Logro de las metas de colesterol LDL en pacientes con enfermedad coronaria aterosclerótica establecida / Achievement of LDL cholesterol targets in patients with coronary artery disease

Resumen Introducción: Los pacientes con enfermedad aterosclerótica establecida requieren tratamiento con estatinas para reducir la probabilidad de nuevos eventos. Objetivo: Identificar el porcentaje de pacientes con enfermedad coronaria aterosclerótica establecida que logran niveles de cLDL (colesterol LDL) inferiores a 70mg/dl y describir su distribución en tres grupos terapéuticos: estatinas, otros hipolipemiantes y sin tratamiento. Métodos: Estudio observacional descriptivo de corte transversal, en el que se seleccionaron pacientes de tres hospitales de alta complejidad, mayores de 18 años, con enfermedad aterosclerótica diagnosticada a partir del año 2017. El registro del perfil lipídico corresponde al realizado al menos tres meses después del diagnóstico. Resultados: Se incluyeron en total 746 pacientes con enfermedad coronaria aterosclerótica, con un promedio de edad de 65,3±10,9 años y predominio del sexo masculino (75,5%). Del total de los pacientes evaluados se prescribieron un 97,8% de terapia con al menos una estatina, 0,7% de otros hipolipemiantes y 1,5% no presentaron tratamiento. Los pacientes con niveles de cLDL inferior a 70mg/dl corresponden al 56%. Conclusiones: La extensa divulgación de guías de práctica clínica para dislipidemias en adultos en Colombia, y la incorporación de estatinas de alta intensidad, demuestran una mejoría en la proporción del cumplimiento en metas de cLDL para pacientes con enfermedad aterosclerótica establecida. Sin embargo, una alta proporción aún persiste fuera de metas, lo cual constituye una oportunidad de optimización del uso de terapias disponibles y recientemente desarrolladas.

Abstract Introduction: Patients with established atherosclerotic disease require treatment with statins in order to reduce the probability of new events. Objective: To identify the percentage of patients with established atherosclerotic coronary disease that achieve cLDL (LDL - cholesterol) levels less than 70mg/dL, and to describe its distribution in three treatment groups: statins, other lipid lowering drugs, and without treatment. Methods: A cross-sectional, descriptive observational study was conducted on patients diagnosed with atherosclerotic disease from 2017 and over 18-years-old from 3 tertiary hospitals. A record was made of the lipid profile that was performed at least three months after the diagnosis. Results: A total of 746 patients with atherosclerotic coronary disease were included. The mean age was 65.3±10.9 years and the majority (75.5%) were males. Of the total number of patients evaluated, 97.8% were prescribed a therapy with at least one statin, 0.7% with other lipid-lowering drugs, and 1.5% had no treatment. Just over half (56%) of the patients had cLDL levels of less than 70mg/dL. Conclusions: The widespread use of clinical practice guidelines for dyslipidaemias in adults in Colombia, and the incorporation of high-intensity statins, has led to an improvement in the proportion of patients with established atherosclerotic disease achieving cLDL targets. However, a high percentage still does not reach the targets, which suggests a need for an improving of the use of available and recently developed therapies.

Os Escores HEART, TIMI e GRACE para Predição de Eventos Cardiovasculares Adversos Maiores no Período de 30 Dias na Era de Troponina I de Alta Sensibilidade / HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin

Resumo Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital Universitario / Clinical and microbiological characteristics of patients with febrile neutropenia in one Colombian Universitary Hospital

Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.

Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.