ABSTRACT
OBJECTIVES: The objective of this prospective study was to determine the differences in the prognostic significance of an exercise test (ET) that indicates a low risk of events (low-risk exercise test [LRET]) between patients with unstable angina (UA) and those with chronic stable angina (CSA). BACKGROUND: It is not known whether the prognostic significance of an LRET is influenced by the disease; that is the reason for performing exercise testing. METHODS: All patients not presenting with high-risk criteria were submitted to a prognostic ET. The ET was performed by patients with CSA and patients with primary UA stabilized with medical therapy. Medical therapy was planned for all patients. A combined end point was defined as cardiac death, nonfatal acute myocardial infarction or hospital admission for UA. Multivariate analysis was performed to determine the independent predictors of events. RESULTS: Low-risk criteria were fulfilled by 105 patients with UA and 86 patients with CSA. The mean follow-up time was 347 +/- 229 days. The event rate was higher in the UA group than in the CSA group (28% vs. 9%, p = 0.001). The CSA group showed worse ET results. Performance of ET by patients with UA was the principal predictor of events (odds ratio 4.2, p = 0.0005). CONCLUSIONS: Among patients who underwent an LRET, those with UA had a rate of events significantly higher than that of patients with CSA, despite the worse results of ET in patients with CSA.
Subject(s)
Angina Pectoris/diagnosis , Angina, Unstable/diagnosis , Electrocardiography , Exercise Test , Aged , Angina Pectoris/mortality , Angina Pectoris/physiopathology , Angina, Unstable/mortality , Angina, Unstable/physiopathology , Cause of Death , Chronic Disease , Female , Heart Conduction System/physiopathology , Hemodynamics/physiology , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Patient Admission/statistics & numerical data , Prognosis , Risk Assessment , Survival RateABSTRACT
INTRODUCTION: Fever appears in a fourth of stroke, approximately. Its origins, (the most of them are infectious) are unknown in a minority of the cases. Some hypotheses indicate that central mechanisms like hypothalamic lesions or segregation of endogenous pyrogens may be implicated. OBJECTIVE: To evaluate the frequency of central fever during stroke and to notice if there are clinical differences between infectious and central origins of the fever. PATIENTS AND METHODS: 103 patients were evaluated prospectively, if someone had fever, an investigation about an infectious origin was made. We divided the fever patients into two groups: "infectious fever" and "fever without infection documented" and we analyzed the clinical differences between them. RESULTS: 23% of the patients had fever, 33% without infection documented. This last group had earlier fevers. They had more clinical severity and more mortality. The fever was higher and it didn't response to the antipyretic treatment also. The others parameters didn't show any difference between the two groups. CONCLUSION: The patients with fever without infection documented ( probably fever of central origin)had a defined model with its own characteristics, in a different way from infectious fever.
Subject(s)
Fever/etiology , Stroke/complications , Aged , Analgesics, Non-Narcotic/therapeutic use , Brain/physiopathology , Diagnosis, Differential , Female , Fever/diagnosis , Fever/drug therapy , Fever/physiopathology , Humans , Infections/complications , Infections/physiopathology , Male , Prospective Studies , Respiratory Tract Infections/complications , Respiratory Tract Infections/physiopathology , Stroke/physiopathology , Treatment Failure , Urinary Tract Infections/complications , Urinary Tract Infections/physiopathologyABSTRACT
Introducción. La fiebre aparece aproximadamente en la cuarta parte de los enfermos con ictus. Aunque en la mayoría de los enfermos es infeccioso, su origen resulta difícil de demostrar en una minoría de casos. El mecanismo de la fiebre en el ictus no está aclarado, y se ha sugerido que tanto la propia lesión isquémica, bien por lesión hipotalámica o por segregación de pirógenos endógenos, sea la responsable de la hipertermia. Objetivos. Valorar la frecuencia de fiebre de origen no infeccioso durante un ictus y analizar si esta fiebre posee un patrón o características especiales que la diferenciarían de la fiebre infecciosa. Pacientes y métodos. Se evaluaron prospectivamente 103 pacientes con ictus; si presentaban fiebre, se realizaba un protocolo buscando una causa infecciosa. Se dividieron los casos en `fiebre de origen infeccioso' y `fiebre sin infección documentada' y se analizaron las características de los ictus en cada grupo y el comportamiento de la fiebre. Resultados. El 23 por ciento de los pacientes presentaron fiebre, el 33 por ciento fueron sin infección documentada. Este último grupo presentó mayor precocidad de la fiebre, mayor afectación clínica inicial, mayor mortalidad precoz, mayores temperaturas máximas y falta de respuesta al tratamiento antitérmico al compararlo con el grupo infeccioso. El resto de los parámetros estudiados no mostraron diferencias estadísticamente significativas entre ambos grupos. Conclusiones. Los pacientes con fiebre de origen no infeccioso tienen un patrón claro y definido, diferente a la fiebre de origen infeccioso. Proponemos un mecanismo central de la fiebre en dichos casos (AU)
