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1.
Hideki Miyachi Atsushi Takagi Katsumi Miyauchi Masao Yamasaki Hiroyuki Tanaka Masatomo Yoshikawa Mike Saji Makoto Suzuki Takeshi Yamamoto Wataru Shimizu Ken Nagao Morimasa Takayama 《Heart and vessels》2016,31(11):1740-1751
Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009–2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p < 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p < 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients. 相似文献
2.
Bin He Luyue Gai Jingjing Gai Huaiyu Qiao Shuoyang Zhang Zhiwei Guan Li Yang Yundai Chen 《Experimental & Clinical Cardiology》2013,18(2):e71-e76
BACKGROUND:
Unstable plaque is believed to be responsible for major adverse cardiac events (MACE).OBJECTIVE:
To determine whether coronary computed tomography angiography (CCTA) could be used to predict future MACE.METHODS:
Patients undergoing CCTA between January 2008 and February 2010 were consecutively enrolled in the study. The hospital database was screened for patients who later developed acute ST segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or cardiac death. Plaque scores were calculated and analyzed using one-way ANOVA to examine the relationship between plaque scores and MACE.RESULTS:
Of the 8557 patients who underwent CCTA, 1055 had hospital records available for follow-up. During follow-up, 25 patients experienced MACE including death (six patients), heart failure (two patients), STEMI (11 patients) and NSTEMI (six patients). The plaque scores were significantly increased in patients who later died, developed heart failure or experienced STEMI (P<0.05). Calcification, erosion and severe stenosis were responsible for the events (P<0.05). Mild and moderate lesions, positive remodelling, drug-eluting stent placement, occlusion and diffuse lesions were not predictive of MACE (P>0.05).CONCLUSION:
Severe calcification, erosion and severe stenosis predict death, heart failure and STEMI. 相似文献3.
José Carlos Nicolau Humberto Graner Moreira Luciano Moreira Baracioli Carlos Vicente Serrano Jr Felipe Galego Lima Marcelo Franken Roberto Rocha Giraldez Fernando Ganem Roberto Kalil Filho José Ant?nio Franchini Ramires Roxana Mehran 《Arquivos brasileiros de cardiologia》2013,101(6):511-518
Background
It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied.Objective
The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center.Methods
Out of 1,655 patients with ACS (547 with ST-elevation ACS and 1,118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1,416. Mortality information and hemorrhagic complications were also obtained.Results
Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001).Conclusions
Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction. 相似文献4.
Marcelo Rodrigues dos Santos Ana Luiza Carrari Sayegh Raphaela Vilar Ramalho Groehs Guilherme Fonseca Ivani Credidio Trombetta Ant?nio Carlos Pereira Barretto Marco Ant?nio Arap Carlos Eduardo Negr?o Holly R. Middlekauff Maria-Janieire de Nazaré Nunes Alves 《Arquivos brasileiros de cardiologia》2015,105(3):256-264
Background
Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.Objective
We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.Methods
Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.Results
Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001).Conclusion
These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT. 相似文献5.
Woo KS Ghali WA Southern DA Tu JV Parsons G Graham MM 《The Canadian journal of cardiology》2008,24(2):115-117
BACKGROUND
Hospital discharge data are used extensively in health research. Given the clinical differences between ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI), it is important that these entities be distinguishable in a medical record. The authors sought to determine the extent to which the type of MI is recorded in medical records, as well as the consistency of this designation within individual records.METHODS
Records of all MI patients admitted to a tertiary care centre in Canada from April 1, 2000, to March 31, 2001, were reviewed. Documentation and consistency of the use of the terms STEMI (Q wave, ST elevation or transmural MI) or NSTEMI (non-Q wave, subendocardial or nontransmural MI) were assessed in the admission history, progress notes, coronary care unit summary and discharge summary sections of each record.RESULTS
Missing data were common; each chart section mentioned MI type in fewer than one-half of charts. When information was combined, it was possible to determine the type of MI in 81.1% of cases. MI type was consistently described as STEMI in 48.7% of cases, and as NSTEMI in 32.4%. Of concern, MI type was discrepant across sections in 10.5% of cases and missing entirely in 8.4% of cases.CONCLUSIONS
The designation of MI cases as STEMI or NSTEMI is both incomplete and inconsistent in hospital records. This has implications for health services research conducted retrospectively using medical record data, because it is difficult to comprehensively study processes and outcomes of MI care if the type cannot be retrospectively determined. 相似文献6.
Maria Inês Pires Fonseca Telmo Pereira Paulo Caseiro 《Arquivos brasileiros de cardiologia》2015,104(1):58-65
Background
Several studies have been attempting to ascertain the risks of Sleep Apnea Syndrome (SAS) and its morbidity and mortality.Objective
The main objective was to verify whether SAS increases the risk of death; the secondary objective was to evaluate its morbidity in relation to cardiovascular disease and the number of days hospitalized.Methods
A systematic review and a meta-analysis were performed of the published literature. The research focused on studies comparing the number of deaths in patients with untreated SAS and in patients with non-SAS.Results
The meta-analysis was based on 13 articles, corresponding to a total of 13394 participants divided into two groups (non-SAS = 6631; SAS = 6763). The meta-analysis revealed a clear association of SAS with the occurrence of fatal events, where the presence of SAS corresponded to a 61% higher risk of total mortality (OR=1.61; CI: 1.43 - 1.81; p < 0.00001), while the risk of death from cardiac causes was 2.52 times higher in these patients (OR = 2.52; IC: 1.80 - 3.52; p < 0.00001). Similar results were obtained for mortality from other causes (OR = 1.68; CI: 1.08 - 2.61; p = 0.02). Resembling results were obtained in the remaining outcomes: non-fatal cardiovascular events were higher in the SAS group (OR = 2.46; IC: 1.80 - 3.36; p < 0.00001), the average number of days hospitalized was also higher in the SAS group (IV = 18.09; IC: 13.34 - 22.84; p < 0.00001).Conclusion
The results show that untreated SAS significantly increases the risk of death, cardiovascular events and the average number of days hospitalized. 相似文献7.
Tara L Sedlak Aihua Pu Eve Aymong Min Gao Nadia Khan Hude Quan Karin H Humphries 《The Canadian journal of cardiology》2010,26(7):360-364
BACKGROUND:
Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist.OBJECTIVES:
To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI).METHODS:
A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI.RESULTS:
Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU/CCU). Specifically, ICU/CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02).CONCLUSIONS:
Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU/CCU care removed the sex difference in catheterization access in patients younger than 65 years of age. 相似文献8.
Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic
Ischemia Grade in STEMI
Emre Yalcinkaya Uygar Cagdas Yuksel Murat Celik Hasan Kutsi Kabul Cem Barcin Gokoglan Yalcin Erkan Yildirim Atila Iyisoy 《Arquivos brasileiros de cardiologia》2015,104(2):112-119
Background
Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI.Objective
To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification.Methods
Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I).Results
Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001).Conclusion
We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores. 相似文献9.
Omar Asdrúbal Vilca Mejía Bruna La Regina Matrangolo David Provenzale Titinger Leandro Batisti de Faria Luís Roberto Palma Dallan Filomena Regina Barbosa Galas Luiz Augusto Ferreira Lisboa Luís Alberto Oliveira Dallan Fabio Biscegli Jatene 《Arquivos brasileiros de cardiologia》2015,105(5):450-456
Background
Risk scores for cardiac surgery cannot continue to be neglected.Objective
To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.Methods
A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.Results
Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).Conclusion
Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. 相似文献10.
Fernando Bassan Roberto Bassan Roberto Esporcatte Braulio Santos Bernardo Tura 《Arquivos brasileiros de cardiologia》2016,106(3):218-225
Background
BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known.Objective
To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).Methods
A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality.Results
Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors.Conclusions
BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification. 相似文献11.
Ricardo Ribeiro Dias Fábio Fernandes Félix José Alvarez Ramires Charles Mady Cícero Piva Albuquerque Fábio Biscegli Jatene 《Arquivos brasileiros de cardiologia》2014,103(1):13-18
Background
Cardiac tumors are rare, mostly benign with high embolic potential.Objectives
To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery.Methods
Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination.Results
Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity.Conclusion
Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event. 相似文献12.
Juliana de Goes Jorge Marcos Antonio Almeida Santos José Augusto Soares Barreto Filho Joselina Luzia Menezes Oliveira Enaldo Vieira de Melo Norma Alves de Oliveira Gustavo Baptista de Almeida Faro Ant?nio Carlos Sobral Sousa 《Arquivos brasileiros de cardiologia》2016,106(1):33-40
Background
Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established.Objective
To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS.Methods
Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records.Results
The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure.Conclusion
A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS. 相似文献13.
Hanan Radwan Abdelhakem Selem Kamel Ghazal 《Journal of the Saudi Heart Association》2014,26(4):192-198
Background
Measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) in the evaluation of patients with acute coronary syndrome has appeared to be a useful prognostic marker of cardiovascular risk.Aim of the work
To assess the in-hospital prognostic value of NT-proBNP in patients with acute coronary syndrome (ACS) and its relation to the severity of coronary artery disease.Patients and methods
This study included 132 consecutive patients with ACS, 64 patients with unstable angina (UA), 46 patients with non-ST segment elevation myocardial infarction (NSTEMI), and 22 patients with ST segment elevation myocardial infarction (STEMI). ECG, echocardiography and pre and post coronary angiography measurement of troponin I, creatine kinase (Ck), C-reactive protein (CRP) and NT-proBNP were done. Patients were divided into two groups: Group A with NT-proBNP less than 474 pg/ml and Group B with NT-proBNP equal or more than 474 pg/ml.Results
There was a significant negative correlation between NT-proBNP and ejection fraction. Incidence of heart failure and duration of hospital stay were significantly higher in Group B (with NT-proBNP equal or more than 474 pg/ml) than Group A (with NT-proBNP less than 474 pg/ml). Moreover, there was a trend to an increased incidence of cardiogenic shock and mortality in Group B compared to Group A. The number of coronary vessels affected, severity of stenosis and proximal left anterior descending artery (LAD) disease were higher in Group B than in Group A. TIMI flow grade was significantly higher in Group A than in Group B.Conclusion
NT-proBNP is a valuable marker for predicting prognosis and severity of coronary artery disease in patients with acute coronary syndrome. 相似文献14.
Durmu? Y?ld?ray ?ahin Mustafa Gür Zafer Elbasan Ali Y?ld?z Zekeriya Kaya Yahya Kemal ??en Ali K?vrak Caner Türko?lu Remzi Y?lmaz Murat ?ayl? 《Experimental & Clinical Cardiology》2013,18(2):e77-e81
BACKGROUND:
Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.OBJECTIVE:
To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.METHODS:
A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.RESULTS:
Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).CONCLUSION:
Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI. 相似文献15.
Sameer Mehta Estefanía Oliveros Carlos E. Alfonso Esther Falcão Faisal Shamshad Ana I. Flores Salomon Cohen 《Journal of the Saudi Heart Association》2009,21(4):229-243
Background
Primary angioplasty decreases mortality and improves long-term outcomes for patients with STEMI. To be most effective, it needs to be performed expediently, with door-to-balloon times (D2B) less than 90 min.Methods
From January 2005 to presently, 420 short D2B STEMI interventions were performed at 5 community hospitals by a single experienced operator creating the SINCERE (Single INdividual Community Experience REgistry) database.Results
Median D2B time was 78 min, median procedure time (local anesthesia to recanalization) was 13 min; 85.2% of procedures had D2B time <90 min; 95% of the procedures were successful – relief of chest pain, >70% ST segment resolution, TIMI 3 flow and Myocardial Perfusion Grade 3.Conclusions
Primary PCI with high success rates and predictable short D2B times can be performed with standardized techniques in community hospitals. 相似文献16.
Silvia Bueno Garofallo Daniel Pinheiro Machado Clarissa Garcia Rodrigues Odemir Bordim Jr. Renato A. K. Kalil Vera Lúcia Portal 《Arquivos brasileiros de cardiologia》2014,102(6):539-548
Background
The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe.Objective
To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP).Methods
Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP.Results
Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus.Conclusion
Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery. 相似文献17.
Tomoko Fujii Shigehiko Uchino Masanori Takinami Rinaldo Bellomo 《Clinical journal of the American Society of Nephrology》2014,9(5):848-854
Background and objectives
AKI is a major clinical problem and predictor of outcome in hospitalized patients. In 2013, the Kidney Disease: Improving Global Outcomes (KDIGO) group published the third consensus AKI definition and classification system after the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease (RIFLE) and the Acute Kidney Injury Network (AKIN) working group systems. It is unclear which system achieves optimal prognostication in hospital patients.Design, setting, participants, & measurements
A retrospective observational study using hospital laboratory, admission, and discharge databases was performed that included adult patients admitted to a teaching hospital in Tokyo, Japan between April 1, 2008, and October 31, 2011. AKI occurring during each hospital stay was identified, and discriminative ability of each AKI classification system based on serum creatinine for the prediction of hospital mortality was assessed. The receiver operating characteristic curve, a graphical measure of test performance, and the area under the curve were used to evaluate how classifications preformed on the study population.Results
In total, 49,518 admissions were studied, of which 11.0% were diagnosed with RIFLE criteria and 11.6% were diagnosed with KDIGO criteria, but only 4.8% were diagnosed with AKIN criteria. Overall hospital mortality was 3.0%. AKI staging and hospital mortality were closely correlated in all systems. Discrimination for hospital mortality was similar for RIFLE and KDIGO criteria (area under the curve=0.77 versus 0.78; P=0.02), whereas AKIN discrimination was inferior (area under the curve=0.69 versus RIFLE [P<0.001] versus KDIGO [P<0.001]).Conclusion
Among hospital patients, KDIGO and RIFLE criteria achieved similar discrimination, but the discrimination of AKIN was inferior. 相似文献18.
Andréia Guedes Oliva Fernandes Carolina Souza-Machado Renata Concei??o Pereira Coelho Priscila Abreu Franco Renata Miranda Esquivel Adelmir Souza-Machado álvaro Augusto Cruz 《Jornal brasileiro de pneumologia》2014,40(4):364-372
OBJECTIVE:
To identify risk factors for death among patients with severe asthma.METHODS:
This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates.RESULTS:
We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma.CONCLUSIONS:
In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality. 相似文献19.
20.
Carlos Henrique Del Carlo Juliano Novaes Cardoso Marcelo Eidi Ochia Mucio Tavares de Oliveira Jr. José Antonio Franchini Ramires Antonio Carlos Pereira-Barretto 《Arquivos brasileiros de cardiologia》2014,102(5):495-504