Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.076
Filtrar
1.
Am J Case Rep ; 22: e931561, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465715

RESUMO

BACKGROUND Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases. CASE REPORT We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test. CONCLUSIONS This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
2.
J Spec Oper Med ; 21(3): 11-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529799

RESUMO

Deployed medical providers at all roles of care must be prepared to recognize and manage acute coronary syndrome (ACS). Under optimal conditions, treatment is initiated with medical therapy and may be followed by prompt coronary angiography and revascularization. Emergent percutaneous coronary intervention (PCI) is not available in most deployed locations, however, and the time for such intervention is often dependent on long-range evacuation. This CPG provides guidance on best management for ACS patients in the deployed and resource-constrained environment.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Angiografia Coronária , Humanos , Resultado do Tratamento
3.
Am J Cardiol ; 156: 16-23, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34353628

RESUMO

Optimal dual antiplatelet therapy (DAPT) duration for patients undergoing percutaneous coronary intervention (PCI) for coronary bifurcations is an unmet issue. The BIFURCAT registry was obtained by merging two registries on coronary bifurcations. Three groups were compared in a two-by-two fashion: short-term DAPT (≤ 6 months), intermediate-term DAPT (6-12 months) and extended DAPT (>12 months). Major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization and stent thrombosis) were the primary endpoint. Single components of MACE were the secondary endpoints. Events were appraised according to the clinical presentation: chronic coronary syndrome (CCS) versus acute coronary syndrome (ACS). 5537 patients (3231 ACS, 2306 CCS) were included. After a median follow-up of 2.1 years (IQR 0.9-2.2), extended DAPT was associated with a lower incidence of MACE compared with intermediate-term DAPT (2.8% versus 3.4%, adjusted HR 0.23 [0.1-0.54], p <0.001), driven by a reduction of all-cause death in the ACS cohort. In the CCS cohort, an extended DAPT strategy was not associated with a reduced risk of MACE. In conclusion, among real-world patients receiving PCI for coronary bifurcation, an extended DAPT strategy was associated with a reduction of MACE in ACS but not in CCS patients.


Assuntos
Síndrome Coronariana Aguda/terapia , Stents Farmacológicos , Terapia Antiplaquetária Dupla/métodos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/administração & dosagem , Sistema de Registros , Síndrome Coronariana Aguda/diagnóstico , Idoso , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Rev Port Cardiol (Engl Ed) ; 40(8): 525-536, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392892

RESUMO

BACKGROUND: Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. METHODS: Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n=298) or absence of IDef (n=519) on admission. The clinical event under study was the occurrence of death or severe HF in the long term. Independent predictors of prognosis were determined with logistic regression analysis. RESULTS: Thirty-six percent of patients had IDef. There was higher mortality (p=0.004), higher incidence of HF (p=0.011) during follow-up and a higher rate of hospital readmissions (p=0.048) in this group. IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. CONCLUSION: IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.


Assuntos
Síndrome Coronariana Aguda , Anemia Ferropriva , Insuficiência Cardíaca , Síndrome Coronariana Aguda/diagnóstico , Anemia Ferropriva/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Prognóstico , Estudos Retrospectivos
6.
Soins Gerontol ; 26(151): 19-23, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34462107

RESUMO

Acute coronary syndrome (ACS) is a pathology frequently encountered in emergency rooms, especially in the elderly. Caregivers must know how to recognize an ACS despite an often heterogeneous and atypical presentation. Management should include an overall assessment of the patient in order to decide on the best management for the patient.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Idoso , Serviço Hospitalar de Emergência , Humanos
7.
Medicine (Baltimore) ; 100(33): e26927, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414950

RESUMO

BACKGROUND: Modern clinical trials and experimental researches of traditional Chinese medicine (TCM) have been conducted for decades and provided support for the prevention and treatment of acute coronary syndrome (ACS). However the level of evidence and the proper application of TCM were still barely satisfactory. METHODS: In this study, we divided ACS into 3 different stages, including unstable angina, acute myocardial infarction, and post myocardial infarction. Then we systematically reviewed and meta-analyzed the existing randomized controlled trials on both clinical manifestations and objective indicators, in these 3 aspects. RESULTS: The results indicate that TCM can both improve the clinical manifestations and ameliorate the objective parameters in different courses of ACS, including C-reactive protein in unstable angina, left ventricular ejection fraction in acute myocardial infarction and post myocardial infarction. And the incidence of short-term cardiovascular events are lower in TCM intervention group. Some of the improvements lead to potential long-term benefits. CONCLUSION: TCM treatment is beneficial to different courses of ACS. To acquire more solid and comprehensive evidence of TCM in treating ACS, more rigorously designed randomized controlled trials with longer follow-up duration are warranted.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Medicina Tradicional Chinesa , Síndrome Coronariana Aguda/diagnóstico , Humanos
8.
J Int Med Res ; 49(8): 3000605211034997, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34344220

RESUMO

Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.


Assuntos
Síndrome Coronariana Aguda , Cardiomiopatia de Takotsubo , Síndrome Coronariana Aguda/diagnóstico , Idoso , Angiografia Coronária , Serviço Hospitalar de Emergência , Feminino , Humanos , Mania , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/diagnóstico por imagem
9.
Orv Hetil ; 162(34): 1383-1385, 2021 08 22.
Artigo em Húngaro | MEDLINE | ID: mdl-34428175

RESUMO

Összefoglaló. Egy 47 éves nobeteg tranziens ST-eleváció miatt került felvételre és coronarographiára. A tranziens ST-elevációnak véleményezett elektrokardiogram poroszsisak-jelnek felelt meg, amelyet egy EKG-mutermék okozott. Habár a poroszsisak-jelnek számtalan, nem coronariaeredetu oka ismert, mutermék okozta poroszsisak-jelet még nem ismertettek. Fontos a felismerése a felesleges diagnosztikai és terápiás beavatkozások elkerülése céljából. Orv Hetil. 2021; 162(34): 1383-1385. Summary. A 47-year-old female patient was admitted for coronary angiography due to transient ST elevation. The electrocardiogram rated for transient ST elevation corresponded to a spiked helmet sign caused by an ECG artifact. Although a number of non-coronary causes of the spiked helmet sign are known, not one caused by a computer artifact has been reported yet. It is important to recognize it to avoid unnecessary diagnostic and therapeutic interventions. Orv Hetil. 2021; 162(34): 1383-1385.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Artefatos , Angiografia Coronária , Eletrocardiografia , Feminino , Dispositivos de Proteção da Cabeça , Humanos , Pessoa de Meia-Idade
10.
BMJ Open ; 11(8): e045815, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433592

RESUMO

OBJECTIVE: To systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions. DESIGN: Systematic review. DATA SOURCES: Electronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020. ELIGIBILITY CRITERIA: The review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool. RESULTS: Searches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools. CONCLUSION: We have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered. PROSPERO REGISTRATION NUMBER: This systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).


Assuntos
Síndrome Coronariana Aguda , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/diagnóstico , Adulto , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Humanos , Revisões Sistemáticas como Assunto , Telefone , Triagem
13.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257130

RESUMO

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air-fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although 'time is the myocardium' in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.


Assuntos
Síndrome Coronariana Aguda , Hérnias Diafragmáticas Congênitas , Síndrome Coronariana Aguda/diagnóstico , Idoso , Dor no Peito , Feminino , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Laparotomia , Tomografia Computadorizada por Raios X
14.
J Coll Physicians Surg Pak ; 30(7): 841-845, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271788

RESUMO

In patients with acute coronary syndrome (ACS), the predicted short-term result of ischemic modified albumin (IMA) is still not recognised now. The above have been searched in PubMed, Embase, Medline, Cochrane Library databases, and Wanfang databases from the beginning to June 2020. The study explored that patients with positive of IMA had differences in short-term results compared to negative of IMA. Odds ratios for each study was compiled and conducted for heterogeneity assessment, quality review, publication bias. A total of 684 patients (405 positive patients; 279 negative patients) were included in four studies. Comprehensive analysis found that compared with the negative of IMA in patients with ACS, the positive of IMA in patients with ACS had a high incidence of major cardiovascular adverse events (MACE) (HR 1.85; p=0.03), but there was no significant difference in the occurrence of cardiac death (HR 4.40; p = 0.16).  It was concluded that the positive of IMA in patients with ACS is associated with an increased incidence of MACE, but there was no statistically significant difference in incidence of cardiac death. Due to the limited data coming from different research groups in different countries, the diagnostic criteria for the IMA cut-off may be different. Future large randomised controlled trials will be certainly needed to confirm these findings. Key Words: Acute coronary syndrome, Ischemia-modified albumin, Meta-analysis, MACE, Cardiac death.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Biomarcadores , Humanos , Prognóstico , Albumina Sérica , Albumina Sérica Humana
15.
BMJ Case Rep ; 14(7)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34290014

RESUMO

We describe a case of a 42-year-old man who presented with anginal chest pain. He had objective evidence of ongoing cardiac injury. After initial treatment for coronary arterial disease, cardiac catheterisation revealed diffuse coronary arterial thrombosis with embolisation. Follow-up testing implicated new-onset antiphospholipid antibody syndrome as the aetiology.


Assuntos
Síndrome Coronariana Aguda , Síndrome Antifosfolipídica , Trombose Coronária , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Adulto , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Cateterismo Cardíaco , Vasos Coronários , Humanos , Masculino
16.
Acad Emerg Med ; 28(7): 718-744, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34228849

RESUMO

This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high-sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits.


Assuntos
Síndrome Coronariana Aguda , Dor no Peito , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Adulto , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Angiografia Coronária , Serviço Hospitalar de Emergência , Teste de Esforço , Hospitalização , Humanos , Medição de Risco
17.
J Invasive Cardiol ; 33(6): E487-E488, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34089312

RESUMO

In the presence of an equivocal culprit lesion in the context of an acute coronary syndrome, the optical coherence tomography (OCT) scan defines the severity and composition of the plaque, elucidating (as in this pathognomonic case) the mechanism related to plaque rupture. Furthermore, OCT analysis allowed stent implantation with adequate sizing and length, and subsequent final optimization of the result. In the presence of non-unequivocal lesions, in the context of acute coronary syndrome, the use of OCT imaging defined the etiology and mechanism of plaque instability, reducing cardiovascular events. In this clinical scenario, it is necessary to have a low threshold for the use of intracoronary imaging methods. In a challenging scenario, resorting to intracoronary imaging when possible can reduce the risk of procedural and postprocedural complication.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Humanos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico , Ruptura Espontânea , Tomografia de Coerência Óptica
18.
Cardiol J ; 28(4): 607-614, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34096012

RESUMO

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome - a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and maintaining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up (ClinicalTrials.gov Identifier: NCT04718025; EudraCT number: 2020-005130-15).


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Aspirina , Humanos , Inibidores da Agregação Plaquetária , Ticagrelor
19.
Int J Cardiol ; 338: 8-13, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34126130

RESUMO

BACKGROUND: The efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with acute coronary syndromes (ACS) are not known. We assessed the efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with ACS undergoing invasive management. METHODS: This pre-specified analysis of the ISAR-REACT 5 trial included 1349 smokers and 2652 nonsmokers randomized to receive ticagrelor or prasugrel. The primary endpoint was the incidence of death, myocardial infarction, or stroke; the secondary endpoint was the incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding (both endpoints assessed at 12 months). RESULTS: There was no significant treatment arm-by-smoking status interaction regarding the efficacy outcome. The primary endpoint occurred in 47 patients (7.0%) in the ticagrelor group and 41 patients (6.2%) in the prasugrel group in smokers (hazard ratio [HR] = 1.15; 95% confidence interval [CI] 0.76-1.75; P = 0.510) and in 133 patients (10.2%) in the ticagrelor group and 94 patients (7.2%) in the prasugrel group in nonsmokers (HR = 1.44 [1.10-1.87]; P = 0.007; P for interaction = 0.378). The secondary endpoint occurred in 27 patients (4.6%) in the ticagrelor group and 33 patients (5.6%) in the prasugrel group in smokers (HR = 0.81 [0.49-1.35]; P = 0.412) and in 66 patients (6.0%) in the ticagrelor group and 46 patients (4.4%) in the prasugrel group in nonsmokers (HR = 1.38 [0.94-2.01]; P = 0.097). CONCLUSIONS: In patients with ACS undergoing an invasive management strategy, the smoking status did not significantly interact with the relative treatment effect of ticagrelor vs. prasugrel. CLINICAL TRIAL REGISTRATION: NCT01944800.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Humanos , não Fumantes , Inibidores da Agregação Plaquetária/efeitos adversos , Cloridrato de Prasugrel/efeitos adversos , Fumantes , Ticagrelor/efeitos adversos , Resultado do Tratamento
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 573-577, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112295

RESUMO

OBJECTIVE: To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio (HCRP/ALB) for the death in patients with acute coronary syndrome (ACS). METHODS: The clinical data of patients with ACS [including unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI)] admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed. The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated. Patients were divided into death group and survival group according to the hospital outcome. The differences of baseline data and biochemical indexes between the two groups were compared. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of each variable to death. Logistic regression was used to analyze the risk factors of death. RESULTS: Among the 1 722 ACS patients, 74 died in hospital. Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia. Among them, patients in death group had higher heart rate (HR), HCRP, B-type natriuretic peptide (BNP), HCRP/ALB [HR (bpm): 89±19 vs. 73±15, HCRP (mg/L): 23.24 (9.79, 33.69) vs. 3.57 (1.03, 14.26), BNP (ng/L): 424.0 (164.3, 1 596.1) vs. 79.0 (31.0, 211.4), HCRP/ALB: 0.700 (0.289, 1.017) vs. 0.089 (0.026, 0.368), all P < 0.01], while ALB was lower (g/L: 35.37±5.16 vs. 39.97±6.43, P < 0.01). ROC curve analysis showed that area under ROC curve and 95% confidence interval [AUC (95%CI)] of BNP, HCRP and HCRP/ALB for predicting death were 0.781 (0.717-0.845), 0.790 (0.724-0.856) and 0.803 (0.738-0.869), respectively. The Youden index of HCRP/ALB was 0.559, and the corresponding HCRP/ALB was 0.246. The patients were divided into low HCRP/ALB group (HCRP/ALB ≤ 0.246, 1 163 cases) and high HCRP/ALB group (HCRP/ALB > 0.246, 559 cases). Except for gender, previous smoking, hypertension and diabetes rates, the other baseline data were statistically different between the two groups. Patients in the high HCRP/ALB group had a higher mortality (10.4% vs. 1.4%, P < 0.01), higher rates of implanted intra-aortic balloon pump (IABP, 12.7% vs. 2.7%, P < 0.01), higher BNP, HCRP, HCRP/ALB [BNP (ng/L): 253.0 (82.8, 749.0) vs. 60.0 (26.0, 145.2), HCRP (mg/L): 25.42±17.47 vs. 2.62±2.43, HCRP/ALB: 0.700±0.435 vs. 0.066±0.062, all P < 0.01], while lower ALB (g/L: 36.89±4.30 vs. 41.17±6.83, P < 0.01). Logistic regression analysis showed that higher HR [odds ratio (OR) = 1.037, 95%CI was 1.020-1.055, P = 0.000] and higher HCRP/ALB (OR = 3.835, 95%CI was 1.612-9.125, P = 0.002) were independent risk factors for the death in ACS patients, while higher ALB could reduce the mortality in ACS patients (OR = 0.884, 95%CI was 0.818-0.957, P = 0.002). CONCLUSIONS: The higher the HCRP/ALB, the higher the risk of death in patients with ACS. When HCRP/ALB is greater than 0.246, the patient has a higher mortality. Therefore, HCRP/ALB in patients with ACS can be used as an effective predictor for death risk.


Assuntos
Síndrome Coronariana Aguda , Proteína C-Reativa , Albumina Sérica , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Proteína C-Reativa/análise , Humanos , Prognóstico , Curva ROC , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...