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INTRODUCTION: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality. METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios. RESULTS: Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p CONCLUSION: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.
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Doença da Artéria Coronariana , Circulação Colateral , Angiografia Coronária , Síndrome Coronariana Aguda , Prognóstico , Circulação Coronária , Pesquisa Qualitativa , Sistema CardiovascularRESUMO
INTRODUCTION: Patients with acute coronary syndrome (ACS) exhibit a wide spectrum of early risk of death (one to 10 percent). High platelet counts may indicate a propensity for platelet-rich thrombi. Lymphocyte counts drop during ACS due to stress-induced cortisol release. Combining these two markers, recent studies have found that the platelet-tolymphocyte ratio (PLR) is associated with adverse cardiac events among patients with ACS, but local data is limited. The objective of this study is to determine if an elevated PLR taken on admission is associated with higher rates of adverse cardiac events. METHODS: A retrospective cohort of adult patients with ACS admitted at the UP-Philippine General Hospital was analyzed. Leukocyte and platelet counts were measured by an automated hematology analyzer. The PLR values of these patients were computed, and they were stratified into two groups after determining the optimal cut-off from the receiver operating characteristic curve (ROC) curve. The primary outcome was in-hospital mortality. Secondary outcomes included development of heart failure, cardiogenic shock, reinfarction, and significant arrhythmias. RESULTS: A total of 174 Filipinos with ACS were included. In-hospital mortality occurred in 30 patients (17%). These patients had a higher PLR compared to those who were discharged alive (p-value CONCLUSION: Among Filipino patients with ACS, an elevated PLR taken within 24 hours of admission is a useful marker to predict in-hospital mortality, thus providing vital information for risk stratification and more aggressive management strategies.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Plaquetas , Síndrome Coronariana Aguda , Choque Cardiogênico , Mortalidade Hospitalar , Hidrocortisona , Hospitais Gerais , Filipinas , Contagem de Linfócitos , Insuficiência Cardíaca , Arritmias Cardíacas , Leucócitos , HematologiaRESUMO
INTRODUCTION: An aorto-enteric fistula is a fistulous communication between the duodenum and the aorta. The non-traumatic form, or primary aorto-enteric fistula (PAEF), is rare and fatal if untreated. This is a case of PAEF in a Filipino patient who presented with upper gastrointestinal bleeding (UGIB).CLINICAL PRESENTATION: A 62-year-old Filipino sought consult for hematemesis and melena. He had just been discharged the previous day and sent home on empiric H. pylori eradication therapy after a week of workup, which included an unremarkable esophagogastroduodenoscopy (EGD). He claimed to be hypertensive but was not taking any maintenance anti-hypertensive medication. PHYSICAL FINDINGS: Blood pressure was 80/50 mmHg,and cardiac rate of 94 bpm. He had pale palpebral conjunctivae, and pale nailbeds.Abdominal exam was unremarkable. Rest of physical exam was normal. Stat hemoglobin was 63 g/dL. RESULTS: Exploratory laparotomy revealed the primary aortoduodenal fistula at the anterolateral aspect of the fourth segment of the duodenum (PADF). Patient was started on metoprolol and atorvastatin. Axillary femoro-femoral bypass, ligation of aorta, wedge resection of aortoduodenal fistula, duodenorrhaphy, tube jejunostomy completed was done. Post-operative course was complicated by peritonitis and sepsis, and eventually went into arrest on his third week.SIGNIFICANCE: This is the first case of PAEF in our institution,and possibly in the country. It is an extremely rare condition that has an annual incidence of 0.007 per million. Since its description in 1843, only 250 cases have been reported in literature.RECOMMENDATIONS: A high index of suspicion is key to its diagnosis and management.Massive UGIB, a negative endoscopy, and known aortic aneurysm should raise the suspicion for PAEF, as prompt surgical intervention is the only chance for survival among these patients.