Fátima Saraiva

Can We Improve Outcomes in Patients With Previous Coronary Artery Bypass Surgery Admitted for Acute Coronary Syndrome

INTRODUCTION AND OBJECTIVES Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG. METHODS This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs. RESULTS Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B patients more frequently had ST-elevation myocardial infarction, and had a higher median ejection fraction (53% [interquartile range, 47%-60%] vs. 50% [42%-55%]; P< .01) and peak troponin-I concentration. There was no difference in the use of invasive techniques. Regarding medication, Group B patients were more likely to receive dual antiplatelet therapy at discharge. No significant difference was observed in in-hospital mortality (9.5% versus 5.9%; P=.2) or mortality at 1 month, 6 months or 1 year (9.8% versus 9.1%; log-rank test, P=.87) and the cumulative major adverse cardiac event rate was equally low in both groups. The presence of a CABG was associated with more readmissions for unstable angina (11.3% vs. 3.1%; P< .01). CONCLUSIONS In our ACS patients, the presence of a CABG had no significant influence on short- or medium-term outcomes, such as all-cause mortality and adverse cardiac events.

Left ventricular end diastolic pressure and acute coronary syndromes

BACKGROUND Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE To assess LVEDP and its prognostic implications in ACS patients. METHODS Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP ≥ 26.5 mmHg (n = 226). RESULTS There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP ≥ 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP ≥ 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION In our selected population, LVEDP had a significant prognostic influence.FUNDAMENTO: Ha falta de dados sobre o impacto prognostico da pressao diastolica final do ventriculo esquerdo (PDFVE) sobre as sindromes coronarianas agudas (SCA). OBJETIVO: Avaliar a PDFVE e suas implicacoes prognosticas em pacientes com SCA. METODOS: Estudo prospectivo, longitudinal e continuo de 1.329 pacientes com SCA de um unico centro, realizado entre 2004 e 2006. A funcao diastolica foi determinada atraves da PDFVE. A populacao foi dividida em dois grupos: Grupo A - PDFVE 26,5 mmHg (n = 226). RESULTADOS: Nao houve diferencas significantes entre os grupos em relacao aos fatores de risco para doenca cardiovascular, historico medico e terapia medica durante a admissao. Nos pacientes do grupo A, a SCA sem elevacao do segmento ST foi mais frequente, bem como angiogramas coronarios normais. A mortalidade hospitalar foi similar entre os grupos, mas a sobrevida de um ano foi maior entre os pacientes do grupo A (96,9 vs 91,2%, log rank p = 0,002). Em um modelo multivariado de regressao de Cox, uma PDFVE > 26,5 mmHg (RR 2,45, IC95% 1,05 - 5,74) permaneceu um preditor independente para mortalidade de um ano, quando ajustado para idade, fracao de ejecao sistolica do VE, SCA com elevacao do segmento ST, pico da troponina, glicemia na admissao hospitalar e diureticos apos 24 horas. Alem disso, uma PDFVE > 26,5 mmHg foi um preditor independente de uma futura rehospitalizacao por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSAO: Em nossa populacao selecionada, a PDFVE apresentou uma influencia prognostica significante.

Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes

OBJECTIVE To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69)--previous insulin and Group B (n = 306)--without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.

Pressão diastólica final do ventrículo esquerdo e síndromes coronarianas agudas

BACKGROUND Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE To assess LVEDP and its prognostic implications in ACS patients. METHODS Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP ≥ 26.5 mmHg (n = 226). RESULTS There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP ≥ 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP ≥ 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION In our selected population, LVEDP had a significant prognostic influence.FUNDAMENTO: Ha falta de dados sobre o impacto prognostico da pressao diastolica final do ventriculo esquerdo (PDFVE) sobre as sindromes coronarianas agudas (SCA). OBJETIVO: Avaliar a PDFVE e suas implicacoes prognosticas em pacientes com SCA. METODOS: Estudo prospectivo, longitudinal e continuo de 1.329 pacientes com SCA de um unico centro, realizado entre 2004 e 2006. A funcao diastolica foi determinada atraves da PDFVE. A populacao foi dividida em dois grupos: Grupo A - PDFVE 26,5 mmHg (n = 226). RESULTADOS: Nao houve diferencas significantes entre os grupos em relacao aos fatores de risco para doenca cardiovascular, historico medico e terapia medica durante a admissao. Nos pacientes do grupo A, a SCA sem elevacao do segmento ST foi mais frequente, bem como angiogramas coronarios normais. A mortalidade hospitalar foi similar entre os grupos, mas a sobrevida de um ano foi maior entre os pacientes do grupo A (96,9 vs 91,2%, log rank p = 0,002). Em um modelo multivariado de regressao de Cox, uma PDFVE > 26,5 mmHg (RR 2,45, IC95% 1,05 - 5,74) permaneceu um preditor independente para mortalidade de um ano, quando ajustado para idade, fracao de ejecao sistolica do VE, SCA com elevacao do segmento ST, pico da troponina, glicemia na admissao hospitalar e diureticos apos 24 horas. Alem disso, uma PDFVE > 26,5 mmHg foi um preditor independente de uma futura rehospitalizacao por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSAO: Em nossa populacao selecionada, a PDFVE apresentou uma influencia prognostica significante.

P2518Frailty and acute coronary syndrome in the over-70 population: frailty is more than age

responding all-cause mortality was 22.6% (n=12,059) and 34.9% (n=18,631). Age-stratified analysis showed that nursing home admissions within one year were 1.9 (95% confidence interval [CI] 1.7–2.0)%, 6.1 (CI 5.8–6.5)%, and 12.9 (CI 11.9–13.9)% for patients aged 70–79, 80–89, and >90 years, respectively (Figure). One-year mortality was 15.4%, 28.0%, and 43.0% for these age groups. After three years, nursing home admission rates were 3.7 (CI 3.5–3.9)%, 10.4 (CI 10.0–10.8)%, and 18.0 (CI 16.8–19.2)% for patients aged 70–79, 80–89, and ≥90 years. Corresponding mortality rates were 25.4%, 41.8% and 55.3%, respectively. Main predictors of nursing home admissions were high age (hazard ratios [HRs] 2.72 [CI 2.45–3.02] and 5.18 [CI 4.56–5.90] for subjects 80–89 and ≥90 years compared to those aged 70–79 years), living alone (HR 1.99 [CI 1.79–2.23], and female sex (HR 1.25 [CI 1.14–1.38]), and HR increased by 1.25 (CI 1.21–1.29) with every increase in the number of comorbidities.

Presión diastólica final del ventrículo izquierdo y síndromes coronarios agudos

BACKGROUND Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE To assess LVEDP and its prognostic implications in ACS patients. METHODS Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP ≥ 26.5 mmHg (n = 226). RESULTS There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP ≥ 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP ≥ 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION In our selected population, LVEDP had a significant prognostic influence.FUNDAMENTO: Ha falta de dados sobre o impacto prognostico da pressao diastolica final do ventriculo esquerdo (PDFVE) sobre as sindromes coronarianas agudas (SCA). OBJETIVO: Avaliar a PDFVE e suas implicacoes prognosticas em pacientes com SCA. METODOS: Estudo prospectivo, longitudinal e continuo de 1.329 pacientes com SCA de um unico centro, realizado entre 2004 e 2006. A funcao diastolica foi determinada atraves da PDFVE. A populacao foi dividida em dois grupos: Grupo A - PDFVE 26,5 mmHg (n = 226). RESULTADOS: Nao houve diferencas significantes entre os grupos em relacao aos fatores de risco para doenca cardiovascular, historico medico e terapia medica durante a admissao. Nos pacientes do grupo A, a SCA sem elevacao do segmento ST foi mais frequente, bem como angiogramas coronarios normais. A mortalidade hospitalar foi similar entre os grupos, mas a sobrevida de um ano foi maior entre os pacientes do grupo A (96,9 vs 91,2%, log rank p = 0,002). Em um modelo multivariado de regressao de Cox, uma PDFVE > 26,5 mmHg (RR 2,45, IC95% 1,05 - 5,74) permaneceu um preditor independente para mortalidade de um ano, quando ajustado para idade, fracao de ejecao sistolica do VE, SCA com elevacao do segmento ST, pico da troponina, glicemia na admissao hospitalar e diureticos apos 24 horas. Alem disso, uma PDFVE > 26,5 mmHg foi um preditor independente de uma futura rehospitalizacao por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSAO: Em nossa populacao selecionada, a PDFVE apresentou uma influencia prognostica significante.