Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo / Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome

RESUMEN

Objetivo: Conocer el perfil clínico, así como el significado pronóstico, de la presencia de niveles elevados de hormona paratiroidea (PTH) en pacientes ingresados por síndrome coronario agudo (SCA). Diseño y ámbito Estudio observacional y prospectivo de pacientes ingresados por SCA en un único centro español durante un periodo de 6meses. Intervención y variables de interés Se determinaron las concentraciones de PTH, calcidiol, calcitriol, NT-proBNP, proteína Creactiva, cistatinaC y fibrinógeno circulantes en las primeras 48h del ingreso y se realizaron modelos ajustados para predecir muerte o reingreso por SCA tras el alta. Resultados: Se reclutaron 161 pacientes (edad 67±14años; 75,2% varones) de los cuales 41 (25,5%) presentaron valores elevados de PTH. Se registraron 50 eventos adversos durante un seguimiento de 275 personas-año. Los pacientes con niveles elevados de PTH fueron en mayor proporción mujeres (21,2 vs. 39,0%) y de mayor edad (63,3 vs. 77,8años, ambos p<0,05). Asimismo, presentaron mayor riesgo cardiovascular y una peor evolución en el seguimiento (razón de tasas de incidencia 2,64; IC 95% 1,5-4,6). Sin embargo, en un modelo ajustado por la escala GRACE, los niveles de PTH no se mostraron como un factor de riesgo independiente (hazard ratio=1,1; IC 95% 0,6-2,2); tampoco el resto de componentes del panel. Conclusiones: La proporción de pacientes con niveles elevados de PTH ingresados por SCA es elevada. Su presencia se asoció con un perfil clínico más adverso y peor evolución durante el seguimiento, aunque no resultó ser un predictor independiente de mal pronóstico (AU)

ABSTRACT

Objective: To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS). Design and setting: Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months. Intervention and variables of interest The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge. Results: A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95% 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI 0.6-2.2), neither other components of the panel. Conclusions: The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis (AU)