Implicaciones pronósticas de la hiperglucemia de estrés en el infarto agudo de miocardio con elevación del ST. Estudio observacional prospectivo / Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study

Introducción y objetivos. La hiperglucemia al ingreso se asocia a mal pronóstico en pacientes con infarto agudo de miocardio. El objetivo es evaluar la asociación independiente entre la hiperglucemia de estrés y la mortalidad hospitalaria en pacientes con infarto agudo de miocardio con elevación del ST (IAMCEST). Métodos. Analizamos a 834 pacientes ingresados de forma consecutiva por IAMCEST en la Unidad Coronaria. La asociación entre la glucemia al ingreso y la mortalidad hospitalaria se evaluó mediante regresión de Cox. La capacidad discriminatoria del modelo multivariable se evaluó mediante el estadístico C de Harrell. Resultados. La mortalidad fue del 10,7% (89/834 pacientes). Mediante las curvas ROC se determinó como punto de corte óptimo para la mortalidad una glucemia >= 140mg/dl. La incidencia de arritmias fue más frecuente en pacientes con glucemias >= 140mg/dl, tanto para las arritmias ventriculares malignas (el 28 frente al 18%; p=0,001) como para los trastornos de conducción intraventricular (el 5 frente al 2%; p=0,005) y auriculoventricular (el 9 frente al 5%; p=0,05), al igual que ocurrió con la incidencia de muerte intrahospitalaria (el 15 frente al 5%; p<0,001). En el análisis multivariable, los pacientes con glucemia >= 140mg/dl presentaron el doble de mortalidad intrahospitalaria (intervalo de confianza del 95%, 1,2-3,5; p=0,008). El valor pronóstico de la glucemia (como variable continua y como variable dicotomizada) no varió significativamente según hubiera diabetes o no (para la interacción, p=0,487 y p=0,653 respectivamente). Conclusiones. La hiperglucemia de estrés al ingreso es un predictor de mortalidad y arritmias en pacientes con IAMCEST y se podría usar en la estratificación de riesgo de estos pacientes(AU)

Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI). Methods: We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose andmortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell´s C statistic. Results: Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose >=140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P = .001), complicative bundle branch block (5% vs. 2%, P = .005), new atrioventricular block (9% vs. 5%, P = .05) and in-hospital mortality (15% vs. 5%, P < .001). Multivariate analysis showed that those with glycemia >=140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively). Conclusions: Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients(AU)

Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study.

INTRODUCTION AND OBJECTIVES: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI). METHODS: We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic. RESULTS: Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P=.001), complicative bundle branch block (5% vs. 2%, P=.005), new atrioventricular block (9% vs. 5%, P=.05) and in-hospital mortality (15% vs. 5%, P<.001). Multivariate analysis showed that those with glycemia ≥140mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P=.008) irrespective of diabetes mellitus status (P-value for interaction=0.487 and 0.653, respectively). CONCLUSIONS: Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.

Mechanical insufflation-exsufflation: pressure, volume, and flow relationships and the adequacy of the manufacturer's guidelines.

OBJECTIVE: Pulmonary complications of neuromuscular disease can be averted by increasing peak cough flows with the use of a forced exsufflation device. The purpose of this study was to examine the pressure, volume, and flow relationships for a range of settings generated by this device, and compare them with clinically efficacious values and the manufacturer's guidelines. METHODS: The In-exsufflator was connected to a standard lung model. The resulting forced deflation volumes, flows, and pressures were averaged over 10 cycles at each setting. RESULTS: The set insufflation pressures significantly correlated with the generated insufflation pressures and volumes and the exsufflation volumes and flows. Increasing set insufflation time significantly increased generated insufflation pressures, flows, and volumes and exsufflation volumes. Increasing set exsufflation time did not significantly increase generated exsufflation flows. At set pressures of 40 to -40 cm H2O, insufflation time of 3 sec, and exsufflation time of 2 sec, the exsufflation flow was 4.09 l/sec. A plateau insufflation volume of 3.8 l was reached after 4.9 sec of insufflation. CONCLUSIONS: In-exsufflator performance was very consistent. Its clinical effectiveness can be explained by its generation of exsufflation flows >2.7 l/sec. Increasing insufflation times more than exsufflation times is more important for optimal function. Current manufacturer use guidelines may not yield optimal exsufflation flows.