Skeletonized coronary arteries: pathophysiological and clinical aspects of vascular calcification

The role of calcification in coronary artery disease is gaining importance, both in research studies and in clinical application. Calcified plaque has long been considered to be the most important atherosclerotic plaque within the arterial tree and frequently presents a challenge for percutaneous intervention. Current investigations have shown that plaque calcification has a dynamic course that is closely related to the magnitude of vascular inflammation. Numerous inflammatory factors synthesized during the early stages of atherosclerosis induce the expression and activation of osteoblast-like cells localized in the arterial wall that produce calcium. There is no doubt that the role of these factors in calcification associated with coronary artery disease could be a crucial strategic point in prevention and treatment. A number of diagnostic imaging methods have been developed in recent years, but their performance needs to be improved. In this context, we undertook an update on coronary calcification, focusing on physiopathology, clinical implications, and imaging techniques

Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when

Intermediate levels of BNP were related with cardiology events in acute coronary syndromes?

Introdução: Diversos estudos na literatura têm relacionado valores elevados de peptídeo natriurético cerebral (BNP) com pior prognóstico em pacientes com síndrome coronária aguda (SCA). No entanto, valores entre 100 pg/mL e 400 pg/mL são considerados limítrofes e ainda questionados em relação à diagnóstico e ocorrência de eventos. Métodos: Trata-se de estudo retrospectivo observacional com objetivo de avaliar se o valor intermediário de BNP na admissão hospitalar é capaz de predizer prognóstico intrahospitalar. Os pacientes foram divididos em dois grupos: grupo I: BNP < 100 pg/mL; grupo II: 100 < BNP < 400 pg/mL. Foram incluídos 405 pacientes (235 no grupo I e 170 no grupo II) com SCA. Obtiveram-se dados referentes à comorbidades e medicações utilizadas. Análise estatística: O desfecho primário foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramento). A comparação entre grupos foi realizada através de Q-quadrado e ANOVA. A análise multivariada foi realizada por regressão logística, sendo considerado significativo p < 0,05. Resultados: Na comparação entre os grupos I e II, observaram-se diferenças em relação à prevalência de diabetes mellitus e angioplastia coronária prévia. Na análise multivariada, observaram-se diferenças significativas entre os grupos I e II em relação à ocorrência de choque cardiogênico (2,55% x 10,59%, OR = 4,09, p = 0,01), respectivamente. Conclusão: Valores intermediários de BNP não foram capazes de predizer mortalidade em pacientes com SCA. No entanto, observou-se uma maior incidência de choque cardiogênico.Introduction: Several studies in the literaturehave linked high levels of brain natriuretic peptide (BNP) withpoor prognosis in patients with acute coronary syndrome (ACS).However, values between 100 pg/ml and 400 pg/ml are consideredborderline and also questioned about the occurrence of events anddiagnosis. Methods: This is an observational retrospective studyto evaluate the BNP intermediate value at hospital admissioncan predict in-hospital prognosis. The patients were divided intotwo groups: Group I: BNP < 100 pg/ml; Group II: 100 < BNP <400 pg/mL. It included 405 patients (235 in group I and 170 ingroup II) with ACS. Data were obtained regarding comorbiditiesand medications used. Statistical analysis: The primary outcomewas mortality from all causes. The secondary endpoint wascombined events (cardiogenic shock, reinfarction, death, strokeand bleeding). The comparison between groups was performedusing Q-square test and ANOVA. Multivariate analysis wasperformed by logistic regression, considering significant p < 0.05.Results: Comparing the groups I and II, there were differences inthe prevalence of diabetes and previous coronary angioplasty. Inmultivariate analysis, there were significant differences betweengroups I and II in the occurrence of cardiogenic shock (2.55%vs. 10.59%, OR = 4.09, p = 0.01), respectively. Conclusion:Intermediate BNP values were not able to predict mortality inpatients with ACS. However, there was a higher incidence ofcardiogenic shock

Sensitive Troponin I Assay in Patients with Chest Pain - Association with Significant Coronary Lesions with or Without Renal Failure

Abstract Introduction: Despite having higher sensitivity as compared to conventional troponins, sensitive troponins have lower specificity, mainly in patients with renal failure. Objective: Study aimed at assessing the sensitive troponin I levels in patients with chest pain, and relating them to the existence of significant coronary lesions. Methods: Retrospective, single-center, observational. This study included 991 patients divided into two groups: with (N = 681) and without (N = 310) significant coronary lesion. For posterior analysis, the patients were divided into two other groups: with (N = 184) and without (N = 807) chronic renal failure. The commercial ADVIA Centaur® TnI-Ultra assay (Siemens Healthcare Diagnostics) was used. The ROC curve analysis was performed to identify the sensitivity and specificity of the best cutoff point of troponin as a discriminator of the probability of significant coronary lesion. The associations were considered significant when p < 0.05. Results: The median age was 63 years, and 52% of the patients were of the male sex. The area under the ROC curve between the troponin levels and significant coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or without renal failure, the areas under the ROC curve were 0.703 (95% CI: 0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff points to discriminate the presence of significant coronary lesion were: in the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%); in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%; specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL (sensitivity, 80.6%; specificity, 42%). Conclusion: In patients with chest pain, sensitive troponin I showed a good correlation with significant coronary lesions when its level was greater than 0.605 ng/dL. In patients with chronic renal failure, a significant decrease in specificity was observed in the correlation of troponin levels and severe coronary lesions