Marcadores en la estratificación de los síndromes coronarios agudos / Risk marker stratification in coronary acute syndromes

ABSTRACT

Acute coronary syndromes have a heterogeneous clinical presentation with a broad spectrum for mortality and adverse events. It is mandatory to identify high risk groups for percutaneous coronary intervention and intensive antithrombotic treatment or common risk for standard treatment. In contemporaneous medicine it is important to get adequate risk stratification because the impact of hospitalary costs, antithrombotic and reperfusion treatment on health systems. The current pathophysiology of atherosclerosis is moving from a disease secondary to cholesterol deposit, to an inflammatory disease. In the stratification process, familiar history, chest pain, ST dynamic abnormalities, left ventricular wall motion abnormalities, all have predictive value. The association of indirect endothelial dysfunction, micro or macronecrosis and ventricular dysfunction markers increase this value. In our experience a close relationship among abnormal fibrinolysis, inflammation and anticoagulation proteins with adverse events has been proved in acute coronary syndromes. Other interesting finding--for it accessibility--in acute myocardial infarction under coronary percutaneous intervention is persistent ST elevation, leukocytes and fibrinogen predictive value. In population allelic polymorphisms -455A and -148T and fibrinogen ( >450 mg/dL) were associated with coronary disease. These polymorphisms improve risk stratification of coronary disease to establish a better secondary prevention and treatment.