0000000000114612

AUTHOR

Vicente Bertomeu

Papel del índice de Charlson en el pronóstico a 30 días y 1 año tras un infarto agudo de miocardio

Introduccion y objetivos.El indice de Charlson (iCh) ha sido utilizado como variable de ajuste en modelos multivariables como indicador de comorbilidad. Debido a que su valor pronostico per se para complicaciones cardiovasculares tras un infarto agudo de miocardio no ha sido ampliamente evaluado, nos propusimos determinar su valor predictivo para muerte de cualquier causa y/o reinfarto, a 30 dias y 1 ano del evento indice. Pacientes y metodo. Se incluyo a 1.035 pacientes con el diagnostico de infarto (508 con elevacion del segmento ST y 527 sin elevacion del segmento ST). La presencia de eventos se determino a 30 dias (13,9%) y a un ano (26,3%). El iCh se calculo junto con otras variables d…

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Prevalencia de fibrilación auricular y uso de fármacos antitrombóticos en el paciente hipertenso ≥ 65 años. El registro FAPRES.

Introduccion y objetivos Entre los principales factores asociados a la presencia de fibrilacion auricular y mayor riesgo embolico estan la edad y la hipertension arterial. Nuestro objetivo es conocer la prevalencia de fibrilacion auricular en el paciente hipertenso de 65 o mas anos de edad en la Comunidad Valenciana y el empleo de farmacos antitromboticos. Metodos Cada investigador incluyo a los primeros 3 pacientes hipertensos de edad ≥ 65 anos que acudian a la consulta el primer dia de la semana durante 5 semanas. Se recogieron los factores de riesgo, la historia cardiovascular, la puntuacion CHADS2 y el tratamiento farmacologico y se realizo un electrocardiograma para su analisis central…

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Prognostic usefulness of white blood cell count on admission and one-year outcome in patients with non-ST-segment elevation acute chest pain.

Little is known about the prognostic value of leukocyte count on admission for patients with chest pain. In total, 1,461 patients who presented to the emergency department with non–ST-segment elevation chest pain were studied by clinical history, electrocardiography, serial troponin I determination, and leukocyte count on admission. End points were 1-year mortality and major events (mortality or infarction). Overall patient distribution by quartiles of leukocyte count showed increased mortality (6%, 7%, 6%, and 17%, p = 0.0001) and major events (13%, 13%, 15%, and 24%, p = 0.0001) in the fourth quartile. After adjustment for other risk factors, the fourth quartile cut-off value (>10,000 cel…

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Estratificación del riesgo de pacientes con dolor torácico sin elevación del segmento ST en la puerta de urgencias

Objectives. To investigate the prognostic factors in patients who come to the emergency room with chest pain but without ST segment elevation. Patients and method. 743 consecutive patients were evaluated by recording clinical history, electrocardiogram and troponin I determination, and early (< 24 h) exercise testing was done for the low-risk subgroup of patients (n = 203). All patients were followed during 3 months for major events (acute myocardial infarction or death). Results. Major events occurred in 71 patients (9.6%). Multivariate analysis (C stadistic = 0.79; 95% CI 0.730.84; p = 0.0001) identified the following predictors: age ≥ 72 years (OR = 1.7; 95% CI, 1.0-2.9; p = 0.05), insul…

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An Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndromes. From Large Trials to the Real World

Introduction and objectives We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome. Patients and method We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a ) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b ) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for post-d…

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Diferencias entre sexos en la mortalidad a un mes y a un año tras un síndrome coronario agudo

Fundamento y objetivo Se pretende estudiar las diferencias entre sexos en la mortalidad a corto plazo (un mes) y a largo plazo (un ano) tras un sindrome coronario agudo Pacientes y metodo Despues de la publicacion de la nueva definicion de infarto de miocardio analizamos prospectivamente a 1.324 pacientes consecutivos ingresados con el diagnostico de sindrome coronario agudo en un hospital terciario. De estos pacientes, 483 (37%) presentaban un infarto con elevacion de ST; 439 (33%), infarto sin elevacion del ST (valores de troponina I superiores a 1 ng/ml), y 402 (30%), angina inestable (troponina I inferior a 1 ng/ml) Resultados Durante un ano hubo 177 muertes (13,4%). La mortalidad fue s…

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Low lymphocyte count in acute phase of ST-segment elevation myocardial infarction predicts long-term recurrent myocardial infarction

Objective We sought to determine the relationship between the lowest lymphocyte count (lymphocyte(min))obtained within the first 96 h of symptoms onset and the risk of postdischarge recurrent spontaneous myocardial infarction (re-MI) in patients admitted with ST-segment elevation MI (STEMI). Methods We analyzed 549 consecutive patients admitted with STEMI from a single academic hospital. Lymphocyte counts were determined at admission and routinely during the first 96 h. Lymphocyte(min) was selected as the main exposure. Patients with inflammatory or infectious diseases, in-hospital death, or reinfarction were excluded from the analysis (final sample= 426 patients). Lymphocyte(min) was divid…

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Risk stratification in non-ST elevation acute coronary syndromes

Abstract Introduction: In acute coronary syndromes, myocardial damage markers and acute-phase reactants predict adverse cardiac events. The aim of this study was to define the fitted prognostic value of the most widely used variables of necrosis and inflammation as well as of homocysteine. Methods and results: Troponin I, high-sensitivity C-reactive protein, fibrinogen and homocysteine were measured in 515 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) through 6 months of follow-up was analysed. In the univariate analysis, all markers were related to major events ( p 11 mg/l (…

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Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality

Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into…

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Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes.

The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes.Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed.In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month we…

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Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. De los grandes estudios al mundo real

Introduccion y objetivos Presentamos el impacto pronostico de una estrategia invasiva (EI) en el sindrome coronario agudo sin elevacion del segmento ST en nuestra institucion. Pacientes y metodo Se ha estudiado a 504 pacientes consecutivos con dolor toracico tipico, cambios electrocardiograficos y elevacion de la troponina I divididos en 2 cohortes: a) grupo conservador, 272 pacientes ingresados entre octubre de 2001 y septiembre de 2002, manejados con una estrategia conservadora (EC); b) grupo invasivo, 232 pacientes ingresados entre octubre de 2002 y septiembre de 2003 y en los que se recomendo una EI. Se recogieron los eventos mayores (defuncion o reinfarto) y menores (reingreso o necesi…

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Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning

ObjectivesWe sought to evaluate the usefulness of a comprehensive assessment of four cardiovascular magnetic resonance imaging (CMR)-derived myocardial viability indexes in the setting of myocardial stunning.BackgroundCardiovascular magnetic resonance imaging allows the simultaneous assessment of several viability indexes.MethodsWe studied 40 patients with a first ST-segment elevation myocardial infarction (MI) and an open infarct-related artery. At the first week, using CMR, wall motion (WM), and four viability indexes were determined: wall thickness, WM improvement with low-dose dobutamine, perfusion, and transmural extent of necrosis. We created a comprehensive score based on the presenc…

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[Myocardial echocardiography with intracoronary injection of contrast in post-infarction patients. Implications and comparison with angiography and magnetic resonance imaging].

We analyzed the safety and feasibility of myocardial echocardiography with intracoronary injection of contrast, its effect on left ventricular remodeling and systolic function, and its relationship with angiography and magnetic resonance imaging (MRI) for the evaluation of post-infarction coronary microcirculation.Thirty patients with a first ST-elevation myocardial infarction and a patent infarct-related artery were studied. Mean perfusion score of the infarcted area was analyzed with myocardial echocardiography. TIMI and Blush grades (angiography) were determined. Mean perfusion score (MRI-perfusion), end-diastolic volume index and ejection fraction were determined with MRI. At 6 months a…

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Heart rate in acute heart failure, lower is not always better.

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Valor independiente de la proteína C reactiva para predecir acontecimientos mayores al primer mes y al año en los síndromes coronarios agudos sin elevación del ST

Fundamento y objetivo: Analizamos si la proteina C reactiva (PCR) aporta informacion pronostica independiente tras un sindrome coronario agudo sin elevacion del ST. Pacientes y metodo: Se estudio prospectivamente a 630 pacientes consecutivos ingresados por sindrome coronario agudo sin elevacion del ST. Los puntos de corte fueron: troponina I > 1 ng/ml (n = 354; 56%) y PCR > 11 mg/l (n = 273; 43%). Resultados: Durante un ano de seguimiento se detectaron 56 (9%) muertes de causa cardiaca, 85 (13%) infartos de miocardio y 127 (20%) primeros acontecimientos mayores. Los pacientes con PCR elevada mostraron mayor mortalidad al mes (el 8 frente al 1%) y al ano (el 15 frente al 4%); mayor porcentaj…

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Prognostic Value of Charlson Comorbidity Index at 30 Days and 1 Year After Acute Myocardial Infarction

Introduction and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for allcause mortality and recurrent AMI 30 days and 1 year after the index event. Patients and method. We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST elevation=508 and non-ST elevation=527). The composite endpoint was determined after 30 days (13.9%) and 1 year (26.3%) of follow-up. The CCI was calculated on admission, and other variables …

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Estudio de perfusión en pacientes postinfarto mediante ecografía miocárdica con inyección de contraste intracoronario. Implicaciones y relación con la angiografía y la resonancia magnética

38 Objetivos. Analizamos la aplicabilidad y seguridad de la ecografia miocardica con inyeccion intracoronaria de contraste, su papel en la remodelacion ventricular y en la funcion sistolica, asi como su relacion con la angiografia y la resonancia magnetica para valorar la microcirculacion coronaria postinfarto. Pacientes y metodo. Se estudio a 30 pacientes con un primer infarto de miocardio con elevacion del segmento ST y arteria responsable abierta. Con inyeccion intracoronaria de contraste se determino la puntuacion media de perfusion en la zona infartada. Mediante angiografia se cuantificaron los grados TIMI y Blush. Se utilizo la resonancia magnetica para determinar la puntuacion media …

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Indicadores pronósticos del síndrome coronario agudo sin elevación del segmento ST

Objectives. We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome. Patients and method. Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%). Predictors of cardiac death or infarction within the following six months were analyzed. Results. In …

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Usefulness of concomitant myoglobin and troponin elevation as a biochemical marker of mortality in non–ST-segment elevation acute coronary syndromes

Koolen JJ. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996;334:1703–1708. 2. Senior R, Kaul S, Soman P, Lahiri A. Power-Doppler contrast echocardiography—a new technique for Assessing myocardial perfusion. Am Heart J 2000; 139:245–251. 3. Picano E, Parodi O, Lattanzi F, Sambuceti G, Andrade MJ, Marzullo P, Giorgetti A, Salvadori P, Marzilli M, Distante A. Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography. Circulation 1994;89:753–761. 4. Jayaweera AR, Wei K, Coggins M, Bin…

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Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo

Introduccion y objetivos. Publicaciones recientes respaldan el papel pronostico del recuento leucocitario (RL) en pacientes con infarto agudo de miocardio (IAM). El objetivo de este trabajo fue determinar el valor predictivo atribuible al RL, con independencia de otras variables de contrastado valor pronostico, para predecir mortalidad a largo plazo en pacientes con IAM sin elevacion del segmento ST (IAMSEST) y con elevacion del segmento ST (IAMEST). Pacientes y metodo. Analizamos a 1.118 pacientes admitidos de forma consecutiva con el diagnostico de IAM (IAMSEST = 569; IAMEST = 549). El RL se obtuvo en la primera determinacion analitica. Se utilizaron modelos de regresion de Cox para deter…

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