Arquivos Brasileiros de Cardiologia (Feb 2005)
Perfil inflamatório, metabólico e lipídico na síndrome isquêmica aguda: relação com eventos intra e pós-hospitalares Inflammatory, lipid, and metabolic profile in acute ischemic syndrome: correlation with hospital and posthospital events
Abstract
OBJETIVO: Associar o perfil lipídico, inflamatório (proteína C reativa ultra sensível - PCR us - e fibrinogênio) e metabólico (glicose) com eventos intra e pós-hospitalares de pacientes com síndrome isquêmica aguda (SIA) e descrever preditores de mortalidade nesta população. MÉTODOS: Estudo de coorte com 199 pacientes com SIA (angina instável, infarto agudo do miocárdio com ou sem supradesnivelamento de ST) internados na unidade de terapia intensiva (UTI) de uma instituição de referência cardiológica, no período de março a novembro de 2002. Foram registrados as doenças prévias, as medicações em uso e os fatores de risco coronarianos. Os eventos clínicos intra-hospitalares considerados foram Re-IAM, angina, insuficiência cardíaca (IC), fibrilação ventricular e óbito e os pós-hospitalares (30 dias após a alta) foram Re-IAM, angina, IC, óbito e re-internação para procedimentos percutâneos (ACTP) ou de revascularização (CRM). RESULTADOS: A PCR us e a glicemia alterada associaram-se, significativamente, com os eventos intra-hospitalares (p=0,03 e pOBJECTIVE: To associate the markers lipid profile, inflammatory profile (high-sensitivity C-reactive protein HSCRP and fibrinogen), and metabolic profile (glucose determination) with hospital and posthospital events in patients with acute ischemic syndrome (AIS) and to describe the predictors of mortality in this population. METHODS: A cohort study with 199 patients with AIS (unstable angina, acute myocardial infarction (AMI) with or without ST segment elevation) admitted to the intensive care unit (ICU) of a university cardiology Hospital, from March to November 2002. The previous diseases, the medication in use, and the coronary risk factors were recorded. The clinical events considered in the hospital were reinfarction, angina, heart failure (HF), ventricular fibrillation, and death; the posthospital events considered (30 days after hospital discharge) were reinfarction, angina, HF, death, and admittance for percutaneous procedures (PTCA) or for revascularization (MRS). RESULTS: HSCRP and altered glycemia were significantly associated with hospital events (P = 0.03 and P < 0.01, respectively); however, they were not associated with posthospital events (P = 0.19 and P = 0.61, respectively). Lipid profile and fibrinogen did not have a statistically significant association in any of the times assessed. Using multiple logistic regression, age (P = 0.04), previous AMI (P = 0.04), myocardial infarction with ST segment elevation (P = 0.008) or without ST segment elevation (P = 0.048), and altered glycemia (P = 0.002) were predictors of hospital mortality. CONCLUSION: Increased HSCRP and altered glycemia were associated with a greater number of hospital events, whereas age, previous AMI, AMI with or without ST segment elevation, and altered glycemia were predictors of hospital mortality.
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