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1.
Med Clin (Barc) ; 129(8): 281-6, 2007 Sep 08.
Artigo em Espanhol | MEDLINE | ID: mdl-17878020

RESUMO

BACKGROUND AND OBJECTIVE: The influence of homocysteine metabolism on the prognosis of acute coronary syndrome without ST elevation is controversial. PATIENTS AND METHOD: Prospective study of 109 patients admitted because of acute coronary syndrome without ST elevation. Basal plasmatic levels of homocysteine and folates were obtained. Clinical features and survival data on follow-up were registered. RESULTS: Both two years-free-of-events and total survival were lower in patients with low folate levels (36.5% vs 72.5%, p = 0.02; 48% vs 94%, p < .001). Patients with high homocysteine levels had lower two years-free-of-events survival (57.4% vs 89.1%, p < .01); but no difference in the total survival was observed (86.3% vs 97.3%, p = 0.11). The multivariate analysis showed that low folate levels was an independent predictor of mortality (odds ratio [OR] = 8.33; 95% confidence interval [CI], 1.88-33.33; p < 0.01), and moderate high homocysteine was an independent predictor of events on follow-up (OR = 4.34; 95% CI, 1.47-12.50; p < 0.01). CONCLUSIONS: Patients with high homocysteine or low folate levels have a poor prognosis compared with those with normal levels. On the other hand, low folate levels and moderate hyiperhomocysteinemia are independent predictors of bad prognosis in the follow-up.


Assuntos
Síndrome Coronariana Aguda , Deficiência de Ácido Fólico/epidemiologia , Hiper-Homocisteinemia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/epidemiologia , Hiper-Homocisteinemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Prognóstico , Índice de Gravidade de Doença
2.
Med. clín (Ed. impr.) ; 129(8): 281-286, sept. 2007. tab, graf
Artigo em Es | IBECS | ID: ibc-057934

RESUMO

FUNDAMENTO Y OBJETIVO: La influencia de las alteraciones del metabolismo de la homocisteína en el pronóstico del síndrome coronario agudo sin elevación del segmento ST está sujeta a controversias. PACIENTES Y MÉTODO: Estudio prospectivo de 109 pacientes con síndrome coronario agudo sin elevación del segmento ST. Se determinaron los valores plasmáticos basales de homocisteína y folatos. Se analizaron sus características clínicas y se estudió la supervivencia según la presencia de concentración alta de homocisteína o baja de folatos en plasma. RESULTADOS: Tanto la supervivencia libre de episodios, como la supervivencia total a 2 años fue menor en los pacientes con folatos bajos (el 36,5 frente al 72,5%, p = 0,02, y el 48 frente al 94%, p < 0,001, respectivamente). Los pacientes con homocisteína elevada presentaron una menor supervivencia libre de episodios a los 2 años (el 57,4 frente al 89,1%, p < 0,01), y no se encontraron diferencias en términos de supervivencia total (el 86,3 frente al 97,3%, p = 0,11). En el análisis mediante regresión de Cox, la presencia de folatos bajos se identificó como predictor independiente de mortalidad (odds ratio [OR] = 8,33; intervalo de confianza [IC] del 95%, 1,88-33,33; p < 0,01); además, la hiperhomocisteinemia moderada fue un predictor independiente de episodios en el seguimiento (OR = 4,34; IC del 95%, 1,47-12,50; p < 0,01). CONCLUSIONES: En esta serie, los pacientes con hiperhomocisteinemia y/o valores bajos de folatos presentaron un pronóstico peor que el de aquéllos con valores normales. La presencia de valores bajos de folatos y la existencia de hiperhomocisteinemia moderada fueron predictores independientes de mal pronóstico en el seguimiento


BACKGROUND AND OBJECTIVE: The influence of homocysteine metabolism on the prognosis of acute coronary syndrome without ST elevation is controversial. PATIENTS AND METHOD: Prospective study of 109 patients admitted because of acute coronary syndrome without ST elevation. Basal plasmatic levels of homocysteine and folates were obtained. Clinical features and survival data on follow-up were registered. RESULTS: Both two years-free-of-events and total survival were lower in patients with low folate levels (36.5% vs 72.5%, p = 0.02; 48% vs 94%, p <.001). Patients with high homocysteine levels had lower two years-free-of-events survival (57.4% vs 89.1%, p <.01); but no difference in the total survival was observed (86.3% vs 97.3%, p = 0.11). The multivariate analysis showed that low folate levels was an independent predictor of mortality (odds ratio [OR] = 8.33; 95% confidence interval [CI], 1.88-33.33; p < 0.01), and moderate high homocysteine was an independent predictor of events on follow-up (OR = 4.34; 95% CI, 1.47-12.50; p < 0.01). CONCLUSIONS: Patients with high homocysteine or low folate levels have a poor prognosis compared with those with normal levels. On the other hand, low folate levels and moderate hyiperhomocysteinemia are independent predictors of bad prognosis in the follow-up


Assuntos
Humanos , Isquemia Miocárdica/fisiopatologia , Hiper-Homocisteinemia/fisiopatologia , Doença das Coronárias/fisiopatologia , gama-Glutamil Hidrolase/deficiência , Estudos Prospectivos , Biomarcadores/análise , Angiografia Coronária
3.
Int J Cardiol ; 118(2): 220-6, 2007 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-17023072

RESUMO

BACKGROUND: To test prospectively whether moderate hyperhomocysteinemia and low folate levels could have an influence in the prognosis of 155 patients who presented with an acute coronary syndrome. METHODS AND RESULTS: After a mean follow-up of 13.4+/-7.4 months, patients with low folate levels had higher percentages of cardiovascular death and major cardiovascular events (33% vs. 5%, p<0.001; 44% vs. 22%, p<0.05) and patients with high homocysteine levels had a higher percentage of major cardiovascular events (31% vs. 14.5%, p<0.03). Kaplan-Meier survival estimates analysis showed that patients with low folate levels had a significantly higher probability of cardiovascular death and lower free-of-events survival (log rank statistic: 21.17, p<0.001 and 6.59, p=0.01). Patients with high homocysteine levels had a lower free-of-events survival (log rank statistic: 4.95, p=0.02). Different survival multivariate analysis model showed that the presence of low folate levels was an independent predictor of cardiovascular death (hazard ratio 8.85, 95% confidence interval 2.6-29.3, p<0.000) and high homocysteine levels was identified as independent predictor of major cardiovascular events (hazard ratio 2.34, 95% confidence interval 1.07-5.12, p<0.03). CONCLUSIONS: Low folate levels and moderate hyperhomocysteinemia were identified as independent predictors of cardiovascular events in the follow-up.


Assuntos
Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/epidemiologia , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/epidemiologia , Isquemia Miocárdica/sangue , Isquemia Miocárdica/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/diagnóstico , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Análise de Sobrevida
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