masterThesis
Proteína c reactiva ultrasensible (PCR-h) en el dolor torácico de probabilidad intermedia para síndrome coronario agudo
Fecha
2009Registro en:
TEME 0016 2009
Autor
Padilla López, Juan Emilio
Institución
Resumen
INTRODUCTION: Chest pain is one of the main causes of admission in cardiology emergency services. It becomes a challenge to correctly classify the patients using a diagnostic tool sufficiently sensitive and specific to establish prognosis and risk. There is a close relationship between the atherosclerotic disease and inflammatory processes; and in the last years the main attention has been focused in the role of plasma markers of inflammation as predictors of risk in cardiovascular events. RCP has been deeply studied in patients with cardiovascular risk factors and in acute coronary syndromes. RCP behaviour is unknown in patients with intermediate risk chest pain.
OBJECTIVES: To determine the usefulness and behaviour of RCP in chest pain patients at intermediate risk of acute coronary syndrome.
MATERIALS AND METHODS: This study was developed in a period of time between June 2008 and February 2009. It was made at an institute cardiology referral center (Fundación Cardio Infantil Bogotá, Colombia); in which 203 patients with chest pain classified as intermediate risk with normal or non diagnostic EKG and negative myocardial injury markers were studied. The patients continued their studies according to the recommendations and international guidelines for chest pain. We took two samples of RCP; a first sample 12 hours before the onset of chest pain (basal) and a second sample of RCP 18 hours after the onset of chest pain. The difference between these two was determined (18 hours RCP Basal RCP). The statistical analysis was made with these results in order to find sensitivity, specificity, positive and negative predictive values; comparing it against induced ischemia proofs and catheterization.
RESULTS: A total of 203 patients were analyzed. The average age was 60.8 +- 11 years. Both genders had a distribution without differences. The associated risk factors were Hypertension 76% (n=155), dyslipidemia 68.1% (n=139), Diabetes Mellitus 20.6% (n=42), Obesity 7.4% (n=15) and smoking 9.3% (n=19). Average hospitalization days were 2.83 +- 2 days. The total of cathetherization procedures was 66 and we found: Normal 27% (n=18), no significant injuries 25.8% (n=17) and obstructive injuries (70%) 47% (n=31). RCP had a low diagnostic utility, finding that 18 hours RCP is the best diagnostic test, with a better behaviour of the ROC curve area of 0.74 (CI 0.64 0.83) with a sensitivity of 16.13% (CI 95%, 1.57-30.69), a specificity of 98,26% (CI 955, 96.01 - 100), a negative predictive value of 86.67% (IC 95%, 81.64 91.69). In the 30 days follow up there were no new hospitalizations because of cardiovascular causes (chest pain, acute coronary syndrome, heart failure and death)
CONCLUSIONS: This research shows a low diagnostic usefulness of RCP in intermediate risk chest pain for significant coronary disease. The best diagnostic behaviour was found in 18 hours RCP with higher specificity and a higher negative predictive value for a RCP > 3 mg/dL, being less useful basal RCP and RCP difference. These findings were not correlated with previous research. A cutoff RCP could not be determined in this study, in contrast with the existing research because of the RCP variability among the study population. The limitation found in our study makes necessary the realization of a multicentric study.