Mário Freitas

Hyperglycaemia at admission in acute coronary syndrome patients: prognostic value in diabetics and non-diabetics

Objective To evaluate the impact of admission glycaemia on short-term and long-term prognosis in diabetic and non-diabetic patients admitted for acute coronary syndromes (ACS), and to identify the independent predictors of post-ACS mortality in this population. Methods This study included 1149 consecutive patients admitted to a single coronary care unit for ACS between May 2004 and December 2006. Our population was divided into four groups according to the quartiles of glycaemia at admission [Q1 > 5.77 mmol/l, Q2 (5.77–7.0) mmol/l, Q3 (7.0–9.22) mmol/l and Q4 ≥ 9.22 mmol/l]. Diabetic (n = 396) and non-diabetic (n = 753) subgroups were then separately analysed. Results Hyperglycaemia at admission was associated with worse cardiovascular risk profile, high levels of necrosis and inflammation biomarkers and low left ventricle ejection fraction. Considering overall population, in-hospital, 30-day and 3-year mortalities were higher in more elevated glycaemia quartiles. In diabetic patients, there were no significant differences in mortality among glycaemia quartiles; however, in non-diabetic group higher admission glucose levels were associated with successively higher in-hospital and 3-year mortalities. After multivariate regression analysis, glycaemia at admission ≥ 5.77 mmol/l, age ≥ 72 years, Killip class [1 and troponin I ≥ 6.0 ng/ml were independent predictors of in-hospital mortality. Conclusion This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.

The magnitude of the variation in glycemia: a new parameter for risk assessment in acute coronary syndrome?

INTRODUCTION AND OBJECTIVES The aim was to evaluate the relationship between the magnitude of the variation in the level of glycemia during hospitalization and in-hospital and long-term mortality and postdischarge endpoints in two groups of patients with acute coronary syndrome: those with and those without a previous diagnosis of diabetes. METHODS The study included 1210 patients admitted for acute coronary syndrome between May 2004 and July 2007. The study population was divided in two subgroups: patients with a previous diagnosis of diabetes (n=386) and nondiabetics (n=824). Each subgroup was further divided into four smaller groups according to the quartile of glycemia variation: diabetics (Q1: <46 mg/dl; Q2: 46-88 mg/dl; Q3: 88-164 mg/dl; Q4: >or=164 mg/dl) and nondiabetics (Q1: <14 mg/dl; Q2: 14-30 mg/dl; Q3: 30-60 mg/dl; Q4: >or=60 mg/dl). Patients were followed up for an average of 18 months after the occurrence of the acute coronary syndrome. RESULTS In diabetic patients, there was no relationship between the magnitude of the glycemia variation and in-hospital or postdischarge endpoints. In nondiabetics, no significant difference was observed in in-hospital mortality or morbidity, but statistically significant clinical differences were found during follow-up. Multivariate regression analysis showed that Q4 versus Q1, age >or=70 years, and previous antiplatelet or angiotensin-converting enzyme inhibitor therapy were independent predictors of postdischarge endpoints in the nondiabetic group. CONCLUSIONS In nondiabetic acute coronary syndrome patients, the magnitude of the variation in glycemia observed during hospitalization was a strong independent predictor of postdischarge clinical endpoints.

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.

Platelet aggregation at discharge, A useful tool in acute coronary syndromes?

INTRODUCTION Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. OBJECTIVE To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. METHODS We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate(®) analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0-188.0) days. RESULTS The median value of platelet aggregation was 16.0U (11.0-22.5U) with a maximum of 41.0U and a minimum of 4.0U (normal value according to the manufacturer: 53-122U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A - platelet aggregation <18.5U, n=44; and group B - platelet aggregation ≥18.5U, n=26. The groups were similar with respect to demographic data (age 60.5 [49.0-65.0] vs. 62.0 [49.0-65.0] years, p=0.21), previous cardiovascular history, and admission diagnosis. There were no associations between left ventricular ejection fraction, GRACE risk score, or length of hospital stay and platelet aggregation. The groups were also similar with respect to antiplatelet, anticoagulant, proton pump inhibitor (63.6 vs. 46.2%, p=0.15) and statin therapy. The variability in platelets and hemoglobin was also similar between groups. Combined event-free survival was higher in group A (96.0 vs. 76.7%, log-rank p<0.01). Platelet aggregation higher than 18.5U was an independent predictor of the combined event (HR 6.75, 95% CI 1.38-32.90, p=0.02). CONCLUSION In our ACS population platelet aggregation at discharge was a predictor of medium-term prognosis.

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.

A importância de um EGC normal em síndromes coronarianas agudas sem supradesnivelamento do segmento ST

FUNDAMENTO: El electrocardiograma (ECG) de ingreso tiene un gran impacto en el diagnostico y tratamiento de sindromes coronarios agudos (SCA) sin supradesnivel del segmento ST. OBJETIVO: Evaluar el impacto del ECG de ingreso en el pronostico del SCA sin supradesnivel de ST. METODOS: Poblacion: estudio prospectivo, continuo, observacional, de 802 pacientes con SCA sin supradesnivel de ST de un unico centro. Los pacientes se dividieron en 2 grupos: A (n=538) - ECG Anormal y B (n=264) - ECG Normal. ECG Normal era sinonimo de ritmo sinusal sin alteraciones isquemicas agudas. Se realizo un seguimiento clinico de un ano teniendo como objetivo todas las causas de mortalidad y la tasa de eventos cardiacos adversos mayores (MACE). RESULTADOS: Los pacientes del Grupo A eran mas viejos (68,7±11,7 vs 63,4±12,7 anos, p<0,001), presentaban clases Killip mas altas y picos mas altos de biomarcadores de necrosis miocardica. Ademas de ello, presentaban menor fraccion de eyeccion del ventriculo izquierdo (FEVI) (52,01±10,55 vs 55,34± 9,51%, p<0,001), tasa de filtrado glomerular, hemoglobina inicial, y niveles de colesterol total. Los pacientes del Grupo B fueron sometidos mas frecuentemente a estrategias invasivas (63,6 vs 46,5%, p<0,001) y tratados con aspirina, clopidogrel, betabloqueantes y estatinas. Estos tambien presentaban mas frecuentemente una anatomia coronaria normal (26,2 vs 18,0%, p=0,45). Se observo una tendencia a la mayor mortalidad hospitalaria en el grupo A (4,6 vs 1,9%, p=0,054). El analisis de Kaplan-Meyer mostro que la sobrevida de 1 mes y un ano (95,1 vs 89. 5%, p=0.012) era mas alta en el grupo B y el resultado se mantuvo significativo en un modelo de regresion de Cox (ECG normal HR 0,45 (0,21 - 0,97). No hubo diferencias con relacion a la tasa de MACE. CONCLUSION: En nuestra poblacion de pacientes son SCA sin supradesnivel de ST, un ECG normal fue un marcador inicial para un buen pronostico.BACKGROUND Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS). OBJECTIVE To assess the impact of the admission ECG on prognosis over non-ST ACS. POPULATION prospective, continuous, observational study of 802 non-ST ACS patients from a single center. METHODS Patients were divided in 2 groups: A (n=538) - Abnormal ECG and B (n=264) - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate. RESULTS Group A patients were older (68.7+/-11.7 vs. 63.4+/-12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01+/-10.55 vs. 55.34+/- 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97). There were no differences regarding the MACE rate. CONCLUSION In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.

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.

La importancia de un ECG normal en síndromes coronarios agudos sin supradesnivel del segmento ST

FUNDAMENTO: El electrocardiograma (ECG) de ingreso tiene un gran impacto en el diagnostico y tratamiento de sindromes coronarios agudos (SCA) sin supradesnivel del segmento ST. OBJETIVO: Evaluar el impacto del ECG de ingreso en el pronostico del SCA sin supradesnivel de ST. METODOS: Poblacion: estudio prospectivo, continuo, observacional, de 802 pacientes con SCA sin supradesnivel de ST de un unico centro. Los pacientes se dividieron en 2 grupos: A (n=538) - ECG Anormal y B (n=264) - ECG Normal. ECG Normal era sinonimo de ritmo sinusal sin alteraciones isquemicas agudas. Se realizo un seguimiento clinico de un ano teniendo como objetivo todas las causas de mortalidad y la tasa de eventos cardiacos adversos mayores (MACE). RESULTADOS: Los pacientes del Grupo A eran mas viejos (68,7±11,7 vs 63,4±12,7 anos, p<0,001), presentaban clases Killip mas altas y picos mas altos de biomarcadores de necrosis miocardica. Ademas de ello, presentaban menor fraccion de eyeccion del ventriculo izquierdo (FEVI) (52,01±10,55 vs 55,34± 9,51%, p<0,001), tasa de filtrado glomerular, hemoglobina inicial, y niveles de colesterol total. Los pacientes del Grupo B fueron sometidos mas frecuentemente a estrategias invasivas (63,6 vs 46,5%, p<0,001) y tratados con aspirina, clopidogrel, betabloqueantes y estatinas. Estos tambien presentaban mas frecuentemente una anatomia coronaria normal (26,2 vs 18,0%, p=0,45). Se observo una tendencia a la mayor mortalidad hospitalaria en el grupo A (4,6 vs 1,9%, p=0,054). El analisis de Kaplan-Meyer mostro que la sobrevida de 1 mes y un ano (95,1 vs 89. 5%, p=0.012) era mas alta en el grupo B y el resultado se mantuvo significativo en un modelo de regresion de Cox (ECG normal HR 0,45 (0,21 - 0,97). No hubo diferencias con relacion a la tasa de MACE. CONCLUSION: En nuestra poblacion de pacientes son SCA sin supradesnivel de ST, un ECG normal fue un marcador inicial para un buen pronostico.BACKGROUND Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS). OBJECTIVE To assess the impact of the admission ECG on prognosis over non-ST ACS. POPULATION prospective, continuous, observational study of 802 non-ST ACS patients from a single center. METHODS Patients were divided in 2 groups: A (n=538) - Abnormal ECG and B (n=264) - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate. RESULTS Group A patients were older (68.7+/-11.7 vs. 63.4+/-12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01+/-10.55 vs. 55.34+/- 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97). There were no differences regarding the MACE rate. CONCLUSION In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.