Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

BACKGROUND: Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. METHODS AND RESULTS: Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. CONCLUSIONS: This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

BACKGROUND: Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. METHODS AND RESULTS: Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. CONCLUSIONS: This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia

[Stratification of cardiovascular risk in patients with non-traumatic chest pain in the emergency department. Perspectives of the Heart Risk Score in patients with acute coronary syndrome.]

INTRODUCTION: Acute chest pain (CP) is a potentially related both to acute coronary syndrome and to other morbidities; this means that 2%-10% patients with cardiogenic CP are improperly discharged from the Emergency Room (ER). In order to identify risk to develop cardiovascular (CV) events in patients admitted to ER with CP, we used Heart Risk Score (HRS).MATERIALS AND METHODS: We included 165 patients referred to the ER for non-traumatic acute CP. We retrospectively analyzed clinical records from ER and Chest Pain Unit (CPU). We calculated HRS, then we analyzed HRS sensitivity and specificity, and correlated raw data of all variables with Spearman's analysis.RESULTS: Diagnosis of ischemic heart disease was made in 53.9% patients referring CP. The remaining patients were affected by other non-ischemic heart disease (35.5%), gastro-esophageal disease (32.3%), pleuro-pulmonary pathology (15.8%), musculoskeletal disorders (10.5%), and panic attacks (6.6%), respectively. Patients affected by coronaropathy had hypertension (80.9%), history of cardiopathy (61.8%), chronic smoking (49.4%), hypercholesterolemia (37.0%) , diabetes (33.7%) and obesity (24.7%). Low, medium and high HRS patients were 15.7%, 59.4% and 24.8%, respectively. Risk of CV events increased with the increase of the score. The negative predictive value (NPV) in low score was 92.3%. In high score, sensitivity and specificity were 94.7% and 82.7%, respectively. Finally, the following positive Spearman's correlations were found: HRS vs its risk variables, including individual risk variables, ischemic heart disease vs CV risk factors, history of ischemic cardiac disease vs risk factors, number of stenotic vessels vs risk factors (significance values: p &lt;0.05).DISCUSSION: HRS contains history of all risk factors for coronary artery disease and considers mild ECG and troponin alterations, giving the possibility to undertake the most appropriate path for the patient.CONCLUSIONS: Our work evidences relevance, reliability and ease of use of HRS in CV risk stratification in the emergency department, giving an important contribution in the evaluation of individuals who are likely to experience ischemic heart disease

Variazioni della concentrazione plasmatica del peptide natriuretico di tipo B in urgenza nella fibrillazione atriale parossistica,nell’edema polmonare acuto, nella sindrome coronarica acuta e nella cardiomiopatia dilatativa

Our research is based on the critical evaluation of plasma concentration variation of B-type natriuretic peptide (BNP) – in emergency – in paroxysmal atrial fibrillation, acute pulmonary edema, acute coronary syndrome and dilated cardiomyopathy. The aim of our research was to assess if the BNP concentration variation may be useful in the diagnosis and therapy. Peptide synthesis takes place mainly in the ventricular myocardium. We selected 102 patients: 27 control subjects, and 75 admitted to the emergency and reception department for dyspnea and/or precordialgia and/or palpitations. At the beginning they were considered as one group only, and then they were divided into groups according to the diagnosis: 20 with paroxysmal atrial fibrillation with reversion to sinus rhythm in the first week; 20 with acute pulmonary edema; 22 with acute coronary syndrome without electrocardiographic ST-segment changes; 13 with compensated dilated cardiomyopathy. Our research assessed that the BNP activation and secretion are evident especially in patients with heart failure and remains at the high level until the administration of an effective therapy and then they reach a balance with values higher than the standards, while in the paroxysmal atrial fibrillation and in acute coronary syndrome they rise and come back to the standard levels or even at lower levels after the disease solution. For this reason, BNP reiterated measurements allow to assess treatment efficacy, even at home, and to optimize the therapy. The main limit of BNP diagnostic role is in the need of knowing in advance the specific values for each patient. The BNP concentration evaluation in the acute phase is necessary to differentiate patients with dyspnea due to heart failure from those with pulmonary pathologies, while the BNP assessment in the acute coronary syndrome predicted exitus or heart failure manifestations