117 research outputs found
Prognostic significance of precordial ST segment depression during inferior myocardial infarction in the thrombolytic era: Results in 16,521 patients
Objectives. We examined the prognostic significance of precordial ST segment depression among patients with an acute inferior myocardial infarction. Background. Although precordial ST segment depression has been associated with a poor prognosis, this correlation has not been adequately quantified, partly because of small sample sizes and methodologic limitations in previous studies. Methods. We examined the clinical and angiographic outcomes of 16,521 patients with an acute inferior myocardial infarction who underwent thrombolysis in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) study. Patients were classified into those without precordial ST segment depression (n = 6,422 [38.9%]), those with ST segment depression in leads V1 to V3 only (n = 5,850 [35.4%]), those with ST segment depression in leads V4 to V6 only (n = 876 [5.3%]) and those with ST segment depression in both leads V1 to V3 and leads V4 to V6 (n = 3,373 [20.4%]) on initial electrocardiography. Outcome measures included postinfarction complications (second- or third-degree heart block, congestive heart failure or shock) and 30-day and 1-year mortality. Results. Patients with precordial ST segment depression had larger infarctions, more postinfarction complications and a higher mortality rate than those without precordial ST segment depression (4.7% vs. 3.2% at 30 days; 5.0% vs. 3.4% at 1 year; both p < 0.001), regardless of whether ST segment depression was noted in leads V1 to V6 or in leads V4 to V6. The magnitude of precordial ST segment depression (sum of leads V1 to V6) added significant independent prognostic information after adjustment for clinical risk factors; the risk of 30-day mortality increased by 36% for every 0.5 mV of precordial ST segment depression. Conclusions. Assessment of the magnitude of precordial ST segment depression is useful for acute risk stratification in patients with an inferior myocardial infarction
Risk Factors for In-hospital Nonhemorrhagic Stroke in Patients With Acute Myocardial Infarction Treated With Thrombolysis: Results from GUSTO-I
BACKGROUND: Nonhemorrhagic stroke occurs in 0.1% to 1.3% of patients with
acute myocardial infarction who are treated with thrombolysis, with
substantial associated mortality and morbidity. Little is known about the
risk factors for its occurrence. METHODS AND RESULTS: We studied the 247
patients with nonhemorrhagic stroke who were randomly assigned to one of
four thrombolytic regimens within 6 hours of symptom onset in the GUSTO-I
trial. We assessed the univariable and multivariable baseline risk factors
for nonhemorrhagic stroke and created a scoring nomogram from the baseline
multivariable modeling. We used time-dependent Cox modeling to determine
multivariable in-hospital predictors of nonhemorrhagic stroke. Baseline
and in-hospital predictors were then combined to determine the overall
predictors of nonhemorrhagic stroke. Of the 247 patients, 42 (17%) died
and another 98 (40%) were disabled by 30-day follow-up. Older age was the
most important baseline clinical predictor of nonhemorrhagic stroke,
followed by higher heart rate, history of stroke or transient ischemic
attack, diabetes, previous angina, and history of hypertension. These
factors remained statistically significant predictors in the combined
model, along with worse Killip class, coronary angiography, bypass
surgery, and atrial fibrillation/flutter. CONCLUSIONS: Nonhemorrhagic
stroke is a serious event in patients with acute myocardial infarction who
are treated with thrombolytic, antithrombin, and antiplatelet therapy. We
developed a simple nomogram that can predict the risk of nonhemorrhagic
stroke on the basis of baseline clinical characteristics. Prophylactic
anticoagulation may be an important treatment strategy for patients with
high probability for nonhemorrhagic stroke, but further study is needed
Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: incidence, predictors, and outcomes
BACKGROUND: The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients. METHODS AND RESULTS: We pooled the datasets of the Global Use of Streptokinase and tPA for Occluded Arteries (GUSTO)-IIb, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON)-A, and PARAGON-B trials (n=26 416). We identified independent predictors of ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared the 30-day and 6-month mortality rates of patients who did (n=552) and did not (n=25 864) develop these arrhythmias during the index hospitalization. Independent predictors of in-hospital VF included prior hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, and ST-segment changes at presentation. Except for hypertension, these variables also independently predicted in-hospital VT. In Cox proportional-hazards modeling, in-hospital VF and VT were independently associated with 30-day mortality (hazard ratio [HR], 23.2 [95% CI, 18.1 to 29.8] for VF and HR, 7.6 [95% CI, 5.5 to 10.4] for VT) and 6-month mortality (HR, 14.8 [95% CI, 12.1 to 18.3] for VF and HR, 5.0 [95% CI, 3.8 to 6.5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died <24 hours after enrollment. CONCLUSIONS: Despite the use of effective therapies for non-ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias
Stroke in Patients With Acute Coronary Syndromes: Incidence and Outcomes in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial
BACKGROUND: The incidence of stroke in patients with acute coronary
syndromes has not been clearly defined because few trials in this patient
population have been large enough to provide stable estimates of stroke
rates. METHODS AND RESULTS: We studied the 10 948 patients with acute
coronary syndromes without persistent ST-segment elevation who were
randomly assigned to placebo or the platelet glycoprotein IIb/IIIa
receptor inhibitor eptifibatide in the Platelet Glycoprotein IIb/IIIa in
Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT)
trial to determine stroke rates, stroke types, clinical outcomes in
patients with stroke, and independent baseline clinical predictors for
nonhemorrhagic stroke. Stroke occurred in 79 (0.7%) patients, with 66
(0.6%) nonhemorrhagic, 6 intracranial hemorrhages, 3 cerebral infarctions
with hemorrhagic conversion, and 4 of uncertain cause. There were no
differences in stroke rates between patients who received placebo and
those assigned high-dose eptifibatide (odds ratios and 95% confidence
intervals 0.82 [0.59, 1.14] and 0.70 [0.49, 0.99], respectively). Of the
79 patients with stroke, 17 (22%) died within 30 days, and another 26
(32%) were disabled by hospital discharge or 30 days, whichever came
first. Higher heart rate was the most important baseline clinical
predictor of nonhemorrhagic stroke, followed by older age, prior anterior
myocardial infarction, prior stroke or transient ischemic attack, and
diabetes mellitus. These factors were used to develop a simple scoring
nomogram that can predict the risk of nonhemorrhagic stroke. CONCLUSIONS:
Stro
Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
AIM: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronar
Campilobacteriose genital bovina e tricomonose genital bovina: epidemiologia, diagnóstico e controle
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