José Ferreira Santos

Comparison of ischemic and bleeding risk scores in non-ST elevation acute coronary syndromes.

Objectives: Compare the discriminatory performance of two validated ischemic risk scores and a bleeding risk score for in-hospital adverse events across the spectrum of non-ST elevation acute coronary syndromes (NSTE-ACS). Material and methods: Single center, 516 consecutive patients admitted with the diagnosis of NSTE-ACS. The following risk scores were calculated for each patient: TIMI, GRACE and CRUSADE. The following in-hospital endpoints were used: major bleeding (as defined by the CRUSADE criteria); recurrent ischemia (re-infarction or recurrent angina); and death. Discriminatory performance was measured by the c-statistic and compared. Results: There were 36 major bleeding events, 34 recurrent ischemic events and 10 deaths. TIMI RS, GRACE RS, and CRUSADE RS demonstrated fair discriminatory accuracy for major bleeding (c-statistic = 0.64, 0.58, and 0.61, respectively). GRACE and CRUSADE risk scores demonstrated a better performance than TIMI RS for predicting in-hospital death (c-statistic = 0.92 and 0.86, respectively versus c-statistic = 0.63, P < 0.001). For the combined endpoint of in-hospital death or recurrent ischemia there was no statistically significant difference between CRUSADE RS, GRACE RS, and TIMI RS (c-statistic = 0.58, 0.57, and 0.62, respectively). Conclusion: Both ischemic and bleeding risk scores are able to predict in-hospital bleeding, ischemic and fatal events.

Habitat use and circadian pattern of Solitary Tinamou Tinamus solitarius in a southern Brazilian Atlantic rainforest

Solitary Tinamou Tinamus solitarius is a threatened Brazilian bird, and very little is known about its ecology and behaviour. In this study we aimed to verify the use of habitats in different stages of plant succession and the circadian activity pattern of the species. The study was conducted in Santa Catarina state (27o43’S, 48o49’W). Six camera traps were used to record the species in three areas of different successional stages during a 12-month period. Traps remained at each sample site for two months, after which they were moved to a new site, a minimum distance of 100 m apart. A total of 76 independent records of Solitary Tinamou were obtained, and its habitat use was found to be different within the three successional stages ( P = 0.02). The majority of 54 independent records were obtained in the secondary forest; not one photo of the species was taken in the most degraded area. Solitary Tinamou exhibited a crepuscular pattern of activity, with most records ( n = 38) taken at 07h00 and 06h00, and it appears to be sensitive to forest clearance.

Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes.

BACKGROUND Although the proven efficacy of evidence-based therapy in patients with cardiovascular diseases, the recommendations are not always instituted. We aimed to analyse the compliance of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients with treatment guidelines and to assess the impact of these measures in hospital death during the index hospitalization. POPULATION AND METHODS All consecutive patients (pts) included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between January 1, 2002 and August 31, 2011 were analysed. Compliance with Guidelines for the management of NSTE-ACS was evaluated with a 6-point therapeutic score (ThSc), comprising the treatment with: aspirin, clopidogrel, heparin, beta-blocker, angiotensin-converting enzyme inhibitor and statin. One point was assigned for each drug prescribed and zero if not given. The total therapeutic compliance was defined as ThSc =6 points. RESULTS The final analysis comprised 14,276 pts (67.1% male; mean age 67.6±12.3 years), most of them admitted with non-ST elevation myocardial infarction (77.4%). The mean value of ThSc was 4.9±1.1 and total compliance occurred in 36.7% pts. Centres with percutaneous coronary intervention (PCI) capacity had a statistically significant higher ThSc (5.0±1.0 vs. 4.8±1.1, P<0.001) and were associated with higher total compliance [OR 1.53, 95% confidence intervals (CI), 1.42-1.65, P<0.001]. In-hospital mortality was 2.4% (354 deaths). Compared to pts who died, the survivors had a higher ThSc (4.9±1.1 vs. 4.2±1.3, P<0.001) and this score was independently associated with lower risk of in-hospital mortality (OR 0.70, 95% CI, 0.64-0.77, P<0.001). Receiver operating characteristics curve analysis showed a good accuracy of ThSc for the occurrence of in-hospital mortality with the area under the curve (AUC) 0.82 (95% CI, 0.80-0.84, P<0.001), sensitivity 71.6% and specificity 78.0%. Age, peripheral artery disease, Killip-Kimball class >I, electrocardiogram (ECG) with ST-segment depression and positive troponin were other independent predictors of in-hospital mortality. CONCLUSIONS In the present study, patients with NSTE-ACS who received medications recommended by guidelines had better in-hospital outcomes. These findings highlight the need to clarify the clinical recommendations and to develop approaches for quality improvement in this subset of patients.

Implicações do índice de dispersão eritrocitária no risco de eventos hemorrágicos em doentes com síndrome coronária aguda sem supradesnivelamento do segmento ST

INTRODUCTION Higher values of red blood cell distribution width (RDW) have recently been associated with worse outcome in patients with cardiovascular disease. However, its relation to bleeding events in patients with non-ST elevation acute coronary syndromes has not been established. AIM To determine the prognostic value of RDW in patients with non-ST segment elevation acute coronary syndromes, particularly regarding the risk of major bleeding. METHODS We analyzed 513 consecutive patients admitted with non-ST elevation acute coronary syndromes. The population was divided into tertiles of baseline RDW and clinical, laboratory characteristics and adverse events were analyzed for each group. The primary outcome was defined as the occurrence of major bleeding (according to the Crusade bleeding score). The predictive value of RDW for risk of major bleeding was determined. RESULTS The mean RDW was 15.13%±1.62%. Patients in the third tertile were older and more frequently had renal dysfunction or previous coronary revascularization. Higher values of RDW were associated with greater risk of major bleeding and in-hospital death. RDW >15.7% was an independent predictor of bleeding events (odds ratio 3.1, 95% CI 1.4-6.9). CONCLUSIONS In a population of patients with non-ST elevation acute coronary syndromes, RDW was associated with higher in-hospital mortality and was an independent predictor of in-hospital major bleeding.