59&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;61&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#40;57&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gesto 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;19&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;20&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;19&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;9&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;5&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;10&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n de las variables del estudio y resultados del an&#225;lisis uni y bivariante</p>"
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        "etiqueta" => "Tabla 2"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalos de confianza al 95&#37;&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#46;</span></p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Test de ajuste del modelo de Hosmer-Lemeshow&#46; &#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;99&#46; Valor de p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;29&#46;</p>"
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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="center" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Coeficiente de regresi&#243;n log&#237;stica &#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Error est&#225;ndar del coeficiente de regresi&#243;n log&#237;stica &#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p de Wald&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Significaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC 95&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Puntuaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</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  " align="center" valign="top">Antecedentes personales de enfermedad coronaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">3&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">80&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">30&#44;40 &#40;14&#44;40-64&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="center" valign="top">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">5&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">2&#44;40 &#40;1&#44;20-64&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="center" valign="top">Puntuaci&#243;n escala de Geleijnse<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 puntos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">1&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">10&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">6&#44;60 &#40;2&#44;12-20&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">A partir de los coeficientes de regresi&#243;n &#40;&#946;&#41; de las variables independientes introducidas en el modelo se puede obtener directamente la OR de cada una de ellas&#44; que corresponde al riesgo de tener el resultado o efecto evaluado para un determinado valor &#40;x&#41; respecto al valor disminuido en una unidad &#40;x<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#41; o&#44; en caso de variable cualitativa frente a la categor&#237;a complementaria &#40;ejemplo&#58; tener dislipidemia frente a no tener&#41;&#46;</p>"
            ]
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              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Cada coeficiente se dividi&#243; por 0&#44;90 y el cociente se redonde&#243; al n&#250;mero entero m&#225;s pr&#243;ximo para determinar el n&#250;mero de puntos asignado a cada predictor independiente&#46;</p>"
            ]
          ]
        ]
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Factores predictivos de s&#237;ndrome coronario agudo&#46; Resultados del modelo final del an&#225;lisis multivariante</p>"
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        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalo de confianza al 95&#37;&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#59;</span> SCA&#58; s&#237;ndrome coronario agudo&#46;</p>"
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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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Puntuaci&#243;n de predicci&#243;n de SCA&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">Pacientes con SCA&#47;total pacientes con esa puntuaci&#243;n de predicci&#243;n&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">Proporci&#243;n de SCA &#40;&#37;&#41;&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">OR &#40;IC 95&#37;&#41;&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">p&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  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11 &#40;0&#44;05-0&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#47;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;53 &#40;0&#44;29-0&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;40 &#40;1&#44;11-17&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#47;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;20 &#40;5&#44;30-101&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#47;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;00 &#40;8&#44;05-35&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Probabilidad de s&#237;ndrome coronario agudo seg&#250;n la puntuaci&#243;n observada en la totalidad de los pacientes estudiados</p>"
        ]
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalo de confianza al 95&#37;&#59; ROC&#58; <span class="elsevierStyleItalic">receiver operating characteristics&#59;</span> VPN&#58; valor predictivo negativo&#59; VPP&#58; valor predictivo positivo&#46;</p>"
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            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">&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">Escala de Geleijnse&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">Escala propuesta&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  " align="left" valign="top">Punto de corte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>5 puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">0&#44;30</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">11&#44;401</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nivel de significaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001</td></tr></tbody></table>
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de la validez diagn&#243;stica del s&#237;ndrome coronario agudo seg&#250;n la escala propia y la de Geleijnse</p>"
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            0 => array:3 [
              "identificador" => "bib0210"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dolor tor&#225;cico en urgencias&#58; frecuencia&#44; perfil cl&#237;nico y estratificaci&#243;n de riesgo"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "M&#46; Mart&#237;nez-Sell&#233;s"
                            1 => "H&#46; Bueno"
                            2 => "A&#46; Sacrist&#225;n"
                            3 => "A&#46; Est&#233;vez"
                            4 => "J&#46; Ortiz"
                            5 => "L&#46; Gallego"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Rev Esp Cardiol&#46;"
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                        "paginaInicial" => "953"
                        "paginaFinal" => "959"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18775237"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
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              ]
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            1 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La cardiopat&#237;a isqu&#233;mica en los servicios de urgencia hospitalarios&#46; Proyecto EVICURE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Garc&#237;a-Castrillo"
                            1 => "A&#46; Loma-Osorio"
                            2 => "E&#46; Recuerda"
                            3 => "P&#46; Mu&#241;oz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emergencias&#46;"
                        "fecha" => "2000"
                        "volumen" => "12"
                        "paginaInicial" => "183"
                        "paginaFinal" => "190"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagn&#243;stico de s&#237;ndrome coronario agudo en pacientes con dolor tor&#225;cico en urgencias&#58; &#191;cambios a la vista&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:3 [
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                            1 => "J&#46; Salamanca"
                            2 => "E&#46; Pozo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "paginaFinal" => "8"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29094819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0225"
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                    0 => array:2 [
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                            5 => "F&#46; Epelde"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "paginaInicial" => "391"
                        "paginaFinal" => "398"
                      ]
                    ]
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                    0 => array:2 [
                      "titulo" => "Manejo del s&#237;ndrome coronario agudo sin elevaci&#243;n del segmento ST en Espa&#241;a&#46; Estudio DESCARTES &#40;Descripci&#243;n del Estado de los S&#237;ndromes Coronarios Agudos en un Registro Temporal Espa&#241;ol&#41;"
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                            2 => "A&#46; Fern&#225;ndez-Ortiz"
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                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "244"
                        "paginaFinal" => "252"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15766446"
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                      "titulo" => "The TIMI risk score for unstable angina&#47;non-ST elevation MI&#58; A method for prognostication and therapeutic decision making"
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                            5 => "G&#46; Papuchis"
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                        ]
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                    ]
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                    0 => array:1 [
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                        "paginaFinal" => "842"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                      "titulo" => "Chest pain in the emergency room&#58; A multicenter validation of the HEART Score"
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                          "autores" => array:6 [
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                            2 => "J&#46;C&#46; Kelder"
                            3 => "T&#46;P&#46; Mast"
                            4 => "F&#46; van den Akker"
                            5 => "E&#46;G&#46; Mast"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HPC.0b013e3181ec36d8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Pathw Cardiol&#46;"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "164"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802272"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0140673605663787"
                          "estado" => "S300"
                          "issn" => "01406736"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0245"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome&#58; A prospective multinational observational study &#40;GRACE&#41;"
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                        0 => array:2 [
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                            3 => "K&#46;S&#46; Pieper"
                            4 => "K&#46;A&#46; Eagle"
                            5 => "F&#46; van de Werf"
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "2006"
                        "volumen" => "333"
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                        "paginaFinal" => "1094"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032691"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "9"
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                    0 => array:2 [
                      "titulo" => "Prospective comparison of the 5 most popular risk scores in clinical use for unselected patients with acute coronary syndrome&#58; Basis for design of the Banach score"
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                            4 => "R&#46; Glowczynska"
                            5 => "Z&#46; Huczek"
                          ]
                        ]
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                    ]
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                        "tituloSerie" => "Circ J&#46;"
                        "fecha" => "2011"
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                        "paginaInicial" => "167"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21071878"
                            "web" => "Medline"
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                  ]
                ]
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              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Development and validation of the Emergency Department Assessment of Chest pain Score and 2<span class="elsevierStyleHsp" style=""></span>h accelerated diagnostic protocol"
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                          "etal" => true
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                            4 => "P&#46; Glasziou"
                            5 => "J&#46; Kline"
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                      ]
                    ]
                  ]
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                ]
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                    0 => array:2 [
                      "titulo" => "Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram"
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                      "doi" => "10.1053/euhj.1999.1860"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10666354"
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new score for the diagnosis of acute coronary syndrome in acute chest pain with non-diagnostic ECG and normal troponin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Boubaker"
                            1 => "M&#46;H&#46; Grissa"
                            2 => "K&#46; Beltaief"
                            3 => "M&#46;H&#46; Amor"
                            4 => "Z&#46; Mdimagh"
                            5 => "A&#46; Boukhris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/emermed-2013-203151"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J&#46;"
                        "fecha" => "2015"
                        "volumen" => "32"
                        "paginaInicial" => "764"
                        "paginaFinal" => "768"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25560250"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0270"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Estratificaci&#243;n del riesgo de pacientes con dolor tor&#225;cico sin elevaci&#243;n del segmento ST en la puerta de urgencias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Sanchis"
                            1 => "V&#46; Bod&#237;"
                            2 => "A&#46; Ll&#225;cer"
                            3 => "L&#46; Facila"
                            4 => "M&#46; Pellicer"
                            5 => "V&#46; Bertomeu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2003"
                        "volumen" => "56"
                        "paginaInicial" => "955"
                        "paginaFinal" => "962"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New risk score for patients with acute chest pain&#44; non-ST-segment deviation&#44; and normal troponin concentrations&#46; A comparison with the TIMI risk score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Sanchis"
                            1 => "V&#46; Bod&#237;"
                            2 => "J&#46; N&#250;&#241;ez"
                            3 => "V&#46; Bertomeu-Gonz&#225;lez"
                            4 => "C&#46; G&#243;mez"
                            5 => "M&#46;J&#46; Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.04.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "443"
                        "paginaFinal" => "449"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16053956"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Limitations of clinical history for evaluation of patients with acute chest pain&#44; non-diagnostic electrocardiogram&#44; and normal troponin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Sanchis"
                            1 => "V&#46; Bod&#237;"
                            2 => "J&#46; N&#250;&#241;ez"
                            3 => "X&#46; Bosch"
                            4 => "M&#46; Heras"
                            5 => "C&#46; Bonanad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2007.10.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2008"
                        "volumen" => "101"
                        "paginaInicial" => "613"
                        "paginaFinal" => "617"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18308008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0285"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of pain presentation characteristics for predicting outcome in patients presenting to the hospital with chest pain of uncertain origin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Sanchis"
                            1 => "V&#46; Bod&#237;"
                            2 => "J&#46; Nu&#241;ez"
                            3 => "X&#46; Bosch"
                            4 => "M&#46; Heras"
                            5 => "C&#46; Bonanad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/emj.2010.098160"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J&#46;"
                        "fecha" => "2011"
                        "volumen" => "28"
                        "paginaInicial" => "847"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20844103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Part 10&#58; Acute coronary syndromes&#58; 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;E&#46; O&#8217;Connor"
                            1 => "W&#46; Brady"
                            2 => "S&#46;C&#46; Brooks"
                            3 => "D&#46; Diercks"
                            4 => "J&#46; Egan"
                            5 => "C&#46; Ghaemmaghami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.971028"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "numero" => "18 Suppl 3"
                        "paginaInicial" => "S787"
                        "paginaFinal" => "S817"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0295"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac chest pain&#58; does body language help the diagnosis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;M&#46; Edmondstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "1995"
                        "volumen" => "311"
                        "paginaInicial" => "1660"
                        "paginaFinal" => "1661"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8541748"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The utility of gestures in patients with chest discomfort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;M&#46; Marcus"
                            1 => "J&#46; Cohen"
                            2 => "P&#46;D&#46; Varosy"
                            3 => "J&#46; Vessey"
                            4 => "E&#46; Rose"
                            5 => "B&#46;M&#46; Massie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2006.05.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med&#46;"
                        "fecha" => "2007"
                        "volumen" => "120"
                        "paginaInicial" => "83"
                        "paginaFinal" => "89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17208083"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validez diagn&#243;stica del lenguaje de las manos en el diagn&#243;stico del dolor tor&#225;cico de origen coronario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Montero-P&#233;rez"
                            1 => "F&#46;B&#46; Quero-Espinosa"
                            2 => "M&#46;J&#46; Clemente-Mill&#225;n"
                            3 => "J&#46; de Burgos-Mar&#237;n"
                            4 => "J&#46;J&#46; Roig-Garc&#237;a"
                            5 => "J&#46;A&#46; Castro Gim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2017.02.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp&#46;"
                        "fecha" => "2017"
                        "volumen" => "217"
                        "paginaInicial" => "252"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28410822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; WHO report on the global tobacco epidemic&#44; 2015 &#91;consultado 23 Ene 2017&#93;&#46; Disponible en&#58; <a href="http://www.who.int/tobacco/global_report/2015/report/en/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;tobacco&#47;global&#95;report&#47;2015&#47;report&#47;en&#47;</a>"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Active and passive smoking are associated with increased carotid wall thickness&#46; The Atherosclerosis Risk in Communities Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Howard"
                            1 => "G&#46;L&#46; Burke"
                            2 => "M&#46; Szklo"
                            3 => "G&#46;S&#46; Tell"
                            4 => "J&#46; Eckfeldt"
                            5 => "G&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Intern Med&#46;"
                        "fecha" => "1994"
                        "volumen" => "154"
                        "paginaInicial" => "1277"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8203995"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673616323807"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a europea sobre prevenci&#243;n de la enfermedad cardiovascular en la pr&#225;ctica cl&#237;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Perk"
                            1 => "G&#46; de Backer"
                            2 => "H&#46; Gohlke"
                            3 => "I&#46; Graham"
                            4 => "Z&#46; Reiner"
                            5 => "M&#46; Verschuren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "937&#46;e1"
                        "paginaFinal" => "937&#46;e66"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization &#40;WHO&#41;&#46; Obesity and overweight &#91;consultado 23 Ene 2017&#93;&#46; Disponible en&#58; <a href="http://www.who.int/mediacentre/factsheets/fs311/es/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;mediacentre&#47;factsheets&#47;fs311&#47;es&#47;</a>"
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;H&#46; Piers"
                            1 => "R&#46; Dikkers"
                            2 => "T&#46;P&#46; Willems"
                            3 => "B&#46;J&#46; de Smet"
                            4 => "M&#46; Oudkerk"
                            5 => "F&#46; Zijlstra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn454"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "2902"
                        "paginaFinal" => "2907"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18854332"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Rivero Cuadrado A&#46; Codificaci&#243;n cl&#237;nica con la CIE-9-MC&#46; Unidad T&#233;cnica de la CIE-9-MC para el Sistema Nacional de Salud&#46; Tema monogr&#225;fico&#58; cardiopat&#237;a isqu&#233;mica&#46; Bolet&#237;n 5&#44; A&#241;o II&#46; Madrid&#58; Ministerio de Sanidad y Consumo&#59; 1996 &#91;consultado 23 Ene 2017&#93;&#46; Disponible en&#58; <a href="http://www.msssi.gob.es/estadEstudios/estadisticas/normalizacion/clasifEnferm/boletines/Codificacion_clinica_n05_96.pdf">http&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;estadEstudios&#47;estadisticas&#47;normalizacion&#47;clasifEnferm&#47;boletines&#47;Codificacion&#95;clinica&#95;n05&#95;96&#46;pdf</a>"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de consenso de expertos&#46; Tercera definici&#243;n universal del infarto de miocardio"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Thygesen"
                            1 => "J&#46;S&#46; Alpert"
                            2 => "A&#46;S&#46; Jaffe"
                            3 => "M&#46;L&#46; Simoons"
                            4 => "B&#46;R&#46; Chaitman"
                            5 => "H&#46;D&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2012.11.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2013"
                        "volumen" => "66"
                        "paginaInicial" => "132&#46;e1"
                        "paginaFinal" => "132&#46;e15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24776048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2012 ACCF&#47;AHA&#47;ACP&#47;AATS&#47;PCNA&#47;SCAI&#47;STS guideline for the diagnosis and management of patients with stable ischemic heart disease&#58; A report of the American College of Cardiology Foundation&#47;American Heart Association task force on practice guidelines&#44; and the American College of Physicians&#44; American Association for Thoracic Surgery&#44; Preventive Cardiovascular Nurses Association&#44; Society for Cardiovascular Angiography and Interventions&#44; and Society of Thoracic Surgeons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Fihn"
                            1 => "J&#46; Gardin"
                            2 => "J&#46; Abrams"
                            3 => "K&#46; Berra"
                            4 => "J&#46; Blankenship"
                            5 => "A&#46; Dallas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.07.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "e44"
                        "paginaFinal" => "e164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23182125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of ST-elevation myocardial infarction&#58; A report of the American College of Cardiology Foundation&#47;American Heart Association task force on practice guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; O&#8217;Gara"
                            1 => "F&#46; Kushner"
                            2 => "D&#46; Ascheim"
                            3 => "D&#46; Casey"
                            4 => "M&#46; Chung"
                            5 => "J&#46; de Lemos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.11.019"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "e78"
                        "paginaFinal" => "e140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23256914"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706026581"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation&#58; The task force for the management of acute coronary syndromes &#40;ACS&#41; in patients presenting without persistent ST-segment elevation of the European Society of Cardiology &#40;ESC&#41;"
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                            0 => "C&#46; Hamm"
                            1 => "J&#46;P&#46; Bassand"
                            2 => "S&#46; Agewall"
                            3 => "J&#46; Bax"
                            4 => "E&#46; Boersma"
                            5 => "H&#46; Bueno"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehr236"
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                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2011"
                        "volumen" => "32"
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                        "paginaFinal" => "3054"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21873419"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2012 ACCF&#47;AHA focused update incorporated into the ACCF&#47;AHA 2007 guidelines for the management of patients with unstable angina&#47;non-ST-elevation myocardial infarction&#58; A report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
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                          "etal" => true
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                            1 => "C&#46;D&#46; Adams"
                            2 => "E&#46;M&#46; Antman"
                            3 => "C&#46;R&#46; Bridges"
                            4 => "R&#46;M&#46; Califf"
                            5 => "D&#46;E&#46; Casey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.01.014"
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "e179"
                        "paginaFinal" => "e347"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23639841"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "An&#225;lisis e interpretaci&#243;n de un estudio en investigaci&#243;n cl&#237;nica"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "N&#46; del Prado"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "LibroEditado" => array:4 [
                        "titulo" => "Manual b&#225;sico para el urgenci&#243;logo investigador&#46; De la idea original a la publicaci&#243;n final"
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                  ]
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              ]
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                0 => array:3 [
                  "comentario" => "&#91;consultado 23 Ene 2017&#93;&#46; Disponible en&#58; <span class="elsevierStyleInterRef" id="intr0020" href="http://www.pedro.org.au/spanish/downloads/confidence-interval-calculator/">http&#58;&#47;&#47;www&#46;pedro&#46;org&#46;au&#47;spanish&#47;downloads&#47;confidence-interval-calculator&#47;</span>"
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                    0 => array:2 [
                      "titulo" => "Confidence interval calculator"
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                            0 => "R&#46; Herbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:2 [
                        "tituloSerie" => "Physiotherapy Evidence Database"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
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              "etiqueta" => "34"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Receiver Operating Characteristics &#40;ROC&#41; curve analysis for medical diagnostic test evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Hajian-Tilki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Caspian J Intern Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "4"
                        "paginaInicial" => "627"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24009950"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratado de Cardiolog&#237;a&#46; Texto de medicina cardiovascular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Bonow"
                            1 => "D&#46; Mann"
                            2 => "D&#46; Zipes"
                            3 => "P&#46; Libby"
                            4 => "E&#46; Braunwald"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "edicion" => "9&#46;a ed&#46;"
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                    0 => array:2 [
                      "titulo" => "Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;A&#46; Mahler"
                            1 => "B&#46;C&#46; Hiestand"
                            2 => "D&#46;C&#46; Goff Jr&#46;"
                            3 => "J&#46;W&#46; Hoekstra"
                            4 => "C&#46;D&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HPC.0b013e3182315a85"
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                        "tituloSerie" => "Crit Pathw Cardiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "128"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989033"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Prospective validation of artificial neural network trained to identify acute myocardial infarction"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;G&#46; Baxt"
                            1 => "J&#46; Skora"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
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                        "paginaInicial" => "12"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8531540"
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                          ]
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                  ]
                ]
              ]
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                      "titulo" => "A computer protocol to predict myocardial infarction in emergency department patients with chest pain"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Goldman"
                            1 => "E&#46;F&#46; Cook"
                            2 => "D&#46;A&#46; Brand"
                            3 => "T&#46;H&#46; Lee"
                            4 => "G&#46;W&#46; Rouan"
                            5 => "M&#46;C&#46; Weisberg"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "doi" => "10.1056/NEJM198803313181301"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "1988"
                        "volumen" => "318"
                        "paginaInicial" => "797"
                        "paginaFinal" => "803"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3280998"
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                          "issn" => "00029378"
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                  ]
                ]
              ]
            ]
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                      "titulo" => "Standardized use of simple criteria from case history improves selection of patients for cardiac-care unit &#40;CCU&#41; admission"
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                          "etal" => false
                          "autores" => array:4 [
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                            2 => "O&#46; Aase"
                            3 => "J&#46; Erikssen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intern Med&#46;"
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                        "paginaInicial" => "299"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1402632"
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                  ]
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                      "titulo" => "Effect of using the HEART score in patients with chest pain in the Emergency Department&#58; A stepped-wedge&#44; cluster randomized trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46;B&#46; Reitsma"
                            2 => "B&#46;E&#46; Backus"
                            3 => "H&#46; Koffijberg"
                            4 => "R&#46;F&#46; Veldkamp"
                            5 => "M&#46;E&#46; Ten Haaf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/M16-1600"
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                        "tituloSerie" => "Ann Intern Med&#46;"
                        "fecha" => "2017"
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                        "paginaInicial" => "689"
                        "paginaFinal" => "697"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28437795"
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                          ]
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                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection&#58; A collaborative meta-analysis"
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                          "etal" => true
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                            4 => "E&#46; Ter Avest"
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                        ]
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