Diretrizes (IIª Edição, 2007) da Sociedade Brasileira de Cardiologia sobre angina instável e infarto agudo do miocárdio sem supradesnível do segmento ST

BackgroundThe classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60.ObjectiveTo validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies.MethodsWe evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI).ConclusionThe Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.

Section: Introductionmentioning

confidence: 99%

Validation of the Killip-Kimball Classification and Late Mortality after Acute Myocardial Infarction

Mello¹,

Oliveira²,

Ramos³

et al. 2014

“…Echocardiography is a noninvasive, low-cost and reproducible examination 7 that has great diagnostic and prognostic value in patients with suspected ACS 8 and acute cardiac failure 2 . It also assists in determining the appropriate therapy for patients with arrhythmias 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

Mancuso¹,

Siqueira²,

Moisés³

et al. 2014

BackgroundCardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.ObjectiveTo evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care.MethodsOne hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated.ResultsThe mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection.ConclusionThe focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

“…Medications were also used in higher proportion prior to hospital admission, such as ASA (73.9% vs. 55.1%), beta-blockers (63.4% vs. 23.1%), ACE inhibitors (53.3% vs. 14.8%) and statins (61.0% vs. 15.6%). Therefore, considering the most recent and national 33 and North-American 2 guidelines, patients with increased cardiovascular risk should be under more intensive medical therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, our study was prospective and observational, did not exclude any patient during the specified period, regardless of age, creatinine level or any other demographic characteristic, and included a population at high cardiovascular risk ( Table 1 ), fully medicated, according to the national 33 and North-American guidelines 2 ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Association between Angiotensin-Converting Enzyme Inhibitors and Troponin in Acute Coronary Syndrome

Minuzzo¹,

Santos²,

Timerman³

2014

BackgroundCardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events.ObjectiveTo determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days.MethodsProspective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira) or Fisher's exact test (Armitage) were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of <10% were submitted to multiple logistic regression model.ResultsA total of 457 patients with a mean age of 62.1 years, of whom 63.7% were males, were included. Risk factors such as hypertension (85.3%) and dyslipidemia (75.9%) were the most prevalent, with 35% of diabetics. In the evaluation of events at 180 days, there were 28 deaths (6.2%). The statistical analysis showed that the variables that interfered with troponin elevation (> 0.5 ng / mL) were high blood glucose at admission (p = 0.0034) and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016). The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482). The C-statistics for this model was 0.77.ConclusionThis study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However, there are no data available yet to state that this reduction could lead to fewer severe clinical events such as death and re-infarction at 180 days.