The CRP troponin test (CTT) stratifies mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).

INTRODUCTION: The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI). METHODS: We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8-4.3]. RESULTS: Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, p < 0.01). However, among patients with "normal" CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, p < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], p < 0.01 for patients with high troponin and high CRP levels). CONCLUSIONS: Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with "normal" CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.

Relationship among sleep, work features, and SARS-cov-2 vaccine antibody response in hospital workers.

STUDY OBJECTIVES: Immunity is influenced by sleep and the circadian rhythm. Healthcare workers are predisposed to both insufficient sleep and circadian disruption. This study aimed to evaluate the relationship between sleep and work characteristics and the antibody response to the mRNA SARS-CoV-2 vaccine BNT162b2. METHODS: The authors' prospective cohort study ("COVI3") evaluated the effect of a third (booster) dose of the BNT162b2 vaccine. A subset of participants provided information on anthropometric measures, sleep, stress and work characteristics including shift work and number of work hours per week. Blood samples for anti-S1-RBD IgG antibody levels were obtained 21 weeks following receipt of the third dose of the vaccine. RESULTS: In total, 201 healthcare workers (73% women) were included. After adjustment for age, body mass index (BMI), shift work, smoking status, and perceived stress, short sleep duration (<7 h per night) was associated with lower anti-S1-RBD IgG levels (Odds ratio 2.36 [95% confidence interval 1.08-5.13]). Participants who performed shift work had higher odds of lower anti-S1-RBD IgG levels compared to those who did not work in shifts [odds ratio = 2.99 (95% confidence interval 1.40, 6.39)] after accounting for age, short sleep duration, BMI, smoking status and perceived stress. CONCLUSIONS: Shift work and self-reported short sleep duration were associated with a lower antibody response following a booster dose of the SARS-CoV-2 vaccine. These findings suggest that the efficacy of vaccination, particularly among healthcare workers, may be augmented by addressing both sleep and circadian alignment.

Síndrome de QT prolongado inducido por medicación no cardiológica / Long QT syndrome due to non-cardiac drugs

Cada vez es mayor el número de medicaciones no cardiológicas que bloquean los cnales del potasio en las celulas miocárdicas y pueden prolongar el intervalo QT desencadenando una peligrosa arritmia llamada torsión de puentes. La despolarización ventricular normal provoca un rápido flujo de sodio hacia dentro de la célula a traves de la membrana citoplasmática. La repolarización ocurre cuando el flujo de potasio hacia fuera de la célula excede el flujo de sodio y calcio hacia dentro de la célula. Estas corrientes de iones utilizan canales específicos que estan bajo la influencia de multiples factores. La mayoría de los pacientes con torsión de puentesinducido por medicación tienen factores de riesgo clínicos adicionales que son facilmente identificables, tales como, enfermedad cardiaca orgánica, sexo femenino, hipokalemia y una historia de QT prolongado o arritmias inducidas por medicación. En los pacientes sin estos factores de riesgo no es práctico ni necesario implementar medidas de selección, tales como electrocardiogramas o nivel de potasio plasmático, antes de iniciar la medicación. Otras medidas preventivas, sin embargo son cruciales. Debe evitarse la administración concomitante de dos o más drogas que prolongan el intervalo QT así como, la administración de fármacos que interfieran en el metabolismo de drogas que prolongan el intervalo QT. Debido al creciente número de medicaciones no cardiológicas que prolongan la repolarización ventricular hemos realizado esta revisión actualizada sobre este interesante tema