Prognostic Value of Glomerular Filtration Rate in Diabetic Patients with Acute Myocardial Infarction

Background: low glomerular filtration rate is a known poor prognostic factor in acute coronary syndrome, particularly when associated with diabetes mellitus.Objective: to determine the prognostic value of glomerular filtration rate in hospitalized diabetic patients with acute ST-segment elevation myocardial infarction.Methods: a case-series study was conducted in 68 diabetic patients with acute ST-segment elevation myocardial infarction admitted to the Camilo Cienfuegos Hospital in Sancti Spiritus from January 2012 to December 2013. The glomerular filtration rate on admission was estimated using the Cockcroft-Gault equation. Cardiovascular risk factors, clinical and laboratory variables, the ejection fraction and hospital mortality were analyzed.Results: low glomerular filtration rate was associated with a left ventricular ejection fraction &lt;45% at discharge (p = 0.0060) and cardiac complications including arrhythmias, atrioventricular conduction disturbances, reinfarction, postinfarction angina and Killip class ≥ III (p = 0.0000). It was also associated with increased mortality and lower reperfusion rates.Conclusions: estimating the glomerular filtration rate in diabetic patients with acute coronary syndrome at the time of admission provides significant information for prognosis in the acute phase, even in those with normal creatinine values. A glomerular filtration rate less than 53 mL/min increases the risk of suffering an adverse event during hospitalization eight times.</p

De Novo Atrial Fibrillation Increases Intra-hospital Mortality in Myocardial Infarction with ST Elevation?

Foundation: atrial fibrillation is the most common arrhythmia in the general population and complicates 2 to 22 % of myocardial infarctions. Objective: to determine the prognostic implications of de novo atrial fibrillation in hospital mortality in patients with myocardial infarction with ST-segment elevation. Method: an observational, retrospective study was performed of 326 patients with myocardial infarction and ST-elevation admitted to the Camilo Cienfuegos Provincial University Hospital from January 1, 2013 to June 30, 2015. The studied variables were: age, sex, factors of coronary risk, history of ischemic heart disease, presence of atrial fibrillation, myocardial dysfunction, cardiogenic shock, number of thrombolyzed patients, success of thrombolysis, glycemia values, uric acid, creatinine, cholesterol, triacylglycerides, leukocytes and hemoglobin. For the statistical significance of the variables under study, the chi-squared test was used if they were qualitative and the student's t test for quantitative ones. A multivariate analysis was also performed to determine the independence of atrial fibrillation as a prognostic factor. Results: the variables associated with in-hospital mortality were: diabetes mellitus, history of ischemic heart disease, age over 75 years, ejection fraction less than 30 %, glomerular filtration rate less than 60 ml/min, Killip class Kimbal III-IV and de novo atrial fibrillation. Atrial fibrillation was found to have a statistically significant association with in-hospital mortality. Conclusions: de novo atrial fibrillation was an independent predictor of intra-hospital mortality in patients with myocardial infarction with ST-segment elevation

De Novo Atrial Fibrillation Increases Intra-hospital Mortality in Myocardial Infarction with ST Elevation?

Foundation: atrial fibrillation is the most common arrhythmia in the general population and complicates 2 to 22 % of myocardial infarctions. Objective: to determine the prognostic implications of de novo atrial fibrillation in hospital mortality in patients with myocardial infarction with ST-segment elevation. Method: an observational, retrospective study was performed of 326 patients with myocardial infarction and ST-elevation admitted to the Camilo Cienfuegos Provincial University Hospital from January 1, 2013 to June 30, 2015. The studied variables were: age, sex, factors of coronary risk, history of ischemic heart disease, presence of atrial fibrillation, myocardial dysfunction, cardiogenic shock, number of thrombolyzed patients, success of thrombolysis, glycemia values, uric acid, creatinine, cholesterol, triacylglycerides, leukocytes and hemoglobin. For the statistical significance of the variables under study, the chi-squared test was used if they were qualitative and the student's t test for quantitative ones. A multivariate analysis was also performed to determine the independence of atrial fibrillation as a prognostic factor. Results: the variables associated with in-hospital mortality were: diabetes mellitus, history of ischemic heart disease, age over 75 years, ejection fraction less than 30 %, glomerular filtration rate less than 60 ml/min, Killip class Kimbal III-IV and de novo atrial fibrillation. Atrial fibrillation was found to have a statistically significant association with in-hospital mortality. Conclusions: de novo atrial fibrillation was an independent predictor of intra-hospital mortality in patients with myocardial infarction with ST-segment elevation

Fístula coronaria a ventrículo derecho en paciente con ateroesclerosis sistémica

Atherosclerosis is a systemic disease that affects a number of vascular beds. Clini-cal manifestations whether acute or chronic (acute myocardial infarction, stable angina, intermittent claudication, cerebrovascular disease, among others) start after long periods of progression; so it may present subclinically in patients with coronary artery disease. What is particularly interesting about this form of presen-tation is that within a series of cases with multivessel disease, associated with an ankle-brachial index (ABI)<0.9, after an acute coronary syndrome, we have identi-fied, as an angiographic finding, the presence of a coronary artery fistula to the right ventricle in a patient with very low ABI and clinical intermittent claudication. This fistula led to the symptoms that hampered cardiovascular rehabilitation. It is an infrequent disease characterized by chest pain; with low reporting (0.3 to 0.8%), as an incidental finding in coronary angiographies.La ateroesclerosis es una enfermedad sistémica que afecta múltiples lechos vasculares. Después de períodos prolongados de progresión comienzan las manifesta-ciones clínicas, de forma aguda o crónica (infarto agudo de miocardio, angina estable, claudicación intermitente, enfermedad cerebrovascular, entre otras); por lo que puede cursar de manera subclínica en pacientes con enfermedad arterial coronaria. Lo interesante de esta forma de presentación es que dentro de una serie de casos con enfermedad multivaso, asociado a un índice tobillo-brazo (ITB) < 0,9, después de un síndrome coronario agudo, hemos encontrado, como hallaz-go angiográfico, la presencia de una fístula coronaria a ventrículo derecho en un paciente con ITB muy bajo y clínica de claudicación intermitente. Esta fístula es la causa de los síntomas que interrumpieron la rehabilitación cardiovascular; es una enfermedad poco frecuente y causa de dolor torácico, que se informa solo de 0,3 a 0,8%, como hallazgo incidental en angiografías coronarias

Duración del QRS como predictor de baja fracción de eyección en el infarto miocárdico con elevación del ST

Introduction: The QRS duration is a prognostic element and it has been associated with a decrease in the ejection fraction of the left ventricular in patients with acute coronary syndrome.Objective: To assess the prognostic implications of the QRS duration in the depression of the left ventricular ejection fraction at discharge.Method: A cross-sectional study was conducted with 347 patients with ST-segment elevation myocardial infarction, admitted at the Hospital Universitario Camilo Cienfuegos from January 1st, 2013 to December 31st, 2015. The variables studied were: age, sex, classical cardiovascular risk factors, blood pressure, reperfusion strategy, Killip-Kimball class, glomerular filtration rate, QRS duration and left ventricular ejection fraction. The qualitative variables were analyzed with the Chi-square statistical method and the quantitative with the t of Student and linear regression. The ROC curve was constructed for the discrimination capacity and a multivariate analysis was performed to determine the independence of variables. Results: The QRS duration was negatively correlated with the ejection fraction r=-0.267; p<0.001) and an adequate discrimination ability as a predictor ejection fraction less than 35% (c=0.643).Conclusions: The QRS duration greater than 90 milliseconds was independently associated with an ejection fraction lower than 35% at discharge.Introducción: La duración del QRS es un elemento pronóstico y se ha asociado a una disminución de la fracción de eyección del ventrículo izquierdo en pacientes con síndrome coronario agudo.Objetivo: Evaluar la implicación pronóstica de la duración del QRS en la reducción de la fracción de eyección del ventrículo izquierdo al egreso.Método: Se realizó un estudio analítico transversal con 347 pacientes con infarto agudo de miocárdico con elevación del segmento ST, ingresados en el Hospital Universitario Camilo Cienfuegos del 1 de enero de 2013 al 31 de diciembre de 2015. Las variables estudiadas fueron: edad, sexo, factores de riesgo cardiovascular clásicos, tensión arterial, estrategia de reperfusión, clase de Killip-Kimbal, filtrado glomerular, duración del QRS y la fracción de eyección del ventrículo izquierdo. Las variables cualitativas se analizaron con el método estadístico Chi cuadrado, las cuantitativas con la t de Student y la regresión lineal. Se construyó la curva ROC para la capacidad de discriminación y se realizó un análisis multivariado para determinar la independencia de variables.Resultados: La duración del QRS tuvo una correlación negativa con la fracción de eyección (r=-0,267;  p<0,001) y una adecuada capacidad de discriminación como predictor de una fracción de eyección inferior a 35% (c=0,643).Conclusiones: La duración del QRS superior a 90 milisegundos se asoció de manera independiente a una fracción de eyección menor de 35% al egreso

The Ankle-brachial Index as a Predictor of Multivess el Coronary Disease in Patients with Acute Coronary Syndrome and Peripheral Arterial Disease

Background: the coexistence of peripheral arterial disease and acute coronary syndrome is associated with a worse prognosis. The ankle-brachial index has been shown to be a marker of multisite atherosclerosis.Objective: to determine the relationship between the ankle-brachial index and coronary artery disease.Method: an analytical observational study was carried out that included all the patients discharged from the coronary care unit of the Camilo Cienfuegos Gorriarán Provincial University Hospital, of the Sancti Spíritus province, in the period from March 1, 2011 to February 30 of 2018, with a diagnosis of acute coronary syndrome, with and without ST segment elevation. Clinical data, ankle-brachial index, echocardiography and coronary angiography were collected and the prognostic implication of the index in disease was determined through a classification tree with the variables included in the binary logistic regression model.Results: multivessel disease occurred in 85.2 % patients, 81.9 % of them were men, 85.9 % of them with multivessel disease, the mean age was 59.1 years, 52.3 % presented STEACS with multivessel disease 78.8 %. The most frequent risk factors were: smoking (86.8 %), dyslipidemia (85.8 %) and arterial hypertension (84.8 %) in the group with multivessel disease and ABI = 0.9 (SD = 0.3). They received treatment with clopidogrel (86.1 %), acetylsalicylic acid (86.3 %), ACEI or ARB (85.8 %), statins (73.2 %), beta-blockers (87.5 %) and nitrates (86, 3 %). On angiography, 85.2 % had severe coronary disease. The two-predictor variables were: NSTEACS and ABI≤0.9, which showed a high positive predictive value in the prognosis of multivessel coronary artery disease.Conclusions: ankle-brachial index &lt;0.9 showed a predictive capacity for multivessel disease that increases if it is associated with diabetes mellitus and smoking