Thirty day prognosis of patients with acute pulmonary oedema complicating acute coronary syndromes. Issue 7 (14th June 2005)

• Record Type: Journal Article
• Authors: Figueras, J; Peña, C; Soler-Soler, J
• Is Part Of: Heart. Volume 91:Issue 7(2005)
• Page Start: 889
• Page End: 893
• Publication Date: 2005-06-14
• Subjects: ACS, acute coronary syndromes -- CK, creatine kinase -- LBBB, left bundle branch block -- MI, myocardial infarction -- MR, mitral regurgitation -- NSTEMI, non-ST segment elevation myocardial infarction -- STEMI, ST segment elevation myocardial infarction -- UA, unstable angina; NSTEMI -- prognosis -- STEMI -- unstable angina -- acute pulmonary oedema; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2004.043703
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre. Main outcome and measures: Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated. Results: Non-ST segment elevation myocardial infarction (NSTEMI) was the most frequent cause of acute pulmonary oedema (61%) followed by unstable angina (UA; 21%) and ST segment elevation myocardial infarction (STEMI; 18%). In each group, mean age was ⩾ 70 years, but NSTEMI patients were the oldest and ⩾ 65% of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction (NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease (94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration (158 v 76 μg/l in the NSTEMI group, p < 0.001) and 30 day mortality (26% v 9% in the NSTEMI group and 8% in the UA group, p < 0.024). Multivariate analysis identified ejection fraction < 40% and a peak creatine kinase MB concentration > 100 μg/l as the main prognostic markers (p < 0.03). Conclusions: Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA (82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.