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Predictive factors for all-cause mortality in the hospitalized elderly subject: the importance of arrhythmia.

Atherosclerosis. 2009 Dec;207(2):507-13

Authors: Vesin C, Protogerou AD, Lieber A, Safar H, Iaria P, Ducimetière P, Safar ME, Blacher J

BACKGROUND: In elderly patients traditional cardiovascular (CV) risk factors are poorly correlated with mortality and few data are available on determinants and consequences of supra-ventricular arrhythmia. In a cohort of 331 hospitalized elderly patients (mean age+/-SD=85+/-7 years), we assessed which CV characteristics were associated with all-cause mortality. AIM OF THE STUDY: We wished to determine whether the presence of arrhythmia was associated with an increase of overall mortality in the hospitalized elderly population, and to ascertain which factors were associated with arrhythmia, in order to better understand the underlying mechanisms of both arrhythmia and arrhythmia-related mortality in these patients. RESULTS: The relative hazard for overall mortality in the presence of arrhythmia was 2.40 (95% CI: 1.41-4.07; p<0.001), independent of major confounding factors, compared to sinus rhythm. Both arrhythmia and low DBP were independent predictors of mortality but no association or interaction between arrhythmia and DBP was observed. The left atrium diameter was found to be a predictor of arrhythmia, and when entered in the Cox regression analysis, it suppressed arrhythmia from the model predicting all-cause mortality. CONCLUSION: In the hospitalized elderly, arrhythmia is an independent predictor of all-cause mortality, and left atrium size is an independent predictor of both arrhythmia and mortality, suggesting that links exist. Therapeutic management could therefore focus more on prevention of heart structure remodelling than on traditional risk factors.

PMID: 19493530 [PubMed - indexed for MEDLINE]

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Independent prognostic value of C-reactive protein and coronary artery disease extent in patients affected by unstable angina.

Atherosclerosis. 2008 Feb;196(2):779-85

Authors: Niccoli G, Biasucci LM, Biscione C, Fusco B, Porto I, Leone AM, Bona RD, Dato I, Liuzzo G, Crea F

BACKGROUND: Previous studies have reported conflicting results on the association between C-reactive protein (CRP) and extent of atherosclerosis, suggesting that the association between CRP and outcome in patients with acute coronary syndromes is independent of coronary artery disease extent. We tested this hypothesis in a selected population of patients with unstable angina undergoing coronary angiography. METHODS: Ninety-seven consecutive patients with unstable angina were enrolled in this single-centre study. All patients underwent coronary angiography. CRP was measured by an ultrasensitive nephelometric method. We also measured serum levels of soluble CD40 ligand by ELISA and plasma fibrinogen levels by use of the Clauss method. Atherosclerotic disease severity and extent were assessed by angiography using the Bogaty score. The extent index refers to the proportion of the coronary tree affected by detectable atheroma on angiography. The primary end-point at 6 months was a composite of: (a) death, (b) myocardial infarction, and (c) recurrence of unstable angina requiring hospitalization. Cardiac death was the secondary end-point. RESULTS: No significant correlation was found between baseline CRP serum levels and angiographic measures of atherosclerotic disease severity and extent, whereas a trend for a significant correlation was found between soluble CD40 ligand and extent index (p=0.06). Diabetic patients exhibited a higher extent index compared to non-diabetic patients (0.94+/-0.1 versus 0.7+/-0.04, p=0.04). Predictors of primary end-point at both univariate and multivariate analysis were: extent index (p=0.04 and 0.04, respectively), CRP levels (p=0.05 and 0.02, respectively), and lack of revascularization (p=0.03 and 0.02, respectively). Fibrinogen levels were the only independent predictor of cardiac death at follow-up (p=0.04). CONCLUSION: In this study we demonstrate that in patients with unstable angina, CRP serum levels and coronary atherosclerosis are not correlated, but both are independently associated with a worse outcome at 6-month follow-up.

PMID: 17306806 [PubMed - indexed for MEDLINE]

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