Estratificação de risco e desfechos clínicos em pacientes com síndrome coronariana aguda em classe funcional de Killip I ou II

Existe grande número de estudos mostrando preditores de mortalidade e outros desfechos desfavoráveis nas síndromes coronarianas agudas (SCA). A mortalidade é aumentada nos pacientes com insuficiência cardíaca (IC), principalmente em classe funcional III e IV de Killip. Contudo, esses pacientes representam a minoria da população internada devido a um evento coronariano agudo. Além disso, a maioria dos estudos inclui apenas pacientes com uma das apresentações das SCAs e todas as classes de Killip. Assim, seria importante estabelecer critérios de estratificação de risco em pacientes com quaisquer das SCAs e sem edema pulmonar ou falência hemodinâmica. No presente estudo, formulou-se a hipótese de que o conjunto de variáveis clínicas e laboratoriais, obtidas na internação, pode predizer desfechos desfavoráveis no paciente com síndrome coronária aguda e em classes funcionais de Killip I ou II. O objetivo primário foi identificar variáveis clínicas, laboratoriais e anatômicas coronarianas, associadas com risco de desfechos desfavoráveis nesses pacientes. Os objetivos secundários foram descrever as alterações clínicas e laboratoriais precoces e identificar as diferenças relacionadas ao sexo. Estudo observacional prospectivo e longitudinal que incluiu 370 pacientes consecutivos (224 homens e 146 mulheres, p < 0,001), admitidos com angina instável (AI), infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) ou infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMST), diagnosticados até quarenta e oito horas após o início dos sintomas. As admissões ocorreram na Unidade de Terapia Intensiva do Pronto-Socorro e na Unidade Coronariana do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no período de março de 2003 a dezembro de 2006. As diferenças entre subgrupos...A large number of studies report mortality predictors and other unfavorable outcomes in acute coronary syndromes (ACSs). Mortality is increased in patients with heart failure (HF), particularly in Killip class III or IV. However, these patients represent the minority of the population hospitalized with acute coronary event. Furthermore, most studies analyzed only patients with one of the ACS presentations, including all Killip classes. Hence, it would be important to establish risk-stratification criteria in patients with any of the ACSs and without pulmonary edema or hemodynamic failure. In the present study, we hypothesized that the set of clinical and laboratory variables obtained at hospitalization can predict unfavorable outcomes in patients with acute coronary syndromes and in Killip classes I or II. The primary aim was to identify clinical, laboratory and coronary anatomical variables associated with the risk for unfavorable outcomes in these patients. The secondary objectives were to describe early clinical and laboratory alterations and to identify gender-related differences. This is a prospective and longitudinal observational study comprising 370 consecutive patients (224 males and 146 females, p < 0.001) admitted to hospital with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) diagnosed up to forty-eight hours after commencement of symptoms. Admissions occurred at the Intensive Care Unit of the Emergency Hospital and at the Coronary Unit of the University Hospital of the Botucatu School of Medicine from March, 2003 to December 2006. The differences between sub-groups were evaluated by Student’s t or the... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Myocardial dysfunction with increased ventricular compliance in volume overload hypertrophy

The aim this study was to evaluate systolic and diastolic function in volume overload induced myocardial hypertrophy in rats.Volume overload myocardial hypertrophy was induced in thirteen male Wistar rats by creating infrarenal arteriovenous fistula (AVF). The results were compared with a SHAM operated group (n = 11). Eight weeks after surgery, tail-cuff blood pressure was recorded, then rats were sacrificed for isolated heart studies using Langendorffs preparation.AVF rats presented increased left and right ventricular weights, compared to controls. The increased normalized ventricular volume (V0/LVW, 0.141 +/- 0.035 mL/g vs. 0.267 +/- 0.071 mL/g, P 0.05).We conclude that volume-overload induced hypertrophy causes myocardial systolic and diastolic dysfunction with increased ventricular compliance. These haemodynamic features help to explain the long-term compensatory phase of chronic volume overload before transition to overt congestive heart failure. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved

Predictors of Beta-Blocker Intolerance and Mortality in Patients After Acute Coronary Syndrome

Purpose: To investigate the predictors of intolerance to beta-blockers treatment and the 6-month mortality in hospitalized patients with acute coronary syndrome (ACS).Methods: This was a single-center, prospective, and longitudinal study including 370 consecutive ACS patients in Killip class I or II. BBs were prescribed according to international guidelines and withdrawn if intolerance occurred. The study was approved by the institutional ethics committee of our university. Statistics: the clinical parameters evaluated at admission, and the related intolerance to BBs and death at 6 months were analyzed using logistic regression (p<0.05) in PATIENTS.Results: BB intolerance was observed in 84 patients and was associated with no prior use of statins (OR: 2.16, 95%CI: 1.26-3.69, p= 0.005) and Killip class II (OR: 2.5, 95%CI: 1.30-4.75, p=0.004) in the model adjusted for age, sex, blood pressure, and renal function. There was no association with ST-segment alteration or left anterior descending coronary artery plaque. Intolerance to BB was associated with the greatest risk of death (OR: 4.5, 95%CI: 2.15-9.40, p<0.001).Conclusions: After ACS, intolerance to BBs in the first 48 h of admission was associated to non previous use of statin and Killip class II and had a high risk of death within 6 months

Demographic and clinical variables of the studied population.

<p> UA: unstable angina; NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction; CV: cardiovascular; AH: arterial hypertension; SBP: systolic blood pressure; ACEI: angiotensin-converting enzyme inhibitor.</p

Multivariate regression analysis for the primary outcome “beta-blocker intolerance”.

<p>OR: odds ratio; CI_95%: 95% confidence interval; SBP: systolic blood pressure; DBP: diastolic blood pressure; ACEI: angiotensin converting enzyme inhibitor.</p

Univariate regression analysis for death at6 months.

<p>OR: odds ratio; CI_95%: 95% confidence interval; AH: arterial hypertension; SBP: systolic blood pressure; DBP: diastolic blood pressure; LV: left ventricular; ACEI: converting enzyme inhibitor; ACS/LAD disease: acute coronary syndrome with lesion in the left anterior descending coronary artery.</p

Univariate regression analysis for the primary outcome “beta-blocker intolerance”.

<p>OR: odds ratio; CI_95%: 95% confidence interval; AH: arterial hypertension; SBP: systolic blood pressure; DBP: diastolic blood pressure; ACEI: angiotensin converting enzyme inhibitor; ACS/DA disease: acute coronary syndrome with lesion in the anterior descending coronary artery.</p