Influence of Factors Affecting Quality of Life on in-Hospital Cardiovascular Events of Patients with Acute Myocardial Infarction with and without ST-segment Elevation

Abstract Background Acute myocardial infarction (AMI), with and without ST-segment elevation (STEMI and NSTEMI, respectively), is the principal cause of cardiovascular morbidity and mortality in Brazil and around the world. Modifiable risk factors (RF) and quality of life (QOL) may correlate with the type of AMI. Objective To evaluate the influence of QOL and RF on the type of AMI and in-hospital cardiovascular events in STEMI and NSTEMI patients. Methods This was an observational, cross-sectional study. Patients with AMI attending four referral hospitals (three private and one public) for cardiovascular disease treatment were assessed for QOL using the Brazilian version of the 36-item short form survey. A p < 0.05 was considered statistically significant. Results We evaluated 480 volunteers; 51% were treated in one of the private hospitals. In total, 55.6% presented with STEMI, and 44.4% with NSTEMI. Patients from the public hospital were 8.56 times more likely to have STEMI compared to those from the private hospitals. There was a higher prevalence of smokers in STEMI (p < 0.028) patients. QOL was not associated with the type of AMI. A negative patient perception of the physical health and pain domains was observed. Although a significant difference between the physical and the mental health domains was not observed, individual domains were correlated with some in-hospital outcomes. Conclusion There was a higher prevalence of smokers among individuals with STEMI. Domains of QOL showed a statistically significant relationship with the occurrence of in-hospital cardiovascular events, with no difference between the types of AMI.

Associação entre Parâmetros Plasmático de Tiol e Níveis de Troponina em Pacientes com Síndrome Coronariana Aguda e Predição de Arritmia Ventricular Hospitalar / Association between Plasma Thiol Parameters and Troponin Levels in Patients with Acute Coronary Syndrome and Prediction of In-Hospital Ventricular Arrhythmia

Resumo Fundamento As arritmias ventriculares (AVs) são a principal causa de mortalidade e morbidade hospitalar em pacientes com síndrome coronariana aguda (SCA) e sua relação com o tiol é desconhecida. Objetivo Investigar a relação entre os níveis plasmáticos de tióis e os níveis de troponina em pacientes com SCA e estimar o desenvolvimento de AV intra-hospitalar durante a internação. Método O estudo incluiu 231 pacientes consecutivos com SCA com supradesnivelamento do segmento ST (SCA-SDST) e pacientes com SCA sem supradesnivelamento do segmento ST (SCA-SSDST). Após a aplicação dos critérios de exclusão, 191 pacientes foram incluídos na análise estatística. Os pacientes foram classificados em dois grupos: grupo SCA-SDST (n=94) e grupo SCA-SSDST (n=97). Os níveis plasmáticos de tiol, dissulfeto e troponina foram medidos e a razão de troponina para tiol nativo (RTTN) foi calculada. Considerou-se estatisticamente significativo um valor de p bilateral inferior a 0,05. Resultados Tiol nativo plasmático, tiol total, dissulfeto e suas razões foram semelhantes entre os grupos. A RTTN se mostrou significativamente maior no grupo SCA-SDST em comparação com o grupo SCA-SSDST. Houve correlação negativa significativa entre os níveis de troponina e tiol. Verificou-se que o tiol nativo é preditor independente do desenvolvimento de AV em pacientes com SCA-SDST e em todos os pacientes com SCA. Verificou-se que o RTTN é preditor independente do desenvolvimento de AV em pacientes com SCA-SSDST e em todos os pacientes com SCA. Conclusão Os níveis plasmáticos de tiol podem ser usados para identificar pacientes com alto risco de desenvolvimento de AV intra-hospitalar em pacientes com SCA. A correlação entre os níveis de troponina e tiol pode sugerir que os tióis possam ser marcadores importantes para o diagnóstico e prognóstico da SCA com a ajuda de estudos futuros.

Abstract Background Ventricular arrhythmias (VAs) are the main cause of in-hospital mortality and morbidity in acute coronary syndrome (ACS) patients and its relationship with thiol is not known. Objective To investigate the relationship between plasma thiol levels and troponin levels in patients with ACS and to estimate in-hospital VA development during hospital stay. Method The study included 231 consecutive ST-segment elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS) patients. After application of exclusion criteria, 191 patients were included in the statistical analysis. Patients were classified into two groups: STE-ACS group (n=94) and NSTE-ACS group (n=97). Plasma thiol, disulphide and troponin levels were measured and troponin-to-native thiol ratio (TNTR) was calculated. A two-sided p value of less than 0.05 was considered to be statistically significant. Results Plasma native thiol, total thiol, disulphide and their ratios were similar between the groups. TNTR was significantly higher in the STE-ACS group compared to the NSTE-ACS group. Troponin and thiol levels correlated negatively and significantly. Native thiol was found to be an independent predictor of VA development in STE-ACS patients and in all ACS patients. TNTR was found to be an independent predictor of VA development in NSTE-ACS patients and in all ACS patients. Conclusion Plasma thiol levels can be used to identify ACS patients at high risk for in-hospital VA development. Correlation between troponin and thiol levels may suggest that thiols may be an important marker for diagnosis and prognosis of ACS with the help of future studies.

Factores pronósticos en mujeres de edad mediana con síndrome coronario agudo sin elevación del segmento ST / Prognostic factors in middle-aged women with acute coronary syndromes and no ST-segment elevation

Introducción: el síndrome coronario agudo sin elevación del segmento ST (SCASEST) reporta una elevada incidencia en mujeres de edad mediana, sin establecerse un pronóstico a mediano plazo. Objetivos: identificar factores pronósticos de morbilidad en mujeres de edad mediana con SCASEST en la unidad cuidados coronarios (UCC) del Hospital "Iván Portuondo", San Antonio de los Baños, Artemisa. Métodos: se realizó un estudio de cohorte prospectivo desde enero 2006 hasta septiembre 2012. De 1 243 mujeres entre 45-65 años se seleccionaron por muestreo aleatorio simple 100 de ellas, con diagnóstico al ingreso en UCC de SCASEST (Grupo A) y otras 100 pacientes de la consulta regional de climaterio/menopausia sin antecedentes de síndrome coronario agudo, la muestra se calculó para un riesgo relativo (RR) conocido de 9,1, confianza del 95 % y precisión 96 %. Resultados: la media de edad en las pacientes del Grupo A fue de 61,6 años (DE 1,5) predominó la hipertensión arterial (RR 3,8) y los síntomas climatéricos intensos (RR 3,7) como variables principales asociadas al climaterio, con alta incidencia de arritmias cardiacas (FA16 DIE 1,7) y taquicardias dependientes del SCASEST. La dosificación plasmática de colesterol fue el complementario de mayor utilidad diagnóstica (sensibilidad 0,8 especificidad 0,9) y el IMA la complicación por excelencia (3,2 IC 2,1-3,3) los síntomas climatéricos fueron intensos, la variable pronóstica de mayor significación estadística. La tasa de morbilidad en el grupo A fue de 14 %. Conclusiones: en la mujer de edad mediana con SCASEST la intensidad de los síntomas climatéricos asociados a la obesidad e hipercolesterolemia ensombrecen su pronóstico a mediano plazo, más allá de un adecuado seguimiento clínico.

Introduction: acute coronary syndrome without ST segment elevation (NSTE ACS) reports high incidence in middle-aged women without established medium-term prognosis. Objectives: to identify predictors of disease in middle-aged women with NSTE ACS in the coronary care unit (CCU) of Ivan Portuondo Hospital in San Antonio de los Baños, Artemisa Province. Methods: a prospective cohort study was conducted from January 2006 to September 2012. 100 out of 1243 women aging 45-65 years were selected by simple random sampling, with the admission diagnosis of NSTEMI UCC for Group A and 100 patients from the climacteric / menopause Regional Consultation with no history of acute coronary syndrome for Group B. The sample was calculated for a relative risk (RR) of 9.1 known, 95 % confidence, and 96 % precision. Results: the mean age of the patients in Group A was 61.6 years (SD 1.5) hypertension (RR 3.8) predominated and severe menopausal symptoms (RR 3.7) as main variables associated with climacteric, with high cardiac arrhythmias incidence (FA16 DIE 1.7) and NSTEMI dependent tachycardias. The cholesterol dosage plasma was the most useful complementary diagnostic (sensitivity 0.8, specificity 0.9) and IMA quintessential complication (3.2 CI 2.1 to 3.3) was severe menopausal symptom, the highest prognostic significance variable. The morbidity rate in group A was 14%. Conclusions: in middle-aged women with NSTEMI, intensity of climacteric symptoms associated with obesity and hypercholesterolemia overshadow its medium-term prognosis, beyond appropriate clinical monitoring.

Design and baseline characteristics of a coronary heart disease prospective cohort: two-year experience from the strategy of registry of acute coronary syndrome study (ERICO study)

OBJECTIVES: To describe the ERICO study (Strategy of Registry of Acute Coronary Syndrome), a prospective cohort to investigate the epidemiology of acute coronary syndrome. METHODS: The ERICO study, which is being performed at a secondary general hospital in São Paulo, Brazil, is enrolling consecutive acute coronary syndrome patients who are 35 years old or older. The sociodemographic information, medical assessments, treatment data and blood samples are collected at admission. After 30 days, the medical history is updated, and additional blood and urinary samples are collected. In addition, a retinography, carotid intima-media thickness, heart rate variability and pulse-wave velocity are performed. Questionnaires about food frequency, physical activity, sleep apnea and depression are also applied. At six months and annually after an acute event, information is collected by telephone. RESULTS: From February 2009 to September 2011, 738 patients with a diagnosis of an acute coronary syndrome were enrolled. Of these, 208 (28.2%) had ST-elevation myocardial infarction (STEMI), 288 (39.0%) had non-ST-elevation myocardial infarction (NSTEMI) and 242 (32.8%) had unstable angina (UA). The mean age was 62.7 years, 58.5% were men and 77.4% had 8 years or less of education. The most common cardiovascular risk factors were hypertension (76%) and sedentarism (73.4%). Only 29.2% had a prior history of coronary heart disease. Compared with the ST-elevation myocardial infarction subgroup, the unstable angina and non-ST-elevation myocardial infarction patients had higher frequencies of hypertension, diabetes, prior coronary heart disease (p<0.001) and dyslipidemia (p = 0.03). Smoking was more frequent in the ST-elevation myocardial infarction patients (p = 0.006). CONCLUSIONS: Compared with other hospital registries, our findings revealed a higher burden of CV risk factors and less frequent prior CHD history.

Choque cardiogénico en síndrome coronario agudo: causas, criterios diagnósticos, tratamiento y mortalidad en el Instituto Nacional del Corazón en Lima, Perú / Cardiogenic shock in coronary acute syndrome: Causes, diagnostic criteria, treatment and mortality at the Instituto Nacional del Corazón in Lima, Peru

Objetivo: Determinar las causas, criterios diagnósticos, tratamiento y mortalidad del choque cardiogénico (ChC) como complicación del síndrome coronario agudo (SCA) en el Instituto Nacional del Corazón, en Lima – Perú. Material y métodos: Se realizó un estudio observacional, descriptivo tipo serie de casos de fuentes secundarias en pacientes con diagnóstico de ChC por SCA del Instituto Nacional del Corazón desde febrero 2004 hasta 31 diciembre 2005. Para seleccionar los pacientes, se utilizaron las palabras clave: choque cardiogénico, balón intraaórtico (BIA) e infarto de miocardio agudo (IMA) más muerte. Los datos obtenidos de las historias clínicas seleccionadas, fueron procesados en el programa SPSS. Resultados: Se encontraron 24 pacientes. Veinte tuvieron ecocardiografía y 70,0%, presentaron disfunción ventricular izquierda (DVI) como causa de ChC, las demás fueron por complicaciones mecánicas. El 95% de pacientes tuvieron criterios clínicos (hipotensión o signos de hipoperfusión tisular); 11 tuvieron estudio hemodinámico, y cumplieron el criteriohemodinámico de choque. El tratamiento fue con vasopresores en 95,8% de los pacientes, inotrópicos en 66,7%, BIA en50%. Trece pacientes tuvieron cinecoronariografia siendo revascularizados el 69,2%. Todos los pacientes fallecieron. Conclusiones: La causa principal de ChC fue DVI. El diagnóstico fue predominantemente clínico. El tratamiento en su mayoría fue médico y la tasa de mortalidad fue del 100%. Estos datos concuerdan con los descritos en otros estudios excepto que la mortalidad fue mayor en nuestro estudio.

Objective: To determine causes, diagnostic criteria, treatment and mortality of cardiogenic shock complicating coronary acute syndrome (CSCCAS), at the Instituto Nacional del Corazón Lima – Peru. Material and methods: Observational – descriptive (case series) study of secondary sources was conducted on patients with CSCCAS. To select patients we used key words: cardiogenic shock, intraaortic balloon pumping (IABP), myocardial infarction plus death. Data of clinic charts was analyzed in SPSS program. Results: We got 24 patients, 20 of them had echocardiographic study and 70% showed left ventricular dysfunction (LVD) as a cause of cardiogenic shock owing to coronary acute syndrome (myocardial infarction) and the rest were mechanical complications. 95% filled clinical criteria (including hypotension or signs of end organ hypoperfusion); 11 patients had hemodynamic study and all of them filled hemodynamic criteria. Treatment consisted on vasopressors in 95.8% of patients, inotropics in 66.7%, IABP in 50%. 13 patients had coronary angiographic study and 69.2% of them were revascularized. All the patients died. Conclusions: LVD was the main cause of CS. Diagnosis was predominantly clinical. Medical treatment were used in the majority of cases. Our results were similar to other studies except in mortality that was higher (100%).

Nadroparina cálcica vs. heparina sódica en el síndrome coronario agudo. Unidad de Cuidados Coronarios del hospital Luis Vernaza / Nadroparine calcium vs. sodic heparine in the acute coronary syndrome. Coronary Unit Care of Luis Vernaza hospital

Tipo de estudio: ensayo clínico, unicéntrico, prospectivo, doble longitudinal, descriptivo, analítico, realizado en la Unidad de Cuidados Coronarios del hospital “Luis Vernaza” de Guayaquil, en pacientes con síndrome coronario agudo. Objetivo: determinar cual de las dos heparinas es superior, tanto en mejoría clínica como en costos y efectos secundarios. Resultados: se estudió un total de 34 pacientes; 14 con heparina sódica (grupo A) y 14 con nadroparina cálcica (grupo B), aparte de la aspirina y demás medicación antianginosa a criterio médico. La edad de presentación más frecuente en varones fue entre los 50 y 59 años, y en mujeres entre los 70 y 79 años; el grupo A tuvo una estancia hospitalaria de 29,35 días (ET 4,39) y en el grupo B de 21,24 días (ET 3,53) p= 0,160; los gastos en el grupo B fueron el doble que en el grupo A; el grupo A tuvo sangrados leves en un 2,9%, anginas recurrentes 11,76%, infarto recurrente 2,9%, trombocitopenia 2,9%. El grupo B tuvo sangrados leves en el 8,8%, infarto recurrente en el 2,9% y angina recurrente en el 14,7%. Conclusiones: absoluta paridad entre las dos estrategias terapéuticas; la única diferencia radica en los costos.

Type of study: clinic test, unicentric, prospective, double longitudinal, analytic and descriptive, performed in the Coronary Unit Care of Luis Vernaza Hospital of Guayaquil, with patient with acute coronary syndrome. Objective: To establish which of two heparin is superior, as much in clinic provement as in fees and secondary effects. Results: In the study was with 34 patients; 14 with sodic heparine (group A) and 14 with nadroparine calcium (group B), besides aspirin and any antiangina drugs of medical criteria. The age more frequently in men was between 50 to 59 years, and women between 70 to 79 years; Group A had a hospital stay of 29,35 days (ET 4,39) and group B de 21,24 days (ET 3,53) p= 0,160; the expenses in the group B was double than group A; Group A had mild bleeding in 2,9 %, recurrent angina 11,76%, recurrent heart attack 2,9 %, thrombocytopenia 2,9%. Group B had mild bleeding in 8,8%, recurrent heart attack in 2,9% and recurrent angina in 14,7%. Conclusion: Absolute similarity between two therapeutic strategies; the only difference is in fees.