Increasing serum troponin I and early prognosis in patients with chest pain or angina equivalent symptoms in the emergency department

The purpose of this research was to determine the relation between negative or positive qualitative troponin I test and the short term prognosis of patients presenting to emergency department with chest pain or angina equivalent symptoms. We assessed the qualitative rapid troponin I in patients with chest pain or angina equivalent symptoms after at least 4 hours and then we followed the patients in 72 hours after presentation for adverse events such as death, CCU admission, fatal arrhythmias and heart failure. After comparing qualitative troponin I test results and adverse events, we concluded that the troponin I was significantly more positive in patients with adverse events [i.e. CCU admission, fatal arrhythmias and heart failure] [P=0.031]. A single measurement of rapid qualitative troponin I test can be used as a prognostic factor in patients with chest pain or angina equivalent symptoms and also as a device for risk stratification of moderate and high risk patients

Prevalence and risk factors of acute renal failure after cardiac surgery in Southern Iran

Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause of major morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury after cardiac surgery have been previously described and based on these variables; several scoring algorithms were proposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factors among our patients in southern Iran. Two hundred and forty patients with normal kidney function who were candidates for cardiac surgery were enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversial preoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and the type of operation was also considered as an independent risk factor. The patients were categorized in two groups including group 1: Patients with post-operation normal kidney function and group 2: Patients with post-operation ARF. All patients were followed with serial measurement of serum creatinine post-operation. The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24 +/- 15.88 and in group 2 was 52.85 +/- 18.20 years. There was not any significant correlation between duration of clamp time and post operation acute renal failure. Clamp time in group 1 was 51.49 +/- 11.88 and in group 2 was 53.48 +/- 13.40 min. Duration of pump time in group 1 was 63.31 +/- 12.56 min and in group 2 was 78.07 +/- 10.85 min. The difference was statistically significant. Forty two [20%] of the patients in group 1 and 13 [50%] in group 2 were diabetic. Although several scoring algorithms are available for prediction of post-cardiac surgery complications, these can also be matched with our patients' criteria enhancing their accuracy for our situation

Factors affecting in-hospital mortality of acute myocardial infarction

Acute myocardia infarction [AMI] is one of the most common causes of morbidity and mortality. Considering immense socioeconomic damages of growing AMI in developing countries we estimated prognostic value of major risk factors of AMI to predict probable In- hospital AMI mortality. In a cohort survey from June 2004 to March 2006, 1798 patients hospitalized with proven AMI entered into two groups: Survived [patients discharged alive] and Expired [patients expired during hospitalization due to AMI]. We evaluated relationship of 17 risk factors including age, sex, smoking, opium usage, hypertension, diabetes mellitus [DM], dyslipidemia, Killip class, existence of Q wave, St segment elevation, bundle branch blocks [BBB], involved surface of heart, mean left ventricular ejection fraction [LVEF], mitral valve regurgitation [MR], and serum level of Troponin I and CKMB, with patients' survival and expiry by using chi square test, T test and multivariate logistic regression analysis. P value II [P<0.001], hypertension [P=0.036], DM [P<0.001], bundle branch block [P<0.001], Moderate to severe mitral regurgitation [P<0.001], lower Mean LVEF [P<0.001], and lower mean serum concentration of CKMB and Troponin I [P<0.001]. Mortality was significantly higher in anterolateral infarction. Mean age>69.01 yr, femaleness, Killip class III and V, hypertension, DM, moderate to severe MR, anterolateral AMI, bundle branch block and higher serum concentration of CKMB and Troponin I are associated with higher In-hospital post-AMI mortality