RESUMEN
Resumen Objetivo: validar y comparar las escalas de riesgo de sangrado CRUSADE y ACTION en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) llevados a estratificación coronaria invasiva temprana en un centro de alta complejidad. Métodos: estudio de tipo observacional, analítico y prospectivo, de validación de escalas en una cohorte de pacientes con SCASEST llevados a estratificación coronaria invasiva temprana en un centro cardiovascular. Las escalas de riesgo CRUSADE y ACTION fueron calculadas con las características basales. La ocurrencia de sangrado mayor fue definido por hemorragia intracerebral, retroperitoneal, caída del hematocrito > 12% o necesidad de transfusión cuando el hematocrito fuera > 3 g/dL o > 28% o < 28% con documentación de sangrado clínico o sangrado no relacionado con cirugía de revascularización. Resultados: en este análisis la tasa de sangrado mayor observada fue de 4.8%. La presencia de sangrado mayor se asoció con una probabilidad mayor de mortalidad durante el seguimiento a seis meses (OR 5.316; IC 95% 1.77 -15.92; p= 0.002). La calibración de las escalas de riesgo fue adecuada de acuerdo al estadístico Hosmer-Lemeshow (p>0.05). Ambas escalas demostraron buena discriminación sin diferencias estadísticamente significativas en el escenario intrahospitalario (AUC ROC CRUSADE ACTION 0.77 vs 0.80 p=0.19), al mes (AUC ROC CRUSADE ACTION 0.70 vs 0.75 p=0.08) y 6 meses (AUC ROC CRUSADE ACTION 0.71 vs 0.76 p=0.09), respectivamente. Conclusiones: las escalas de riesgo CRUSADE y ACTION son herramientas útiles para la predicción del riesgo de sangrado en pacientes con SCASEST llevados a estratificación coronaria invasiva temprana. Estos hallazgos sugieren el uso de la escala ACTION sobre la escala de riesgo CRUSADE.
Abstract Objective: to validate and compare the CRUSADE and ACTION bleeding risk scores in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) undergoing early invasive coronary stratification in a highly complex center. Methods: an observational, analytical and prospective study of scale validation in a cohort of patients with NSTEACS who underwent early invasive coronary stratification in a cardiovascular center. The CRUSADE and ACTION risk scales were calculated with the baseline characteristics. The occurrence of major bleeding was defined by intracerebral, retroperitoneal hemorrhage, he-matocrit drop > 12% or need for transfusion when the hematocrit was> 3 g/dL or > 28% or <28% with clinical bleeding documentor bleeding not related to revascularization surgery. Results: in this analysis, the highest observed bleeding rate was 4.8%. The presence of major bleeding was associated with a higher probability of mortality during six-month follow-up (OR 5.316, 95% CI 1.77 -15.92, p = 0.002). The calibration of the risk scales was adequate according to the Hosmer-Lemeshow statistic (p> 0.05). Both scales showed good discrimination without statistically significant differences in the intrahospital setting (AUC ROC CRUSADE ACTION 0.77 vs 0.80 p = 0.19) one month (AUC ROC CRUSADE ACTION 0.70 vs 0.75 p = 0.08) and 6 months (AUC ROC CRUSADE ACTION 0.71 vs 0.76 p = 0.09), respectively. Conclusions: the CRUSADE and ACTION risk scales are useful tools for the prediction of bleeding risk in patients with NSTEACS who are undergoing early invasive coronary stratification. These findings suggest the use of the ACTION scale over the CRUSADE risk scale.
Asunto(s)
Humanos , Animales , Masculino , Adulto , Síndrome Coronario Agudo , Pacientes , Calibración , Infarto del Miocardio sin Elevación del ST , HemorragiaRESUMEN
Anemopsis californica (Saururaceae) commonly called yerba mansa, is an important medicinal plant in many deserts in the southwestern region of North America. Populations of A. californica, collected throughout New Mexico, were examined for chemical variability in roots and rhizomes for select monocyclic (cymene, limonene, piperitone and thymol) and bicyclic (alpha-pinene, 1,8-cineole and myrtenol) monoterpenoid and phenylpropanoid (methyleugenol, isoeugenol and elemicin) derived essential oil components. Three distinct chemotypes were detected using a hierarchical clustering analysis on the concentration of 10 different analytes in three individuals from each of 17 populations. One chemotype was characterized by high elemicin concentrations, a second chemotype by high methyleugenol concentrations and the third by high piperitone and thymol concentrations. Steam distilled oil was used to screen for anticancer bioactivity. A. californica root oils demonstrated anti-proliferative activity against AN3CA and HeLa cells in vitro but no activity against lung, breast, prostate or colon cancer cells. The IC(50) values for the root oil were 0.056% and 0.052% (v/v) for the AN3CA and HeLa cells, respectively.
