Prevalence of conventional cardiovascular risk factors in patients with acute coronary syndrome

Background: Primary prevention studies have shown that early detection and aggressive treatment of cardiovascular risk factors (CRF) prevent cardiovascular events. It is not well described the prevalence of CRF in patients, at the moment of admission due to acute coronary syndrome (ACS). Aim: To determine the prevalence of CRF among patients admitted with ACS. Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. We studied the prevalence of conventional risk factors (diabetes, hypertension, smoking, dyslipidaemia) and compared findings according to gender and type of ACS: ACS with ST elevation (STEMI), ACS without ST elevation (NSTEMI). Results: Men represented 75% (n=3658) of the total population, were younger than women (61.6±12,9 vs 70.9 ±11.8 years; p<0.001) and had more frequently body mass index ≥ 25 kg/m2 (70.9% vs 62.3%; p<0.001). The most frequent CRF was hypertension (62.4%; n=3038), followed by dyslipidaemia (50.6%, n=2467), smoking (43.2%; n=2106) and diabetes (27.2%; n=1324). In women, the more common CRF were hypertension (75%) and dyslipidaemia (51.2%), whereas in men were smoking (54.4%) and dyslipidaemia (50.5%). We identify, at least, one CRF in 92,4% of all patients and two or three risk factors in 58.1%. Women had more frequently 2 CRF than men (40.1% vs 36.3%; p=0.011), although mean had, more often, 4 CRF (8.9% vs 4.1%; p<0.001). Previous history of cerebrovascular disease was more observed in women (8.6% vs 6.1%; p=0.002), but men had more often history of previous revascularization (9.8% vs 6.8%; p<0.001). On admission men presented more frequently STEMI (50.8% vs 43.5%; p<0,001) and less frequently renal dysfunction (17.2% vs 39.6%; p<0.001) and anaemia (18.8% vs 33.3%; p<0.001). Hypertension was the most prevalent CFR as in patients STEMI (56.6%) as in NSTEMI patients (67.9%), followed by smoking (47.5%) in STEMI patients and by dyslipidaemia (55.7%) in NSTEMI patients. Conclusion: We found at least one CRF in 92.8% of patients and two or three in more than half. Hypertension emerged as the major CRF in both forms of presentation of ACS

Modified shock index - a strong preditor of outcome among patients presenting ST-segment elevation myocardial infarction

Background: Prompt identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention will allow a more assertive strategy and approach. Aim: To evaluate the modified shock index (MSI) - a ratio of heart rate (HR) to mean blood pressure (MAP), as a predictor of in hospital and 6-month mortality among patients (pts) admitted with STEMI. Methods: We analyzed retrospectively 2389 pts admitted consecutively in our coronary care unit with acute coronary syndrome, from July of 2009 to June 2014 and we selected those who presented with STEMI (n=1140). They were divided in two groups: group 1 – pts with MSI <1.3, n=1076, 94.4%); group 2 – pts with MSI ≥1.3 (n=64, 5.6%). For each group we compared clinical and laboratory features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 99% of patients. Results: Patients of group 2 were older (62±14 vs 67±14; p=0.003), more frequent women (19% vs 37.5%; p1 (18.0% vs 56.3%; p<0.001), Killip=4 (2.9% vs 28.1%; p<0.001), anaemia (20.9% vs 48.4%; p<0.001) and renal insufficiency (eGFR<60 ml/min) (21.8% vs 42.6%; p<0,001). They also presented more severe coronary disease - left main coronary artery or 3 vessels disease (16.3% vs 31.3%; p=0.005) and higher prevalence of moderate to severe systolic dysfunction (48.3% vs 68.9%; p=0.009). They required more often aminergic support (7.4% vs 50%; p<0.001), intra-aortic balloon pump (2.9% vs 38.3%; p<0.001) and mechanical ventilation (2.6% vs 17.4%; p<0.001). They also had higher prevalence of malignant arrhythmias (6.1% vs 15.6%; p= 0.008) and mechanical complications (1.7 vs 6.3%; p=0.031). Compared with 1st group, the 2nd group had 6.42 times higher in hospital mortality [OR 6.42; 95% CI (4.07 – 12.67)]; p <0.001] and 7.18 times higher 6-month mortality [OR 7.18; 95% CI (3.30 - 12.46)]; p <0.001]. After adjusting for different baseline characteristics in multivariate analysis, MSI ≥1.3 remained as independent predictor of overall 6-month mortality [OR 3.81, 95% CI (1.81-8.03), p<0.001]. Conclusion: Modified shock index ≥1.3 is a stronger predictor of in hospital and 6 month mortality among patients with STEMI

High-grade atrioventricular block in ST-segment elevation myocardial infarction patients: insights of a terciary centre

Background: High-grade atrioventricular block (HABV) is associated with poorer outcomes in the setting of acute coronary syndromes. Limited information is available on the incidence and death associated with HABV in STEMI patients (pts) receiving contemporary treatment. Aim: To evaluate the incidence of HABV and its impact on outcome of STEMI patients, in primary percutaneous coronary intervention era. Methods: We analysed retrospectively 1149 STEMI pts admitted, consecutively, in our coronary care unit, from July of 2009 to June 2014. They were divided in two groups: group 1 – pts without HABV, n=1057, 92%); group 2 – pts with HABV (n=92, 8%). For each group we compared clinical features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 99,8% of patients. Results: Patients of group 2 were older (62±13 vs 69±15;p1 (18.0 % vs 42.4%;p1 (71.4% vs 37,2%;p<0.001), left ventricular dysfunction (100% vs 34.8%;p<0.001), but less right ventricular dysfunction (7.1% vs 28.4%;p<0.001). Compared with IMI pts, AMI pts had higher risk of in hospital [OR 9.04, 95% CI (2.87-28.50);p<0.001] and 6-month mortality [OR 10.88; 95% CI (3.33 – 35.53);p<0.001]. After adjusting for different baseline characteristics in multivariate analysis, HABV patients had higher risk of overall 6-month mortality compared to those without HABV [OR 2.18, 95% CI (1.25-3.79),p=0.006]. Conclusion: Besides low incidence of HABV, this complication continues to have a high risk of in-hospital and 6-month mortality and occurring with AMI the risk increases significantly

Temporal trends of risk profile among patients admitted with acute coronary syndrome

Background: Clinical practice focuses on the primary prevention of cardiovascular (CVD) disease through the modification and pharmacological treatment of elevated risk factors, in order to minimize long-term CVD risk. Aim: To determine if there are differences in risk profile of patients admitted with acute coronary syndrome over time. Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups of 4 consecutive years: group 1 – from 2002 to 2005 (n=1245, 25.6%); group 2 – from 2006 to 2009 (n=1562, 32%); group 3 - from 2010 to 2013 (n=2064, 42.4%). For each group we studied the prevalence of conventional risk factors (CRF) including diabetes, hypertension, smoking and dyslipidaemia over time and compared findings according to sex and type of acute coronary syndrome: Results: Women were less prevalent in group 3 (26.2% vs 26.9% vs 22.6%, p=0.006). Temporal trends of age and diabetes didn’t show statistic signify. Group 2 and 3 evidenced higher body mass index (26.48±4.0 vs 27.13±5.8 vs 27.15±4.67 kg/m2; p<0.001), had higher prevalence of dyslipidaemia (43.1% vs 49.2% vs 56.3%; p<0.001), smoking (39.4% vs 65.0% vs 64.4%; p<0.001) and hypertension (55.7% vs 65.0% vs 64.4%; p<0.001). We found at least 1 CRF in 92,4% of patients. The first temporal period had higher prevalence of 1 or 2 CRF, on the contrary two thirds of patients in group 3 had 2 or 3 CRF. Over time, hypertension was more prevalent in women (69.3% vs 77,4% vs 78.6%; p=0,007), on the other hand, smoking and dyslipidaemia occurred more often in men. It was observed an increasing tendency of smoking (44% vs 41.6% vs 54%; p100 mg/dl more often (66% vs 57% vs 68.8%; p=0.022), but higher control of systolic blood pressure below 140mmHg (54.2% vs 59.6% vs 65.7%, p<0.001. Conclusion: We found that the risk profile of patients presenting with acute coronary syndrome worsened over the years. In recent time, patients had more CRF, being smoking and hypertension the leaders

Cardiogenic shock complicating acute coronary syndromes

INTRODUCTION: Despite advances in the treatment of patients with acute coronary syndromes (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. PURPOSE: Determine characteristics and management of patients with an ACS complicated by CS. Determine predictors of development of CS during hospitalization and predictors of in-hospital mortality. METHODS: Retrospective study of 2064 patients consecutively admitted for ACS in a Coronary Unit over a period of 4 years. RESULTS: During the years under study, 111 patients (5.4%) developed CS. Patients with CS were more likely to be older (69.8 ± 13.2 vs 63.5 ± 13.1 years, p<0.001); there were no significant differences in other clinical characteristics. Myocardial Infarction with ST segment elevation (STEMI) was more frequent in patients with CS (p<0.001). Patients with CS underwent less often coronary angiography (p<0.001), revascularization (p = 0.004) and were less treated with β-blocker (p <0.001) and ACE inhibitors therapy (p <0.001). In multivariate analysis, predictors of occurrence of CS during hospitalization were: tachycardia (OR 3.2, 95% CI 1.6-6.3), systolic blood pressure 1 (OR 3.5, 95% CI 1.8-6.8) at admission. The in-hospital mortality of patients with CS was 45%, compared with 1.7% in those who did not develop CS. Factors associated with an increased mortality in patients with CS included absence of coronary revascularization (OR 4.9, 95% CI 1.5-16.0), GFR <60ml/min (OR 4.4, 95% CI 1.3-15.6), advanced age (OR 6.4, 95% CI 1.6-26.2) and LVEF ≤ 35 % (OR 3.9, 95% CI 1.3-12.4). CONCLUSION: According to the literature, our review showed that CS in the context of ACS is associated with a high mortality. We identified clinical markers that are associated with the development of CS and may spot patients at risk earlier. Absence of coronary revascularization remains an independent predictor of mortality in CS

The use of muscle biomarkers for assessing physiological effects of heavy metal pollution in the greater white-toothed shrew (Crocidura russula)

The greater white-toothed shrew Crocidura russula has been used as a sentinel species for estimating environmental risks to human populations. Previous studies in mining areas have focused on the liver of shrews as the primary target of physiological and metabolic changes due to heavy metal pollution. However, populations persist even when detoxification by the liver seems to be compromised and damage is observed. These pollutant-adapted individuals inhabiting contaminated sites may exhibit altered biochemical parameters that confer increased tolerance in various tissues other than the liver. The skeletal muscle tissue of C. russula might be an alternative tissue that allows the survival of organisms inhabiting historically polluted sites due to the detoxification of redistributed metals. Organisms from two heavy metal mine populations and one population derived from an unpolluted site were used to determine the detoxification activities, antioxidant capacity, and oxidative damage, as well as cellular energy allocation parameters and acetylcholinesterase activity (a biomarker of neurotoxicity). Muscle biomarkers differ between shrews from polluted sites and shrews from the unpolluted location, with the mine animals showing: (1) a decreased energy consumption concomitant with increased energy reserves and total available energy; (2) reduced cholinergic activity, suggesting an impairment of neurotransmission at the neuromuscular junction; (3) an overall decrease in detoxification capacity and enzymatic antioxidant response and a higher level of lipid damage. Also, some of these markers differed between females and males. These changes may have resulted from a decreased detoxifying capacity of the liver and could potentially bring about significant ecological effects for this highly active species. Heavy metal pollution induced physiological changes in Crocidura russula showing that skeletal muscle may serve as a backup sink organ allowing rapid species adaptation and evolution.publishe

Low serum albumin – another prognostic marker?

Introduction: Population-based studies have suggested an association between low serum albumin levels and coronary atherosclerosis and heart failure. The role of albumin in the context of acute coronary syndromes (ACS) remains unclear, however, seems to associate with an adverse prognosis. Aim: The aim of the present study was to determine whether low serum albumin levels are associated with development of heart failure in ACS. Methods: Study of patients consecutively admitted for ACS in a Coronary Unit over 6 months. Patients with infectious complications were excluded. Results: One hundred sixty-eight patients were eligible for analysis. Males were predominant (81.5%) and the mean age was 61.7±13.4 years old. Low serum albumin levels (serum albumin <3.5g/dl) were present in 44.6%. No significant differences were observed regarding demographic characteristics, except higher mean age (p <0.001) and a higher prevalence of hypertension (p = 0.04) in the hypoalbuminemia group. This group had lower values of hemoglobin (p<0.001) and higher levels of pro-BNP (p=0.018) and C Reactive Protein (p<0.001). In univariate analysis, hypoalbuminemia was associated with a higher prevalence of heart failure (p=0.015, OR 2.45 CI95% 1.17-5.10) and the use of intra-aortic balloon (p = 0.005) during hospitalization. There were no statistically significant differences in the use of ionotropic drugs and invasive ventilation as well as in-hospital mortality. At follow-up at 6 months showed a positive association between hypoalbuminemia and mortality (p <0.05). Conclusions: The hypoalbuminemia was associated with an increased risk of heart failure during hospitalization and death at 6 months. Although the etiology of hypoalbuminemia remain unclear, albumin assay may be useful in risk stratification of acute coronary syndromes