Clinical factors of extension and severity of the coronary disease in patients with acute coronary syndrome

Introduction

The presence of multicoronary artery disease is a predictor of a worse prognosis in patients who suffer from an acute coronary syndrome (ACS). The objective of this study is to identify all clinical factors that are indicative of multicoronary artery disease in those patients who are suffering from an ACS.

Materials and methods

One hundred patients with an ACS, admitted to our CCU, were studied prospectively. Sixty-nine percent presented a non-ST segment elevation myocardial infarction (NSTEMI) and 13% a ST segment elevation myocardial infarction (STEMI). During their hospitalization we registered cardiovascular risk factors; we determined the presence of microalbuminuria (MA) (>3 mg/dl) in a 24-hour urine sample. We also took blood samples in the first 24 hours of their admittance to the CCU for a complete hemogram, levels of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose, HbAc1, high-sensibility C-reactive protein (HS-CRP) and a follow-up of levels of troponin, CK and CK-MB. All patients were submitted to a coronary angiography in the first 72 hours to give a clinical score to their coronary artery disease (disease of one, two or three arteries).

Results

We observed that the antecedents of diabetes mellitus (P = 0.000), hyperlipemia (P = 0.000), arterial hypertension, ischemic heart disease (P = 0.000), ictus (P = 0.000), periphery artery disease (P = 0.000), chronic renal insufficiency (P = 0.000), type of ACS (NSTEMI, P = 0.000), development of cardiac failure during hospitalization (P = 0.000), and lowering of ST segment on EKG (P = 0.025) present a greater extent of coronary artery disease. In the biochemical parameters we found that levels of tropinin, CK and CK-MB were significantly inferior in patients with a more extended coronary artery disease (P = 0.05), and high levels of fibrinogen corresponded to a more severe coronary artery disease (P = 0.03). The levels of HS-CRP and MA did not evidence differences in the severity of coronary artery disease.

Conclusion

By means of numerous clinical factors and biochemical parameters it is possible to determine easily the severity and extension of coronary artery disease of each patient during his/her stay in the CCU.