Comparison of prognostic risk scores after successful primary percutaneous coronary intervention.

BACKGROUND: The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with ST-segment elevation acute myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (pPCI). METHODS: A total of 685 patients successfully treated with pPCI were evaluated and the risk scores were calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE. RESULTS: Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p<0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p<0.05). EuroSCORE II conferred incremental discrimination (Harrell's C, p<0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p<0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for study's main endpoints. EuroSCORE II independently predicted CVD (HR=1.06, 95% CIs: 1.03-1.09, p<0.001) and MACE (HR=1.07, 95% CIs: 1.04-1.10, p<0.001). CONCLUSION: EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI.

Cancer cachexia: global awareness and guideline implementation on the web.

BACKGROUND: Cancer cachexia is a common associate of cancer and has a negative impact on patients' survival. Nonetheless, cancer cachexia assessment and management are frequently less than satisfactory in daily practice. AIM: To scrutinise global cancer cachexia awareness and relative web guideline implementation among oncology societies. METHODS: Systematical identification of scientific and policymaker oncology societies and their guideline implementation on cancer cachexia. Assessment of the general level of awareness on cancer cachexia and evaluation of intercontinental and national variations on guideline implementation. RESULTS: 144,000 web pages were scrutinised, and 275 oncology societies identified covering a large array of oncology setting (educational/clinical/research/policymaker); 71 were international (African, American, Asian, European, Oceania and Intercontinental), 110 belonged to the top 10 countries with the highest development index and 94 pertained to 10 countries with a long lasting tradition in medical oncology (not included in the top 10 high developed countries). Overall, only 10/275 web sites provided guidelines; six of them (2.2%) provided guidelines for physicians and four (0.7%) for patients. Half of the guidelines (4/10) were outdated. All guidelines for physicians reported references, while only one of the recommendations for patients reported references to support its sentences. CONCLUSIONS: Cancer cachexia global awareness appears extremely low; guideline implementation on the web was inconsistent for any category analysed (nation vs continent vs international vs society type vs physician vs patient oriented) and for updating.

Relation between physical activity and blood pressure levels in young Greek adolescents: the Leontio Lyceum Study.

BACKGROUND: Elevated blood pressure (BP) during childhood and adolescence is not so rare and increases the risk of hypertension in adulthood. Physical activity (PA) is considered a key component for the prevention and treatment of hypertension in children and adolescents. Thus, the purpose of our study was to assess the level of PA in Greek adolescents and its relation to BP levels. METHODS: The study included 496 students aged 12-17 years who were enrolled on a volunteer basis. All children were subjected to BP measurement on two different occasions during a routine school day. Demographic, socio-economic and lifestyle characteristics were assessed by means of a standard questionnaire. Information on the frequency and duration of PA and on the amount of time spent on sedentary activities was obtained by the short-form self-administered questionnaire International Physical Activity Questionnaire-IPAQ. RESULTS: The study population was divided in three groups according to the score achieved in IPAQ questionnaire: low PA (n = 39), moderate PA (n = 230) and high PA (n = 231). Children with high PA compared to those with low PA exhibited higher systolic BP and pulse pressure levels, greater prevalence of prehypertension/hypertension status, while heart rate was significantly lower as the level of PA rose (P < 0.05 for all cases). Intense PA was positively correlated to systolic BP (r = 0.139, P = 0.003) and pulse pressure (r = 0.22, P = 0.0001). CONCLUSION: Intense PA is associated with higher systolic BP, pulse pressure levels and lower heart rate in healthy young adolescents. PA should be practiced at a moderate intensity level in everyday life.

Leontio Lyceum ALbuminuria (3L Study) epidemiological study: aims, design and preliminary findings.

INTRODUCTION: The significance of microalbuminuria (MA) in paediatric essential hypertension has yet to be established. The Leontio Lyceum ALbuminuria Study (3L Study) was designed to determine the prevalence of MA among Greek schoolchildren and to evaluate these rates in relation to the children's anthropometric and lifestyle characteristics, and dietary habits. METHODS: During April 2009, 498 students from the Leontio Lyceum, aged 12-17 years (7th-12th grade), were asked to participate in the 3L Study. For each child a questionnaire was completed that was developed for the purposes of the study to retrieve information on socio-demographic and lifestyle characteristics, as well as dietary habits (through a semi-quantitative Food Frequency Questionnaire), and physical activity status. Overweight and obesity were defined using the international body mass index cut-off points established for children and young people. Office blood pressure (BP) was measured on two different occasions and those students who had BP >95th percentile for gender, age and height on both occasions were considered as hypertensives. Microalbuminuria was determined as albumin to creatinine ratio >or=22 mg/g in boys and >or=31 mg/g in girls in a morning spot urine sample using a quantitative assay (DCA 2000). RESULTS: The prevalence of MA was found to be 12.9% and that of childhood hypertension 5.2%. The prevalence of overweight status was 25.8% and 5.8% of the students were classified as obese. Low physical activity was reported by 7% of boys and girls, while 46.5% of the students reported participation in vigorous physical activities during a normal week. Based on the KIDMED score of each student, only 6% of them were classified as high adherers to a Mediterranean diet and 41.9% were classified as having very low diet quality. CONCLUSIONS: In this paper we present the aims, design and preliminary results of an epidemiological study on MA, hypertension, increased body size and lifestyle characteristics among Greek schoolchildren.