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Objective To investigate the clinical application of high-sensitivity cardiac troponin T (hs-cTnT) in the diagnosis of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods The clinical data of 126 patients with NSTE-ACS admitted to the Department of Emergency of the Third People's Hospital in Yunnan Province from July 2016 to June 2017 were retrospectively analyzed, including 76 patients in non-ST-segment elevation myocardial infarction (NSTEMI) group and 50 patients in unstable angina (UA) group. Moreover, the clinical data of venous blood hs-cTnT and creatine kinase MB (CK-MB) were collected at immediate admission, 4 hours and 12 hours after admission to the hospital in the two groups. At last, the differences in levels of hs-cTnT and CK-MB were compared between the two groups. Results The hs-cTnT and CK-MB in NSTEMI group were gradually increased with the prolongation of therapeutic time, the elevation ratios of hs-cTnT were 88.2% (67 cases) and 100.0% (76 cases), 100.0% (76 cases) at admission and 4 hours, 12 hours after admission respectively; and the elevation ratios of CK-MB were 60.0% (30 cases), 80% (40 cases) and 96% (48 cases) respectively at the above time points; there were no significant differences in UA group. The levels of hs-cTnT and CK-MB in NSTEMI group were significantly higher compared to those of UA group at admission and 4 hours, 12 hours after admission [hs-cTnT (μg/L): the levels were respectively 0.182±0.052 vs. 0.010±0.001, 2.421±0.084 vs. 0.011±0.012, 5.647±0.012 vs. 0.11±0.012, CK-MB (U/L): the levels were respectively 36.3±12.1 vs. 8.1±0.5, 179.6±26.3 vs. 8.5±0.5, 286.0±23.2 vs. 7.9±0.7, all P ＜ 0.05]. Conclusion The blood level of hs-cTnT in acute myocardial infarction (AMI) patients is obviously increased, which can be used as the basis to distinguish NSTEMI from UA.
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Objetivo: Describir el perfil clinicoepidemiológico y el proceso de atención del síndrome coronario agudo sin elevación del segmento ST en un hospital de tercer nivel. Método: Se analiza la información clínica, la estratificación de riesgo, la terapia de revascularización y los hábitos de prescripción al egreso de los casos con síndrome coronario agudo sin elevación del segmento ST atendidos en un año. Resultados: Se incluyeron 283 pacientes con una edad media de 58 años; el 63%, masculino. La mayoría (88.6%) de los casos ocurrió entre los 50 y 59 años. La hipertensión arterial fue el factor de riesgo predominante. El 82.5% de los sujetos tuvo índice TIMI de riesgo bajo-intermedio. En el 37% de los pacientes hubo isquemia residual y en 80 (70%) se demostraron obstrucciones coronarias. Setenta y dos pacientes (90%) fueron revascularizados con stent, principalmente farmacológico (87.5%). Más del 90% de los casos recibió estatina y antiplaquetarios al egreso; otros medicamentos se indicaron en poco más del 50%. Conclusiones: En la población estudiada, el síndrome coronario agudo sin elevación del ST predomina en hombres relativamente jóvenes e hipertensos. Estratificar el riesgo, buscar isquemia residual y revascularizar con stent farmacológico son prácticas comunes; el cumplimiento de las recomendaciones basadas en la evidencia es subóptimo.
Objective: To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. Method: We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. Results: Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. Conclusions: In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal.
Subject(s)
Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Age Distribution , Acute Coronary Syndrome/epidemiology , Drug-Eluting Stents , Electrocardiography , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypertension/complications , Mexico/epidemiology , Myocardial Revascularization/methods , Platelet Aggregation Inhibitors/therapeutic use , Registries , Risk Assessment , Risk Factors , Sex Distribution , Tertiary Care CentersABSTRACT
Introduction: Data regarding management characteristics of non-ST elevation acute coronary syndromes (NSTE ACS) in Mexican, Hispanic and Non- Hispanic white patients are scarce. Methods: We sought to describe the clinical characteristics, process of care, and outcomes of Mexicans, Hispanics and non-Hispanic whites presenting with NSTE ACS at Mexican and US hospitals. We compared baseline characteristics, resource use, clinical practice guidelines (CPGs) compliance and in-hospital mortality among 3 453 Mexicans, 3 936 Hispanics and 90, 280 non-Hispanic whites with NSTE ACS from the RENASICA and CRUSADE registries. Results: Mexicans were younger with a different cardiovascular risk profile, fewer incidences of hypertension (p<0.001), hiperlipidemia (p<0.001), renal failure (p<0.001) and prior revascularization (p<0.001) but were more likely to be smoking compared with Hispanics and non-Hispanic white populations. Mexicans and Hispanics had a higher incidence of diabetes (p<0.001). At clinical presentation Mexican patients were more likely to have ST depression (p<0.001) but less likely to have left ventricular dysfunction (p<0.001) and troponin stratification (p<0.001). Regarding CPGs compliance, aspirin was used in 90% of patients in all groups, but clopidogrel or unfractionated or low-molecular weight heparin in 50% of patients or less. Mexican patients were less likely to receive glycoprotein IIb/IIIa inhibitors and revascularization. In spite of clinical differences and therapeutic trends, cardiovascular mortality was similar among all groups (Mexicans 4%, Hispanics 4% and non-Hispanic white 5%). In all groups of patients, a poor CPGs compliance was observed. Conclusions: In a post-hoc analysis, Mexican patients with NSTE ACS had a different cardiovascular risk factor profile and clinical presentation, and less intensive in - hospital treatment than Hispanic and non-Hispanic white patients. However, these differences do not appear to affect in - hospital mortality.
Introducción: Existe poca información que compara características clínicas y tendencias terapéuticas en población mexicana, hispánica y anglosajona, con síndrome coronario agudo sin elevación del ST (SCA SEST). Métodos: Describimos características clínicas, proceso de atención y evolución hospitalaria en población mexicana, hispánica y anglosajona con SCA SEST, en hospitales mexicanos y americanos. En tres mil cuatrocientos veinticuatro mexicanos, 3 936 hispánicos y 90 280 anglosajones de los registros RENASICA y CRUSADE, se analizaron características basales, uso de recursos, apego a las guías clínicas y mortalidad hospitalaria. Resultados: Los pacientes mexicanos fueron más jóvenes y con diferente perfil de riesgo cardiovascular, por menor incidencia de hipertensión (p< 0.001), hiperlipidemia (p<0.001), insufciencia renal (p<0.001) e historia de revascularización (p< 0.001), pero tuvieron mayor historia de tabaquismo (p<0.001) en comparación con hispánicos y anglosajones. La mayor incidencia de diabetes se observó en pacientes hispánicos y mexicanos (p<0.001). En éstos, al ingreso se observó mayor incidencia de desnivel negativo del ST (p<0.001), y menor grado de disfunción ventricular (p<0.001) y uso de troponinas (p<0.001). En relación al apego de las guías clínicas, en prácticamente todos se utilizó aspirina (90%), pero el uso de clopidogrel y heparina no fraccionada o de bajo peso molecular, sólo se utilizó en aproximadamente el 50%. Los pacientes mexicanos recibieron menos inhibidores de la glicoproteínas IIb / IIIa y menos revascularización. A pesar de algunas diferencias clínicas y terapéuticas, la mortalidad cardiovascular fue similar en los tres grupos (mexicanos 4%, hispánicos 4% y anglosajones 5%). En todos los grupos, el apego a las guías clínicas no fue el ideal. Conclusiones: En un análisis retrospectivo, pacientes mexicanos con un SCA SEST tuvieron diferente perfil de riesgo cardiovascular, presentación clínica y tratamiento hospitalario, que los pacientes hispánicos y anglosajones. Sin embargo, estas diferencias no parecen afectar la mortalidad hospitalaria.
Subject(s)
Aged , Aged, 80 and over , Humans , Middle Aged , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , White People , Hispanic or Latino , Mexico , Registries , Retrospective Studies , Treatment Outcome , United StatesABSTRACT
Objective To explore the concentration of pregnancy associated plasma-A(PAPP-A),insulin-like growth factor-1(IGF-1)in indicating the instability of atherosclerotic plaques in patients with non-ST elevation acute coronary syndromes(NSTEACS).Methods Totally 65 patients with confirmed NSTEACS were subjected,including 30 non-ST elevation myocardial infarction(NSTEMI)and 35 unstable angina(UA)patients.Another 28 stable angina pectoris verified with vascular stenosis by coronary angiography(CAG)and 30 healthy matched individuals served as control.Serum levels of PAPP-A,C-reactive protein(CRP)and cTnT were measured respectively by enzyme linked immunosorbent assays(ELISA),rate nephelometry(RN),and microparticle enzyme immunoassay(MEIA).Correlation analysis was made among different groups.Results Serum PAPP-A,IGF-1 and CRP levels in NSTEACS group were significantly increased in comparison to SAP group and control group(P