BackgroundBNP 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.ObjectiveTo 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).MethodsA 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.ResultsUnstable 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.ConclusionsBNP 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.
Patients with 50% or more LMCAD and LV dysfunction had increased survival with CABG. However, outcomes of patients with 50% or more LMCAD and normal LV function were not significantly different with either MT or CABG.
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Hospital de Clínicas de Porto Alegre Research and Event Incentive Fund (FIPE-HCPA) Introduction The 12-lead resting electrocardiogram is a useful tool for diagnosing pathological conditions in athletes. The prevalence of electrocardiographic abnormalities in Brazilian soccer players are unknown. Purpose To describe the prevalence of abnormal electrocardiographic findings in young Brazilian soccer players based on the "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Methods Continuous variables were displayed as mean and standard deviation or median and interquartile range, while prevalence’s with 95% confidence intervals, and stratified by race. Intra-group differences were estimated by linear models or binomial and multinomial logistic regressions. Type I error was set to set a at 0.05. An additional margin of 0.025 was considered at the discretion of the statistician conditioned to the quality of the model. All analysis were running in Stata version 16.0.0. Results 2,581 young Brazilian soccer players from 27 clubs (mainly first division), aged 15-35 years (median: 18 years) were evaluated. 1,268 (49.1%) were Caucasians, 796 (30.8%) Mixed-Race (MR) and 517 (20.1%) Afro-Brazilians (AB). T-wave inversion (TWI) in the inferior leads (3.0%), high lateral leads (DI/aVL) (0.6%), V5 (2.3%), V6 (1.8%), and V5-V6 (1.7%) were present. Six Caucasians (0.5%) presented TWI in V1-V4. Prolonged corrected QT interval (QTc) (0.5%), QRS ≥140 ms (0.2%), "pathological" anterior Q waves (0.2%), lateral ST-segment depression (0.07%), premature ventricular contractions (0.5%), Mobitz type II atrioventricular block (0.03%), and a Wolff-Parkinson-White pattern (0.04%) were also observed. There were no athletes with short QTc interval, epsilon waves, profound sinus bradycardia (<30 beats per minute), complete left bundle branch block, third-degree atrioventricular block, or Brugada pattern (1, 2 or 3). Overall, 111/2,581 (4.3%) soccer players had electrocardiographic changes considered to be abnormal (4.4% in Caucasians, 4.5% in MR and 6.4% in AB). There was no difference between the abnormal findings among races, except for the prevalence of TWI in V6, which was higher in AB compared to Caucasians (3.1% versus 1.2%, respectively; P = 0.01). Conclusion To the best of our knowledge, this is the first large electrocardiographic cohort of Brazilian young soccer players to be described. In this sample, we evidence a prevalence <5% of abnormal findings according to the "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Additional evaluation in all these cases is indicated.
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