title: Long-term analysis in acute coronary syndrome: are there any differences in morbidity and mortality?
abstract: BACKGROUND
  Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  To evaluate the predictors of morbidity and mortality in ACS in the long term.
  
  
  METHODS
  A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths.
  
  
  RESULTS
  There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality.
  
  
  CONCLUSIONS
  HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it.
authors.affiliation: Universidade do Estado do Rio de Janeiro - Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brazil.
authors.forename: Adolfo Alexandre Farah de
authors.initials: AA
authors.lastname: Aguiar
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mourilhe-Rocha
authors.forename: Roberto
authors.initials: R
authors.lastname: Esporcatte
authors.forename: Liana Amorim
authors.initials: LA
authors.lastname: Corrêa Trotte
authors.forename: Liana Correa
authors.initials: LC
authors.lastname: Amorim
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: Denilson Campos de
authors.initials: DC
authors.lastname: Albuquerque
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D006339:Heart Rate / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D003404:Creatinine