Tirti pasirinktiniai 193 pacientai, gydyti Vilniaus universiteto ligoninės Santariškių klinikų Kardiologijos reanimacijos ir intensyviosios terapijos skyriuje. Tyrime buvo nagrinėjami vyresnio amžiaus pacientų ūminio koronarinio sindromo klinikinės eigos ypatumai, ligonių išgyvenamumo ryšys su klinikinės eigos ypatumais bei gydymo būdais. Tuo tikslu buvo išanalizuotas vyresnio amžiaus pacientų, patyrusių ūminį koronarinį sindromą, išgyvenamumas bei didžiųjų nepageidaujamų kardiovaskulinių įvykių dažnis per 3 metus nuo ūminio koronarinio sindromo pasireiškimo pradžios. Buvo įvertintas pacientų grupių homogeniškumas pagal amžiaus grupes, ūminio koronarinio sindromo formas bei GRACE riziką. Buvo palyginti pacientų, kuriems taikytas ir netaikytas invazinis gydymas, ūminio koronarinio sindromo klinikinės eigos bei išeičių ypatumai. Tyrime buvo įvertintos išgyvenamumo sąsajos su pacientų anamnezės, klinikinės eigos bei gydymo veiksniais, taip pat bei palyginti išgyvenę ir neišgyvenę pacientai, patyrę ūminį koronarinį sindromą pagal anamnezės, klinikinės eigos bei gydymo veiksnius priklausomai nuo invazinio ar neinvazinio gydymo taikymo. Tokiu būdu buvo ieškoma veiksnių, kurie skirtingai reikšmingi pacientų, gydytų invaziniu ir neinvaziniu būdu, išgyvenamumui. / 193 consecutive patients older than 75 years with ACS were included in the study. Clinical process characteristics of acute coronary syndrome in elderly patients have been assessed in this study; the relation between patient survival and clinical process characteristics as well as treatment methods has been established. For this purpose the survival of elderly patients with acute coronary syndrome and, also, the frequency of MACE (major adverse cardiovascular events) during the 3 years after acute coronary syndrome has been analysed. The assessment of the patient group homogeneity according to the age group, acute coronary syndrome forms and GRACE risk has been performed. The analysis and comparison of the patients who received and those who did not receive invasive treatment, as well as the characteristics of their acute coronary syndrome clinical progress and outcomes have been presented in this study. The links between the patient survival and the factors of patient history, clinical progress and treatment have been established. The comparison of the patients with acute coronary syndrome who survived with the ones who did not survive based on the various factors of their history, clinical progress and treatment subject to the invasive or conservative treatment received has been provided. Thus, the study searched for the factors having various impacts on the patients survival depending on the treatment – invasive or conservative – received.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010. / Härtill 5 uppsatser.

Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking. Aims: Aim 1 was to determine trajectories of severity of common symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain and shoulder pain) in the six months following an ED visit for potential ACS. Aim 2 was to identify relationships between symptom trajectories and baseline physiologic factors (age, gender, diabetes status, diagnosis, comorbidities, functional status) and situational factors (marital status, insurance status, education level). Aim 3 was to identify relationships between symptom trajectories and health service use (outpatient visits and calls, ED visits, 911 calls, hospitalization) in the six months after the ED visit. Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Symptom severity was modeled across the three study time points using growth mixture modeling. Model selection was based on interpretability, theoretical justification, and statistical fit indices. Patient characteristics were used to predict trajectories using logistic regression and differences in health service use were tested using chi-square analysis. Results: Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset," and "severe/improving." Age, sex, diabetes, BMI, functional status, insurance status, and diagnosis significantly predicted symptom trajectories. Clinic visits and phone calls, 911 calls, ED visits, and probability of hospitalization varied significantly among trajectories. Conclusions: Research on the individual nature of symptom trajectories can support patient-centered care. Patients at risk for ongoing symptoms and increased health service use can be targeted for education and follow-up based on clinically observable characteristics. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations.

The purpose of the current project is to illustrate the application of advanced statistical techniques to address research questions about depression and anxiety in patients with an acute coronary syndrome (ACS). The first study, using data from 100 patients who were randomized into a clinical trial of cognitive behavioral therapy, used bivariate mixed models to determine trajectories of depression and anxiety after an ACS, to examine the effects of cognitive behavioral therapy (CBT) on depression and anxiety, and to determine if anxiety and depression symptoms change at the same rate with CBT treatment as indicated by joint modeling of these two psychiatric disorders. The findings suggest that depression and anxiety are highly correlated and persistent in patients with an ACS both at baseline and over time. The intervention used in the present investigation does not appear to uncouple the association between anxiety and depression, suggesting that CBT has comparable effects on both psychiatric disorders. The second study used latent transition analysis to identify symptomatology profiles of depression, anxiety, and functional impairment in patients with an ACS, describe changes over time (two, three and six-month follow-up) in patient’s acute symptom profiles, and determine if patients receiving CBT showed signs of remission in depression, anxiety and impaired function earlier than patients that received usual care. A three-class model was selected to identify and describe these acute symptom profiles. One class was characterized by patients with both psychiatric disorders and impaired function, the second by patients with psychiatric disorders but normal function, and the third by patients with anxiety but without depression, and having normal function. There was moderate improvement in depression, anxiety and functional status for control patients, but this improvement was less evident than in the treatment group. Women showed a better response to CBT than men. The third study used latent class and latent transition analysis to determine symptom profiles of depression and anxiety in patients with an ACS using the Hospital Anxiety Depression Scale; a secondary study goal was to examine the effects of age and gender on these symptom patterns. A two-class model was selected to describe depression and anxiety symptomatology profiles. Class I (76% of patients at baseline) was labeled as “severe depression and some anxiety” whereas Class II (24% of patients at baseline) was labeled as “mild depression and distress anxiety”. More than 70% of older patients continued to have severe depression and anxiety at follow-up and a large proportion of these patients who reported mild depression and anxiety at baseline showed worsening of symptoms at follow-up. The current study demonstrates that patients with depression and anxiety after an ACS can be identified on the basis of the symptoms that they present. This is particularly important to identifying individuals at potential risk for developing clinical complications after an ACS.

Fundamentos: A insuficiência cardíaca tem uma grande importância como preditor de morbimortalidade em pacientes com síndrome coronariana aguda. Objetivo: Avaliar a ocorrência de insuficiência cardíaca e outros preditores de morbimortalidade na síndrome coronariana aguda em longo prazo. Métodos: Foi estudada uma coorte de 403 pacientes consecutivos e prospectivos, com queixas de dor torácica. Descreveram-se os dados demográficos e as características clínicas e laboratoriais. Comparou-se a estratificação de risco invasiva versus não invasiva, e as diferenças entre o tratamento medicamentoso com o intervencionista avaliando a evolução durante a internação e no período de até oito anos após a alta, em relação aos eventos cardiovasculares, não cardiovasculares e óbitos. Os dados numéricos serão apresentados em médias e desvios-padrão ou mediana e distância interquartílica, os dados categóricos através da porcentagem. Foram utilizados testes de t de Student, teste de Mann-Whitney, teste de qui-quadrado e teste exato de Fisher segundo sua indicação. Para a construção do modelo de sobrevida foram utilizados o teste de Kaplan-Meier e o teste de log-rank; o modelo multivariado foi ajustado utilizando o modelo de Cox. Após realizar a análise de sobrevida de Cox, para garantir o pressuposto do risco proporcional foi utilizado o modelo de Cox estratificado. Todas as análises foram realizadas utilizando o programa R versão 2.9.1. Resultados: População amostral constituída por 403 pacientes com queixas de dor torácica, sendo 65,8% com diagnóstico de SCA sem supra de ST, 27,8% SCA com supra de ST e 6,5% sem SCA. Da população amostral, foram avaliados 377 pacientes, sendo 37,93% do sexo feminino e a média de idade foi de 62,211,6 anos. A creatinina merece destaque como fator prognóstico, sendo o ponto de corte de 1,4mg/dL, com acurácia de 62,1%. Foram ainda observadas diferenças estatisticamente significativas quanto à idade na presença de insuficiência cardíaca; e quanto às terapias utilizadas antes e depois de 2002 em relação à mortalidade. Incluiu-se uma variável adicional no modelo multivariado, que se chamou de FC>PAS, para qualquer frequência cardíaca maior que a pressão arterial sistólica na admissão. Conclusões: A presença de IC na admissão, creatinina inicial >1,4mg/dL, idade e FC dos pacientes internados com SCA são preditores independentes de mortalidade. Observou-se que os pacientes com IC atendidos antes de 2002 apresentaram pior sobrevida do que os pacientes atendidos a partir de 2002 e que a mudança na terapia foi a responsável por isso. Mesmo com a diferença da sobrevida relacionada com a época da internação, o impacto dessas variáveis clínicas e laboratoriais na mortalidade foi semelhante. Outros estudos devem ser realizados a fim de avaliar se condutas diferenciadas para os pacientes com IC na admissão da internação de SCA podem reduzir esta mortalidade. / Background: Heart failure (HF) is extremely important as a morbidity and mortality predictor in patients with acute coronary syndrome. Objective: To assess the occurrence of heart failure and other morbidity and mortality predictors in acute coronary syndrome over the long term. Methods: A cohort of 403 prospective consecutive patients was studied, complaining of chest pain. The demographic data were described, together with the clinical and laboratory characteristics. Invasive versus non-invasive risk stratification was compared, as well as differences between surgical and percutaneous intervention and drug treatment, assessing progression during hospitalisation and for periods of up to eight years after discharge, in terms of cardiovascular and non-cardiovascular events and deaths. The numerical data will be presented as means and standard deviations or as medians and interquartíle distances, with the categorical data shown as percentages. The Students t, Mann-Whitney, chi-square and Fishers exact tests were used as indicated. The Kaplan-Meier and log-rank tests were used to construct the survival model; the multivariate model was adjusted through the Cox model. After conducting the Cox survival analysis in order to underpin the proportional risk assumption, the stratified Cox model was used. All the analyses were conducted through the R Programme, version 2.9.1. Results: In the sample population of 403 patients complaining of chest pain, 65.8% were diagnosed with non-ST elevation ACS, 27.8% with ST elevation ACS, and 6.5% without ACS. In the sample population, 377 patients were assessed, with 37.93% of them women and an average age of 62.211.6 years. Creatinine was particularly noteworthy as a prognostic factor, with a cut-off point of 1.4mg/dL and accuracy of 62.1%. Statistically significant differences were also observed for age with HF and the treatments used before and after 2002 in terms of mortality. An additional variable was included in the multivariate model called the HR>SBP, for any heart rate higher than systolic blood pressure on admission. Conclusion: The presence of HF on admission, with initial creatinine of >1.4mg/dL, age and HR of patients hospitalized with ACS are independent mortality predictors. It was noted that patients with HF treated prior to 2002 presented shorter survival times than HF patients treated after 2002, due to alterations in treatment. Even with the difference in survival times related to the period of hospitalization, the impact of the clinical variables remains significant regardless of the time of hospitalization. Other studies must be conducted in order to assess whether different types of conduct for patients with HF on admission for hospitalization with ACS might lower this mortality rate.

A pesquisa, de natureza qualitativa, teve como objetivos implementar e avaliar uma intervenção educativa para enfermeiros voltada ao reconhecimento precoce e manejo das alterações glicêmicas em pacientes com diagnóstico de síndrome coronariana aguda e identificar o número de inclusões de pacientes ao protocolo hospitalar de tratamento das alterações glicêmicas antes e após intervenção educativa aplicada aos Enfermeiros. Foi realizada em duas Etapas. A Etapa Um (De Investigação) consistiu na identificação dos participantes da pesquisa, no manejo do diabetes e do protocolo de tratamento hospitalar. A Etapa Dois consistiu na Implementação e Avaliação do Programa Educativo (PE) para enfermeiros, que foi desenvolvido em três fases: reconhecimento dos sujeitos e mobilização afetiva; discussão de casos clínicos com foco na problematização e retomada de situações clínicas vivenciadas;, mobilização de conceitos e avaliação do Programa Educativo. O PE foi estruturado com base no trabalho de Puschel em sua tese de doutorado e em métodos psicodramáticos e no referencial problematizador de Paulo Freire. Participaram do PE todos os 14 enfermeiros da Unidade Coronariana do Hospital Israelita Albert Einstein, em São Paulo, sendo resguardados os preceitos éticos de desenvolvimento de pesquisas. Os resultados evidenciaram grupo de participantes jovem, com experiências profissionais variadas. A análise de conteúdo das respostas aos questionários aplicados na Etapa Um e na Fase três da Etapa Dois permitiu construir seis categorias: Conhecimento, Manifestações Clínicas, Raciocínio Clínico, Tomada de Decisão, Manejo das alterações glicêmicas e Intervenções de Enfermagem. Após aplicação do PE em todas as categorias houve a inserção de novos elementos com maior destaque ao aprofundamento dos aspectos relacionados à fisiopatologia, aos sinais e sintomas e às complicações agudas; maior preocupação com a identificação precoce de situações predisponentes a eventos de hipoglicemia; maior consistência na descrição das ações contempladas no protocolo institucional de tratamento principalmente em relação à dose e à frequência das insulinas utilizadas. As cenas dramatizadas nas fases um e três e a discussão dos casos clínicos promoveram grande interação e confiança no grupo e agregação de conceitos. O número de inclusões de pacientes no protocolo hospitalar de tratamento no trimestre que antecedeu a implementação do programa educativo foi de um enquanto que no trimestre posterior ao PE foram de três. Os participantes atribuíram conceitos de excelentes e bons ao conteúdo, à metodologia, ao desempenho da instrutora, à participação, às expectativas, aos recursos e objetivos do PE, O estudo abre perspectivas para utilização de novas estratégias educativas para o desenvolvimento de profissionais de saúde com foco na atenção aos indivíduos com doença crônica / The research was qualitative, aimed to implement and evaluate an educational intervention for nurses aimed at early recognition and management of glucose in patients with acute coronary syndrome and identify the number of inclusions of patients to hospital protocol for treatment of changes glucose before and after educational intervention applied to nurses was carried out in two steps. Step A (Investigation) involved the identification of research participants in the management of diabetes and treatment protocol hospital. Step Two was the Implementation and Evaluation of Educational Program (EP) for nurses, which was developed in three stages: recognition of subjects and affective mobilization, clinical case discussions focusing on questioning and resumption of clinical situations experienced, mobilizing concepts and evaluation of the educational program. The EP was structured based on Puschel and Psychodramatic methods and problem-solving framework of Paulo Freire. EP participated all 14 nurses of the Coronary Care Unit of Hospital Israelita Albert Einstein, Sao Paulo, being safeguarded the ethical development of research. The results showed group of young participants with varied professional experiences. A content analysis of responses to questionnaires applied in Step One and Step Two Phase Three possible to build six categories: Knowledge, Clinical Manifestations, Clinical Reasoning, Decision Making, Management of glucose and Nursing Interventions. After application of PE in all categories was the insertion of new elements, most notably the deepening of the aspects related to the pathophysiology, signs and symptoms and the acute complications; biggest concern with the early identification of conditions predisposing to nocturnal hypoglycemia; greater consistency in the description of the actions contemplated in institutional treatment protocol especially in relation to the dose and frequency of insulin used. Dramatized scenes in phases one and three and the discussion of clinical cases promoted great interaction and confidence in the group and aggregation concepts. The number of inclusions of patients in hospital protocol treatment in the quarter prior to the implementation of the educational program was a while later in the quarter to PE were three. Participants attributed concepts of good and excellent content, methodology, instructor performance, participation, expectations, resources and objectives of the EP, the study opens new perspectives for the use of educational strategies for the development of health professionals with focus on attention to individuals with chronic disease

Fundamentos: A insuficiência cardíaca tem uma grande importância como preditor de morbimortalidade em pacientes com síndrome coronariana aguda. Objetivo: Avaliar a ocorrência de insuficiência cardíaca e outros preditores de morbimortalidade na síndrome coronariana aguda em longo prazo. Métodos: Foi estudada uma coorte de 403 pacientes consecutivos e prospectivos, com queixas de dor torácica. Descreveram-se os dados demográficos e as características clínicas e laboratoriais. Comparou-se a estratificação de risco invasiva versus não invasiva, e as diferenças entre o tratamento medicamentoso com o intervencionista avaliando a evolução durante a internação e no período de até oito anos após a alta, em relação aos eventos cardiovasculares, não cardiovasculares e óbitos. Os dados numéricos serão apresentados em médias e desvios-padrão ou mediana e distância interquartílica, os dados categóricos através da porcentagem. Foram utilizados testes de t de Student, teste de Mann-Whitney, teste de qui-quadrado e teste exato de Fisher segundo sua indicação. Para a construção do modelo de sobrevida foram utilizados o teste de Kaplan-Meier e o teste de log-rank; o modelo multivariado foi ajustado utilizando o modelo de Cox. Após realizar a análise de sobrevida de Cox, para garantir o pressuposto do risco proporcional foi utilizado o modelo de Cox estratificado. Todas as análises foram realizadas utilizando o programa R versão 2.9.1. Resultados: População amostral constituída por 403 pacientes com queixas de dor torácica, sendo 65,8% com diagnóstico de SCA sem supra de ST, 27,8% SCA com supra de ST e 6,5% sem SCA. Da população amostral, foram avaliados 377 pacientes, sendo 37,93% do sexo feminino e a média de idade foi de 62,211,6 anos. A creatinina merece destaque como fator prognóstico, sendo o ponto de corte de 1,4mg/dL, com acurácia de 62,1%. Foram ainda observadas diferenças estatisticamente significativas quanto à idade na presença de insuficiência cardíaca; e quanto às terapias utilizadas antes e depois de 2002 em relação à mortalidade. Incluiu-se uma variável adicional no modelo multivariado, que se chamou de FC>PAS, para qualquer frequência cardíaca maior que a pressão arterial sistólica na admissão. Conclusões: A presença de IC na admissão, creatinina inicial >1,4mg/dL, idade e FC dos pacientes internados com SCA são preditores independentes de mortalidade. Observou-se que os pacientes com IC atendidos antes de 2002 apresentaram pior sobrevida do que os pacientes atendidos a partir de 2002 e que a mudança na terapia foi a responsável por isso. Mesmo com a diferença da sobrevida relacionada com a época da internação, o impacto dessas variáveis clínicas e laboratoriais na mortalidade foi semelhante. Outros estudos devem ser realizados a fim de avaliar se condutas diferenciadas para os pacientes com IC na admissão da internação de SCA podem reduzir esta mortalidade. / Background: Heart failure (HF) is extremely important as a morbidity and mortality predictor in patients with acute coronary syndrome. Objective: To assess the occurrence of heart failure and other morbidity and mortality predictors in acute coronary syndrome over the long term. Methods: A cohort of 403 prospective consecutive patients was studied, complaining of chest pain. The demographic data were described, together with the clinical and laboratory characteristics. Invasive versus non-invasive risk stratification was compared, as well as differences between surgical and percutaneous intervention and drug treatment, assessing progression during hospitalisation and for periods of up to eight years after discharge, in terms of cardiovascular and non-cardiovascular events and deaths. The numerical data will be presented as means and standard deviations or as medians and interquartíle distances, with the categorical data shown as percentages. The Students t, Mann-Whitney, chi-square and Fishers exact tests were used as indicated. The Kaplan-Meier and log-rank tests were used to construct the survival model; the multivariate model was adjusted through the Cox model. After conducting the Cox survival analysis in order to underpin the proportional risk assumption, the stratified Cox model was used. All the analyses were conducted through the R Programme, version 2.9.1. Results: In the sample population of 403 patients complaining of chest pain, 65.8% were diagnosed with non-ST elevation ACS, 27.8% with ST elevation ACS, and 6.5% without ACS. In the sample population, 377 patients were assessed, with 37.93% of them women and an average age of 62.211.6 years. Creatinine was particularly noteworthy as a prognostic factor, with a cut-off point of 1.4mg/dL and accuracy of 62.1%. Statistically significant differences were also observed for age with HF and the treatments used before and after 2002 in terms of mortality. An additional variable was included in the multivariate model called the HR>SBP, for any heart rate higher than systolic blood pressure on admission. Conclusion: The presence of HF on admission, with initial creatinine of >1.4mg/dL, age and HR of patients hospitalized with ACS are independent mortality predictors. It was noted that patients with HF treated prior to 2002 presented shorter survival times than HF patients treated after 2002, due to alterations in treatment. Even with the difference in survival times related to the period of hospitalization, the impact of the clinical variables remains significant regardless of the time of hospitalization. Other studies must be conducted in order to assess whether different types of conduct for patients with HF on admission for hospitalization with ACS might lower this mortality rate.

Acute Coronary Syndrome (ACS), whose main pathological substrate is atherosclerosis, constitutes a major cause of morbidity and mortality in the modern world. Physical inactivity, present in 85% of the population, is considered a risk factor for the development of atherosclerosis. This investigation was conducted to determine the degree of physical activity in patients with ACS, using the International Physical Activity Questionnaire (IPAQ), consorting with the in-hospital prognosis. It is an observational and analytical study, using 215 subjects, consecutively, admitted with a diagnosis of ACS in cardiology reference hospital from July 2009 to February 2011. All volunteers answered a short version of IPAQ and were followed regarding the appearance of cardiovascular events (CVE) during hospitalization from standardized assessment administered by the investigator, corroborated with data from medical records. To evaluate the association between physical activity and presence of in-hospital complication, we chose the logistic regression technique to determine the odds ratio adjusted and unadjusted. The patients were admitted with a diagnosis of unstable angina (34.4%), Acute Myocardial Infarction (AMI) without ST elevation (41.4%) and AMI with ST elevation (24.2%), and were classified as sedentary (39.5%), insufficiently active (16.7%), assets (35.8%) and very active (7.9%). From the standpoint of baseline, the sedentary group was older (p = 0.001), showed higher frequency of prior episodes of congestive heart failure (0.01) compared to the others and has higher systolic blood pressure, (p = 0, 05) that group is very active. It was verified the presence of ECV in 49.8% of the sample, with a linear trend in increasing frequency of acute pulmonary edema (p = 0.01), recurrent ischemia (p = 0.03) and atrial fibrillation (p ˂ 0.001), as a decrement in the level of physical activity. The occurrence of in-hospital complication was associated with length of hospitalization (OR = 1.14) and sedentary lifestyle (OR = 5.78), regardless of age, systolic blood pressure and history of congestive heart failure. Therefore, it is concluded that physical inactivity predicts ECV during hospitalization of patients with ACS. / A Síndrome Coronariana Aguda (SCA), cujo principal substrato anatomopatológico é a aterosclerose, constitui uma das principais causas de morbimortalidade do mundo moderno. O sedentarismo, presente em 85% da população brasileira, é considerado fator de risco para o surgimento da aterosclerose. A presente investigação foi conduzida visando determinar o grau de atividade física em portadores de SCA, mediante a utilização do Questionário Internacional de Atividade Física (IPAQ), associando com o prognóstico intra-hospitalar. Trata-se de estudo observacional, transversal e analítico, utilizando-se 215 sujeitos admitidos, consecutivamente, com diagnóstico de SCA em hospital de referência cardiológica no período de julho de 2009 a fevereiro de 2011. Todos os voluntários responderam à versão curta do IPAQ e foram seguidos quanto ao aparecimento de eventos cardiovasculares (ECV) durante o internamento, a partir de avaliação padronizada, administrada pelo pesquisador, corroborada com os dados do prontuário médico. Para avaliar a associação entre nível de atividade física e presença de complicação intra-hospitalar, optou-se pela técnica de regressão logística para determinação da razão de chance ajustada e não ajustada. Os pacientes foram internados com o diagnóstico de: angina instável (34,4%), Infarto Agudo do Miocárdio (IAM) sem supra de ST (41,4%) e IAM com supra de ST (24,2%), sendo classificados como: sedentários (39,5%), insuficientemente ativos (16,7%), ativos (35,8%) e muito ativos (7,9%). Do ponto de vista basal, o grupo de sedentários era mais idoso (p=0,001), exibia maior frequência de episódio anterior de insuficiência cardíaca congestiva (0,01) comparada aos demais integrantes e apresentava pressão arterial sistólica mais elevada (p=0,05) que o grupo de muito ativo. Constatou-se a presença de ECV em 49,8% da amostra, com tendência linear crescente na frequência de edema agudo do pulmão (p=0,01), de isquemia recorrente (p=0,03) e de fibrilação atrial (p˂0,001), conforme decremento do nível de atividade física. A ocorrência de complicação intra-hospitalar esteve associada ao tempo de internamento (OR=1,14) e sedentarismo (OR=5,78), independente da idade, pressão arterial sistólica e passado de insuficiência cardíaca congestiva. Portanto, conclui-se que o sedentarismo prediz ECV durante o internamento de portadores de SCA.

The association between depression and acute coronary syndrome (ACS) is common, but it remains underdiagnosed and undertreated, although there is evidence of influence in the poor outcome. The mechanisms defy scientific knowledge. This study investigated the presence of depression, psychosocial factors associated in ACS and the impact on in-hospital prognosis in patients admitted to the Chest Pain Unit of a referral center for cardiology. In a cohort study, 151 patients with ACS, responded to the Beck Depression Inventory and a clinical survey and were followed until hospital discharge. 51.7% (). The frequency of depression in ACS was 51.7% (95% CI: 57.0 to 72.2). Mild depression, moderate depression, dysthymia and atypical depression were statistically significant. In 13% of cases, depression was installed after the coronary event. Family history of ACS (p = 0.04), history of depression (p = 0.006), childhood trauma (p = 0.001), insomnia (p = 0.01), chronic pain (p = 0.004), irritability easy (p=0,005), trauma in adolescence (p=0,003), trauma in adulthood (p=0,0003), personality disorders with emotional instability (p=0,001) and recent trauma (p=0,004), were significantly higher in patients with depression. In multivariate analysis, independent variables associated with depression were trauma in adolescence (0.004), trauma in adulthood (p = 0.001), easy irritability (p = 0.04) and personality disorders with emotional instability (p = 0.03) and acute myocardial infarction (0.02). In-hospital outcomes, acute pulmonary edema (p = 0.01), reinfarction (p = 0.001), recurrent ischemic events (p = 0.0001) were more frequent in the group with depression. These also showed a longer duration of hospitalization (p = 0.001). Depression (oddis ratio (OR) = 5.93, p <0.0001), and ejection fraction, left ventricular (OR = 0.02; p= 0.01.) were predictive of cardiovascular complications. The results suggest an association between depression and ACS. Depression linked existed before the coronary event. Trauma in adolescents and adults, easy irritability, personality disorder, emotionally unstable were psychosocial variables predictive of depression in ACS. Patients with depression are more prone to cardiovascular events in hospital. Depression is a risk factor for ACS and a marker of poor prognosis and SCA can trigger symptoms of depression. / A associação entre depressão e síndrome coronariana aguda (SCA) é frequente, porém subdiagnosticada, embora haja evidências de influência na pior evolução. Os mecanismos relacionados desafiam o conhecimento científico. Esse trabalho investigou a presença da depressão, fatores psicossociais associados e prognóstico na SCA em pacientes admitidos em um centro de referência em cardiologia. Em uma coorte, 151 pacientes com SCA, responderam ao Inventário Beck de Depressão e a um inquérito clínico, sendo acompanhados até a alta hospitalar. Houve uma frequência de depressão prévia de 51,7% (IC95%: 57,0 - 72,2). Depressão leve, depressão moderada, distimia e depressão atípica tiveram significância estatística. Em 13% dos casos, sintomas de depressão se instalaram após o evento coronariano. Antecedentes familiares de SCA (p=0,04), história prévia de depressão (p=0,006), traumas na infância (p=0,001), insônia (p=0,01), dor crônica (p=0,004), irritabilidade fácil (p=0,005), personalidade com instabilidade emocional (p=0,001), traumas na adolescência (p=0,003), traumas na fase adulta p=(0,0003) e traumas recentes (p=0,004) foram significativamente maior no grupo com depressão (p=0,04). Na análise multivariada, as variáveis independentes associadas à depressão foram: dores crônicas (p=0,001), insônia (p=0,03), traumas na adolescência (0,004), traumas na fase adulta (p= 0,001), irritabilidade fácil (p=0,04), transtorno de personalidade com instabilidade emocional (p=0,03) e infarto agudo do miocárdio prévio (0,02). Na evolução intra-hospitalar, edema agudo de pulmão (p =0,01), reinfarto (p=0,001), eventos isquêmicos recorrentes (p= 0,0001) foram mais frequentes no grupo com depressão. Também estes apresentaram um maior tempo de internamento (p=0,001). Depressão (oddis ratio (OR)=5,93; p<0,0001), e fração de ejeção do ventrículo esquerdo (OR=0,02; .p=0,01.) foram preditoras de complicações cardiovasculares. Os resultados sugerem associação entre depressão e SCA. A depressão associada existia antes do evento coronariano. Traumas no adolescente e no adulto, irritabilidade fácil, transtornos de personalidade com instabilidade emocional foram variáveis psicossociais preditoras de depressão na SCA. Pacientes com SCA e depressão estão mais sujeitos a eventos cardiovasculares intra-hospitalares. A depressão, além de fator de risco para a SCA, é um marcador de pior prognóstico e a SCA pode desencadear sintomas de depressão.

Background: Renal failure (RI) is a common and treatable disease. Its presentation is frequent in patients with coronary artery disease (CAD). Numerous studies have demonstrated significant increases in morbidity and mortality in patients with Acute Coronary Syndrome (ACS) and RI. However, the current prognostic models available for SCA use little of the study of renal function as a predictive and predictive factor. Objectives: To analyze renal function in patients with Acute Coronary Syndrome through creatinine clearance and to evaluate whether there is interference of renal dysfunction in the in-hospital evolution of patients with ACS. Methods: This is a longitudinal and prospective hospital cohort study performed at the Thoracic Pain Unit (UDT) of a private hospital considered a cardiological reference in Sergipe, Brazil. Subjects of both sexes with SCA and hospitalized for investigation and treatment were used during the period from May 2012 to December 2016. A total of 401 patients were included, analyzed for the presence or absence of renal damage, followed up until hospital discharge (or death). Results: The mean age of patients was 65.4 (± 13.0) years with male predominance (58.6%). Of the 324 (80.8%) patients with acute coronary syndrome without ST-segment elevation, 165 (41.1%) were suffering from unstable angina and 159 (39.6%), myocardial infarction without ST. Among the risk factors, hypertension was more prevalent (72.5%) followed by dyslipidemia (53.6%). Regarding the distribution of hospital days, there was a median of 6 days and a mean of 9 (± 12.8) days.The mean creatinine clearance was 80.8 (± 33.6) mL/min/1.73m², in which 241 patients presented with estimated glomerular filtration rate below 90 mL/min/1.73m² (OR= 1.74; CI 95% 1.11-2.71; p= 0.015) was a predictor for events. Conclusion: Patients with acute coronary syndrome and renal failure had a greater number of days of hospitalization when compared to patients without renal injury (IRR 0.9; CI 0.9-0.9; p=0.02). Therefore, assessment of renal function is an important tool for prognostic stratification in patients with ACS. / Fundamentos: A insuficiência renal (IR) é uma enfermidade comum e tratável. Sua apresentação é frequente em pacientes portadores de doença arterial coronariana (DAC). Inúmeros estudos têm demonstrado aumentos expressivos de morbidade e mortalidade em pacientes com Síndrome Coronariana Aguda (SCA) e IR. Contudo, os atuais modelos prognósticos disponíveis para SCA pouco se utilizam do estudo da função renal como fator preditivo e de prognósticos. Objetivos: Analisar a função renal em pacientes com Síndrome Coronariana Aguda através do clearance de creatinina e avaliar se há interferência da disfunção renal na evolução intra-hospitalar dos pacientes com SCA. Métodos: Trata-se de um estudo de coorte hospitalar, longitudinal e prospectivo, realizado na Unidade de Dor Torácica (UDT) de um hospital privado considerado referência cardiológica em Sergipe, Brasil. Foram utilizados sujeitos de ambos os sexos, com quadro de SCA e internados para investigação e tratamento durante o período de maio de 2012 a dezembro de 2016. Foram incluídos 401 pacientes, analisados pela presença ou ausência de lesão renal, acompanhados até a alta hospitalar (ou óbito). Resultados: A média de idade dos pacientes foi de 65,4 (± 13,0) anos com predominância do sexo masculino (58,6%). Dos 324 (80,8%) pacientes que apresentaram síndrome coronariana aguda sem supradesnivelamento do segmento ST, 165 (41,1%) foram acometidos por angina instável e 159 (39,6%), infarto sem supra. Dentre os fatores de risco, a hipertensão arterial sistêmica mostrou-se mais prevalente (72,5%) seguida da dislipidemia (53,6%). Quanto à distribuição dos dias de internamento, observou-se uma média de 9 (± 12,8) dias. A média do clearance de creatinina foi de 80,8 (± 33,6) mL/min/1,73m², em que 241 pacientes apresentaram taxa de filtração glomerular estimada inferior a 90 mL/min/1,73m² (OR= 1,74; IC95% 1,11-2,71; p= 0,015) foi fator preditor para eventos. Conclusão: Pacientes com síndrome coronariana aguda e insuficiência renal apresentaram maior número de dias de internação quando comparados aos pacientes sem lesão renal (IRR 0,9; IC 0,9-0,9; p=0,02). Portanto, a avaliação da função renal é uma importante ferramenta para a estratificação prognóstica em pacientes com SCA. / Aracaju, SE