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
The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecuti...The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecutive patients. To this effect, the clinical, electrocardiographic, echocardiographic and angiographic characteristics were analyzed. Coronary artery disease was identified in 185 patients(86%)-146 with acute myocardial infarction-as the underlying cause, isolated valvular disease in 10(5%) and other causes in 21(11%). Most patients were elderly(≥70 years, 72%), hypertensive(71%)and diabetic(44%). Among coronary disease(CAD) patients, however, 105(57%) showed conduction disturbances in theECG(QRS >0.10 s) and 84(45%) had no anginal pain during pulmonary edema. A 2D echocardiogram showed a 30%incidence of moderate-severe mitral regurgitation in coronary disease and non-coronary disease patients, and a 67%incidence of reduced ejection fraction(< 50%), particularly in coronary disease patients(73%). A coronary angiography performed in 99 patients with coronary disease showed multivessel disease in 89(91%) with a 32%incidence of significant left main disease. Therefore, these findings demonstrate that coronary disease is the most common cause of acute pulmonary edema and it is associated with a distinctly high prevalence of multivessel and left main disease. This diagnosis, however, may often be overlooked if no serial enzymatic sampling is performed given the increased frequency of conduction abnormalities and lack of anginal pain.展开更多
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The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecutive patients. To this effect, the clinical, electrocardiographic, echocardiographic and angiographic characteristics were analyzed. Coronary artery disease was identified in 185 patients(86%)-146 with acute myocardial infarction-as the underlying cause, isolated valvular disease in 10(5%) and other causes in 21(11%). Most patients were elderly(≥70 years, 72%), hypertensive(71%)and diabetic(44%). Among coronary disease(CAD) patients, however, 105(57%) showed conduction disturbances in theECG(QRS >0.10 s) and 84(45%) had no anginal pain during pulmonary edema. A 2D echocardiogram showed a 30%incidence of moderate-severe mitral regurgitation in coronary disease and non-coronary disease patients, and a 67%incidence of reduced ejection fraction(< 50%), particularly in coronary disease patients(73%). A coronary angiography performed in 99 patients with coronary disease showed multivessel disease in 89(91%) with a 32%incidence of significant left main disease. Therefore, these findings demonstrate that coronary disease is the most common cause of acute pulmonary edema and it is associated with a distinctly high prevalence of multivessel and left main disease. This diagnosis, however, may often be overlooked if no serial enzymatic sampling is performed given the increased frequency of conduction abnormalities and lack of anginal pain.
