RESUMO
OBJECTIVE: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease. DESIGN: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients. SETTING: Coronary care unit in Spain. PARTICIPANTS: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome. MAIN OUTCOME MEASURES: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events. RESULTS: Concentrations of C reactive protein and fibrinogen, and leucocyte count on admission were higher in diabetic than in non-diabetic patients (7 mg/l v 5 mg/l, p = 0.020; 3.34 g/l v 2.90 g/l, p = 0.013; and 8.8 x 10(9)/l v 7.8 x 10(9)/l, p = 0.040). Among diabetic patients, these values were also higher in those who died during the 22 month follow up (13 mg/l v 6 mg/l, p = 0.001; 3.95 g/l v 3.05 g/l, p < 0.001; and 11.4 x 10(9)/l v 8.4 x 10(9)/l, p = 0.005). After adjustment for confounding factors, diabetic patients in the highest tertile of C reactive protein had a hazard ratio for cardiovascular death of 4.51 (95% confidence interval (CI) 1.62 to 12.55). Similar hazard ratios were for fibrinogen 3.74 (95% CI 1.32 to 10.62) and for leucocyte count 3.64 (95% CI 1.37 to 9.68). CONCLUSIONS: Inflammation appears more evident in diabetic than in non-diabetic patients with acute coronary syndrome. C reactive protein concentration, fibrinogen concentration, and leucocyte count constitute independent predictors of cardiovascular death in diabetics with unstable coronary disease.
Assuntos
Angina Instável/mortalidade , Proteína C-Reativa/análise , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Fibrinogênio/análise , Infarto do Miocárdio/mortalidade , Idoso , Angina Instável/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Feminino , Humanos , Contagem de Leucócitos , Masculino , Análise Multivariada , Infarto do Miocárdio/sangue , Prognóstico , Espanha/epidemiologia , Análise de SobrevidaRESUMO
Endocarditis related to pacemaker lead is a rare complication of permanent transvenous pacing, of which the diagnosis is carried out with the presence of verrucae in echocardiography and positive blood cultures, its treatment being mixed -medical and surgical- because the isolated medical treatment is rarely successful and the lead should be extracted. We present the case of recurrent endocarditis of several years of evolution, in the which it was not possible to extract of the electrode due to the special characteristics of the patiente (epicardial lead perforating into right atrial).
Assuntos
Endocardite Bacteriana , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis , Idoso , Eletrodos , Humanos , Masculino , Pericárdio , RecidivaRESUMO
Atrial standstill is a very rare form of bradyarrhythmia and consists of a transitory or permanent loss of the electrical and mechanical activity of the atria. We report a series of 8 patients, all of them with rheumatic valve disease (5 of them with a prosthetic valve) with symptomatic bradyarrhythmia secondary to atrial standstill, requiring an implantable pacemaker.