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INTRODUCTION: To date, there is no consensus regarding the follow-up of asymptomatic coronary patients with an intermediate risk of events. Indeed, most of cardiovascular events (CVE) occur in asymptomatic patients, hence the clinician's interest in establishing risk stratification scores. In asymptomatic patient, the risk assessment after acute coronary syndrome (ACS) can currently be based on 3 types of score: clinical with, for example, the REACH score; angiographic with the residual SYNTAX score; imaging with different scintigraphic scores. These scores differ widely in terms of evaluation criteria and period of analysis. The aim of our study was therefore, in stable and asymptomatic coronary patients after ACS, to compare these different predictive scores; to establish that the combination of these scores makes it possible to optimize the risk assessment during the follow-up. METHODS: Our retrospective study included 236 revascularized patients after ACS. Three different risk scores were collected: 1) the residual SYNTAX score, calculated at the time of revascularization; 2) the scintigraphic risk score described by Sharir et al., performed 3 to 12 months after the event and taking into account the extent of ischemia (SDS) and the poststress left ventricular ejection fraction (LVEF). Patients with LVEF <50% and/or moderate to severe ischemic disease (SDS≥2) were considered with an intermediate or high scintigraphic risk; 3) the REACH clinical score calculated on the day of the scintigraphic examination. After the myocardial scintigraphic exam, patients had a 1-year follow-up and CVE were recorded. Continuous data were analyzed either by Student's t-test or non-parametric Mann-Whitney test. The dichotomous data were compared either by the χ2 test or by Fisher's exact test. RESULTS: Forty-eight patients (20.1%) had a CVE during the 1-year follow-up. Thirty patients (13.8%) had a high residual SYNTAX score (≥8) without any correlation observed between the residual SYNTAX score and CVE (P=0.359). 148 patients (57.7%) had a high REACH clinical score (≥11) with no significant correlation observed with CVE (P=0.079). Lastly, 34 patients (14.4%) had an intermediate or high scintigraphic score, this imaging score being strongly correlated with a greater number of CVE (P<0.001). Multivariate analysis revealed 3 independent factors associated with CVE: a scintigraphic score> 2 (OR [(95% CI): 5.530 [2.426-12.605] P<0.001); Peripheral Arterial Obstructive Disease (PAOD) (OR [95% CI]: 8.531 [2.540-28.660] P<0.001); diabetes (OR [95% CI]: 2.86 [1.262-6.517] P=0,012). CONCLUSION: The combination of the scintigraphic score with two clinical factors, such as PAOD and diabetes, provides optimal prognostic value in the evaluation of asymptomatic and stable patients after ACS. Our study therefore highlights the importance of optimizing evaluation strategies in the follow-up of these patients who remain at risk of post-revascularization CVE.
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Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/diagnóstico por imagen , Anciano , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Cintigrafía , Estudios RetrospectivosRESUMEN
Within the first day after birth, infants develop the tendency to respond to human voices with enhanced asymmetrical mouthing. Breast-fed infants generally mouthed in the same direction as the voice while bottle-fed infants usually mouthed towards the left, wherever the voice came from. In both groups, this response thus reflects the orientation of anticipatory mouthing in the feeding situation.
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Pups aged 1 to 10 days, of deaf and hearing mouse strains, were monitored with an ultrasound detector while submitted to standard conditions of cold, isolation, and retrieving. The number of detections varied with the age of the pups and with the type of treatment (as established previously) but not with the genotype of the pups. Thus, occurrence and changes with age in ultrasound emission do not seem to be greatly influenced by their effects upon adult behavior.
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Conducta Animal , Sordera/fisiopatología , Ratones Endogámicos/fisiología , Ultrasonido , Envejecimiento , Animales , Audición , RatonesRESUMEN
Individual male mice of several groups were observed during daily encounters with a male intruder. The groups differed with regard to social and sexual experience of the resident animal and of the intruder. Aggressive behavior was most intense in residents actually living with a female and least intense in sexually naïve residents living alone. Residents that had only once cohabited with a female for a short time obtained intermediate scores. Experienced intruders were attacked less than naïve ones.