Examinando por Materia "Prognosis"
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- PublicaciónAcceso abiertoHyperglycaemia is associated with worse outcomes in Latin-American individuals with acute myocardial infarction(2016) Gómez Arbeláez, Diego; Sánchez Vallejo, Gregorio; Pérez, Maritza; García, Ronald G.; Arguello, Jhon Freddy; Peñaherrera, Ernesto; Duarte, Yan Carlos; Casanova, Maria Eugenia; Accini, Jose Luis; Sotomayor Rubio, Aristides; Camacho López, Paul Anthony; Lopez-Jaramillo, PatricioIntroducción Las alteraciones en el metabolismo de la glucosa son un factor de riesgo y de peor pronóstico para infarto agudo de miocardio (IAM), pero esta información en población latinoamericana es limitada. Por tanto, evaluamos la asociación del estado glucémico con desenlaces a corto y largo plazo en pacientes con un primer IAM. Métodos Estudio observacional de cohorte, multicéntrico, prospectivo, conducido en 8 hospitales de Colombia y Ecuador. Resultados Se incluyeron en total 439 pacientes con diagnóstico confirmado de IAM, de los cuales 305 (69,5%) presentaron prediabetes o diabetes mellitus tipo 2 (DM2). En comparación con el grupo de normoglucemia, los pacientes con DM2 conocida presentaron mayor riesgo de estancia hospitalaria prolongada (HR: 2,60, IC 95%: 1,38-4,92, p = 0,003), de Killip clase iii/iv (HR: 9,46, IC 95%: 2,20-40,62, p = 0,002) y de insuficiencia cardiaca intrahospitalaria (HR: 10,76, IC 95%: 3,37-34,31, p < 0,001). Los pacientes con prediabetes, DM2 conocida y DM2 nueva tuvieron tasas más altas de episodios adversos cardiovasculares mayores en el seguimiento a 3 años. Conclusión Alteraciones en el metabolismo de la glucosa tienen una importante significación pronóstica a corto y a largo plazo en pacientes latinoamericanos sobrevivientes a un primer IAM.
- PublicaciónAcceso abiertoHyperinsulinemia is a predictor of new cardiovascular events in colombian patients with a first myocardial infarction(2011-04-01) García, Ronald G.; Rincón, Melvin Y.; Arenas, William D.; Silva, Sandra Y.; Reyes, Laura M.; Ruiz, Silvia L.; Ramírez, Fabián; Camacho López, Paul Anthony; Luengas, Carlos; Saaibi, José F.; Balestrini, Sebastián; Morillo, Carlos; Lopez-Jaramillo, PatricioBackground: Acute Myocardial Infarction (AMI) is one of the main causes of mortality and disability in Colombia. The factors associated to a new event in surviving subjects to a first AMI in our population have not yet been fully identified. Methods: Two hundred and ninety five surviving subjects to a first AMI (58.8±12.6 years) were included in a prospective cohort study between 2000 and 2006. Lipid profile, glycemia and plasma insulin levels were measured. Deaths of cardiovascular origin, a new AMI, unstable angina, heart failure, stroke, new myocardial revascularization or angioplasty were considered new cardiovascular events. Results: The study included 61 (20.6%) women and 234 (79.4%) men. The mean follow up time was 50± 30 months with a 38.9% incidence of new events. Fifty five patients (18.6%) were diabetic. Bi-varied analysis identified as risk factors for a new cardiovascular event the presence of: hypertension, anterior descending coronary artery stenosis, intrahospital cardiac failure, age over 55, low income, lack of education, Killip III–IV, heart rate over 76 bpm, pulse pressure over 80 mm Hg, total cholesterol over 200 mg/dl and insulin over 10 IU/ml. After logistic regression analysis, the log values of insulin remained as the only significant predictor for new cardiovascular events. Conclusions: Hyperinsulinism was the most important factor associated to the occurrence of new cardiovascular events in Colombian patients with AMI, which emphasizes the pivotal role of insulin resistance in the physiopathologic mechanisms of atherosclerosis, especially in undeveloped countries.
- PublicaciónRestringidoPeripheral Blood MCEMP1 Gene Expression as a Biomarker for Stroke Prognosis(2016-01-12) Lopez-Jaramillo, Patricio; Raman, Kripa; O’Donnell, Martin J.; Czlonkowska, Anna; Duarte, Yan Carlos; Peñaherrera, Ernesto; Sharma, Mike; Shoamanesh, Ashkan; Skowronska, Marta; Yusuf, Salim; Paré, GuillaumeBackground and Purpose—A limitation when making early decisions on stroke management is the lack of rapid diagnostic and prognostic testing. Our study sought to identify peripheral blood RNA biomarkers associated with stroke. The secondary aims were to assess the discriminative capacity of RNA biomarkers for primary stroke type and stroke prognosis at 1-month. Methods—Whole-blood gene expression profiling was conducted on the discovery cohort: 129 first-time stroke cases that had blood sampling within 5 days of symptom onset and 170 control participants with no history of stroke. Results—Through multiple regression analysis, we determined that expression of the gene MCEMP1 had the strongest association with stroke of 11181 genes tested. MCEMP1 increased by 2.4-fold in stroke when compared with controls (95% confidence interval, 2.0–2.8; P=8.2×10−22). In addition, expression was elevated in intracerebral hemorrhage when compared with ischemic stroke cases (P=3.9×10−4). MCEMP1 was also highest soon after symptom onset and had no association with stroke risk factors. Furthermore, MCEMP1 expression independently improved discrimination of 1-month outcome. Indeed, discrimination models for disability and mortality that included MCEMP1 expression, baseline modified Rankin Scale score, and primary stroke type improved discrimination when compared with a model without MCEMP1 (disability Net Reclassification Index, 0.76; P=3.0×10−6 and mortality Net Reclassification Index, 1.3; P=1.1×10−9). Significant associations with MCEMP1 were confirmed in an independent validation cohort of 28 stroke cases and 34 controls. Conclusions—This study demonstrates that peripheral blood expression of MCEMP1 may have utility for stroke diagnosis and as a prognostic biomarker of stroke outcome at 1-month.