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INTRODUCTION: Risk prediction models, such as The Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), are recommended for assessing operative mortality in coronary artery bypass grafting (CABG). However, their performance is questionable in Brazil. OBJECTIVE: To assess the performance of the STS score and EuroSCORE II in isolated CABG at a Brazilian reference center. METHODS: Observationaland prospective study including 438 patients undergoing isolated CABG from May 2022-May 2023 at the Instituto Dante Pazzanese de Cardiologia. Observed mortality was compared with predicted mortality (STS score and EuroSCORE II) by discrimination (area under the curve [AUC]) and calibration (observed/expected ratio [O/E]) in the total sample and subgroups of stable coronary artery disease (CAD) and acute coronary syndrome (ACS). RESULTS: Observed mortality was 4.3% (n=19) and estimated at 1.21% and 2.74% by STS and EuroSCORE II, respectively. STS (AUC=0.646; 95% confidence interva [CI] 0.760-0.532) and EuroSCORE II (AUC=0.697; 95% CI 0.802-0.593) presented poor discrimination. Calibration was absent for the North American mode (P<0.05) and reasonable for the European model (O/E=1.59, P=0.056). In the subgroups, EuroSCORE II had AUC of 0.616 (95% CI 0.752-0.480) and 0.826 (95% CI 0.991-0.661), while STS had AUC of 0.467 (95% CI 0.622-0.312) and 0.855 (95% CI 1.0-0.706) in ACS and CAD patients, respectively, demonstrating good score performance in stable patients. CONCLUSION: The predictive models did not perform optimally in the total sample, but the EuroSCORE was superior, especially in elective stable patients, where accuracy was satisfactory.

Asunto(s)

Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Humanos , Puente de Arteria Coronaria/mortalidad , Femenino , Masculino , Estudios Prospectivos , Brasil , Anciano , Persona de Mediana Edad , Medición de Riesgo/métodos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/mortalidad , Factores de Riesgo , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/mortalidad , Mortalidad Hospitalaria , Reproducibilidad de los Resultados

RESUMEN

Background: Acute coronary syndrome (ACS) is the most serious manifestation of coronary heart disease. The Infarction Code (according to its initialism in Spanish, CI: Código Infarto) program aims to improve the care of these patients. Objective: To describe the clinical presentation and outcomes of CI program in a coronary care unit (CCU). Material and methods: A database of a CCU with 5 years of consecutive records was analyzed. Patients diagnosed with ACS were included. The groups with acute myocardial infarction with and without ST-segment elevation were compared using Student's t, Mann-Whitney U and chi-squared tests. We calculated the relative risk (RR) and 95% confidence intervals (95% CI) of cardiovascular risk factors for mortality. Results: A total of 4678 subjects were analyzed, 78.7% men, mean age 63 years (± 10.7). 80.76% presented acute myocardial infarction with positive ST-segment elevation and fibrinolytic was granted in 60.8% of cases. Percutaneous coronary intervention was performed in 81.4% of patients, which was successful in 82.5% of events. Patients classified as CI presented mortality of 6.8% vs. 11.7%, p = 0.001. Invasive mechanical ventilation had an RR of 26.58 (95% CI: 20.61-34.3) and circulatory shock an RR of 20.86 (95% CI: 16.16-26.93). Conclusions: The CI program decreased mortality by 4.9%. Early fibrinolysis and successful coronary angiography are protective factors for mortality within CCU.

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Introducción: el síndrome coronario agudo (SICA) es la manifestación más grave de la enfermedad coronaria. El programa Código Infarto (CI) tiene como objetivo mejorar la atención de estos pacientes. Objetivo: describir la presentación clínica y los resultados del programa CI de una unidad de cuidados coronarios (UCC). Material y métodos: se analizó una base de datos de una UCC con 5 años de registros consecutivos. Se incluyeron pacientes con diagnóstico de SICA. Se compararon los grupos con infarto agudo de miocardio con y sin elevación del segmento ST mediante las pruebas t de Student, U de Mann-Whitney y chi cuadrada. Se calculó el riesgo relativo (RR) y el intervalo de confianza del 95% (IC 95%) de los factores de riesgo cardiovascular para mortalidad. Resultados: se analizaron 4678 sujetos, 78.7% hombres, con media de edad de 63 años (± 10.7). El 80.76% presentó infarto agudo de miocardio con desnivel positivo del segmento ST y se otorgó fibrinolítico en el 60.8% de los casos. Se realizó intervencionismo coronario percutáneo en el 81.4% de los pacientes, el cual fue exitoso en el 82.5% de los eventos. Los pacientes catalogados como CI presentaron mortalidad del 6.8% frente a 11.7%, p = 0.001. La ventilación mecánica invasiva tuvo una RR de 26.58 (IC 95%: 20.61-34.3) y el choque circulatorio una RR de 20.86 (IC 95%: 16.16-26.93). Conclusiones: el programa CI disminuyó 4.9% la mortalidad. La fibrinólisis temprana y la angiografía coronaria exitosa son factores protectores para mortalidad dentro de la UCC.

Asunto(s)

Síndrome Coronario Agudo , Infarto del Miocardio , Sistema de Registros , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/mortalidad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Unidades de Cuidados Coronarios/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/terapia

RESUMEN

OBJECTIVE: History, electrocardiogram, age, risk factors, troponin risk score and troponin level follow-up are used to safely discharge low-risk patients with suspected non-ST elevation acute coronary syndrome from the emergency department for a 1-month period. We aimed to comprehensively investigate the 6-month mortality of patients with the history, electrocardiogram, age, risk factors, troponin risk score. METHODS: A total of 949 non-ST elevation acute coronary syndrome patients admitted to the emergency department from 01.01.2019 to 01.10.2019 were included in this retrospective study. History, electrocardiogram, age, risk factors, troponin scores of all patients were calculated by two emergency clinicians and a cardiologist. We compared the 6-month mortality of the groups. RESULTS: The mean age of the patients was 67.9 (56.4-79) years; 57.3% were male and 42.7% were female. Six-month mortality was significantly lower in the high-risk history, electrocardiogram, age, risk factors, troponin score group than in the low- and moderate-risk groups: 11/80 (12.1%), 58/206 (22%), and 150/444 (25.3%), respectively (p=0.019). CONCLUSION: Patients with high history, electrocardiogram, age, risk factors, troponin risk scores are generally treated with coronary angioplasty as soon as possible. We found that the mortality rate of this group of patients was lower in the long term compared with others. Efforts are also needed to reduce the mortality of moderate and low-risk patients. Further studies are needed on the factors affecting the 6-month mortality of moderate and low-risk acute coronary syndrome patients.

Asunto(s)

Síndrome Coronario Agudo , Electrocardiografía , Troponina , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/sangre , Factores de Riesgo , Troponina/sangre , Medición de Riesgo/métodos , Factores de Edad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Factores de Tiempo , Biomarcadores/sangre , Anamnesis

RESUMEN

BACKGROUND: Women, in comparison to men, experience worse outcomes after acute coronary syndrome (ACS). However, whether the female sex per se is an independent predictor of such adverse events remains unclear. OBJECTIVE: This study aims to assess the association between the female sex and in-hospital mortality after ST-elevation myocardial infarction (STEMI). METHODS: We conducted a retrospective cohort study by enrolling consecutive STEMI patients admitted to a tertiary hospital from January 2018 to February 2019. All patients were treated per current guideline recommendations. Multivariable logistic regression models were applied to evaluate in-hospital mortality using GRACE variables. Model accuracy was evaluated using c-index. A p-value < 0.05 was statistically significant. RESULTS: Out of the 1678 ACS patients, 709 presented with STEMI. The population consisted of 36% women, and the median age was 61 years. Women were older (63.13 years vs. 60.53 years, p = 0.011); more often presented with hypertension (75.1% vs. 62.4%, p = 0.001), diabetes (42.2% vs. 27.8%, p < 0.001), and hyperlipidemia (34.1% vs. 23.9%, p = 0.004); and were less likely to undergo percutaneous coronary intervention (PCI) via radial access (23.7% vs. 46.1%, p < 0.001). In-hospital mortality rate was significantly higher in women (13.2% vs. 5.6%, p = 0.001), and the female sex remained at higher risk for in-hospital mortality (OR 2.79, 95% CI 1.15-6.76, p = 0.023). A multivariate model including age, sex, systolic blood pressure, cardiac arrest, and Killip class was 94.1% accurate in predicting in-hospital mortality, and the c-index was 0.85 (95% CI 0.77-0.93). CONCLUSION: After adjusting for the risk factors in the GRACE prediction model, women remain at higher risk for in-hospital mortality.

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FUNDAMENTO: As mulheres, em comparação aos homens, apresentam piores resultados após a síndrome coronariana aguda (SCA). No entanto, ainda não está claro se o sexo feminino em si é um preditor independente de tais eventos adversos. OBJETIVO: Este estudo tem como objetivo avaliar a associação entre o sexo feminino e a mortalidade hospitalar após infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). MÉTODOS: Conduzimos um estudo de coorte retrospectivo, recrutando pacientes consecutivos com IAMCSST, internados em um hospital terciário de janeiro de 2018 a fevereiro de 2019. Todos os pacientes foram tratados de acordo com as recomendações das diretrizes atuais. Modelos de regressão logística multivariada foram aplicados para avaliar a mortalidade hospitalar utilizando variáveis de GRACE. A precisão do modelo foi avaliada usando o índice c. Um valor de p < 0,05 foi estatisticamente significativo. RESULTADOS: Dos 1.678 pacientes com SCA, 709 apresentaram IAMCSST. A população era composta por 36% de mulheres e a idade média era de 61 anos. As mulheres tinham maior idade (63,13 anos vs. 60,53 anos, p = 0,011); apresentavam hipertensão (75,1% vs. 62,4%, p = 0,001), diabetes (42,2% vs. 27,8%, p < 0,001) e hiperlipidemia (34,1% vs. 23,9%, p = 0,004) mais frequentemente; e apresentaram menor probabilidade de serem submetidas a intervenção coronária percutânea (ICP) por acesso radial (23,7% vs. 46,1%, p < 0,001). A taxa de mortalidade hospitalar foi significativamente maior em mulheres (13,2% vs. 5,6%, p = 0,001), e o sexo feminino permaneceu em maior risco de mortalidade hospitalar (OR 2,79, IC de 95% 1,15­6,76, p = 0,023). Um modelo multivariado incluindo idade, sexo, pressão arterial sistólica, parada cardíaca e classe de Killip atingiu 94,1% de precisão na previsão de mortalidade hospitalar, e o índice c foi de 0,85 (IC de 95% 0,77­0,93). CONCLUSÃO: Após ajuste para os fatores de risco no modelo de previsão do GRACE, as mulheres continuam em maior risco de mortalidade hospitalar.

Asunto(s)

Mortalidad Hospitalaria , Infarto del Miocardio con Elevación del ST , Humanos , Femenino , Infarto del Miocardio con Elevación del ST/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Anciano , Medición de Riesgo/métodos , Factores de Riesgo , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/terapia , Modelos Logísticos , Intervención Coronaria Percutánea

Asunto(s)

Humanos , Medición de Riesgo/métodos , Síndrome Coronario Agudo/mortalidad , Predicción/métodos , Pronóstico , Síndrome Coronario Agudo/etiología , Factores de Riesgo de Enfermedad Cardiaca

RESUMEN

Abstract Background The wide range of clinical presentations of acute coronary syndrome (ACS) makes it indispensible to use tools for risk stratification and for appropriate risks management; thus, the use of prognosis scores is recommended in the immediat clinical decision-making. Objective To validate the Global Registry of Acute Coronary Events (GRACE) score as a predictor of in-hospital and 6-month post-discharge mortality in a population diagnosed with ACS. Methods This is a prospective cohort study of consecutive patients diagnosed with ACS between May and December 2018. GRACE scores were calculated, as well as their predictive value for in-hospital and 6-month post-discharge mortality. The validity of the model was assessed by two techniques: discriminative power using the area under the receiver operating characteristic curve (AUC) and goodness-of-fit, using the Hosmer-Lemeshow (HL) test, at the 5% level of significance. Results A total of 160 patients were included, mean age 64 (±10.9) years; of which 60% were men. The risk model showed to have satisfactory ability to predict both in-hospital mortality, with an area under the curve (AUC) of 0.76 (95% confidence interval [CI], 0.57-0.95; p = 0.014), and 6-month post-discharge mortality, with AUC of 0.78 (95%CI, 0.62-0.94), p = 0.002. The HL test indicated good-fit for both models of the GRACE score. Conclusion In this study, the GRACE risk score for predicting mortality was appropriately validated in patients with ACS, with good discriminative power and goodness-of-fit. The results suggest that the GRACE score is appropriate for clinical use in our setting.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Medición de Riesgo/métodos , Síndrome Coronario Agudo/mortalidad , Pronóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Curva ROC , Estudios de Seguimiento , Mortalidad Hospitalaria , Síndrome Coronario Agudo/diagnóstico

RESUMEN

RESUMEN Introducción: el infarto agudo de miocardio con elevación del segmento ST como parte del síndrome coronario agudo, es una afección frecuente que cursa con una elevada mortalidad. En los últimos años, las enfermedades cardiovasculares han constituido la primera causa de muerte en Cuba, y en 2018 lo fueron en la provincia de Matanzas. Objetivo: caracterizar la morbimortalidad de los pacientes atendidos con síndrome coronario agudo. Materiales y métodos: se realizó un estudio transversal, descriptivo de 106 pacientes ingresados con diagnóstico de síndrome coronario agudo en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, en 2019. Resultados: 83 % de los pacientes llegaron en trasporte sanitario a la Unidad de Emergencia. El grupo de edad más afectado fue el de 70 a 79 años (28,30 %). Predominó el sexo masculino, con 51,89 %. El síndrome coronario agudo con elevación del segmento ST prevaleció sobre el síndrome coronario agudo sin elevación del segmento ST, en un total de 58 pacientes. El mayor número de casos se diagnosticó en los meses de invierno y en horas de la mañana. Prevaleció el tratamiento trombolítico en las primeras seis horas de iniciados los síntomas. Se demostró la desaparición del dolor y la regresión de los cambios electrocardiográficos como resultados de la reperfusión. Las arritmias malignas constituyeron la principal causa de muerte en los pacientes no trombolizados. Conclusiones: el uso de la trombólisis en servicios de emergencias disminuyó la mortalidad en las primeras horas, por enfermedades cardiovasculares, en la provincia de Matanzas en 2019.

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ABSTRACT Introduction: Acute myocardium infarct with elevation of the ST segment as a part of the acute coronary syndrome, is a frequent disease that causes a high mortality. In the last years, cardiovascular diseases have constituted the first cause of death in Cuba, and in 2018 they were in the province of Matanzas. Objective: to characterize morbidity and mortality in patients attended with acute coronary syndrome. Materials and methods: a cross-sectional, descriptive study was carried out in 106 patients admitted with diagnosis of acute coronary syndrome in the Unit of Emergent Intensive Care of the Teaching Clinical-surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas, in 2019. Results: 83 % of patients arrived in sanitary transportation to the Emergency Unit. The most affected age group was the one aged 70-79 years (28.30 %). Male sex predominated, with 51.89 %. Acute coronary syndrome with elevation of ST segment prevailed over the acute coronary syndrome without elevation of the ST segment, in a total of 58 patients. The biggest number of cases was diagnosed in the winter months and in the morning. Thrombolytic treatment prevailed in the first six hours after the beginning of the symptoms. There it was demonstrated the disappearance of the pain and the regression of the electrocardiographic changes as a result of the reperfusion. Malignant arrhythmias were the main causes of death in non thrombolyzed patients. Conclusions: the use of thrombolysis in emergency services diminished mortality caused by cardiovascular diseases in the first hours in the province of Matanzas in 1919.

Asunto(s)

Humanos , Masculino , Anciano , Síndrome Coronario Agudo/mortalidad , Infarto del Miocardio/mortalidad , Reperfusión , Trombolisis Mecánica , Infarto del Miocardio con Elevación del ST/diagnóstico

RESUMEN

Abstract Background Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population. Methods This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) - a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/mortalidad , Factores de Riesgo de Enfermedad Cardiaca , MINOCA/mortalidad , Pronóstico , Espectroscopía de Resonancia Magnética , Estudios Retrospectivos , Angiografía Coronaria , MINOCA/complicaciones

RESUMEN

BACKGROUND: Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. AIM: To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. METHODS: Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. RESULTS: At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07-1.47) and cardiac death [HR 1.28 (95% CI 1.02-1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. CONCLUSIONS: CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01377402, NCT00521976.

Asunto(s)

Síndrome Coronario Agudo/sangre , Angina de Pecho/sangre , Complemento C7/análisis , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Anciano , Anciano de 80 o más Años , Angina de Pecho/diagnóstico , Angina de Pecho/mortalidad , Argentina , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Causas de Muerte , Femenino , Hospitalización , Humanos , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Noruega , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo

RESUMEN

BACKGROUND: Plasma levels of angiopoietin-2 (ANGPT2) and angiopoietin-like 4 protein (ANGPTL4) reflect different pathophysiological aspects of cardiovascular disease. We evaluated their association with outcome in a hospitalized Norwegian patient cohort (n = 871) with suspected acute coronary syndrome (ACS) and validated our results in a similar Argentinean cohort (n = 982). METHODS: A cox regression model, adjusting for traditional cardiovascular risk factors, was fitted for ANGPT2 and ANGPTL4, respectively, with all-cause mortality and cardiac death within 24 months and all-cause mortality within 60 months as the dependent variables. RESULTS: At 24 months follow-up, 138 (15.8%) of the Norwegian and 119 (12.1%) of the Argentinian cohort had died, of which 86 and 66 deaths, respectively, were classified as cardiac. At 60 months, a total of 259 (29.7%) and 173 (17.6%) patients, respectively, had died. ANGPT2 was independently associated with all-cause mortality in both cohorts at 24 months [hazard ratio (HR) 1.27 (95% confidence interval (CI), 1.08-1.50) for Norway, and HR 1.57 (95% CI, 1.27-1.95) for Argentina], with similar results at 60 months [HR 1.19 (95% CI, 1.05-1.35) (Norway), and HR 1.56 (95% CI, 1.30-1.88) (Argentina)], and was also significantly associated with cardiac death [HR 1.51 (95% CI, 1.14-2.00)], in the Argentinean population. ANGPTL4 was significantly associated with all-cause mortality in the Argentinean cohort at 24 months [HR 1.39 (95% CI, 1.15-1.68)] and at 60 months [HR 1.43 (95% CI, 1.23-1.67)], enforcing trends in the Norwegian population. CONCLUSIONS: ANGPT2 and ANGPTL4 were significantly associated with outcome in similar ACS patient cohorts recruited on two continents. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00521976. ClinicalTrials.gov Identifier: NCT01377402.

Asunto(s)

Síndrome Coronario Agudo , Angiopoyetina 2/sangre , Proteína 4 Similar a la Angiopoyetina/sangre , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Argentina/epidemiología , Humanos , Noruega/epidemiología , Pronóstico , Modelos de Riesgos Proporcionales

RESUMEN

Objective: The aim of this study was to develop, train, and test different neural network (NN) algorithm-based models to improve the Global Registry of Acute Coronary Events (GRACE) score performance to predict in-hospital mortality after an acute coronary syndrome. Methods: We analyzed a prospective database, including 40 admission variables of 1255 patients admitted with the acute coronary syndrome in a community hospital. Individual predictors included in GRACE score were used to train and test three NN algorithm-based models (guided models), namely: one- and two-hidden layer multilayer perceptron and a radial basis function network. Three extra NNs were built using the 40 admission variables of the entire database (unguided models). Expected mortality according to GRACE score was calculated using the logistic regression equation. Results: In terms of receiver operating characteristic area and negative predictive value (NPV), almost all NN algorithms outperformed logistic regression. Only radial basis function models obtained a better accuracy level based on NPV improvement, at the expense of positive predictive value (PPV) reduction. The independent normalized importance of variables for the best unguided NN was: creatinine 100%, Killip class 61%, ejection fraction 52%, age 44%, maximum creatine-kinase level 41%, glycemia 40%, left bundle branch block 35%, and weight 33%, among the top 8 predictors. Conclusions: Treatment of individual predictors of GRACE score with NN algorithms improved accuracy and discrimination power in all models with respect to the traditional logistic regression approach; nevertheless, PPV was only marginally enhanced. Unguided variable selection would be able to achieve better results in PPV terms.

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Objetivo: El objetivo fue desarrollar, entrenar y probar diferentes modelos basados en algoritmos de redes neuronales (RN) para mejorar el rendimiento del score del Registro Global de Eventos Coronarios Agudos (GRACE) para predecir la mortalidad hospitalaria después de un síndrome coronario agudo. Métodos: Analizamos una base de datos prospectiva que incluía 40 variables de ingreso de 1255 pacientes con síndrome coronario agudo en un hospital comunitario. Las variables incluidas en la puntuación GRACE se usaron para entrenar y probar tres algoritmos basados en RN (modelos guiados), a saber: perceptrones multicapa de una y dos capas ocultas y una red de función de base radial. Se construyeron tres RN adicionales utilizando las 40 variables de admisión de toda la base de datos (modelos no guiados). La mortalidad esperada según el GRACE se calculó usando la ecuación de regresión logística. Resultados: En términos del área ROC y valor predictivo negativo (VPN), casi todos los algoritmos RN superaron la regresión logística. Solo los modelos de función de base radial obtuvieron un mejor nivel de precisión basado en la mejora del VPN, pero a expensas de la reducción del valor predictivo positivo (VPP). La importancia normalizada de las variables incluidas en la mejor RN no guiada fue: creatinina 100%, clase Killip 61%, fracción de eyección 52%, edad 44%, nivel máximo de creatina quinasa 41%, glucemia 40%, bloqueo de rama izquierda 35%, y peso 33%, entre los 8 predictores principales. Conclusiones: El tratamiento de las variables del score GRACE mediante algoritmos de RN mejoró la precisión y la discriminación en todos los modelos con respecto al enfoque tradicional de regresión logística; sin embargo, el VPP solo mejoró marginalmente. La selección no guiada de variables podría mejorar los resultados en términos de PPV.

Asunto(s)

Síndrome Coronario Agudo/mortalidad , Algoritmos , Mortalidad Hospitalaria , Redes Neurales de la Computación , Sistema de Registros , Anciano , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico

RESUMEN

Abstract Objective: The aim of this study was to develop, train, and test different neural network (NN) algorithm-based models to improve the Global Registry of Acute Coronary Events (GRACE) score performance to predict in-hospital mortality after an acute coronary syndrome. Methods: We analyzed a prospective database, including 40 admission variables of 1255 patients admitted with the acute coronary syndrome in a community hospital. Individual predictors included in GRACE score were used to train and test three NN algorithm-based models (guided models), namely: one- and two-hidden layer multilayer perceptron and a radial basis function network. Three extra NNs were built using the 40 admission variables of the entire database (unguided models). Expected mortality according to GRACE score was calculated using the logistic regression equation. Results: In terms of receiver operating characteristic area and negative predictive value (NPV), almost all NN algorithms outperformed logistic regression. Only radial basis function models obtained a better accuracy level based on NPV improvement, at the expense of positive predictive value (PPV) reduction. The independent normalized importance of variables for the best unguided NN was: creatinine 100%, Killip class 61%, ejection fraction 52%, age 44%, maximum creatine-kinase level 41%, glycemia 40%, left bundle branch block 35%, and weight 33%, among the top 8 predictors. Conclusions: Treatment of individual predictors of GRACE score with NN algorithms improved accuracy and discrimination power in all models with respect to the traditional logistic regression approach; nevertheless, PPV was only marginally enhanced. Unguided variable selection would be able to achieve better results in PPV terms.

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Resumen Objetivo: El objetivo fue desarrollar, entrenar y probar diferentes modelos basados en algoritmos de redes neuronales (RN) para mejorar el rendimiento del score del Registro Global de Eventos Coronarios Agudos (GRACE) para predecir la mortalidad hospitalaria después de un síndrome coronario agudo. Métodos: Analizamos una base de datos prospectiva que incluía 40 variables de ingreso de 1255 pacientes con síndrome coronario agudo en un hospital comunitario. Las variables incluidas en la puntuación GRACE se usaron para entrenar y probar tres algoritmos basados en RN (modelos guiados), a saber: perceptrones multicapa de una y dos capas ocultas y una red de función de base radial. Se construyeron tres RN adicionales utilizando las 40 variables de admisión de toda la base de datos (modelos no guiados). La mortalidad esperada según el GRACE se calculó usando la ecuación de regresión logística. Resultados: En términos del área ROC y valor predictivo negativo (VPN), casi todos los algoritmos RN superaron la regresión logística. Solo los modelos de función de base radial obtuvieron un mejor nivel de precisión basado en la mejora del VPN, pero a expensas de la reducción del valor predictivo positivo (VPP). La importancia normalizada de las variables incluidas en la mejor RN no guiada fue: creatinina 100%, clase Killip 61%, fracción de eyección 52%, edad 44%, nivel máximo de creatina quinasa 41%, glucemia 40%, bloqueo de rama izquierda 35%, y peso 33%, entre los 8 predictores principales. Conclusiones: El tratamiento de las variables del score GRACE mediante algoritmos de RN mejoró la precisión y la discriminación en todos los modelos con respecto al enfoque tradicional de regresión logística; sin embargo, el VPP solo mejoró marginalmente. La selección no guiada de variables podría mejorar los resultados en términos de PPV.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Algoritmos , Sistema de Registros , Redes Neurales de la Computación , Mortalidad Hospitalaria , Síndrome Coronario Agudo/mortalidad , Pronóstico , Bases de Datos Factuales

RESUMEN

Abstract Acute cardiac injury is associated with higher mortality in patients with the novel coronavirus disease-2019 (COVID-19) and the exact etiology can be challenging to diagnose in the emergency setting during the pandemic. From a pathophysiological perspective, SARS-CoV-2 infection is characterized by an overproduction of inflammatory cytokines (IL-6, TNF-alpha) that leads to systemic inflammation and consequent increased risk of acute myocardial infarction (AMI) caused by atheromatous plaque rupture and significant myocardial oxygen supply-demand imbalance. Moreover, SARS-CoV-2 tropism to the renin-angiotensin-aldosterone system through the ACE2 receptor induces myocarditis that may rapidly progress to left ventricular dysfunction and hemodynamic instability. Myocardial inflammation with pericardial involvement, i.e. , myopericarditis, can progress to cardiac tamponade and obstructive shock. These cardiovascular complications, which are associated with a worse prognosis and higher mortality, can be associated with clinical manifestations, electrocardiographic changes, and troponin values similar to AMI. Thus, the diagnosis and treatment of patients with acute chest pain and dyspnea admitted to the emergency department is a significant challenge during the COVID-19 pandemic. Here, we provide a review of the literature focusing on a practical approach to acute coronary syndrome patients with confirmed or suspected COVID-19.

Asunto(s)

Humanos , Masculino , Femenino , Electrocardiografía/métodos , Síndrome Coronario Agudo/diagnóstico , COVID-19/complicaciones , Infarto del Miocardio/diagnóstico , Troponina/sangre , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/mortalidad , COVID-19/mortalidad , Infarto del Miocardio/mortalidad

RESUMEN

OBJECTIVES: The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. METHODS: We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). RESULTS: ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. CONCLUSIONS: Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

Asunto(s)

Síndrome Coronario Agudo/epidemiología , Pacientes Ambulatorios , Enfermedad Arterial Periférica/epidemiología , Trombosis/epidemiología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Enfermedades Asintomáticas , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/mortalidad , Prevalencia , Pronóstico , Sistema de Registros , Medición de Riesgo , Trombosis/diagnóstico , Trombosis/mortalidad , Factores de Tiempo , Adulto Joven

RESUMEN

This study examined the association between coffee consumption and all-cause mortality in patients with a prior acute myocardial infarction or unstable angina. Data were from the prospective study ERICO, totalising 928 patients with Acute Coronary Syndrome (ACS). During 4 years' follow-up, a total of 111 deaths occurred. Moderate coffee consumption (1-2 and 2-3 cups/day) was inversely associated with total mortality (HR 0.13, 95% CI: 0.06-0.29 and 0.22, 95% CI: 0.13-0.39, respectively). For patients with higher coffee consumption (>3 cups/day), there was a positive association with mortality (HR 2.12, 95% CI: 1.06-4.24). After stratification by smoking status, the analysis revealed lower risk of mortality in never and former smokers, drinking 1-2 and 2-3 cups/day. Among current smokers there was a positive association between >3 cups/day and mortality. The moderate consumption of coffee was associated with lower risk of all-cause mortality in patients with a prior ACS, particularly in non-smokers.

Asunto(s)

Síndrome Coronario Agudo , Café , Síndrome Coronario Agudo/mortalidad , Humanos , No Fumadores , Estudios Prospectivos , Factores de Riesgo

RESUMEN

AIMS: The goal of this study was to evaluate the performance of the InspironTM coronary stent (Scitech Medical™, Goiás, Brazil). The InspironTM sirolimus-eluting stent uses an ultrathin L-605 cobalt-chromium alloy with a 75 µm strut thickness platform coated with an abluminal biodegradable polymer. The polymer is eliminated from the body through the tricarboxylic acid cycle in 6-9 months, releasing 80% of the drug within 30 days after its deployment. METHODS: It was a prospective, single-center registry. To represent clinical practice, all patients undergoing percutaneous coronary intervention were included in this registry. There were no exclusion criteria. Clinical follow-ups were performed at twelve months. The endpoints were the occurrence of all-cause death, definite stent thrombosis, and new revascularization. RESULTS: Between November 2017 and May 2019, 790 patients were included (1067 lesions). The mean age was 60.42 ± 14.94 years, and 74.7% presented with acute coronary syndrome. Diabetes mellitus was present in 43.9% of patients, and previous myocardial infarction and previous percutaneous coronary intervention were present in 17.9% and 11.3%, respectively. Angiographic success was achieved in 99.1%. The incidence of all-cause death was 11.5% (6.2% in-hospital and 5.3% in the follow-up) and definitive stent thrombosis was 0.2%. New revascularization was performed in only 5.8% (target lesion revascularization: 2.2%; progression of disease in another lesion: 3.6%). Based on the multivariate regression analysis, only chronic renal failure was an independent predictor of adverse events (OR: 3.3; 95% CI: 1.22-8.92). CONCLUSION: The result of this single-center registry demonstrates the safety and excellent performance of the InspironTM stent in daily clinical practice with a low rate of adverse cardiac events.

Asunto(s)

Síndrome Coronario Agudo , Plásticos Biodegradables/farmacología , Aleaciones de Cromo/farmacología , Stents Liberadores de Fármacos/efectos adversos , Intervención Coronaria Percutánea , Sirolimus/farmacología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/cirugía , Brasil/epidemiología , Materiales Biocompatibles Revestidos/farmacología , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/etiología , Reestenosis Coronaria/cirugía , Femenino , Humanos , Inmunosupresores/farmacología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Estudios Prospectivos , Diseño de Prótesis , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Anciano , Infarto del Miocardio con Elevación del ST/complicaciones , COVID-19/complicaciones , Síndrome Respiratorio Agudo Grave/mortalidad , Diabetes Mellitus , Síndrome Coronario Agudo/mortalidad , COVID-19/terapia , Hipertensión

Asunto(s)

Cardiología/métodos , Publicaciones Periódicas como Asunto/normas , Edición/normas , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/prevención & control , Adolescente , Adulto , Anciano , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/terapia , Brasil/epidemiología , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Cardiología/estadística & datos numéricos , Cardiomiopatía Hipertrófica/epidemiología , Cardiomiopatía Hipertrófica/mortalidad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Niño , Enfermedad Crónica , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/prevención & control , Femenino , Cardiopatías Congénitas/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Portugal/epidemiología , Embarazo , Edición/estadística & datos numéricos

RESUMEN

BACKGROUND: The aim was to assess the utility of cumulative sum techniques for continuous monitoring of coronary care outcomes, applied to patients with acute coronary syndrome stratified by the Global Registry for Acute Coronary Events (GRACE) risk score. METHODS: A prospective longitudinal study to assess GRACE score for real-time monitoring of coronary care mortality in a community hospital was conducted between January 2012 and December 2017. An expected-to-observed probability of death chart for individual risk and a variable life-adjusted display were used to monitor the results. RESULTS: A total of 1,255 patients undergoing acute coronary syndrome were included in the analysis. GRACE-based variable life-adjusted plots monitoring in-hospital mortality showed that observed death rates remained in general within the expected 95% confidence limit over time, and these behaviors were similar for ST-segment elevation and non-ST-segment elevation myocardial infarction. In-hospital all-cause mortality was 2.6% for the overall population, and 56% of these cases corresponded to unexpected deaths; conversely, unexpected survival occurred in 5.2% of survivors. CONCLUSIONS: Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable.

Asunto(s)

Síndrome Coronario Agudo/mortalidad , Sistema de Registros , Medición de Riesgo/métodos , Anciano , Argentina/epidemiología , Electrocardiografía , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias

RESUMEN

Aims and objective: Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding. Materials and methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year. Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27). Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events.

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Antecedentes y objetivo: El interés sobre la influencia del sexo en pacientes con síndrome coronario agudo (SCA) tratados con stent y nuevos antiagregantes inhibidores de P2Y12 en la práctica clínica es creciente. Se analizan las diferencias en función del sexo en el tratamiento con doble antiagregación plaquetaria (DAPT) y los eventos adversos isquémicos y hemorrágicos. Materiales y métodos: Estudio prospectivo de pacientes consecutivos con diagnóstico de SCA tratados con stent coronario desde julio de 2015 hasta enero de 2016. Resultados: De un total de 283 pacientes incluidos, 75 (26.5%) correspondió a mujeres y 208 (73.5%) a hombres. La edad media fue de 71 ± 13 y 66.5 ± 13 años, respectivamente. Un 44% de mujeres se presentó como SCA con elevación del segmento ST contra un 52.4 de los hombres, p = 0.21. Las mujeres mostraron un mayor riesgo de sangrado (CRUSADE), sin diferencias en el riesgo isquémico (GRACE y TIMI). Se usaron stents farmacoactivos con más frecuencia en mujeres (88.9 vs. 75.5%, p = 0.04). Se observó una tendencia de menor prescripción del ticagrelor en mujeres (42.6 vs. 50.9%, p = 0.29) en favor de un mayor uso del clopidogrel. No se identificaron diferencias en cuanto a la prescripción del prasugrel. Las mujeres presentaron al año una menor mortalidad (1.4 vs. 6.7%, p = 0.19), aunque mayor sangrado (23.3 vs. 17.4%, p = 0.27). Conclusiones: En este estudio de pacientes consecutivos con SCA tratados con stent se registró una mayor prescripción de clopidogrel en las mujeres que en los hombres. Las mujeres presentaron una menor incidencia anual de mortalidad, pero mayor sangrado en comparación con los hombres, no significativo.

Asunto(s)

Síndrome Coronario Agudo/terapia , Intervención Coronaria Percutánea/métodos , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Stents , Síndrome Coronario Agudo/mortalidad , Anciano , Anciano de 80 o más Años , Clopidogrel/administración & dosificación , Stents Liberadores de Fármacos , Femenino , Hemorragia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pronóstico , Estudios Prospectivos , Factores Sexuales , Ticagrelor/administración & dosificación , Ticlopidina/administración & dosificación