title: [The prognostic value of hyperglycemia, leukocytosis and decreased glomerular filtration rate in acute coronary syndromes--pharmacological protection capabilities].
abstract: The evaluation of the risk of complications and death from cardiovascular causes is conducted in all patients with acute coronary syndromes (ACS) using a variety of methods. The assessment of the risk of cardiovascular events, including also death, the cause of which are cardiovascular diseases, is a very important and essential part of clinical evaluation. Moreover, all patients with ACS are assessed as regards the risk of complications and in-hospital mortality and the short- and long-term patient outcomes. Recently, in the prognostic assessment of ACS patients attention has been paid to hyperglycemia, leukocytosis, and decreased GFR, which might worsen the prognosis. Hyperglycemia on admission and especially its occurrence and persistence during hospitalization speak for particularly poor prognosis. Furthermore, the annual and long-term mortality rate is observed to increase with the higher HbA1c level, regardless of the glucose concentration on admission to hospital. Increased risk of the occurrence of cardiovascular events is observed with the intensity of the inflammation which is reflected, among others, in elevated number of peripheral blood leukocytes. Attention is drawn to the higher rate of complications in patients with increased baseline leukocytosis. The correlation between the increase in leukocyte count and all-cause mortality is statistically significant. A higher risk of non- fatal myocardial infarction is also observed with the increase of leukocytosis. Neutrophils, which are the main pool of white blood cells, and whose activation is observed during PCI, may play a role in these unfavorable phenomena. This activation results in increased production of oxygen free radicals by these cells, intensification of adhesion and aggregation. A number of studies point to the cardioprotective mechanism of action of statins (anti-inflammatory and anti-thrombotic) in patients with ACS. The use of leukocyte reduction filters in patients during CABG may be one of the methods limiting the impact of leukocytosis on cardiovascular events in patients with ACS. Renal failure is a strong and independent predictor of mortality in patients with ACS. Contrast-induced nephropathy is a complication following coronarography which is performed in patients with ACS for diagnostic and therapeutic purposes. Hyperglycemia also has an adverse effect on this complication. The prevention of contrast-induced nephropathy includes the use of statins prior to PCI.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Obrebska
authors.forename: Jan
authors.initials: J
authors.lastname: Kowalski
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015897:Comorbidity; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006943:Hyperglycemia / Q000453:epidemiology*; D007964:Leukocytosis / Q000453:epidemiology*; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors