Background: The present study GREECS was conducted in order to evaluate the annual incidence of acute coronary syndromes (ACS) and to delineate the role of clinical, biochemical, lifestyle and behavioral characteristics on the severity of disease. In this work we present the design, methodology of the study and various baseline characteristics of people with ACS.
revious studies have demonstrated that renal insufficiency is an independent risk factor for cardiovascular morbidity and for all-cause as well as cardiovascular death in both the general population and patients with cardiovascular disease. [1][2][3][4] In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term mortality among patients with myocardial infarction (MI), even after administration of fibrinolytics. [5][6][7][8] Moreover, it has been demonstrated that impaired renal function is associated with poorer clinical outcome after either percutaneous coronary intervention or coronary artery bypass graft surgery. [9][10][11][12] Several recently published studies have shown that renal insufficiency is common among patients with a broad spectrum of acute coronary syndromes (ACS) at admission and is associated with higher risk of death as well as major bleeding. [13][14][15][16][17][18][19] However, the effect of renal insufficiency in patients with non-ST-segment elevation MI (NSTEMI) and unstable angina (UA) has been less extensively investigated.The primary objective of this study was to evaluate the characteristics of patients with varying degrees of renal dysfunction among those hospitalized with all clinical presentations of ACS and the impact of renal dysfunction on in-hospital cardiovascular mortality of those patients. Secondarily, we sought to investigate the aforementioned for those with ST-segment elevation MI (STEMI) and those with NSTEMI and UA, separately and to compare the predictive value of these 2 final models in order to conclude in which of these 2 subgroups creatinine clearance is the better predictor. Methods DesignThe design and rationale of this study have been described in detail previously. 20 Briefly, from October 2003 to September 2004 (12 months) we enrolled almost all consecutive patients (participation rate =98%) that entered cardiology clinics or emergency units of 6 major general hospitals in Greece. Finally, the study included only those patients with a discharge diagnosis of ACS; that is, patients STEMI or NSTEMI and UA. The criteria for the diagnosis of STEMI, NSTEMI and UA took into account clinical presentation, ECG findings and the results of serum biochemical markers of necrosis. In particular, acute MI was defined by a typical rise and gradual fall of troponin or a more rapid rise and fall of creatine kinase (CK)-MB, with at least 1 of the following: (a) ischemic symptoms, (b) development of Background The relationship between renal dysfunction and mortality in patients with myocardial infarction (MI) has been extensively investigated, but there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. Therefore, the aim of the present study was to investigate whether renal insufficiency is an independent predictor for in-hospital mortality among such patients. Methods and ResultsTwo thousand a hundred and seventy-two patie...
Abstract:The association between marital status and short-term prognosis of patients hospitalized for acute coronary syndrome (ACS) was evaluated. From October 2003 to September 2004, a sample of 6 hospitals located in Greek regions was selected, and almost all survivors after an ACS were enrolled into the study (2172 patients were included in the study; 76% were men). The in-hospital mortality rate was 3.2% in male patients and 5.7% in female patients (p = 0.009). Never-married patients had 2.8-times higher risk of dying during hospitalization compared with married, after adjusting for various confounders (p Ͻ 0.01, attributable risk = 64%). Furthermore, never-married had 2.7-times higher risk of dying during the fi rst 30-days following hospitalization compared with married (p Ͻ 0.01, attributable risk = 62%). Moderate depressive symptoms 3.26-fold (95% CI 1.40-7.11) the risk of recurrent events, while severe depressive symptoms were associated with 8.2-fold (95% CI 3.98-17.1) higher risk of events. No interaction was observed between marital status and depression on 30-day prognosis of ACS patients (p Ͼ 0.5). People who were not-married and depressed at the time of an acute cardiac episode were at higher risk of fatal events than people who were married, irrespective of depression status and other characteristics.
In conclusion, physical activity is associated with a reduced severity of ACS, reduced in-hospital mortality rates, and improved short-term prognosis.
We studied the sex-specific distribution of various factors in hospitalized patients who presented with acute coronary syndromes (ACS), as well as the annual incidence and the in-hospital and short-term outcomes in males and females. A sample of six hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all nonfatal admissions with a first event of ACS, from October 2003 to September 2004. Sociodemographic, clinical, dietary, and other lifestyle characteristics were recorded. A total of 2,172 patients were included in the study (1,649, 76% male and 523, 24% female). The annual incidence rate was almost three times higher in males than in females (34 per 10,000 males and 10.9 per 10,000 females). The highest frequency of events was observed in winter, in both sexes. Females had higher in-hospital mortality rate as compared to males (5.7% vs 3.2%, P = 0.007), while the 30-day mortality and rehospitalization rate was 17% in male and 16% in female patients. The most common discharged diagnosis for males was Q-wave myocardial infraction (35%), while females were more likely to suffer from unstable angina (42%). Females were older than males, waited longer between seeking and receiving medical advice, and were more likely to have a history of hypertension, obesity, and diabetes mellitus as compared to males. On the other hand, males were more likely to be smokers, to follow a more typical Mediterranean diet, and to be more physically active (P < 0.05). We revealed a sex-related difference in the profile of clinical characteristics and other cardiovascular risk factors in hospitalized patients for ACS.
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