Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Med Intensiva 2018;42:73-81 - Vol. 42 Num.2 DOI: 10.1016/j.medine.2017.09.002
Original
Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome
Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo
P. Ramos Ruiza, L. Jaulent Huertasa, M. Castañeda Sancirilob, J.J. Martínez Díaza, G. Clavel Ruipéreza, L. García de Guadiana Romualdob, S. Wasniewskia, M. Merelo Nicolása, I. García Escribanoa, F. Soria Arcosa, J.A. Castillo Morenoa, L. Consuegra Sáncheza,,
a Servicio de Cardiología, Hospital Universitario de Santa Lucía, Santa Lucía, Cartagena, Spain
b Servicio de Análisis Clínicos, Hospital Universitario de Santa Lucía, Santa Lucía, Cartagena, Spain
Received 19 May 2017, Accepted 07 September 2017
Abstract
Objective

To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS).

Design and setting

Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months.

Intervention and variables of interest

The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatin C and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge.

Results

A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both p<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5–4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6–2.2), neither other components of the panel.

Conclusions

The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis.

Resumen
Objetivo

Conocer el perfil clínico, así como el significado pronóstico, de la presencia de niveles elevados de hormona paratiroidea (PTH) en pacientes ingresados por síndrome coronario agudo (SCA).

Diseño y ámbito

Estudio observacional y prospectivo de pacientes ingresados por SCA en un único centro español durante un periodo de 6meses.

Intervención y variables de interés

Se determinaron las concentraciones de PTH, calcidiol, calcitriol, NT-proBNP, proteínaC reactiva, cistatinaC y fibrinógeno circulantes en las primeras 48h del ingreso y se realizaron modelos ajustados para predecir muerte o reingreso por SCA tras el alta.

Resultados

Se reclutaron 161 pacientes (edad 67±14años; 75,2% varones) de los cuales 41 (25,5%) presentaron valores elevados de PTH. Se registraron 50 eventos adversos durante un seguimiento de 275 personas-año. Los pacientes con niveles elevados de PTH fueron en mayor proporción mujeres (21,2 vs. 39,0%) y de mayor edad (63,3 vs. 77,8años, ambos p<0,05). Asimismo, presentaron mayor riesgo cardiovascular y una peor evolución en el seguimiento (razón de tasas de incidencia: 2,64; IC 95%: 1,5-4,6). Sin embargo, en un modelo ajustado por la escala GRACE, los niveles de PTH no se mostraron como un factor de riesgo independiente (hazard ratio=1,1; IC 95%: 0,6-2,2); tampoco el resto de componentes del panel.

Conclusiones

La proporción de pacientes con niveles elevados de PTH ingresados por SCA es elevada. Su presencia se asoció con un perfil clínico más adverso y peor evolución durante el seguimiento, aunque no resultó ser un predictor independiente de mal pronóstico.

Keywords
Parathyroid hormone, Acute coronary syndrome, Prognosis
Palabras clave
Hormona paratiroidea, Síndrome coronario agudo, Pronóstico
Med Intensiva 2018;42:73-81 - Vol. 42 Num.2 DOI: 10.1016/j.medine.2017.09.002
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