title: [Influence of the combination of antiplatelet agents on the occurrence of early left ventricular insufficiency in patients with acute coronary syndromes without persistent ST-segment elevation].
abstract: OBJECTIVE
  The frequency of left ventricular failure (LVF) in the early stages of non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been described so far. The objective of this study is to describe for the first time the frequency of LVF in the early course of NSTE ACS and to assess its association with other interventions.
  
  
  METHODS
  Observational prospective cohort multicenter study in intensive and coronary care units (ICCU). Patients with NSTE ACS admitted within 24h after onset were included. Main outcome was the occurrence of LVF. We evaluated the association between LVF and clinical and therapeutic variables.
  
  
  RESULTS
  LVF occurred in 15.6% of patients. Coronary angiography (CA) during admission to the ICCU was a protective variable against the main outcome, performed before 72h (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.25-0.89; P=.022) and later (OR 0,39; 95% CI 0,15-0,98; P=.044). The administration of beta-blockers was a protective variable against the occurrence of LVF (OR 0,54; 95% CI 0,32-0,87; P=.013). Patients receiving acetylsalicylic acid before admission to the ICCU had a higher risk of developing LVF (OR 1.74; 95% CI 1.06-2.86; P=.028). Age was also a factor of risk for LVF (OR 1.02; 95% CI 1.00-1.05; P=.032).
  
  
  CONCLUSIONS
  CA and beta-blockers can decrease the occurrence of LVF. The association between previous administration of acetylsalicylic acid and age with the occurrence of LVF may reflect long-standing cardiovascular disease.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España. Electronic address: rafael.blancas@salud.madrid.org.
authors.forename: Rafael
authors.initials: R
authors.lastname: Blancas Gómez-Casero
authors.affiliation: Departamento de Urgencias, Hospital Universitario La Paz, Madrid, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana Díaz
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Miriam
authors.initials: M
authors.lastname: Chana García
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martín Parra
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Blanca
authors.initials: B
authors.lastname: López Matamala
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Belén
authors.initials: B
authors.lastname: Estébanez Montiel
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ballesteros Ortega
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Oscar
authors.initials: O
authors.lastname: Martínez González
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario del Tajo, Aranjuez, Madrid, España.
authors.forename: Dolores
authors.initials: D
authors.lastname: Vigil Escribano
authors.affiliation: Servicio de Medicina Intensiva, Hospital de Santa Bárbara, Puertollano, Ciudad Real, España.
authors.forename: Francisca
authors.initials: F
authors.lastname: Prieto Valderrey
authors.affiliation: Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Marina Martínez
authors.affiliation: Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España.
authors.forename: Olmos
authors.initials: O
authors.lastname: Castro Gallego
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D013988:Ticlopidine; D001241:Aspirin
keywords: Cardiogenic shock; Clopidogrel; Insuficiencia ventricular izquierda; Left ventricular failure; Non-ST-segment elevation acute coronary syndrome; Shock cardiogénico; Síndrome coronario agudo sin elevación del segmento ST; Tirofiban; Tirofibán