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Resumo Fundamento O infarto do miocárdio com artérias coronárias não obstrutivas (MINOCA) constitui um subconjunto significativo de infartos agudos do miocárdio (IAM) com marcadores prognósticos incertos. A avaliação precoce do risco é crucial para identificar pacientes MINOCA em risco de resultados adversos. Objetivos Este estudo teve como objetivo avaliar a capacidade preditiva do escore PRECISE-DAPT na avaliação do prognóstico de curto e longo prazo em pacientes MINOCA que apresentam infarto do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) ou com supradesnivelamento do segmento ST (IAMCSST). Métodos Entre 741 pacientes MINOCA, o escore PRECISE-DAPT foi calculado para analisar sua associação com eventos cardiovasculares adversos maiores (MACE) intra-hospitalares e de acompanhamento. Os parâmetros que apresentaram significância nos grupos MACEM (+) foram submetidos à análise estatística: regressão logística univariada para eventos intra-hospitalares e regressão univariada de Cox para eventos de seguimento. Para significância estatística, foi adotado nível pré-definido de α = 0,05. Os parâmetros que demonstraram significância foram submetidos à regressão logística múltipla para eventos intra-hospitalares e à regressão multivariada de Cox para eventos de seguimento. Resultados Os MACE intra-hospitalares ocorreram em 4,1% dos pacientes, enquanto 58% apresentaram MACE no acompanhamento. Os níveis de hemoglobina e o escore PRECISE-DAPT foram identificados como parâmetros independentes para MACE intra-hospitalar. Além disso, a fração de ejeção (FE%) e o escore PRECISE-DAPT surgiram como preditores independentes de MACE no acompanhamento. Conclusões O estudo revelou que um escore PRECISE-DAPT mais alto foi significativamente associada a riscos aumentados de eventos cardiovasculares adversos maiores tanto intra-hospitalares quanto de longo prazo em pacientes MINOCA que apresentam síndrome coronariana aguda (SCA), ressaltando o potencial do escore na estratificação de risco para esta coorte de pacientes.

We present a 73-year-old male patient with an unusual complication of a broken coronary stent catheter during percutaneous coronary angioplasty, which was successfully retrieved by balloon trapping and pulling-back method, along with literature review of similar cases.

INTRODUCTION[|]Pathological studies have suggested that local inflammation, particularly eosinophilic infiltration of the adventitia, could be related to nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD). However, the role of systemic inflammation in the pathogenesis of NA-SCAD remains unknown. Our aim was to investigate systemic inflammatory activation in patients with an acute coronary syndrome (ACS) secondary to NA-SCAD.[¤]METHODS[|]The institutional electronic medical database was reviewed, and 22 patients with NA-SCAD-ACS were identified after the review. Furthermore, 30 random patients with CAD-ACS and 30 random subjects without any history of CAD or ACS with demographic and clinical characteristics similar to those of NA-SCAD-ACS patients were identified from the institutional database to be included in the study. [¤]RESULTS[|]Patients with NA-SCAD-ACS and those with CAD-ACS both had higher white blood cell and neutrophil counts than controls. Neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were only significantly higher in the NA-SCAD-ACS group [2.01 (1.54–6.17) for NLR and 0.70 (0.13–2.70) for CRP] than in the controls [1.55 (1.27–2.13), p=0.03 for NLR and 0.15 (0.10–0.43), p=0.049 for CRP]; however, there were no differences between the NA-SCAD-ACS and CAD-ACS groups [1.91 (1.41–2.78) for NLR and 0.41 (0.09–1.10) for CRP, p>0.05 for both comparisons] regarding all tested parameters.[¤]DISCUSSION AND CONCLUSION[|]The degree of inflammatory activation in NA-SCAD-ACS patients was similar to, or even greater than, that in CAD-ACS patients; thus, suggesting a role of inflammation in the pathophysiology of NA-SCAD-ACS.[¤]

Objectives: A new version of the Global Registry of Acute Coronary Events (GRACE) risk score (version 2.0) has been released recently. The purpose of the present study was to assess the validity of GRACE 2.0 for in-hospital and 1-year mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. Methods: The prospective cohort comprised 396 consecutive NSTE-ACS patients admitted to a tertiary hospital between May 2012 and January 2013. The main outcome measure was the discrimination and calibration performance of GRACE 2.0, which were evaluated with the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. Results: In-hospital and 1-year mortality were 2% (8/396) and 12.4% (48/388), respectively. The discrimination performance was inadequate (AUC=0.62) for predicting in-hospital mortality for the overall cohort. Also, the calibration performance for in-hospital mortality could not be evaluated due to the low number of patients who died. At one year, the Hosmer-Lemeshow p-values for all subgroups were >0.05, suggesting a good model fit, and the discrimination performance was good (AUC=0.77) for the overall cohort, driven mainly by better accuracy for low-risk patients. Conclusions: In a contemporary cohort of NSTE-ACS patients, GRACE 2.0 was valid for 1-year mortality assessment. Its value for in-hospital mortality requires validation in a larger cohort. Resumo: Objetivos: Foi recentemente publicada uma nova versão do score de risco do Global Registry of Acute Coronary Events (GRACE). O objetivo do presente estudo consistiu em avaliar a validade da versão GRACE 2,0 em doentes com síndrome coronária aguda sem elevação do segmento ST (NSTE-ACS) internados e mortalidade a um ano. Métodos: A coorte prospetiva compreendeu 396 doentes consecutivos com NSTE-ACS admitidos num hospital terciário entre maio de 2012 e janeiro de 2013. A principal medida do resultado foi a discriminação e o desempenho da aferição da versão 2,0 do estudo GRACE, avaliadas com a área sob a curva característica do recetor (AUC) e com o teste de adesão Hosmer-Lemeshow, respetivamente. Resultados: O internamento e a mortalidade a um ano foram de 2% (8 em 396) e de 12,4% (48 em 388), respetivamente. O desempenho da discriminação foi inadequado (AUC = 0,62) para a previsão da mortalidade intra-hospitalar para a coorte global. Também a avaliação do desempenho da aferição para a mortalidade intra-hospitalar foi inapropriada devido ao reduzido número de mortes. A um ano, os valores–p Hosmer-Lemeshow para todos os grupos foram > 0,05 sugerindo um modelo adequado; e o desempenho da discriminação foi bom (AUC = 0,77) para a coorte global, orientada principalmente por uma melhor precisão para os doentes de baixo risco. Conclusões: Num coorte contemporânea de doentes NSTE-ACS, o estudo GRACE 2,0 foi considerado válido para avaliação da mortalidade a um ano. O seu valor para a mortalidade intra-hospitalar requer validação numa coorte superior. Keywords: Acute coronary syndrome, GRACE risk score, Mortality, Prognosis, Risk assessment, Palavras-chave: Síndrome coronária aguda, Score de risco GRACE, Mortalidade, Prognóstico, Avaliação do risco

Abstract Background: The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF). Methods: In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient. Results: The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis. Conclusion: Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.