Elizabete Silva dos Santos

Registro de síndrome coronariana aguda em um centro de emergências em cardiologia

OBJECTIVE Describe clinical characteristics of patients (P) admitted to hospital with suspected acute coronary syndrome (ACS), identifying medical treatment and in-hospital mortality. METHODS Evaluated were 860 patients with ACS from January through December, 2003. We evaluated baseline characteristics, ACS mode of presentation, medication during hospital stay, indication for clinical treatment or myocardial revascularization (MR) and in-hospital mortality. RESULTS Five hundred and three (58.3%) were male, mean age 62.6 years ( +/- 11.9). Seventy-eight (9.1%) were discharged with the diagnosis of acute ST-elevation myocardial infarction (STEMI), 238 (27.7%) with non-ST-elevation myocardial infarction (non-STEMI), 516 (60%) with unstable angina (UA), two (0.2%) with atypical manifestations of ACS and 26 (3%) with non-cardiac chest pain. During hospitalization, 87.9% of patients were given a beta-blocker, 95.9% acetylsalicylic acid, 89.9% anti-thrombin therapy, 86.2% intravenous nitroglycerin, 6.4% glycoprotein (GP) IIb/IIIa receptor inhibitor, 35.9% clopidogrel, 77.9% angiotensin-converting enzyme inhibitor, and 70,9% statin drugs. Coronary arteriography was performed in 72 patients (92.3%) with STEMI, and in 452 (59.8%) with non-STEMI ACS (p< 0.0001). Myocardial revascularization (MR) surgery was indicated for 12.9% and percutaneous coronary intervention for 26.6%. In-hospital mortality was 4.8%, and no difference was recorded between the proportion of deaths among patients with STEMI and non-STEMI ACS (6.4% versus 4.8%; p = 0.578). CONCLUSION In this registry, we provide a description of ACS patient, which allows the evaluation of the demographic characteristics, medical treatment prescribed, and in-hospital mortality. A greater awareness of our reality may help the medical community to adhere more strictly to the procedures set by guidelines.

Desfechos clínicos aos 30 dias do registro brasileiro das síndromes coronárias agudas (ACCEPT)

BACKGROUND There are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome. OBJECTIVES Demography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome. METHODS The ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up. RESULTS Between August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively. CONCLUSIONS The prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.

Time course proteomic profiling of human myocardial infarction plasma samples: an approach to new biomarker discovery.

BACKGROUND The aim of this study was to identify novel candidate biomarker proteins differentially expressed in the plasma of patients with early stage acute myocardial infarction (AMI) using SELDI-TOF-MS as a high throughput screening technology. METHODS Ten individuals with recent acute ischemic-type chest pain (<12 h duration) and ST-segment elevation AMI (1STEMI) and after a second AMI (2STEMI) were selected. Blood samples were drawn at six times after STEMI diagnosis. The first stage (T0) was in Emergency Unit before receiving any medication, the second was just after primary angioplasty (T2), and the next four stages occurred at 12 h intervals after T0. Individuals (n=7) with similar risk factors for cardiovascular disease and normal ergometric test were selected as a control group (CG). Plasma proteomic profiling analysis was performed using the top-down (i.e. intact proteins) SELDI-TOF-MS, after processing in a Multiple Affinity Removal Spin Cartridge System (Agilent). RESULTS Compared with the CG, the 1STEMI group exhibited 510 differentially expressed protein peaks in the first 48 h after the AMI (p<0.05). The 2STEMI group, had ~85% fewer differently expressed protein peaks than those without previous history of AMI (76, p<0.05). Among the 16 differentially-regulated protein peaks common to both STEMI cohorts (compared with the CG at T0), 6 peaks were persistently down-regulated at more than one time-stage, and also were inversed correlated with serum protein markers (cTnI, CK and CKMB) during 48 h-period after IAM. CONCLUSIONS Proteomic analysis by SELDI-TOF-MS technology combined with bioinformatics tools demonstrated differential expression during a 48 h time course suggests a potential role of some of these proteins as biomarkers for the very early stages of AMI, as well as for monitoring early cardiac ischemic recovery.

Acute coronary syndrome behavior: results of a Brazilian registry.

BACKGROUND Brazil lacks published multicenter registries of acute coronary syndrome. OBJECTIVE The Brazilian Registry of Acute Coronary Syndrome is a multicenter national study aiming at providing data on clinical aspects, management and hospital outcomes of acute coronary syndrome in our country. METHODS A total of 23 hospitals from 14 cities, participated in this study. Eligible patients were those who came to the emergency wards with suspected acute coronary syndrome within the first 24 hours of symptom onset, associated with compatible electrocardiographic alterations and/or altered necrosis biomarkers. Follow-up lasted until hospital discharge or death, whichever occurred first. RESULTS Between 2003 and 2008, 2,693 ACS patients were enrolled, of which 864 (32.1%) were females. T he final diagnosis was unstable angina in 1,141 patients, (42.4%), with a mortality rate of 3.06%, non-ST elevation acute myocardial infarction (AMI) in 529 (19.6%), with mortality of 6.8%, ST-elevation AMI 950 (35.3%), with mortality of 8.1% and non-confirmed diagnosis 73 (2.7%), with mortality of 1.36%. The overall mortality was 5.53%. The multiple logistic regression model identified the following as risk factors for death regarding demographic factors and interventions: female gender (OR=1.45), diabetes mellitus (OR=1.59), body mass index (OR=1.27) and percutaneous coronary intervention (OR=0.70). A second model for death due to major complications identified: cardiogenic shock/acute pulmonary edema (OR=4.57), reinfarction (OR=3.48), stroke (OR=21.56), major bleeding (OR=3.33), cardiopulmonary arrest (OR=40.27) and Killip functional class (OR=3.37). CONCLUSION The Brazilian Registry of Acute Coronary Syndrome data do not differ from other data collected abroad. The understanding of their findings may help promote better planning and management of acute coronary syndrome care in public and private health services.

Escore de risco Dante Pazzanese para síndrome coronariana aguda sem supradesnivelamento do segmento ST

BACKGROUND The probability of adverse events estimate is crucial in acute coronary syndrome condition. OBJECTIVES To develop a risk score for the brazilian population presenting non-ST-segment elevation acute coronary syndrome. METHODS One thousand and twenty seven (1,027) patients were investigated prospectively at a cardiology center in Brazil. A multiple logistic regression model was developed to estimate death or (re)infarction risk within 30 days. Model predictive accuracy was determined by C statistic. RESULTS Combined event occurred in 54 patients (5.3%). The score was created by the arithmetic sum of independent predictors points. Points were determined by corresponding probabilities of event occurrence. The following variables have been identified: age increase (0 to 9 points); diabetes mellitus history (2 points) or prior stroke (4 points); no previous use of angiotensin converting enzyme inhibitor (1 point); creatinine level increase (0 to 10 points); the combination of troponin I level increase and ST-segment depression (0 to 4 points). Four risk groups were defined: very low (up to 5 points); low (6 to 10 points ); intermediate (11 to 15 points ); high risk (16 to 30 points ). The C statistic was 0.78 for event probability, and 0.74 for risk score. CONCLUSION A risk score of easy application in the emergency service was developed to predict death or (re)infarction within 30 days in a brazilian population with non-ST-segment elevation acute coronary syndrome.FUNDAMENTO: En el sindrome coronario agudo (SCA), es importante estimar la probabilidad de eventos adversos. OBJETIVO: Desarrollar un score de riesgo en una poblacion brasilena con SCA sin supradesnivel del segmento ST (SST). METODOS: Se evaluaron prospectivamente 1.027 pacientes en un centro brasileno de cardiologia. Un modelo de regresion logistica multiple se desarrollo para prever el riesgo de muerte o de (re)infarto en 30 dias. La exactitud predictiva del modelo fue determinada por el C statistic. RESULTADOS: El evento combinado ocurrio en 54 pacientes (5,3%). El score se creo por la suma aritmetica de puntos de los predictores independientes, cuyos puntajes se designaron por las respectivas probabilidades de ocurrencia del evento. Se identificaron las siguientes variables: aumento de la edad (0 a 9 puntos); antecedente de diabetes mellitus (2 puntos) o de accidente vascular cerebral (4 puntos); no utilizacion previa de inhibidor de la enzima conversora de la angiotensina (1 punto); elevacion de la creatinina (0 a 10 puntos); y combinacion de elevacion de la troponina I cardiaca y depresion del segmento ST (0 a 4 puntos). Se definieron cuatro grupos de riesgo: muy bajo (ate 5 puntos); bajo (6 a 10 puntos); intermedio (11 a 15 puntos); y alto riesgo (16 a 30 puntos). El C statistic para la probabilidad del evento fue de 0,78 y para el score de riesgo en puntaje de 0,74. CONCLUSION: Se desarrollo un score de riesgo para prever muerte o (re)infarto en 30 dias en una poblacion brasilena con SCA sin SST, pudiendo facilmente se aplicable en el departamento de emergencia.

Dante Pazzanese risk score for non-st-segment elevation acute coronary syndrome

BACKGROUND The probability of adverse events estimate is crucial in acute coronary syndrome condition. OBJECTIVES To develop a risk score for the brazilian population presenting non-ST-segment elevation acute coronary syndrome. METHODS One thousand and twenty seven (1,027) patients were investigated prospectively at a cardiology center in Brazil. A multiple logistic regression model was developed to estimate death or (re)infarction risk within 30 days. Model predictive accuracy was determined by C statistic. RESULTS Combined event occurred in 54 patients (5.3%). The score was created by the arithmetic sum of independent predictors points. Points were determined by corresponding probabilities of event occurrence. The following variables have been identified: age increase (0 to 9 points); diabetes mellitus history (2 points) or prior stroke (4 points); no previous use of angiotensin converting enzyme inhibitor (1 point); creatinine level increase (0 to 10 points); the combination of troponin I level increase and ST-segment depression (0 to 4 points). Four risk groups were defined: very low (up to 5 points); low (6 to 10 points ); intermediate (11 to 15 points ); high risk (16 to 30 points ). The C statistic was 0.78 for event probability, and 0.74 for risk score. CONCLUSION A risk score of easy application in the emergency service was developed to predict death or (re)infarction within 30 days in a brazilian population with non-ST-segment elevation acute coronary syndrome.FUNDAMENTO: En el sindrome coronario agudo (SCA), es importante estimar la probabilidad de eventos adversos. OBJETIVO: Desarrollar un score de riesgo en una poblacion brasilena con SCA sin supradesnivel del segmento ST (SST). METODOS: Se evaluaron prospectivamente 1.027 pacientes en un centro brasileno de cardiologia. Un modelo de regresion logistica multiple se desarrollo para prever el riesgo de muerte o de (re)infarto en 30 dias. La exactitud predictiva del modelo fue determinada por el C statistic. RESULTADOS: El evento combinado ocurrio en 54 pacientes (5,3%). El score se creo por la suma aritmetica de puntos de los predictores independientes, cuyos puntajes se designaron por las respectivas probabilidades de ocurrencia del evento. Se identificaron las siguientes variables: aumento de la edad (0 a 9 puntos); antecedente de diabetes mellitus (2 puntos) o de accidente vascular cerebral (4 puntos); no utilizacion previa de inhibidor de la enzima conversora de la angiotensina (1 punto); elevacion de la creatinina (0 a 10 puntos); y combinacion de elevacion de la troponina I cardiaca y depresion del segmento ST (0 a 4 puntos). Se definieron cuatro grupos de riesgo: muy bajo (ate 5 puntos); bajo (6 a 10 puntos); intermedio (11 a 15 puntos); y alto riesgo (16 a 30 puntos). El C statistic para la probabilidad del evento fue de 0,78 y para el score de riesgo en puntaje de 0,74. CONCLUSION: Se desarrollo un score de riesgo para prever muerte o (re)infarto en 30 dias en una poblacion brasilena con SCA sin SST, pudiendo facilmente se aplicable en el departamento de emergencia.

Comparison between cardiac troponin I and CK-MB mass in acute coronary syndrome without st elevation

BACKGROUND There is uncertainty as to the comparative prognostic value between cardiac troponin I (cTnI) and CK-MB in acute coronary syndrome (ACS). OBJECTIVE To compare the prognostic value between cTnI and CK-MB mass in patients with ACS without ST-segment elevation. METHODS 1,027 patients were analyzed in a prospective way in a tertiary cardiology center. Combinations of biomarkers were examined: normal cTnI, normal CK-MB mass (65.5%), normal cTnI, elevated CK-MB mass (3.9%), elevated cTnI, normal CK-MB mass (8.8%), elevated cTnI, elevated CK-MB mass (20.7%). A multivariate analysis of clinical, electrocardiographic and laboratory variables determined the independent prognostic value of biomarkers for the event of death or (re)infarction within 30 days. RESULTS Patients with at least one elevated biomarker were older (p = 0.02) and males (p < 0.001). The previous use of aspirin (p = 0.001), beta-blockers (p = 0.003) or statin (p = 0.013) was most frequent among those without elevated cTnI. Patients with both biomarkers elevated had more ST-segment depression (p < 0.001) or elevated creatinine (p < 0.001). In a multivariate analysis with the inclusion of cTnI, the CK-MB mass was not an independent variable for the event of death or (re) infarction within 30 days (odds ratio [OR] 1.16, p = 0.71). When cTnI was not included, we had the following values: age (OR 1.07; p < 0.001); male (OR 1.09; p = 0.77); diabetes mellitus (OR 1.95; p = 0.02); previous stroke (OR 3.21; p = 0.008); creatinine level (OR 1.63; p = 0.002); CK-MB mass (OR 1.96; p = 0.03). C-statistic 0.77 (p < 0.001). CONCLUSION With a dose of cTnI, CK-MB mass may be dispensable for prognostic evaluation. If cTnI is unavailable, CK-MB mass is acceptable for making a decision on treatment options.FUNDAMENTO: Ha incertezas do valor prognostico comparativo entre troponina I cardiaca (cTnI) e CK-MB em sindrome coronariana aguda (SCA). OBJETIVO: Comparar o valor prognostico entre a cTnI e a CK-MB massa em pacientes com SCA sem supradesnivel do segmento ST. METODOS: Foram analisados 1.027 pacientes, de modo prospectivo, em um centro terciario de cardiologia. Combinacoes dos biomarcadores foram examinadas: cTnI normal, CK-MB massa normal (65,5%); cTnI normal, CK-MB massa elevada (3,9%); cTnI elevada, CK-MB massa normal (8,8%); cTnI elevada, CK-MB massa elevada (20,7%). Analise multivariada de variaveis clinicas, eletrocardiograficas e laboratoriais determinou o valor prognostico independente dos biomarcadores para o evento de morte ou (re)infarto em 30 dias. RESULTADOS: Pacientes com pelo menos um biomarcador elevado foram mais idosos (p = 0,02) e do sexo masculino (p < 0,001). Uso previo de aspirina (p = 0,001), betabloqueador (p = 0,003) ou estatina (p = 0,013) foi mais frequente naqueles sem elevacao da cTnI. Pacientes com elevacao de ambos os biomarcadores tinham mais depressao do segmento ST (p < 0,001) ou creatinina elevada (p < 0,001). Em analise multivariada com a inclusao da cTnI, a CK-MB massa nao foi variavel independente para o evento de morte ou (re)infarto em 30 dias (odds ratio [OR] 1,16; p = 0,71). Quando nao se incluiu a cTnI, teve-se: idade (OR 1,07; p < 0,001); sexo masculino (OR 1,09; p = 0,77); diabete melito (OR 1,95; p = 0,02); acidente vascular cerebral previo (OR 3,21; p = 0,008); creatinina elevada (OR 1,63; p = 0,002); elevacao da CK-MB massa (OR 1,96; p = 0,03); estatistica-C 0,77 (p < 0,001). CONCLUSAO: Com dosagem da cTnI, a CK-MB massa pode ser dispensavel para avaliacao prognostica. Na indisponibilidade da cTnI, a CK-MB massa e aceitavel para decisao terapeutica.

[Electrical cardioversion and myocardial injury: evaluation by new cardiac injury markers].

OBJECTIVE Evaluate, based on the evolution of new biochemical markers of cardiac damage, if electrical cardioversion (ECV) causes myocardial injury. METHODS Seventy-six patients (P) submitted to elective ECV for atrial fibrillation or atrial flutter were evaluated. Creatine phosphokinase (CPK), CK-MB activity, CK-MB mass, myoglobin and cardiac troponin I (cTnI) were measured before, and 6 and 24 hours after ECV. RESULTS ECV was successful in 58 P (76.3%). Cumulative energy (CE) was up to 350 joules (J) in 36 P, from 500 to 650 J in 20 P and from 900 to 960 J in 20 P; the mean energy delivered being 493 J (+/- 309). The levels of cTnI remained within normal limits in all 76 P. The increase of cumulative energy led to an elevation of CPK levels (> p value = 0.007), CK-MB activity (> p value = 0.002), CK-MB mass (> p value = 0.03), and myoglobin (> p value = 0.015). A positive correlation between the cumulative energy and CPK peaks was observed (r = 0.660; p < 0.001), CK-MB activity (r = 0.429; p < 0.0001), CK-MB mass (r = 0.265; p = 0.02), and myoglobin (r = 0.684; p < 0.0001), as well as between the number of shocks and the CPK peaks (r = 0.770; p < 0.001), CK-MB activity (r = 0.642; p < 0.0001), CK-MB mass (r = 0.430; p < 0.0001), and myoglobin (r = 0.745; p < 0.0001). CONCLUSION ECV does not cause myocardial injury detectable by cTnI measurement. Elevations of CPK, CK-MB activity, CK-MB mass and myoglobin result from skeletal muscle injury and are positively correlated with the CE delivered or with the number of shocks.OBJECTIVE: Evaluate, based on the evolution of new biochemical markers of cardiac damage, if electrical cardioversion (ECV) causes myocardial injury. METHODS: Seventy-six patients (P) submitted to elective ECV for atrial fibrillation or atrial flutter were evaluated. Creatine phosphokinase (CPK), CK-MB activity, CK-MB mass, myoglobin and cardiac troponin I (cTnI) were measured before, and 6 and 24 hours after ECV. RESULTS: ECV was successful in 58 P (76.3%). Cumulative energy (CE) was up to 350 joules (J) in 36 P, from 500 to 650 J in 20 P and from 900 to 960 J in 20 P; the mean energy delivered being 493 J (± 309). The levels of cTnI remained within normal limits in all 76 P. The increase of cumulative energy led to an elevation of CPK levels (> p value = 0.007), CK-MB activity (> p value = 0.002), CK-MB mass (> p value = 0.03), and myoglobin (> p value = 0.015). A positive correlation between the cumulative energy and CPK peaks was observed (r = 0.660; p < 0.001), CK-MB activity (r = 0.429; p < 0.0001), CK-MB mass (r = 0.265; p = 0.02), and myoglobin (r = 0.684; p < 0.0001), as well as between the number of shocks and the CPK peaks (r = 0.770; p < 0.001), CK-MB activity (r = 0.642; p < 0.0001), CK-MB mass (r = 0.430; p < 0,0001), and myoglobin (r = 0.745; p < 0.0001). CONCLUSION: ECV does not cause myocardial injury detectable by cTnI measurement. Elevations of CPK, CK-MB activity, CK-MB mass and myoglobin result from skeletal muscle injury and are positively correlated with the CE delivered or with the number of shocks.

Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome

BACKGROUND The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion ≥ 50%, using Spearmans non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion ≥ 50%. RESULTS Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and coronary lesion ≥ 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. CONCLUSION Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Comparação entre troponina I cardíaca e CK-MB massa em síndrome coronariana aguda sem supra de ST

BACKGROUND There is uncertainty as to the comparative prognostic value between cardiac troponin I (cTnI) and CK-MB in acute coronary syndrome (ACS). OBJECTIVE To compare the prognostic value between cTnI and CK-MB mass in patients with ACS without ST-segment elevation. METHODS 1,027 patients were analyzed in a prospective way in a tertiary cardiology center. Combinations of biomarkers were examined: normal cTnI, normal CK-MB mass (65.5%), normal cTnI, elevated CK-MB mass (3.9%), elevated cTnI, normal CK-MB mass (8.8%), elevated cTnI, elevated CK-MB mass (20.7%). A multivariate analysis of clinical, electrocardiographic and laboratory variables determined the independent prognostic value of biomarkers for the event of death or (re)infarction within 30 days. RESULTS Patients with at least one elevated biomarker were older (p = 0.02) and males (p < 0.001). The previous use of aspirin (p = 0.001), beta-blockers (p = 0.003) or statin (p = 0.013) was most frequent among those without elevated cTnI. Patients with both biomarkers elevated had more ST-segment depression (p < 0.001) or elevated creatinine (p < 0.001). In a multivariate analysis with the inclusion of cTnI, the CK-MB mass was not an independent variable for the event of death or (re) infarction within 30 days (odds ratio [OR] 1.16, p = 0.71). When cTnI was not included, we had the following values: age (OR 1.07; p < 0.001); male (OR 1.09; p = 0.77); diabetes mellitus (OR 1.95; p = 0.02); previous stroke (OR 3.21; p = 0.008); creatinine level (OR 1.63; p = 0.002); CK-MB mass (OR 1.96; p = 0.03). C-statistic 0.77 (p < 0.001). CONCLUSION With a dose of cTnI, CK-MB mass may be dispensable for prognostic evaluation. If cTnI is unavailable, CK-MB mass is acceptable for making a decision on treatment options.FUNDAMENTO: Ha incertezas do valor prognostico comparativo entre troponina I cardiaca (cTnI) e CK-MB em sindrome coronariana aguda (SCA). OBJETIVO: Comparar o valor prognostico entre a cTnI e a CK-MB massa em pacientes com SCA sem supradesnivel do segmento ST. METODOS: Foram analisados 1.027 pacientes, de modo prospectivo, em um centro terciario de cardiologia. Combinacoes dos biomarcadores foram examinadas: cTnI normal, CK-MB massa normal (65,5%); cTnI normal, CK-MB massa elevada (3,9%); cTnI elevada, CK-MB massa normal (8,8%); cTnI elevada, CK-MB massa elevada (20,7%). Analise multivariada de variaveis clinicas, eletrocardiograficas e laboratoriais determinou o valor prognostico independente dos biomarcadores para o evento de morte ou (re)infarto em 30 dias. RESULTADOS: Pacientes com pelo menos um biomarcador elevado foram mais idosos (p = 0,02) e do sexo masculino (p < 0,001). Uso previo de aspirina (p = 0,001), betabloqueador (p = 0,003) ou estatina (p = 0,013) foi mais frequente naqueles sem elevacao da cTnI. Pacientes com elevacao de ambos os biomarcadores tinham mais depressao do segmento ST (p < 0,001) ou creatinina elevada (p < 0,001). Em analise multivariada com a inclusao da cTnI, a CK-MB massa nao foi variavel independente para o evento de morte ou (re)infarto em 30 dias (odds ratio [OR] 1,16; p = 0,71). Quando nao se incluiu a cTnI, teve-se: idade (OR 1,07; p < 0,001); sexo masculino (OR 1,09; p = 0,77); diabete melito (OR 1,95; p = 0,02); acidente vascular cerebral previo (OR 3,21; p = 0,008); creatinina elevada (OR 1,63; p = 0,002); elevacao da CK-MB massa (OR 1,96; p = 0,03); estatistica-C 0,77 (p < 0,001). CONCLUSAO: Com dosagem da cTnI, a CK-MB massa pode ser dispensavel para avaliacao prognostica. Na indisponibilidade da cTnI, a CK-MB massa e aceitavel para decisao terapeutica.