Estratificación de riesgo en el síndrome coronario agudo. Nuevos marcadores de amplia y rápida disponibilidad.

Risk stratification in acute coronary syndromes (ACS) remains a challenge for cardiologist for several reasons: 1) high incidence and prevalence; 2) epidemiologic changes observed in the last years; 3) high morbidity and mortality rates and; 4) recent classification of ACS. In the present study, presented as compilation of published scientific articles, the objectives were: 1. To evaluate the influence of comorbidity (Charlson index) in 30-days and 1-year major events (mortality/reinfarction) after and admission for acute myocardial infarction. 2. To establish the independent association between white blood cells count (WBC) and long term mortality and to determine its functional form for both types of acute myocardial infarction. 3. To determine the prognostic value of renal dysfunction to predict long-term mortality in patients with non-ST-segment acute coronary syndromes (NSTACS). 4. To analyze the presence of a differential prognosis value of renal dysfunction to predict mortality in the presence of heart failure in patients with ST-segment elevation acute myocardial infarction (STEMI). 5. To conclude if myoglobin and troponin determination in patients with NSTACS add incremental prognostic value than isolated troponin determination to predict in-hospital mortality in patients with NSTACS. 6. To create a clinical risk score to stratify the risk in patients with acute chest pain and no troponin elevation and non-ST-segment deviation. Conclusions. 1. Charlson index is strongly associated with 30-days and 1-year major events in patients with STEMI. 2. WBC obtained in the first 24 hours of acute myocardial infarction is independently associated with long-term mortality in STEMI and non-STEMI patients. 3. Renal dysfunction estimates, are independently associated with 1-year mortality in NSTACS and STEMI patients. 4. In STEMI patients, renal dysfunctions estimates show a higher risk trend in patients with no heart failure, meanwhile a lower risk trend is observed in patients with heart failure on admission. 5. In NSTACS, the elevation of myoglobin and troponin exhibit a higher 30-days mortality risk than isolated troponin elevation. 6. In patients with acute chest pain and no troponin elevation and non-ST segment deviation, variables as: 2 or more episodes of chest pain in the prior 24 hours, a typical chest pain, age higher than 67 years, insulindependent diabetes and previous percutaneous interventions were positively related with major 1-year events.