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Modified shock index - a strong preditor of outcome among patients presenting ST-segment elevation myocardial infarction
Get PDFBackground: Prompt identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention will allow a more assertive strategy and approach.
Aim: To evaluate the modified shock index (MSI) - a ratio of heart rate (HR) to mean blood pressure (MAP), as a predictor of in hospital and 6-month mortality among patients (pts) admitted with STEMI.
Methods: We analyzed retrospectively 2389 pts admitted consecutively in our coronary care unit with acute coronary syndrome, from July of 2009 to June 2014 and we selected those who presented with STEMI (n=1140). They were divided in two groups: group 1 – pts with MSI <1.3, n=1076, 94.4%); group 2 – pts with MSI ≥1.3 (n=64, 5.6%). For each group we compared clinical and laboratory features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 99% of patients.
Results: Patients of group 2 were older (62±14 vs 67±14; p=0.003), more frequent women (19% vs 37.5%; p1 (18.0% vs 56.3%; p<0.001), Killip=4 (2.9% vs 28.1%; p<0.001), anaemia (20.9% vs 48.4%; p<0.001) and renal insufficiency (eGFR<60 ml/min) (21.8% vs 42.6%; p<0,001). They also presented more severe coronary disease - left main coronary artery or 3 vessels disease (16.3% vs 31.3%; p=0.005) and higher prevalence of moderate to severe systolic dysfunction (48.3% vs 68.9%; p=0.009). They required more often aminergic support (7.4% vs 50%; p<0.001), intra-aortic balloon pump (2.9% vs 38.3%; p<0.001) and mechanical ventilation (2.6% vs 17.4%; p<0.001). They also had higher prevalence of malignant arrhythmias (6.1% vs 15.6%; p= 0.008) and mechanical complications (1.7 vs 6.3%; p=0.031). Compared with 1st group, the 2nd group had 6.42 times higher in hospital mortality [OR 6.42; 95% CI (4.07 – 12.67)]; p <0.001] and 7.18 times higher 6-month mortality [OR 7.18; 95% CI (3.30 - 12.46)]; p <0.001]. After adjusting for different baseline characteristics in multivariate analysis, MSI ≥1.3 remained as independent predictor of overall 6-month mortality [OR 3.81, 95% CI (1.81-8.03), p<0.001].
Conclusion: Modified shock index ≥1.3 is a stronger predictor of in hospital and 6 month mortality among patients with STEMI
Pelvic mass in a young woman with a background of ovarian dysgerminoma: differential diagnosis
Get PDFValidação da Versão Portuguesa do Questionário EHP-30 (The Endometriosis Health Profile-30)
Get PDFINTRODUCTION:
Endometriosis Health Profile Questionnaire-30 is currently the most used questionnaire for quality of life measurement in women with endometriosis. The aim of this study is to evaluate the psychometric properties and to validate the Portuguese Endometriosis Health Profile Questionnaire-30 version.
MATERIAL AND METHODS:
A sequential sample of 152 patients with endometriosis, followed in a Portugal reference center, were asked to complete a questionnaire on social and demographic features, the Portuguese version of the Endometriosis Health Profile Questionnaire-30 and of the Short Form Health Survey 36 Item â version 2. Appropriate statistical analysis was performed using descriptive statistics, factor analysis, internal consistency, item-total correlation and convergent validity.
RESULTS:
Factorial analysis confirmed the validity of the five-dimension structure of the Endometriosis Health Profile Questionnaire-30 core questionnaire, which explained 83.2% of the total variance. All item-total correlations presented acceptable results and high internal consistency, with Cronbach's alpha ranging between 0.876 and 0.981 for the core questionnaire and between 0.863 and 0.951 for the modular questionnaire. Significant negative associations between similar scales of Endometriosis Health Profile Questionnaire-30 and Short Form Health Survey 36 Item â version 2 were demonstrated. Data completeness achieved was high for all dimensions. The emotional well-being scale in the core questionnaire and the infertility scale in the modular section had the highest median scores, and therefore the most negative impact on the quality of life of participating women.
DISCUSSION:
The test-retest reliability and responsiveness of the questionnaire should be evaluated in future studies.
CONCLUSION:
The present study demonstrates that the Portuguese version of the Endometriosis Health Profile Questionnaire-30 is a valid, reliable and acceptable tool for evaluating the health-related quality of life of Portuguese women with endometriosis