A incorporação da força de preensão manual ao escore de GRACE melhora sua performance na predição de risco cardiovascular no período de 30 dias após a admissão hospitalar nas síndromes coronarianas agudas sem supradesnivelamento do segmento ST
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2018-07-13
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Universidade Estadual Paulista (Unesp)
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Introdução: A síndrome coronariana aguda sem supradesnivelamento do segmento ST (SCASSST) é responsável por grande parte das hospitalizações, morbidade e mortalidade no mundo. Diversos estudos sugerem que os escores de risco são ferramentas importantes no manejo das SCASSST e que aperfeiçoamento dos mesmos é fundamental. A literatura tem mostrado correlação entre força muscular (FM), fatores de risco cardiovasculares e mortalidade. É sabido que o teste de força de preensão manual (FPM) é indicador de estado geral de força de fácil aplicabilidade, porém pouco estudado no contexto das síndromes coronarianas agudas. Hipótese: A medida de força de preensão manual pode ser preditora de risco cardiovascular, podendo ser incorporada ao escore de GRACE nos pacientes admitidos com SCASSST. Objetivo: Analisar se a incorporação da FPM ao escore de GRACE, por meio do escore GRACE/FPM, melhora sua performance na predição de risco do desfecho combinado mortalidade, recorrência de angina ou infarto, acidente vascular cerebral (AVC) e reinternação em 30 dias após a admissão hospitalar, nos pacientes com SCASSST. Casuística e Métodos: Trata-se de estudo prospectivo e observacional com pacientes admitidos com SCASSST na Unidade de Emergências Cardiológicas e na Unidade de Terapia Intensiva Coronariana de nossa instituição com idade maior ou igual a 18 anos, durante 6 meses. Na admissão, foi calculado o escore de GRACE e realizado o teste de FPM em até 72h da admissão. Foram realizadas análises uni e multivariadas e construída a curva ROC. O nível de significância adotado foi de 5%. Resultados: Foram avaliados 73 pacientes de julho de 2017 a janeiro de 2018. A média da FPM foi menor no grupo de pacientes com doença aterosclerótica documentada (p=0,028) e nos indivíduos que possuíam três ou mais comorbidades relacionadas a risco cardiovascular (p=0,040). Na análise univariada apenas o índice GRACE/FPM foi associado com o desfecho combinado em 30 dias (p=0,026), mantendo sua significância após análise de regressão logística multivariada, ajustada pelo tempo de internação em unidade de dor torácica (p=0,042). O escore de GRACE não apresentou diferença significativa entre os pacientes que tiveram ou não os desfechos estudados. Conclusão: Para populações menores e no período de 30 dias após a admissão hospitalar, o índice GRACE/FPM se mostrou superior ao GRACE na predição de risco de morte, recorrência de angina ou infarto, reinternação e AVC nas SCASSST.
Introduction: Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation (NSTE-ACS) represent a large amount of hospitalizations, morbidity and mortality around the world. Several researches suggest that risk scores are important tools in NSTE-ACS patients management and its improvement is primordial. Literature has shown a correlation between muscle strength, cardiovascular risk factors and death. It is well known that handgrip strength (HGS) is an easily applicable indicator of general muscular strength, but it is poorly studied in the context of ACS. Hypothesis: Handgrip strength measurement would be a good cardiovascular risk predictor and can be incorporated into the GRACE risk score for the patients with NSTE-ACS. Objective: To analyze whether the incorporation of HGS into GRACE risk score, by the score GRACE/HGS, improves its performance in risk predicting of combined outcome death, recurrence of angina or myocardial infarction, stroke and re-hospitalization in 30 days after hospital admission in patients with NSTE-ACS. Methods: This is a prospective and observational study that includes patients admitted with NSTE-ACS in Cardiologic Emergency Unit and in Coronary Intensive Care Unit of our institution aged over 18 years, for 6 months. In admission, GRACE risk score was calculated and HGS was measured within 72 hours of admission. Uni and multivariate analyses were done and ROC curve was built. Significant p value adopted was 5%. Results: 73 patients were studied from july 2017 to January 2018. HGS was lower in the group of patients with proven atherosclerosis (p=0,028) and in those patients who had three or more than three diseases related to cardiovascular risk (p = 0.040). In univariate analyses, only the index GRACE/HGS was associated with combined outcome in 30 days (p=0,026) and it keeps its statistical significance after multiple logistic regression, adjusted by length of chest pain unit stay (p=0,042). GRACE risk score showed no statistical difference between the groups with or without outcomes. Conclusion: For smaller populations and in the period of 30 days after hospital admission, GRACE/HGS index was better than GRACE risk score in risk predicting of death, recurrence of angina or myocardial infarction, stroke and re-hospitalization in 30 days after hospital admission in patients with NSTE-ACS.
Introduction: Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation (NSTE-ACS) represent a large amount of hospitalizations, morbidity and mortality around the world. Several researches suggest that risk scores are important tools in NSTE-ACS patients management and its improvement is primordial. Literature has shown a correlation between muscle strength, cardiovascular risk factors and death. It is well known that handgrip strength (HGS) is an easily applicable indicator of general muscular strength, but it is poorly studied in the context of ACS. Hypothesis: Handgrip strength measurement would be a good cardiovascular risk predictor and can be incorporated into the GRACE risk score for the patients with NSTE-ACS. Objective: To analyze whether the incorporation of HGS into GRACE risk score, by the score GRACE/HGS, improves its performance in risk predicting of combined outcome death, recurrence of angina or myocardial infarction, stroke and re-hospitalization in 30 days after hospital admission in patients with NSTE-ACS. Methods: This is a prospective and observational study that includes patients admitted with NSTE-ACS in Cardiologic Emergency Unit and in Coronary Intensive Care Unit of our institution aged over 18 years, for 6 months. In admission, GRACE risk score was calculated and HGS was measured within 72 hours of admission. Uni and multivariate analyses were done and ROC curve was built. Significant p value adopted was 5%. Results: 73 patients were studied from july 2017 to January 2018. HGS was lower in the group of patients with proven atherosclerosis (p=0,028) and in those patients who had three or more than three diseases related to cardiovascular risk (p = 0.040). In univariate analyses, only the index GRACE/HGS was associated with combined outcome in 30 days (p=0,026) and it keeps its statistical significance after multiple logistic regression, adjusted by length of chest pain unit stay (p=0,042). GRACE risk score showed no statistical difference between the groups with or without outcomes. Conclusion: For smaller populations and in the period of 30 days after hospital admission, GRACE/HGS index was better than GRACE risk score in risk predicting of death, recurrence of angina or myocardial infarction, stroke and re-hospitalization in 30 days after hospital admission in patients with NSTE-ACS.
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síndrome coronariana aguda, força de preensão manual, risco cardiovascular, acute coronary syndrome, Handgrip strength, cardiovascular risk, GRACE score, força muscular, muscular strength