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1.
Tex Heart Inst J ; 46(3): 161-166, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708695

RESUMO

In a time when cardiac troponin assays are widely used to detect myocardial injury, data remain scarce concerning the incidence and predictors of substantial obstructive coronary artery disease that causes unstable angina. This retrospective single-center study included consecutive patients hospitalized for unstable angina from January 2015 through January 2016. Patients with troponin I levels above the upper reference limit and those who did not undergo angiography were excluded. Multivariate logistic regression analysis was used to identify predictors of obstructive coronary artery disease that warranted revascularization and of major adverse cardiac events up to 6 months after discharge from the hospital. Of the 114 patients who met the inclusion criteria, 46 (40%) had obstructive coronary artery disease. In the univariate analysis, male sex, white race, history of coronary artery disease, prior revascularization, hyperlipidemia, chronic kidney disease, aspirin use, long-acting nitrate use, and Thrombolysis in Myocardial Infarction score ≥3 were associated with obstructive coronary artery disease. History of coronary artery disease, prior revascularization, hyperlipidemia, and long-acting nitrate use were associated with major adverse cardiac events. Male sex was an independent predictor of obstructive coronary artery disease (adjusted odds ratio=4.82; 95% CI, 1.79-13; P=0.002) in the multivariate analysis. Our results showed that coronary artery disease warranting revascularization is present in a considerable proportion of patients who have unstable angina. The association that we found between male sex and obstructive coronary artery disease suggests that the risk stratification of patients presenting with unstable angina may need to be refined to improve outcomes.


Assuntos
Angina Instável/sangue , Oclusão Coronária/epidemiologia , Medição de Risco/métodos , Troponina/sangue , Angina Instável/diagnóstico , Angina Instável/etiologia , Biomarcadores/sangue , Angiografia Coronária , Oclusão Coronária/sangue , Oclusão Coronária/complicações , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
3.
Scand Cardiovasc J ; 53(5): 280-285, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31216908

RESUMO

Objectives. The main aim of the Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain (WESTCOR-study) (Clinical Trials number NCT02620202) is to improve diagnostic pathways for patients presenting to the Emergency department (ED) with acute chest pain. Design. The WESTCOR-study is a two center, cross-sectional and prospective observational study recruiting unselected patients presenting to the ED with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). Patient inclusion started September 2015 and we plan to include 2250 patients, finishing in 2019. The final diagnosis will be adjudicated by two independent cardiologists based on all available information including serial high sensitivity cardiac troponin measurements, coronary angiography, coronary CT angiography and echocardiography. The study includes one derivation cohort (N = 985) that will be used to develop rule out/rule in algorithms for NSTEMI and NSTE-ACS (if possible) using novel troponin assays, and to validate established NSTEMI algorithms, with and without clinical scoring systems. The study further includes one subcohort (n = 500) where all patients are examined with coronary CT angiography independent of biomarker status, aiming to assess the associations between biomarkers and the extent and severity of coronary atherosclerosis. Finally, an external validation cohort (N = 750) will be included at Stavanger University Hospital. Prospective studies will be based on the merged cohorts. Conclusion. The WESTCOR study will provide new diagnostic algorithms for early inclusion and exclusion of NSTE-ACS and insights in the associations between cardiovascular biomarkers, CT-angiographic findings and short and long-term clinical outcomes.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Projetos de Pesquisa , Troponina/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Algoritmos , Angina Instável/sangue , Angina Instável/mortalidade , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Estudos Transversais , Humanos , Estudos Multicêntricos como Assunto , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Noruega , Estudos Observacionais como Assunto , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
4.
Iran J Allergy Asthma Immunol ; 18(2): 200-208, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31066256

RESUMO

Unstable angina pectoris (USAP) is a complex condition in which widespread coronary inflammatory processes have important implications for clearer understanding of its pathogenesis and also its treatment. This study aimed at evaluating the diagnostic as well as prognostic value of serum inflammatory markers of pentraxin-3 (PTX-3), Von Willebrand Factor (vWf) and C-X-C Motif Chemokine Ligand 13 (CXCL13) in such patients. Out of sixty-nine patients, thirty-nine had USAP, thirty had stable angina pectoris (SAP), and thirty-nine were healthy controls. For all participants, serum PTX-3, vWf and CXCL13 levels were measured using ELISA. For each patient with USAP, the Thrombolysis in Myocardial Infarction (TIMI) and the scores of Global Registry of Acute Coronary Events (GRACE) were calculated to determine the severity of the disease. We, then, analyzed the relation of PTX-3, vWf and CXCL13 levels with TIMI and GRACE scores in patients with USAP. Serum PTX-3, vWf and CXCL13 levels were significantly higher in USAP group than those in either SAP or control groups (p˂0.001). Strong correlation was observed between CXCL13 level and TIMI risk score (p=0.019). In receiver operating characteristic (ROC) curves, area under the curve (AUC) values of PTX3, vWf and CXCL13 for detection of USAP were 0.755, 0.751, and 0.906, respectively. The levels of serum PTX3, vWf and CXCL13 increased in patients with USAP. The notable correlation implied that CXCL13 might be a sensitive and specific biomarker for the diagnosis of USAP as well as its severity. It might also show additional diagnostic values when measured in combination with vWf.


Assuntos
Angina Instável/diagnóstico , Proteína C-Reativa/análise , Quimiocina CXCL13/sangue , Infarto do Miocárdio/diagnóstico , Componente Amiloide P Sérico/análise , Fator de von Willebrand/análise , Adulto , Idoso , Angina Instável/sangue , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Índice de Gravidade de Doença
5.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(2): 117-122, 2019 Feb 24.
Artigo em Chinês | MEDLINE | ID: mdl-30818939

RESUMO

Objective: To explore the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on admission on left ventricular ejection fraction (LVEF) and the in-hospital major adverse cardiac and cerebrovascular events (MACCE) in hospitalized patients with unstable angina (UA). Methods: Data of 2 972 consecutive hospitalized patients with UA in Beijing Friendship Hospital from January 2013 to September 2017 were retrospective analyzed. Patients were divided into 4 groups according to the level of NT-proBNP on admission: 733 cases with NT-proBNP lower than 61 ng/L, 749 cases with NT-proBNP between 61 and 133 ng/L, 747 cases with NT-proBNP between 133 and 326 ng/L, and 743 cases with NT-proBNP higher than 326 ng/L. LVEF and in-hospital MACCE were compared among 4 groups and the predictive value of NT-proBNP on admission on LVEF and in-hospital MACCE was determined by multiple logistical regression analysis. Results: LVEF value became lower with increasing on admission NT-proBNP value ((68.4±4.8)%, (68.2±5.2)%, (67.2±6.7)% and (62.6±10.4)%, F=77.98, P<0.01), while in-hospital MACCE was higher with increasing on admission NT-proBNP value (3.4% (25/733), 3.5% (26/749), 5.5% (41/747) and 7.3% (54/743), χ(2)=16.23, P<0.01) in NT-proBNP lower than 61 ng/L, NT-proBNP between 61 and 133 ng/L, NT-proBNP between 133 and 326 ng/L, and NT-proBNP higher than 326 ng/L group. Multiple logistic regression analysis showed that on admission NT-proBNP was an independent predictor for LVEF<50% (Exp(ß)=5.875, 95%CI 3.382-10.207, P<0.001), but not predictor for in-hospital MACCE (Exp(ß)=0.783, 95%CI 0.400-1.996, P=0.783). Conclusion: The on admission NT-proBNP level is an independent predictor of left ventricular systolic dysfunction (LVEF<50%), but not an independent predictor of total in-hospital MACCE in hospitalized patients with UA.


Assuntos
Angina Instável , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Disfunção Ventricular Esquerda , Angina Instável/diagnóstico , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico/análise , Fragmentos de Peptídeos/análise , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Volume Sistólico
6.
Laeknabladid ; 105(2): 79-84, 2019 Feb.
Artigo em Islandês | MEDLINE | ID: mdl-30713155

RESUMO

BACKGROUND: Marked changes in the epidemiology of acute coronary syndromes (ACS) have been observed over the last few decades in the Western Hemisphere. Incidence rates of ACS in Iceland 2003-2012 are presented. METHODS: All patients with unstable angina (UA), non ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarc-tion (STEMI) admitted to Landspitali were included in the study. Data were obtained from hospital records and changes during the period were examined. RESULTS: The total number of ACS cases was 7,502. STEMI incidence was reduced from 98/100,000 inhabitants in 2003 to 63 in 2012, a reduction of nearly 36%. Age standardized incidence rates of STEMI declined annually by 5.5% in men and 5.3% in women (p <0.05). Incidence of NSTEMI increased from 54 /100,000 inhabitants in 2003 to 93 in 2012. UA patients were 56/100,000 inhabitants in 2003, 115 in 2008 and 50 in 2012. No significant annual change in age-standardized incidence rates of NSTEMI and UA was observed. About 35% of patients with NSTEMI and 30% with STEMI and UA were female. The mean age of NSTEMI patients was 72 years, five years higher than patients with STEMI and UA. About 30% of -pat-ients were living outside of the capital region. CONCLUSIONS: 2003-2012 there was a significant 5% annual -decrease in the number of STEMI cases and a tendency to -increasing incidence of NSTEMI which by the end of the research period was the most common of the syndromes. An unusual development in the incidence of UA was observed. Possible effect of psychological stress in the society should be considered.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Angina Instável/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Distribuição por Idade , Idoso , Angina Instável/diagnóstico , Feminino , Humanos , Islândia/epidemiologia , Incidência , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Distribuição por Sexo , Fatores de Tempo
8.
Pract Neurol ; 19(2): 173-175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30337475

RESUMO

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.


Assuntos
Angina Instável/terapia , Encéfalo/fisiopatologia , Transtornos da Cefaleia/fisiopatologia , Cefaleia/terapia , Angina Instável/diagnóstico , Encéfalo/irrigação sanguínea , Angiografia Coronária/métodos , Eletrocardiografia/métodos , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/diagnóstico , Humanos , Pessoa de Meia-Idade
9.
J Cardiovasc Med (Hagerstown) ; 20(2): 74-80, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30540646

RESUMO

AIMS: An increased mortality risk during weekend hospital admission has been consistently observed. In the present study, we evaluated whether the current improvement in management of acute coronary syndromes (ACS) has reduced this phenomenon. METHODS AND RESULTS: We extracted data from the Italian National Healthcare System Databank of 80 391 ACS admissions in the region of Lombardia between 2010 and 2014. ICD-9 codes were used to assess the diagnosis. We performed a multiple logistic regression analysis to compare the mortality rates between weekend and weekday admissions.Mean age of the study population was 67.6 years; 30.1% of patients were women. ST segment elevation myocardial infarction (STEMI) accounts for 42.2% of admissions. The total in-hospital mortality was 3.05% and was positively predicted by weekend admission [odds ratio (OR) 1.13, P = 0.006], age and female sex. The weekend effect on mortality was only significant for STEMI (OR 1.11, P = 0.04) in comparison to non-STEMI (NSTEMI) or unstable angina.The trend of the risk of death was found to be negatively correlated with age: the risk of death was significantly higher in all age clusters younger than 75 (OR 1.22, P < 0.01) and even greater in the very young subgroup under 45 years of age (OR 2.09, P = 0.03). CONCLUSION: Our data indicate that increased mortality risk is still present during weekend admissions. This phenomenon is particularly evident in younger patients and in individuals admitted for STEMI.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Plantão Médico , Mortalidade Hospitalar , Admissão do Paciente , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Adulto , Fatores Etários , Idoso , Angina Instável/diagnóstico , Angina Instável/mortalidade , Angina Instável/terapia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Itália/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Prognóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores Sexuais , Fatores de Tempo
10.
Circulation ; 139(1): 67-77, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30586704

RESUMO

BACKGROUND: Polymer-free amphilimus-eluting stents (PF-AES) represent a novel elution technology in the current era of drug-eluting stents. The clinical safety and efficacy of PF-AES as compared with latest-generation permanent-polymer zotarolimus-eluting stents (PP-ZES) have not yet been investigated in a large randomized trial. METHODS: In this physician-initiated, prospective, multicenter, randomized, noninferiority trial, an all-comers population requiring percutaneous coronary intervention was enrolled across 3 European sites. Randomization (1:1 ratio) to PP-ZES or PF-AES was performed after stratification for troponin status and diabetes mellitus. In both treatment arms, troponin-positive patients were planned for 12-month dual antiplatelet therapy, whereas troponin-negative patients were planned for 1-month dual antiplatelet therapy. Outcome assessors were blinded to the allocated treatment. The device-oriented primary end point of target-lesion failure was defined as cardiac death, target-vessel myocardial infarction, or target-lesion revascularization at 12-months as analyzed by modified intention-to-treat (80% power, and a 3.5% noninferiority margin). RESULTS: In total, 1502 patients were randomized and 1491 treated with the assigned stent and available for follow-up. The primary end point occurred in 42 (5.6%) of the 744 patients receiving PP-ZES versus 46 (6.2%) of the 747 patients receiving PF-AES. PF-AES were clinically noninferior to PP-ZES (risk difference, 0.5%; upper limit 1-sided 95% confidence interval, 2.6%; Pnoninferiority=0.0086). Cardiac death occurred in 10 (1.3%) versus 10 patients (1.3%; P value for difference, 1.00), target-vessel myocardial infarction occurred in 18 (2.4%) versus 17 patients (2.3%; P value for difference, 0.87), and target-lesion revascularization occurred in 22 (2.9%) versus 20 patients (2.6%; P value for difference, 0.75) for PF-AES as compared with PP-ZES. Overall, definite or probable stent thrombosis occurred in 1.0%. CONCLUSIONS: PF-AES were noninferior to PP-ZES regarding target-lesion failure at 12 months. Findings regarding the secondary end point and prespecified subgroups were generally consistent with that of the primary end point. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02328898.


Assuntos
Síndrome Coronariana Aguda/terapia , Angina Estável/terapia , Angina Instável/terapia , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/instrumentação , Polímeros/química , Sirolimo/análogos & derivados , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , Angina Estável/diagnóstico , Angina Estável/mortalidade , Angina Instável/diagnóstico , Angina Instável/mortalidade , Fármacos Cardiovasculares/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/etiologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Sirolimo/administração & dosagem , Sirolimo/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
12.
J Heart Valve Dis ; 27(1): 1-8, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30560593

RESUMO

BACKGROUND: Previous studies have reported an association between aortic valve sclerosis (AVS) and coronary atherosclerosis. However, the threshold of sclerosis used to identify high-risk patients has not yet been determined. METHODS: A total of 225 patients admitted with non- ST-elevation myocardial infarction (NSTEMI) or unstable angina was studied. Echocardiography was performed on all patients within 24 h of admission. Sclerosis scores were determined for each aortic cusp, and the average AVS score index (AVSSI) was calculated. The left ventricular ejection fraction (LVEF) and variables of left ventricular diastolic function and filling pressure, such as transmitral pulsed Doppler early diastolic velocities (E wave), early diastolic tissue Doppler mitral annular velocities (e'), and E/e', were also determined. These patients underwent coronary angiography, and SYNTAX scores were determined. RESULTS: Patients with an average AVSSI >1 were older, more hypertensive, and had higher rates of previous coronary artery bypass grafting. In addition, the prevalences of significant coronary artery disease (CAD) and three-vessel CAD were higher in these patients. Among the echocardiographic variables, LVEF and e' velocity were significantly lower and E/e' was significantly higher in patients with an AVSSI >1. These patients also had a higher prevalence of left ventricular hypertrophy, diastolic dysfunction, and ischemic mitral regurgitation than those with an average AVSSI ≤1. Regression analysis showed that AVS was independently associated with significant CAD and SYNTAX score. CONCLUSIONS: The average AVSSI may be a useful marker in the risk stratification of acute coronary syndrome patients, and is consistent with other high-risk echocardiographic variables, the presence of significant CAD, and more complex coronary artery lesions.


Assuntos
Angina Instável/diagnóstico , Valva Aórtica/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Angina Instável/complicações , Valva Aórtica/patologia , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Ecocardiografia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Humanos , Esclerose
13.
Ned Tijdschr Geneeskd ; 1622018 12 05.
Artigo em Holandês | MEDLINE | ID: mdl-30570939

RESUMO

In patients presenting with acute chest pain, acute myocardial infarction should first be ruled out as a cause as these patients will often need coronary revascularisation. In the remaining patients, those with normal high-sensitivity cardiac troponin levels should undergo additional cardiac investigations to discriminate patients with an episode of unstable angina pectoris from those who have a non-cardiac cause of the chest pain. In the large majority (86%), the medical history does not raise suspicion of angina pectoris and an exercise test will show normal results; in these patients, further cardiac imaging does not seem to be indicated. In conclusion, less cardiac imaging and more non-cardiac investigations are required in patients with acute chest pain and normal high-sensitivity cardiac troponin levels.


Assuntos
Angina Instável/complicações , Dor no Peito/sangue , Dor no Peito/etiologia , Infarto do Miocárdio/complicações , Troponina/sangue , Dor Aguda/etiologia , Angina Instável/diagnóstico , Teste de Esforço , Humanos , Anamnese , Infarto do Miocárdio/diagnóstico
14.
High Blood Press Cardiovasc Prev ; 25(3): 253-259, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30066227

RESUMO

Uncontrolled hypertension is one of the most common determinant for the persistently high burden of cardiovascular (CV) disease, mostly including coronary artery disease (CAD) and hospital admissions due to acute coronary events. Markedly high blood pressure (BP) levels are also frequently observed during the acute phase of coronary syndromes (both ST-segment and non-ST-segment elevation myocardial infarction and unstable angina). In particular, a sustained raise of BP levels above 180/110 mmHg associated with acute cardiac organ damage, i.e. myocardial ischemia, represents a condition of hypertension emergency and requires rapid hospital admission, prompt pharmacological therapies and non-pharmacological interventions, aimed at restoring coronary flow and preserve vital myocardium. Diagnosis of CAD in hypertensive patients may often be complicated by the concomitant presence of electrocardiographic abnormalities, such as ST-segment depression (at rest or during exercise), which may occur even in the absence of coronary atherosclerosis. Thus, proper identification of CAD may result difficult to perform in the setting of clinical practice, mostly in the presence of left ventricular hypertrophy. In this review, we will briefly discuss diagnostic protocols and pharmacological strategies that can be applied in a setting of hypertension emergency with acute cardiac organ damage in the light of the currently available evidence and recommendations from recent guidelines on hypertension management and control.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Angina Instável/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Angina Instável/diagnóstico , Angina Instável/epidemiologia , Angina Instável/fisiopatologia , Anti-Hipertensivos/efeitos adversos , Emergências , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Fatores de Risco , Resultado do Tratamento
15.
Bratisl Lek Listy ; 119(8): 509-512, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30160160

RESUMO

INTRODUCTION: In this study, our aim was to evaluate clinical utilities of Pentraxin 3 (PTX3) and Ischemia-modified Albumin (IMA) in diagnosis of acute coronary syndrome (ACS) and compare these two biomarkers with a conventional diagnostic marker, cardiac troponin I (cTnI). MATERIALS AND METHODS: Sixty adult patients with ACS diagnosis were involved into this prospective study. Additionally, 20 healthy subjects were determined as control group (Group IV). Patients were divided into 3 groups as follows: Patients with Acute Myocardial Infarction (STEMI Group, n=20, Group I), patients without ST elevation but with elevated cTnI levels (NSTEMI Group, n=20, Group II), and patients with unstable angina pectoris (USAP Group, n=20, Group III). Blood measurements were obtained for each marker at admission and in the 4th hour. RESULTS: Troponin level was significantly different between groups I and II at both admission and in the 4th hour. Additionally, PTX 3 level was significantly different at admission and 4th hour between groups II and III. CONCLUSION: This study revealed that cTnI is the most sensitive test in ACS diagnosis at the admission to Emergency Department. Our results also revealed that PTX 3 may be a useful diagnostic tool for ACS at admission, however, IMA alone cannot be used for diagnosis of ACS. Similarly, in the 4th hour, cTnI was found to be the most useful marker in ACS diagnosis, however, PTX 3 and IMA were found to be inadequate for diagnosis of ACS (Tab. 3, Ref. 19).


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Proteína C-Reativa/metabolismo , Albumina Sérica/metabolismo , Componente Amiloide P Sérico/metabolismo , Troponina I/sangue , Síndrome Coronariana Aguda/sangue , Adulto , Idoso , Angina Instável/sangue , Angina Instável/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Albumina Sérica/análise , Albumina Sérica Humana
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 394-402, out.-dez. 2018. tab, ilus, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-970499

RESUMO

A dor torácica aguda é um sintoma muito frequente nas unidades de emergência, constituindo-se em um possível sinal de alerta para as doenças com risco iminente de morte. Como a maioria desses pacientes é internada para avaliação de uma possível síndrome coronariana aguda, isso gera um custo hospitalar muito alto por paciente. Por conta dessa possibilidade diagnóstica, muitos emergencistas internam a maioria dos pacientes. Por outro lado, a liberação inapropriada daqueles com infarto agudo do miocárdio representa um risco para o médico e, especialmente, para o paciente. Outro ponto importante é a demora para o atendimento, em que há a influência de fatores relacionados ao paciente, assim como, pontos negativos na logística de atendimento dos serviços de emergência em nosso país. Para excelência no atendimento, é importante uma anamnese detalhada adicionada ao exame físico, a qual permite a elaboração das hipóteses diagnósticas. E para auxiliar os médicos na escolha da hipótese diagnóstica e na tomada rápida de decisão, escores de risco são disponibilizados, os quais, facilmente, identificam a probabilidade de eventos adversos. A conduta imediata de casos com risco de morte imediata tem como principal objetivo reduzir a morbidade e a mortalidade, aumentando, consequentemente, a segurança do profissional da emergência. Sugestões de fluxogramas e algoritmos para o atendimento desses pacientes na sala de emergência definem, de forma objetiva, quem fica e quem pode ser liberado


Acute chest pain is a frequent symptom in emergency units, being a possible war-ning sign of diseases with an imminent risk of death. Since most of these patients are hospitalized to evaluate possible acute coronary syndrome, this generates a very high hospital cost per patient. Because of this diagnostic possibility, emergency professionals admit most patients. In contrast, the inappropriate release of those with acute myocardial infarction poses a risk to the physician and, especially, the patient. Another important point is the delay in care, where there is an influence of patient-related factors, as well as negative points in the logistics of care in the emergency services in our country. For excellence in care, a detailed anamnesis added to the examination is important, allowing the elaboration of diagnostic hypotheses. Moreover, to assist physicians in selecting the diagnostic hypothesis and making fast decisions, there are risk scores that easily identify the likelihood of adverse events. The immediate management of cases with an imminent risk of death is the main objective to reduce morbidity and mortality and, consequently, increase the safety of emergency professionals. Flowcharts and algorithm suggestions targeting patients in the emergency room objectively define who stays and who can be released


Assuntos
Humanos , Masculino , Feminino , Dor no Peito/diagnóstico , Dor no Peito/terapia , Diagnóstico Diferencial , Emergências , Aorta , Troponina/uso terapêutico , Ecocardiografia/métodos , Radiografia Torácica/métodos , Biomarcadores , Fatores de Risco , Eletrocardiografia/métodos , Teste de Esforço/métodos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Angina Instável/complicações , Angina Instável/diagnóstico , Infarto do Miocárdio/diagnóstico
18.
Lipids Health Dis ; 17(1): 176, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30053815

RESUMO

BACKGROUND: Apolipoprotein CIII (apoCIII) is an independent risk for coronary heart disease (CHD). In this study, we investigated the associations among plasma apoCIII, hs-CRP and TNF-α levels and their roles in the clinical features of CHD in the Li and Han ethnic groups in China. METHODS: A cohort of 474 participants was recruited (238 atherosclerotic patients and 236 healthy controls) from the Li and Han ethnic groups. Blood samples were obtained to evaluate apoCIII, TNF-α, hs-CRP and lipid profiles. Chi-squared, t-tests, and Kruskal-Wallis or Wilcoxon-Mann-Whitney tests, Pearson or Spearman correlation tests and multiple unconditional logistic regression were employed to analyze lipid profiles and variations in plasma apoCIII, TNF-α, hs-CRP in subgroups of CHD and their contributions to CHD using SPSS version 20.0 software. RESULTS: Compared to healthy participants, unfavorable lipid profiles were identified in CHD patients with enhanced systolic pressure, diastolic pressure, fasting blood sugar (FBS), TG, TC, LDL-C, apoB, Lp(a) (P < 0.05, TC and Lp(a); P < 0.01, FBS, TG, LDL-C, apoB); and lower HDL-C and apoAI (P < 0.05). Plasma apoCIII, TNF-α and hs-CRP levels were higher in CHD individuals (16.77 ± 5.98 mg/dL vs. 10.91 ± 4.97 mg/dL; 17.23 ± 6.34 pg/mL vs. 9.49 ± 3.88 pg/mL; 9.55 ± 7.32 mg/L vs. 2.14 ± 1.56 mg/L; P < 0.01 vs. healthy participants). Identical patterns were obtained in the Li and Han groups (16.46 ± 6.08 mg/dL vs. 11.72 ± 5.16 mg/dL; 15.71 ± 5.52 pg/mL vs. 9.74 ± 4.31 pg/mL; 8.21 ± 7.09 mg/L vs. 2.15 ± 1.51 mg/L in Li people; 17.05 ± 5.90 mg/dL vs. 10.07 ± 4.63 mg/dL; 18.59 ± 6.73 pg/mL vs. 9.23 ± 3.38 pg/mL; 10.75 ± 7.44 mg/L vs. 2.12 ± 1.63 mg/L in Han people; P < 0.01). Paired comparisons of subgroups with stable angina, unstable angina, and acute myocardial infarction (AMI) revealed significant variation in plasma levels of apoCIII, TNF-α and hs-CRP (P < 0.01), but not among subgroups with mild, moderate and severe stenosis (P > 0.05). Plasma apoCIII, TNF-α and hs-CRP contributed to the development of CHD (OR = 2.554, 7.252, 6.035, P < 0.01) with paired correlations in CHD patients (apoCIII vs. TNF-α, r = 0.425; apoCIII vs. hs-CRP, r = 0.319; TNF-α vs. hs-CRP, r = 0.400, P < 0.01). CONCLUSIONS: Association among plasma apoCIII, hs-CRP and TNF-α interacts with unfavorable lipid profiles to contribute to the clinical features of CHD with stable angina, unstable angina, and AMI in the Li and Han ethnic groups in China.


Assuntos
Angina Estável/sangue , Angina Instável/sangue , Apolipoproteína C-III/sangue , Aterosclerose/sangue , Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/sangue , Infarto do Miocárdio/sangue , Fator de Necrose Tumoral alfa/sangue , Idoso , Angina Estável/diagnóstico , Angina Estável/etnologia , Angina Estável/patologia , Angina Instável/diagnóstico , Angina Instável/etnologia , Angina Instável/patologia , Apolipoproteínas B/sangue , Aterosclerose/diagnóstico , Aterosclerose/etnologia , Aterosclerose/patologia , Glicemia/metabolismo , Estudos de Casos e Controles , China , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/patologia , Grupos Étnicos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/patologia , Triglicerídeos/sangue
19.
Int. j. cardiovasc. sci. (Impr.) ; 31(3)jul.-ago. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-908839

RESUMO

Fundamento: As doenças cardiovasculares são a principal causa de morte no Brasil. Marcadores bioquímicos possuem importância diagnóstica e prognóstica nas síndromes coronarianas agudas (SCAs), sendo a troponina o biomarcador preferido. Estudos já demonstram relação positiva entre elevação da troponina ultrassensível (TnUs) e prognóstico. Entretanto, poucos relacionam seus níveis com a complexidade das lesões coronárias. Objetivos: Comparar níveis de TnUs com a complexidade das lesões coronarianas pelo escore SYNTAX e relacionar os escores TIMI e GRACE com os níveis desse biomarcador em pacientes com SCA. Métodos: Estudo retrospectivo, transversal com 174 indivíduos com SCA. A correlação entre as variáveis foi avaliada pelo teste de correlação linear não paramétrico de Spearman e a análise estatística realizada pelo programa SPSS, com nível de significância de 5%. Resultados: A média de idade foi 63 anos, predominando o sexo feminino (52,9%). A maioria dos pacientes era hipertensa, não diabética e não tabagista. Dos pacientes avaliados, 19,0% apresentaram IAM com SST, 43,1% IAM sem SST e 36,8% angina instável. A maioria encontrava-se em Killip 1 (82,8%). A mediana de TnUs foi de 67pg/ml. As medianas dos escores de risco foram de 3, 121 e 3 pontos nas escalas TIMI, GRACE e SYNTAX, respectivamente. Houve correlação da taxa de TnUs com os escores SYNTAX (p < 0,001, r = 0,440), TIMI (p < 0,001, r = 0,267) e GRACE (p = 0,001, r = 0,261). Conclusão: Encontrada correlação linear positiva entre os níveis de TnUs e complexidade das lesões coronarianas, assim como entre esse biomarcador e os escores clínicos TIMI e GRACE


Background: Cardiovascular diseases are the leading cause of death in Brazil. Biochemical markers have diagnostic and prognostic importance in acute coronary syndromes (ACSs), with troponin as the preferred biomarker. Studies have already demonstrated a positive relationship between increased levels of high-sensitivity troponin (hsTn) and prognosis. However, few studies have correlated hsTn levels with the complexity of coronary lesions. Objectives: To compare hsTn levels with the complexity of coronary lesions according to the SYNTAX score, and to correlate the levels of this biomarker with the TIMI and GRACE scores in patients with ACS. Methods: Retrospective, cross-sectional study with 174 patients with ACS. The correlation between variables was assessed by the nonparametric Spearman's rank correlation, and statistical analysis was performed by the SPSS program, with a significance level of 5%. Results: Mean age was 63 years, and most patients were women (52.9%), hypertensive, non-diabetic and non-smokers. Nineteen percent of the patients had STEMI, 43.1% NSTEMI, and 36.8% unstable angina. Most were in Killip 1 (82.8%). Median hsTn was 67 pg/mL. Median risk scores were 3, 121 and 3 in the TIMI, GRACE and SYNTAX scores, respectively. There was a correlation of hsTn with SYNTAX (p <0.001, r = 0.440), TIMI (p < 0.001, r = 0.267) and GRACE (p = 0.001, r = 0.261) scores. Conclusion: A positive linear correlation was found of hsTn levels with the complexity of coronary lesions, and with the TIMI and GRACE


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Coronariana Aguda/terapia , Vasos Coronários/patologia , Troponina , Angina Instável/diagnóstico , Angina Instável/terapia , Biomarcadores , Doenças Cardiovasculares/mortalidade , Angiografia por Tomografia Computadorizada/métodos , Hospitalização/economia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Prognóstico , Estudos Retrospectivos , Análise Estatística
20.
Int J Cardiol ; 267: 16-21, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-29957255

RESUMO

BACKGROUND: Coronary haemodynamic testing frequently identifies abnormal pathophysiological parameters in patients with angina and non-obstructed coronaries on angiography (NoCAD) but the clinical utility of these measures has received limited attention. OBJECTIVE: This study aims to identify the clinical and coronary haemodynamic determinants of recurrent chest pain at one month in patients with NoCAD. METHODS: Patients with angina, NoCAD (<50% stenosis) and normal LV systolic function underwent invasive coronary haemodynamic testing involving: (1) angiographic TIMI frame and opacification rate, (2) microvascular functional measures including coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR), (3) coronary endothelial function assessment with low dose intracoronary acetylcholine (IC-ACh) infusions (0.18 µg/min & 1.8 µg/min over 2 min), and (4) Provocative spasm testing with high dose IC-ACh boluses (25, 50 and 100 µg). Clinical and health status were assessed at baseline and one month. RESULTS: In the 49 NoCAD patients (78% female, mean age of 54 ±â€¯11) undergoing comprehensive coronary haemodynamic testing, 33 (67%) continued to experience chest pain at one month. Determinants of recurrent chest pain on univariate analysis included baseline chest pain status or a HMR > 1.9. Multivariate logistic regression analysis identified frequent angina at baseline (OR: 68.9 [4.1, 1165.0], p = 0.003), previous unstable angina admission (OR: 43.9 [3.5, 547.9], p = 0.003) and a HMR > 1.9 (OR: 15.6 [2.1, 114.0], p = 0.007) as independent predictors of recurrent chest pain. CONCLUSION: In this small pilot study, an abnormal HMR was the only coronary haemodynamic parameter that was a determinant of ongoing angina at short-term follow-up.


Assuntos
Angina Instável/diagnóstico , Resistência Capilar , Dor no Peito , Vasoespasmo Coronário/diagnóstico , Vasos Coronários , Angina Microvascular/diagnóstico , Adulto , Austrália , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/fisiopatologia , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Feminino , Hemodinâmica , Humanos , Hiperemia/diagnóstico por imagem , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Recidiva
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