Prognostic impact of iron deficiency in acute coronary syndromes.

Background: Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study.

Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation.

Introduction: Prompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach.

Objective: We aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI.

Methods: A retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014.

Randomized controlled trial of remote ischaemic conditioning in ST-elevation myocardial infarction as adjuvant to primary angioplasty (RIC-STEMI).

To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials.gov).

Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease.

Introduction: There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD).

Objectives: To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD.

Remote ischemic conditioning in ST-elevation myocardial infarction as adjuvant to primary angioplasty (RIC-STEMI): study protocol for a randomized controlled trial.

Background: ST-elevation myocardial infarction (STEMI) accounts for nearly one third of acute coronary syndromes. Despite improved STEMI patient care, mortality remains high, contributing significantly to the ischemic heart disease burden. This may partly be related to ischemia-reperfusion injury (IRI).

Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis.

Introduction: Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial.

Objectives: To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS).

Methods: We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.

New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis.

Introduction: New-onset atrial fibrillation (AF) frequently complicates myocardial infarction, with an incidence of 6-21%.

Objective: To assess the predictors and prognosis of new-onset AF during acute coronary syndromes (ACS).

Methods: We performed a retrospective observational cohort study including 902 consecutive patients (mean age 64 years, 77.

Multimarker approach with cystatin C, N-terminal pro-brain natriuretic peptide, C-reactive protein and red blood cell distribution width in risk stratification of patients with acute coronary syndromes.

Introduction And Aim: Biomarkers have emerged as interesting predictors of risk in patients with acute coronary syndromes (ACS). The aim of this study was to determine the utility of the combined measurement of cystatin C (CysC), C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and red blood cell distribution width (RDW) in the risk stratification of patients with ACS.

Methods: In this prospective study including 682 patients consecutively admitted to a coronary care unit for ACS, baseline measurements of CysC, CRP, NT-proBNP and RDW were performed.

Ischemic rupture of the anterolateral papillary muscle.

We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation in the inferior leads, R>S in V1 and ST depression in the anterior leads due to proximal occlusion of the first obtuse marginal. Primary coronary angioplasty and stenting of this artery were performed. Twelve hours later the patient became hemodynamically unstable and severe mitral regurgitation due to rupture of one of the heads of the anterolateral papillary muscle was diagnosed.

Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction.

Background: Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis.

Methods: We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007.

Proton pump inhibitors in patients treated with aspirin and clopidogrel after acute coronary syndrome.

Introduction: Clopidogrel is an antiplatelet agent converted to its active metabolite by cytochrome P-450 isoenzymes. Numerous drugs are known to inhibit P-450 isoenzymes, including proton pump inhibitors (PPIs), which are often associated with aspirin and clopidogrel to prevent adverse gastrointestinal effects. In vitro studies first showed that PPIs reduced the antiplatelet effect of clopidogrel, while recent clinical studies have raised concerns that the addition of a PPI to clopidogrel in acute coronary syndrome (ACS) patients could actually increase the risk of recurrent cardiovascular events.

Association between red blood cell distribution width and outcomes at six months in patients with acute coronary syndromes.

Background: Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS).

Methods: We studied 1796 patients with ACS admitted to a coronary care unit.

Non-ST elevation acute coronary syndrome: QRS duration and long-term prognosis.

Background: Recent studies have demonstrated that QRS duration (QRSd) is associated with poor prognosis in heart failure and ST-elevation myocardial infarction. Less is known about the prognostic importance of QRSd in patients with non-ST elevation acute coronary syndrome (non-ST ACS).

Aim: To determine if admission QRSd is associated with 1-year mortality in non-ST ACS.

Smoking in acute coronary syndromes--the "smoker's paradox" revisited.

Introduction: Although a well-known risk factor for coronary disease, smoking has long been associated with lower short-term mortality in acute coronary syndromes (ACS). There are few recent works on Portuguese populations examining all aspects of smoking in ACS, particularly the interaction between smoking and other risk factors, and the management and prognosis of patients according to smoking status.

Objective: We sought to examine clinical characteristics, presentation, in-hospital treatment, angiographic features and prognosis of patients with and without smoking history admitted with ACS.

Prognostic impact of hemoglobin drop during hospital stay in patients with acute coronary syndromes.

Introduction: Bleeding is currently the most common non-cardiac complication of therapy in patients with acute coronary syndromes (ACS), and may itself be associated with adverse outcomes. The aim of this study was to determine the effect of hemoglobin drop during hospital stay on outcome among patients with ACS.

Methods: Using Cox proportional-hazards modeling, we examined the association between hemoglobin drop and death or myocardial infarction (MI) at 6 months in 1172 patients admitted with ACS to an intensive cardiac care unit.

Impact of atrial fibrillation in acute coronary syndromes.

Introduction: Atrial fibrillation (AF) is a relatively common arrhythmia in the context of acute coronary syndromes (ACS). However, the impact of AF on these patients' survival is not well established. The present study aimed to estimate the prevalence of AF in ACS patients and to evaluate its impact on in-hospital and six-month post-event mortality, from any cause.

Prognostic impact of moderate renal dysfunction in acute coronary syndromes.

Introduction: End-stage renal disease is associated with high cardiovascular mortality. The prognostic importance of milder degrees of renal impairment in patients who have had an acute coronary syndrome (ACS) is less well defined. The purpose of this study was to evaluate the impact of baseline renal dysfunction assessed by estimated glomerular filtration rate (GFR) on mortality in patients admitted with an ACS.

Admission glycemia: a predictor of death after acute coronary syndrome in non-diabetic patients?

Background: Previous studies have demonstrated that acute phase hyperglycemia is associated with increased in-hospital mortality in diabetic patients admitted with acute coronary syndrome (ACS), but this has not been clearly demonstrated in non-diabetic patients. The present study was designed to determine whether admission hyperglycemia (AG) is an independent predictor of in-hospital and six-month mortality after ACS in non-diabetic patients.

Methods: This was a retrospective cohort study of 426 non-diabetic patients consecutively admitted with ACS.

Heart failure after acute coronary syndrome: identify to treat better!

Introduction: The development of heart failure (HF) following acute coronary syndromes (ACS) significantly worsens short- and long-term prognosis. The present study aimed to identify clinical characteristics, detectable at admission for ACS, that could predict HF development during hospitalization, and to evaluate its impact on in-hospital mortality.

Methods: This was a retrospective cohort study that included 601 patients consecutively admitted with ACS.