老龄冠状动脉粥样硬化性心脏病患者冠状动脉钙化危险因素分析

目的:分析老龄冠心病患者发生冠状动脉钙化的临床危险因素。方法:分析165例老年冠心病患者的心血管危险因素、生化数据。多排螺旋计算机体层扫描(MDCT)冠状动脉成像评估患者冠状动脉钙化情况,Agatston法计算钙化积分,多因素Logistic回归分析老龄冠心病伴冠状动脉钙化患者的危险因素。结果:钙化组患者收缩压水平、血肌酐及血尿酸水平、糖尿病发生率及吸烟率均高于非钙化组,差异有统计学意义(P0.023~0.035),多因素Logistic回归分析显示,年龄(OR=1.032,P=0.035)、收缩压(OR=1.546,P=0.024)、吸烟史(OR=1.328,P=0.029)、血肌酐增高(OR=1.325,P=0.025)、糖化血红蛋白(OR=1.697,P=0.031)、血尿酸水平(OR=1.732,P=0.015)为冠状动脉钙化性斑块形成的危险因素,Spearman分析显示糖化血红蛋白、血肌酐和尿酸水平与钙化积分呈线性相关。结论:老龄冠心病患者冠状动脉钙化程度与其糖化血红蛋白、血肌酐和尿酸水平正相关。     

非ST段抬高急性冠状动脉综合征的预后危险因素与危险评分

目的：探讨非 ST 段抬高急性冠状动脉综合征的预后危险因素及不同危险评分的预测预后价值。方法：2003年1月至2004年4月期间,连续入院且资料完整的非 ST 段抬高急性冠状动脉综合征患者337例,随访 30天与1年的终点事件(心原性死亡和非致命性心肌梗死)。根据入院时的临床指标分别计算每例患者的心肌梗死溶栓治疗临床试验(TIMI)评分和全球急性冠状动脉事件注册(GRACE)评分,进行多变量回归分析,筛查30天和1年时心血管事件的预测危险因素(根据有无终点事件发生分为30天事件组、30天无事件组和1年事件组、1年无事件组)；分析 TIMI 评分和 GRACE 评分的预后价值,以及与血运重建的相互关系。结果：随访1年共发生终点事件57例(16.9%)。死亡19例(5.6%),非致死性心肌梗北38例(11.3%)。预测危险因素包括：年龄、血肌酐升高、入院时心率、左心室射血分数＜0.40和高血压。TIMI 评分和 GRACE 评分方法预测30天终点事件的敏感性和特异性相似,但 GRACE 评分预测1年终点事件的敏感性和特异性优于 TIMI 评分,GRACE 评分＞ 133分的患者进行血运重建治疗后远期终点事件发生率明显下降(P=0.01)。结论：除传统危险因素外,血肌酐水平升高是非 ST 段抬高急性冠状动脉综合征患者预后的重要危险因素；GRACE 评分较 TIMI 评分能更好的预测非 ST 段抬高急性冠状动脉综合征患者1年的终点事件危险,GRACE 评分＞133分的患者进行血运重建的获益更多。     

肌钙蛋白Ⅰ结合心电图aVR导联ST段变化对非ST段抬高型急性冠状动脉综合征临床预后的评估

目的结合实验室检测肌钙蛋白Ⅰ与心电图aVR导联ST段抬高情况,探讨二者在非ST段抬高型急性冠状动脉综合征患者的预后评估中的价值。方法入选非ST段抬高型急性冠状动脉综合征患者255例,采血检验肌钙蛋白Ⅰ,并详细测量心电图AVR导联ST段抬高情况,均行冠脉造影,根据具体情况分别行冠脉介入治疗、冠脉搭桥手术及药物保守治疗,随访6个月,观察终点为不良心血管事件,包括心肌梗死(包括再梗)、心血管死亡和血运重建。结果在随访的6个月内,肌钙蛋白Ⅰ值(OR=7.01,95%CI=1.22～12.63,P=0.02)和aVR导联ST段抬高值(OR=1.38,95%CI=1.084～1.751,P=0.009)是患者发生死亡和心肌梗死(包括再梗)的独立危险因素;同时,肌钙蛋白Ⅰ值(OR=1.249,95%CI=1.114～1.501,P0.01)和aVR导联ST段抬高值(OR=2.03,95%CI=1.20～4.29,P=0.04)亦是患者不良心血管事件(包括死亡、心肌梗死及血运重建术)发生的独立危险因素。在NSTE-ACS患者中,肌钙蛋白Ⅰ的升高的同时aVR导联ST段抬高者,其左主干病变或三支冠状动脉血管病变发生,以及不良心血管事件(包括死亡、心肌梗死、再梗、血运重建)的发生均是最高的。结论在临床中结合肌钙蛋白Ⅰ和心电图aVR导联ST段变化,可以早期应用于非ST段抬高型急性冠状动脉综合征患者预后的判断。     

外周血淋巴细胞、单核细胞计数及其比值、红细胞分布宽度对急性冠脉综合征患者预后的预测价值

目的:分析外周血淋巴细胞计数(LC)、单核细胞计数(MC)及其比值(LMR)、红细胞分布宽度(RDW)对急性冠脉综合征(ACS)患者预后的预测价值。方法:回顾性收集189例ACS患者的病历资料,根据患者入院30 d内是否发生心血管事件,分为无心血管事件组128例和心血管事件组61例。记录患者年龄、Killip分级、冠状动脉的病变支数、全球急性冠状动脉事件注册危险评分(GRACE)、外周血LC、MC、LMR、RDW和血清C反应蛋白(CRP)、白介素6(IL-6)水平。Logistic回归模型分析影响ACS患者预后的独立因素,Pearson相关性分析血常规参数与GRACE评分之间的相关性; ROC曲线分析血LC、MC、LMR和RDW对ACS患者预后的预测价值。结果:冠状动脉病变(OR=1.891,P=0.042)、GRACE评分(OR=2.065,P=0.009)、CRP (OR=1.874,P=0.038)、LC (OR=1.850,P=0.046)、LMR(OR=1.956,P=0.023)和RDW(OR=1.887,P=0.036)均为影响ACS患者预后的独立因素。外周血LC和LMR与GRACE评分呈负相关性(r=-0.276,-0.379; P 0.05),血RDW和CRP与GRACE评分呈正相关性(r=0.327,0.351; P 0.05);血LC、LMR和RDW预测ACS患者预后的AUC依次为0.697、0.784、0.711,联合预测的AUC为0.840。结论:联合检测分析ACS患者的外周血LC、LMR和RDW,有助于评估患者的病情发展,指导临床治疗。     

中性粒细胞淋巴细胞比值对老年急性小脑梗死患者死亡风险的预测价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)对老年急性小脑梗死患者死亡风险的预测价值。方法因首发急性小脑梗死住院的老年患者共53例,并纳入同期入院的急性小脑梗死中青年患者34例为非老年组。收集临床基本资料,分析老年组与非老年组NLR等指标差别。并进行随访,任何原因的死亡为心脑血管不良事件(MACE)。结果老年组NLR、吸烟比例、舒张压水平低于非老年组,尿素氮水平、CysC水平高于非老年组。相关分析表明,老年组NLR与尿素氮(r=0.416,P=0.002)、尿素氮肌酐比值(r=0.367,P=0.007)呈正相关。单因素Logistic回归显示结果显示:NLR(OR=1.215,P=0.005,95%CI 1.059～1.394)、总胆红素(OR=1.100,P=0.021,95%CI 1.015～1.192)、间接胆红素(OR=1.166,P=0.010,95%CI 1.038～1.310)是发生MACE危险因素。多因素Logistic回归显示NLR(OR=1.201,P=0.026,95%CI为1.022～1.411)是发生MACE危险因素。结论 NLR为老年急性小脑梗死患者死亡独立风险因素。对NLR水平较高患者应早期进行干预,积极治疗。     

血清胱抑素C与ACS患者PCI术后主要不良心血管事件的关系

目的:观察ACS患者PCI术后主要不良心血管事件(MACE)的发生率,探讨急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后发生MACE的影响因素。方法:对374例在我院接受PCI治疗的ACS患者的资料进行回顾性分析,采用Logistic多元回归分析ACS患者PCI术后1年内发生MACE的危险因素。结果:本研究374例患者,术后1年内发生MACE 86例,发生率22.99%。多因素Logistic回归分析显示年龄72.6岁、糖尿病、低密度脂蛋白-胆固醇(LDL-C)3.38mmol/L、CysC1.53mg/L是ACS患者PCI术后1年MACE发生的独立危险因素(OR=1.550～4.723,P0.05或0.01),围术期强化他汀治疗和围术期应用替罗非班是其保护性因素(OR=0.672、0.596,P均=0.001)。结论:急性冠脉综合征患者PCI术后MACE是多种因素协同作用的结果,术前CysC水平升高与患者PCI术后MACE发生密切相关,应引起临床重视。     

高龄重症社区获得性肺炎并心血管事件患者预后不良因素分析

目的:分析高龄重症社区获得性肺炎(CAP)合并心血管事件患者预后不良因素,探讨临床诊疗策略。方法:将116例高龄重症CAP并发心血管事件患者按照住院30d内的预后分为治愈出院组(54例)和预后不良组(62例)。分析2组患者性别、年龄、入院时CURB65评分(包括意识障碍、尿素氮、呼吸频率、血压、年龄)、肺炎严重指数(PSI评分)及CRB65评分(包括意识障碍、呼吸频率、血压、年龄)、重症肺炎评判主要标准及次要标准构成情况、住院前心血管事件发生史、住院期间心血管事件类别、辅助治疗措施、初始疗效、并发症情况等,将组间差异有统计学意义的指标纳入多因素Logistic回归分析,分析高龄重症CAP并心血管事件患者预后不良的危险因素。结果:住院期间新发心律失常47例(40. 52%)、急性心肌梗死33例(28. 45%)、心绞痛21例(18. 10%)、急性心力衰竭15例(12. 93%)。2组患者年龄、入院时CURB65评分、PSI评分、CRB65评分、住院前心血管事件发生史、住院期间心血管事件类别、初始疗效比较,差异有统计学意义(均P 0. 05)。多因素Logistic分析显示,年龄(OR=4. 156)、入院时CURB65评分5分(OR=3. 632)、PSIⅤ级(OR=4. 589)、CRB65评分4分(OR=2. 445)、住院前有心血管事件史(OR=4. 625)、住院期间发生急性心肌梗死(OR=4. 514)、初始治疗无效(OR=3. 422)为高龄重症CAP并发心血管事件患者预后不良的危险因素。结论:高龄重症CAP并发心血管事件患者预后不良率高,临床应采取措施加以防范,降低不良事件风险率,改善患者预后。     

老年急性呼吸窘迫综合征患者临床特点及预后相关危险因素

目的探讨老年急性呼吸窘迫综合征(ARDS)患者临床特点及预后相关危险因素。方法 92例老年ARDS患者的临床资料,根据患者临床结局不同分为生存组与死亡组,多因素Logistic回归分析老年ARDS患者预后相关危险因素,并对出院患者进行随访跟踪,搜集其结局资料。结果 92例老年ARDS患者经积极治疗后生存50例,死亡42例,病死率45.65%。多因素Logistic回归分析发现,老年ARDS患者预后相关危险因素有急性生理与慢性健康(APACHE)Ⅱ评分(OR=3.248,P=0.014)、器官障碍数目(OR=3.410,P=0.013)、ARDS诱因(OR=2.728,P=0.045)及脓毒症严重程度(OR=3.523,P=0.009),住院时APACHEⅡ评分不同的患者出院后1~2年后良好结局率略有不同。结论临床上对于老年ARDS患者,尤其是肺源性ARDS患者,应关注APACHEⅡ评分,早期采取液体复苏及抗感染治疗脓毒症,并尽早做到全面的诊断和处理,防止多器官功能障碍综合征的发生。     

IABP辅助治疗重症急性冠脉综合征患者近期死亡的危险因素分析

目的讨论主动脉球囊反搏术(IABP)辅助治疗重症急性冠脉综合征(ACS)患者30 d死亡的影响因素。方法入选2014年10月~2017年5月于青岛市市立医院行IABP的重症ACS患者239例,其中女性70例(19.3%),根据30 d生存情况,分为30 d存活组198例,30 d死亡组41例,比较两组患者的一般资料,采用单因素及多因素二元Logistic回归分析该人群30 d死亡的危险因素。结果与30天存活组相比,30 d死亡组患者中女性、ST段抬高型心肌梗死、心源性休克、单纯药物保守治疗患者所占比例更高,心率更快(P均0.05),行冠状动脉旁路移植(CABG)治疗、预置入IABP患者所占比例较低(P均0.05),多因素二元Logistic回归分析发现:经皮冠状动脉介入治疗(PCI)(OR=0.28,95%CI:0.08~0.94,P=0.039)是IABP辅助重症ACS患者30 d死亡的保护因素,女性(OR=2.45,95%CI:1.01~5.92,P=0.047)、心源性休克(OR=7.86,95%CI:2.83~21.81,P0.001)是IABP辅助重症ACS患者30 d死亡的独立危险因素。结论 PCI是IABP辅助重症ACS患者的30 d死亡的保护因素。女性、心源性休克是IABP辅助重症ACS患者30 d死亡的独立危险因素。支持在治疗过程中,尤其是对女性患者,应积极纠正心源性休克并尽可能选择PCI治疗。     

老年急性冠脉综合征经皮冠状动脉介入治疗术后并发慢血流事件的危险因素分析

目的探讨老年急性冠脉综合征(ACS)病人经皮冠状动脉介入治疗(PCI)术后慢血流事件的危险因素。方法回顾性分析行PCI治疗的ACS病人95例,包括不稳定型心绞痛(UAP)59例和急性心肌梗死(AMI)36例,依据其是否发生慢血流事件分为慢血流组(n=32)和血流正常组(n=63)。比较2组的一般临床资料及尿素氮(BUN)、肌酐(SCr)和D-二聚体(D-dimer)等指标水平,采用多因素Logistic回归分析慢血流发生的危险因素。结果 2组的年龄、糖尿病史、高血脂、吸烟史及D-dimer水平比较,差异均有统计学意义(P0.05);Logistic回归分析表明,年龄(OR=3.618,95%CI:1.337~7.522)、糖尿病史(OR=4.781,95%CI:1.405~7.724)、高血脂(OR=5.026,95%CI:1.520~9.875)、吸烟史(OR=5.155,95%CI:1.596~10.337)和D-dimer(OR=5.547,95%CI:1.662~11.347)与PCI术后慢血流事件的发生独立相关。结论年龄、糖尿病史、高血脂、吸烟史和D-dimer是PCI术后慢血流事件发生的危险因素。     

Cardiac troponin I levels and clinical outcomes in patients with acute coronary syndromes: the potential role of early percutaneous revascularization

OBJECTIVES: To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels. BACKGROUND: The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified by plasma Tn-I levels has not been established. METHODS: In-hospital complications and long-term outcomes were assessed in 1,321 consecutive patients with non-ST elevation ACS undergoing early (within 72 h) catheter-based coronary interventions. Patients were grouped according to admission Tn-I levels. Group I (n = 1,099) had no elevated plasma Tn-I (<0.15 ng/ml), Group II (n = 95) had Tn-I level between 0.15 to 0.45 ng/ml and Group III (n = 127) had Tn-I >0.45 ng/ml. In-hospital composite cardiac events (death, Q-wave MI, urgent in-hospital revascularization) and 8 months clinical outcomes (death, MI, repeat revascularization or any cardiac event) were compared between the three groups. RESULTS: The rate of in-hospital composite cardiac events was 6.1% among patients with Tn-I >0.45 ng/ml, 1.0% in patients with Tn-I between 0.15-0.45 ng/ml and 3.1% in patients without elevated admission Tn-I (p = 0.09 between groups). There was no difference in hospital mortality (p = 0.25). At eight months of follow-up, there was no difference in out-of-hospital death (3.5%, 3.8% and 1.8%, p = 0.17, respectively), MI (2.6%, 3.8% and 2.9%, p = 0.94) or target lesion revascularization (9.0%, 8.3% and 11.5%, p = 0.47), and cardiac event-free survival was also similar between groups (p = 0.66). By multivariate analysis, Tn-I >0.45 ng/ml was independently associated with in-hospital composite cardiac events [odds ratio (OR) = 2.4, p = 0.04] but not with out-of-hospital clinical events up to eight months. CONCLUSIONS: In patients with ACS, early (within 72 h) catheter-based coronary intervention may attenuate the adverse prognostic impact of admission Tn-I elevation during eight months of follow-up despite a trend towards increased in-hospital composite cardiac events.     

急性冠状动脉综合征患者基线C反应蛋白和低密度脂蛋白水平对其急性期预后的意义

目的分析基线高敏C反应蛋白（hs—CRP）和低密度脂蛋白胆固醇（LDL—C）水平与不同急性冠状动脉综合征（ACS）急性期预后的相关性及意义。方法连续入选172例ACS患者,入院24h内测定患者基线状态的hs—CRP和LDL—C水平,对所有患者随访30d,记录任何原因死亡、心血管事件（事件）发生次数和时间。按出现死亡、事件和无事件对患者进行分组,分析和比较三组患者基线hs—CRP、LDL～C和hs—CRP／LDL—C。应用Logistic回归分析包括年龄,治疗前、后血肌酐（Cr）水平等共19项危险因素对死亡率和事件发生率的影响。结果单因素分析显示,三组ACS患者基线LDL—C水平差异无统计学意义,死亡患者的LDL—C有更低的倾向。死亡患者的hs—CRP是无“事件”患者的13．0倍,是单纯有“事件”患者的5．5倍,差异有统计学意义。结论基线hs—CRP是ACS患者急性期死亡和心血管事件的非独立危险因素,基线LDL—C与急性预后不相关。hs—CRP可作为急性期治疗的靶目标。     

中高危非ST段抬高急性冠状动脉综合征早期侵入与早期保守策略的评价

目的　了解早期侵入与早期保守策略对中高危非ST段抬高急性冠状动脉综合征(ACS)患者住院主要不良心脏事件(MACE)发生情况的影响。方法　根据入院后冠状动脉造影(CAG)与否和时间(≤48h与>48h)对910例中高危非ST段抬高ACS患者分为早期侵入策略组(n=237)和早期保守策略(n=673)两组,分析早期策略与血管重建方式对住院MACE(包括死亡、新发心肌梗死和靶血管再次血管重建)的关系。结果　早期侵入与早期保守组的住院病死率和靶血管血管重建率相当,早期侵入组的住院时间较短,住院MACE(6. 3%比2 .5%,OR0 .384, 95% CI0 188~0 .781,P=0 .006)与新发心肌梗死(4. 6%比0 .9%,OR0 .185, 95% CI0 068~0 .505,P=0.001)的发生率更高。早期侵入组MACE与新发心肌梗死的增加可能与其血管重建操作较多( 86 .9%比67. 5%,P<0 .001)有关。亚组分析显示,早期侵入组与早期保守组中接受经皮冠状动脉介入治疗(PCI)的患者新发心肌梗死、靶血管再次血管重建(TVR)和MACE发生率均相当,无1例死亡;而早期侵入组中接受冠状动脉旁路移植术(CABG)的患者新发心肌梗死的发生率高于早期保守组中接受CABG的患者(7 .5%比1 .8%,P=0 .027)。结论　中高危非ST段抬高ACS患者采取早期侵入策略不增加住院病死率,但有可能增加住院心肌梗死。早期PCI安全可行     

红细胞体积分布宽度与急性冠状动脉综合征近期预后关系的研究

目的探讨红细胞体积分布宽度(RDW)与急性冠状动脉综合征(ACS)患者近期预后的关系。方法选择ACS患者1654例,根据基线RDW四分位数分为≤12.1%组419例、12.2%¹2.8%组364例、12.9%12.8%组364例、12.9%¹3.2%组463例和≥13.3%组408例。比较各组生化指标、1个月时心源性死亡、心力衰竭及再次心肌梗死发生率。评估RDW与1个月时恶性事件的关系。结果随着RDW逐步升高,心源性死亡、心力衰竭及再次心肌梗死发生率也逐步升高。logistic回归分析显示,RDW(OR=2.116,95%CI:1.42713.2%组463例和≥13.3%组408例。比较各组生化指标、1个月时心源性死亡、心力衰竭及再次心肌梗死发生率。评估RDW与1个月时恶性事件的关系。结果随着RDW逐步升高,心源性死亡、心力衰竭及再次心肌梗死发生率也逐步升高。logistic回归分析显示,RDW(OR=2.116,95%CI:1.427³.137,P=0.000)、B型钠尿肽>100ng/L(OR=3.510,95%CI:1.2213.137,P=0.000)、B型钠尿肽>100ng/L(OR=3.510,95%CI:1.221¹0.093,P=0.020)、LVEF<40%(OR=4.149,95%CI:2.00110.093,P=0.020)、LVEF<40%(OR=4.149,95%CI:2.001⁸.602,P=0.000)是ACS患者1个月时心源性死亡的独立危险因素。同时,RDW(OR=2.134,95%CI:1.6028.602,P=0.000)是ACS患者1个月时心源性死亡的独立危险因素。同时,RDW(OR=2.134,95%CI:1.602².844,P=0.000)、年龄>65岁(OR=2.010,95%CI:1.1352.844,P=0.000)、年龄>65岁(OR=2.010,95%CI:1.135³.560,P=0.017)、糖尿病(OR=2.279,95%CI:1.3453.560,P=0.017)、糖尿病(OR=2.279,95%CI:1.345³.862,P=0.002)和LVEF<40%(OR=5.009,95%CI:2.6943.862,P=0.002)和LVEF<40%(OR=5.009,95%CI:2.694⁹.316,P=0.000)是1个月时心力衰竭及再次心肌梗死发生的独立危险因素。结论 RDW是ACS患者近期预后的独立危险因素。     

非ST段抬高急性冠状动脉综合征的危险因素分析及早期干预

目的　探讨非ST段抬高急性冠状动脉综合征(ACS)的临床高危因素及早期有创干预的价值。方法　在 2001年 10月至 2003年 10月期间连续入院的非ST段抬高的ACS患者共 545例,随机分成早期保守治疗组与早期有创干预组;随访 30天与 6个月患者的复合心血管事件 (包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院 )发生率,将患者一般临床特征及辅助检查指标对复合心血管事件做多变量回归分析,筛查主要的高危因素;评价早期保守治疗与早期有创干预对患者预后的影响。结果　随访 513例患者, 30天与 6个月的复合心血管事件发生率分别为 14 0%与 25 7%;多变量Logistic回归分析,显示ST段压低、肌钙蛋白Ⅰ (TnI)水平升高、高敏C反应蛋白(hs CRP)增高、左室射血分数(LVEF)值下降以及心肌梗死溶栓疗法(TIMI)危险评分高分者与 6个月的复合心血管事件增高密切相关,它们分别是患者复合心血管事件危险性增加的独立预测因子;与早期保守治疗组比较,早期有创干预组随访 30天时反复心绞痛发作住院率减少,复合心血管事件减少;随访 6个月时复合心血管事件也减少 (P均 <0 05)。结论　ST段压低、TnI水平升高、hs CRP增高、LVEF值下降或TIMI危险评分增高是非ST段抬高ACS患者的高危因素,早期有创干预能     

Admission glycemia: a predictor of death after acute coronary syndrome in non-diabetic patients?

BACKGROUND: Previous studies have demonstrated that acute phase hyperglycemia is associated with increased in-hospital mortality in diabetic patients admitted with acute coronary syndrome (ACS), but this has not been clearly demonstrated in non-diabetic patients. The present study was designed to determine whether admission hyperglycemia (AG) is an independent predictor of in-hospital and six-month mortality after ACS in non-diabetic patients. METHODS: This was a retrospective cohort study of 426 non-diabetic patients consecutively admitted with ACS. The patients were stratified into quartile groups according to AG, which was also analyzed as a continuous variable. Vital status was obtained at six-month follow-up in 96.8% of the patients surviving hospitalization. Logistic regression analysis was used to identify independent predictors of in-hospital and six-month death. RESULTS: Of the 426 patients included in the study (age 62.6 years+/-13.1, 77% male), 22 (5.4%) patients died during hospitalization and 20 (5.2% of the patients surviving hospitalization) within six months of ACS. Mean AG was 134.89 mg/dl+/-51.95. The higher the AG, the more probable was presentation with ST-segment elevation ACS (STEMI), anterior STEMI, higher heart rate, Killip class higher than one (KK >1), higher serum creatinine and greater risk of in-hospital and six-month death. In multivariate analysis, only age (OR=1.10; 95% CI 1.04-1.17), STEMI (OR=3.02; 95% CI 1.07-8.50), AG (OR=1.073; 95% CI 1.004-1.146), serum creatinine (OR=1.10; 95% CI 1.009-1.204) and KK >1 on admission (OR=4.65; 95% CI 1.59-13.52) were independently associated with in-hospital death. Age (OR=1.07; 95% CI 1.03-1.12), serum creatinine (OR=1.09; 95% CI 1.01-1.18) and in-hospital development of heart failure (OR=2.34; 95% CI 1.07-5.10) were independently associated with higher risk of death within six months of ACS. CONCLUSIONS: AG is an independent predictive factor of in-hospital death after ACS in non-diabetic patients. Although it did not show an independent association with higher risk of six-month death, AG appears to contribute to it, since the risk is greater the higher the AG. Its predictive value may have been blunted by the insufficient power of the sample and/or by the time interval between acquisition of AG and the evaluated endpoint.     

Procalcitonin in patients with acute coronary syndrome: correlation with high-sensitive C-reactive protein, prognosis and severity of coronary artery disease

OBJECTIVES: The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS). METHODS AND RESULTS: Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50 patients (41 men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P = 0.01 3, P = 0.045 and P = 0.000 1, respectively) and hsCRP (P = 0.000 1, P = 0.01 and P = 0.00 1, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease.There was no correlation between procalcitonin and hsCRP levels at admission and after 48 hours and primary end points after 3 months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48 hours were found higher in the patients with a revascularization procedure (P = 0.04). CONCLUSIONS: In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.     

C-reactive protein elevation and disease activity in patients with coronary artery disease.

AIMS: We sought to assess (1) whether C-reactive protein (CRP) is an independent predictor of future cardiovascular events after adjustment for coronary artery disease (CAD) severity and (2) whether CRP levels correlate with number of angiographically complex coronary artery stenosis. METHODS AND RESULTS: We studied 825 consecutive angina patients (mean age 63+/-10 years, 74% men), 700 with chronic stable angina (CSA) and 125 with acute coronary syndromes without ST-segment elevation (ACS). The composite endpoint of non-fatal acute myocardial infarction, hospital admission with class IIIb unstable angina and cardiac death was assessed at one year follow-up. Hs-CRP level was higher in CSA patients with the combined end-point (P=0.03) after adjustment for number of diseased coronary arteries. Hs-CRP was also significantly higher in patients with ACS compared to CSA ( P=0.004) and correlated with number of complex angiographic stenoses (r=0.36, P=0.01). Hs-CRP was also increased in patients with NYHA functional class III or IV compared to those in class I or II (p<0.0001). CONCLUSIONS: CRP levels predict future cardiovascular events independently of CAD severity and correlate with number of angiographically complex coronary artery stenosis in patients with ACS. Thus, CRP levels are a marker of atheromatous plaque vulnerability and CAD activity.     

The prognostic value of creatine kinase elevations extends across the whole spectrum of acute coronary syndromes.

OBJECTIVES: The study investigated the relationship among creatine kinase (CK) elevations, clinical characteristics and cardiac events across the whole spectrum of acute coronary syndromes (ACS). BACKGROUND: Elevated serum levels of cardiac enzymes have been shown to be a major prognostic determinant in acute myocardial ischemia. Yet prior to this report, the relation between cardiac enzyme levels and other prognostic determinants across the entire spectrum of ACS has not been explored by a large clinical study. METHODS: We evaluated the relation between the maximum CK ratio (CK level/upper limit of normal) in the early hours following admission and cardiac events at six months in 11,725 patients enrolled in a large trial of ACS. RESULTS: Patients with higher risk characteristics, such as older age, female gender, hypertension, diabetes, prior coronary events or heart failure, more frequently presented without ST-segment elevation on the electrocardiogram and tended to develop lesser enzyme elevations. After adjusting for significant baseline predictors of cardiac events, a continuous correlation was observed between the CK ratio and death (chi-square 63.04, p < 0.0001) and (re)infarction or death (chi-square 55.48, p < 0.0001). This correlation was similar for patients with and without ST-segment elevation. The adjusted incidence of cardiac events at follow-up began to rise even for CK levels within the normal range, the steepest part of the curve residing between one and three times the upper limit of normal. In patients with a CK ratio of >1 to 2 compared with those within the normal range, the adjusted odds ratio for death was 1.26 (95% confidence interval [CI] 0.98 to 1.63), and 1.59 (95% CI 1.38 to 1.90) for (re)infarction and death. For all CK levels, the event rate was higher among patients without ST-segment elevation. CONCLUSIONS: Although high-risk patients with ACS often develop lesser CK elevations, this study demonstrated that even minor enzyme elevations appear to have important and independent prognostic implications.     

Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome: myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18.

AIMS: We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS). METHODS AND RESULTS: We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6%, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3%, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95% CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk. CONCLUSION: MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.