OBJECTIVES: The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram(ECG), and normal troponin levels. BACKGROUND: Prognosis assessment in this ...OBJECTIVES: The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram(ECG), and normal troponin levels. BACKGROUND: Prognosis assessment in this population remains a challenge. METHODS: A total of 646 consecutive patients were evaluated by clinical history(risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days(similar to the Thrombolysis In Myocardial Infarction[TIMI] risk score). RESULTS: Primary and secondary end point rates were 6.7%and 5.4%. A risk score was constructed using the variables related to the primary end point: chest pain score< 10 points(hazard ratio[HR]=2.5; 1 point),< 2 pain episodes in last 24 h(HR=2.2; 1 point), age< 67 years(HR=2.3; 1 point), insulin-dependent diabetes mellitus(HR=4.2; 2 points), and prior percutaneous transluminal coronary angioplasty(HR=2.2; 1 point). Patients were classified into five categories of risk(p=0.0001): 0 points, 0%event rate; 1 point, 3.1%; 2 points, 5.4%; 3 points, 17.6%;≥4 points, 29.6%. The accuracy of the score was greater than that of the TIMI risk score for the primary(C index of 0.78 vs. 0.66, p=0.0002) and secondary(C index of 0.70 vs. 0.66, p=0.1) end points. CONCLUSIONS: Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score.展开更多
Background: 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 s...Background: 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. Methods: 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. Results: In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C- reactive protein(P=.007) and myoglobin(P=.02), and at first year troponin I(P=.02), C- reactive protein(P=.03), and homocysteine(P=.04). The rate of major events depending on the number(0- 5) of elevated biomarkers were at first month: 4.1% , 3.7% , 5.7% , 6.1% , 6.5% , and 30.8% (P< .0001), and at first year: 8.2% , 11.1% , 12.3% , 16.2% , 23.7% , and 50% (P< . 0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6[1.3- 1.9] at first month and of 1.4[1.2- 1.7] at first year. Conclusions: Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.展开更多
Spontaneous Valsalva sinus pseudoaneurysm is a rare and highly lethal conditio n. Below we present a clinical case of a young woman with spontaneous Valsalva s inus pseudoaneurysm diagnosed presenting with acute myoca...Spontaneous Valsalva sinus pseudoaneurysm is a rare and highly lethal conditio n. Below we present a clinical case of a young woman with spontaneous Valsalva s inus pseudoaneurysm diagnosed presenting with acute myocardial infarction (AMI) and ischemic stroke.展开更多
文摘OBJECTIVES: The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram(ECG), and normal troponin levels. BACKGROUND: Prognosis assessment in this population remains a challenge. METHODS: A total of 646 consecutive patients were evaluated by clinical history(risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days(similar to the Thrombolysis In Myocardial Infarction[TIMI] risk score). RESULTS: Primary and secondary end point rates were 6.7%and 5.4%. A risk score was constructed using the variables related to the primary end point: chest pain score< 10 points(hazard ratio[HR]=2.5; 1 point),< 2 pain episodes in last 24 h(HR=2.2; 1 point), age< 67 years(HR=2.3; 1 point), insulin-dependent diabetes mellitus(HR=4.2; 2 points), and prior percutaneous transluminal coronary angioplasty(HR=2.2; 1 point). Patients were classified into five categories of risk(p=0.0001): 0 points, 0%event rate; 1 point, 3.1%; 2 points, 5.4%; 3 points, 17.6%;≥4 points, 29.6%. The accuracy of the score was greater than that of the TIMI risk score for the primary(C index of 0.78 vs. 0.66, p=0.0002) and secondary(C index of 0.70 vs. 0.66, p=0.1) end points. CONCLUSIONS: Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score.
文摘Background: 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. Methods: 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. Results: In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C- reactive protein(P=.007) and myoglobin(P=.02), and at first year troponin I(P=.02), C- reactive protein(P=.03), and homocysteine(P=.04). The rate of major events depending on the number(0- 5) of elevated biomarkers were at first month: 4.1% , 3.7% , 5.7% , 6.1% , 6.5% , and 30.8% (P< .0001), and at first year: 8.2% , 11.1% , 12.3% , 16.2% , 23.7% , and 50% (P< . 0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6[1.3- 1.9] at first month and of 1.4[1.2- 1.7] at first year. Conclusions: Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.
文摘Spontaneous Valsalva sinus pseudoaneurysm is a rare and highly lethal conditio n. Below we present a clinical case of a young woman with spontaneous Valsalva s inus pseudoaneurysm diagnosed presenting with acute myocardial infarction (AMI) and ischemic stroke.
