Alexandre C. Souza

Prognostic value of cytokines and chemokines in addition to the GRACE Score in non-ST-elevation acute coronary syndromes.

BACKGROUND Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS. METHODS Five cytokines (interleukin (IL)-1beta, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-alpha soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS. RESULTS During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1beta, IL-12, TNF-alpha, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80). CONCLUSION Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS.

Prognostic value of GRACE scores versus TIMI score in acute coronary syndromes

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Valor prognóstico do Escore de Risco GRACE versus Escore de Risco TIMI em síndromes coronarianas agudas

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Does acute hyperglycemia add prognostic value to the GRACE score in individuals with non-ST elevation acute coronary syndromes?

BACKGROUND It is not known in what extent admission glucose improves risk stratification of the GRACE Score in patients with non-ST-segment elevation acute coronary syndromes (ACS). We tested the hypothesis that admission glucose adds relevant prognostic information to the GRACE Score. METHODS Consecutive patients admitted with ACS had plasma glucose measured at admission and cardiovascular events were defined as death, non-fatal myocardial infarction or non-fatal refractory angina during hospitalization. RESULTS Among the 148 patients studied, 11.5% developed cardiovascular events. Patients in the forth quartile of admission glucose (> or =175mg/dl) had a greater incidence of events, compared with those in the first 3 quartiles (22% vs. 8.1%; RR=2.7; 95%CI 1.1-6.4; P=0.03). Plasma glucose remained a predictor of events, after adjustment for diabetes (P=0.03). After adjustment for the GRACE Score, glucose in the forth quartile lost its predictive value (P=0.29). Plasma glucose added to GRACE did not improve the C-statistics (0.82; 95%CI 0.75-0.88), as compared with the original Score (0.81; 95%CI 0.74-0.87). Net reclassification improvement by new score was -0.03 (P=0.86), indicating no useful reclassification. CONCLUSION Despite its association with adverse events, admission plasma glucose does not improve GRACEs accuracy to predict in-hospital events in patients with ACS.

Acurácia dos escores GRACE e TIMI na predição da gravidade angiográfica da síndrome coronariana aguda

FUNDAMENTO: A acuracia dos escores GRACE e TIMI em predizer a extensao da doenca coronariana em pacientes com sindromes coronarianas agudas sem supradesnivelamento do segmento ST (SCA) nao esta estabelecida. OBJETIVO: Testar a hipotese de que os escores de risco GRACE e TIMI predizem satisfatoriamente a extensao da doenca coronariana, em pacientes com SCA submetidos a coronariografia. METODOS: Individuos admitidos com criterios objetivos de SCA e que realizaram coronariografia durante o internamento foram consecutivamente analisados. A doenca coronariana angiografica foi descrita de tres formas: quantificacao da extensao da doenca coronariana pelo escore de Gensini; presenca de qualquer obstrucao coronariana (> 70% ou > 50% quando tronco de coronaria esquerda); presenca de doenca severa (triarterial ou tronco de coronaria esquerda). RESULTADOS: Em 112 pacientes avaliados, observou-se correlacao positiva do escore de Gensini com os escores GRACE (p = 0,017) e TIMI (p = 0,02), porem essa associacao foi de fraca magnitude (r = 0,23 e r = 0,27; respectivamente). O escore GRACE nao foi capaz de predizer doenca coronariana obstrutiva (area abaixo da curva ROC = 0,57; 95%IC = 0,46 - 0,69), nem doenca coronariana severa (ROC = 0,59; 95%IC = 0,48 -0,70). O Escore TIMI se mostrou modesto preditor em relacao a presenca de doenca coronariana (ROC = 0,65; 95%IC = 0,55 - 0,76) e presenca de doenca severa (ROC = 0,66; 95%IC = 0,56 - 0,76). CONCLUSAO: (1) Existe associacao positiva entre o valor dos escores TIMI ou GRACE e a extensao da doenca coronaria em pacientes com SCA; (2) No entanto, o grau dessa associacao nao e suficiente para que esses escores sejam preditores acurados dos resultados da coronariografia.

Valor Pronóstico del Score de Riesgo GRACE versus Score de Riesgo TIMI en Síndromes Coronarios Agudos

BACKGROUND Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.Resumen Fundamento: Aunque el Score de Riesgo TIMI sea el mas utilizado en sindromes coronarios agudos sin supradesnivel del segmento ST (SCA), el Score GRACE tiene potencial superioridad pronostica, pues fue creado a partir de un registro observacional, parte de las variables son tratadas de forma semicuantitativa y la funcion renal se computa en su calculo.Objetivo: Probar la hipotesis de que el Score de Riesgo GRACE tiene superior valor pronostico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA.Metodos: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009.Resultados: Fueron estudiados 154 pacientes, edad 71 ± 13 anos, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el periodo de internacion, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal). El test de Hosmer-Lemeshow aplicado al Score GRACE presento χ

Primary Mitral Valve Regurgitation Outcome in Patients With Severe Aortic Stenosis 1 Year After Transcatheter Aortic Valve Implantation: Echocardiographic Evaluation

Background Mitral valve regurgitation (MR), present in up to 74% of the patients with severe aortic stenosis (AS), can be a negative prognostic factor when moderate or severe. The outcome of MR after percutaneous transcatheter aortic valve implantation (TAVI) and predictors associated with that outcome have not been well established in the literature. Objective To assess the outcome of primary MR in patients submitted to TAVI and to identify associated factors. Methods Observational study of patients with symptomatic severe AS submitted to TAVI from January 2009 to April 2015 at two specialized centers. Echocardiographic outcome was assessed with data collected before and 1 year after TAVI. Results Of the 91 patients with MR submitted to TAVI and followed up for at least 12 months, 67 (73.6%) had minimum/mild MR before the procedure and 24 (26.4%) had moderate/severe MR. Of those with minimum/mild MR, 62 (92.5%) had no change in the MR grade (p < 0.001), while 5 (7.5%) showed worsening. Of those with moderate/severe MR, 8 (33.3%) maintained the same grade and 16 (66.7%) improved it (p = 0.076). Patients with moderate/severe MR who improved MR grade had lower EuroSCORE II (p = 0.023) and STS morbidity (p = 0.027) scores, as compared to those who maintained the MR grade. Conclusion MR grades change after TAVI. This study suggests a trend towards improvement in moderate/severe MR after TAVI, which was associated with lower preoperative risk scores.