Mário S Rocha

Universidade Federal da Bahia, Bahia, Estado de Bahía, Brazil

Are you Mário S Rocha?

Claim your profile

Publications (8)41.06 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: It is not known in what extent admission glucose improves risk stratification of the GRACE Score in patients with non-ST-segment elevation acute coronary syndromes (ACS). We tested the hypothesis that admission glucose adds relevant prognostic information to the GRACE Score. Consecutive patients admitted with ACS had plasma glucose measured at admission and cardiovascular events were defined as death, non-fatal myocardial infarction or non-fatal refractory angina during hospitalization. Among the 148 patients studied, 11.5% developed cardiovascular events. Patients in the forth quartile of admission glucose (> or =175mg/dl) had a greater incidence of events, compared with those in the first 3 quartiles (22% vs. 8.1%; RR=2.7; 95%CI 1.1-6.4; P=0.03). Plasma glucose remained a predictor of events, after adjustment for diabetes (P=0.03). After adjustment for the GRACE Score, glucose in the forth quartile lost its predictive value (P=0.29). Plasma glucose added to GRACE did not improve the C-statistics (0.82; 95%CI 0.75-0.88), as compared with the original Score (0.81; 95%CI 0.74-0.87). Net reclassification improvement by new score was -0.03 (P=0.86), indicating no useful reclassification. Despite its association with adverse events, admission plasma glucose does not improve GRACE's accuracy to predict in-hospital events in patients with ACS.
    Clinica chimica acta; international journal of clinical chemistry 10/2009; 410(1-2):74-8. · 2.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the setting of acute coronary syndromes, plasma lipids have not been defined as prognostic variables, however little research has been dedicated to this specific issue. In order to test the independent predictive value for in-hospital events of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides measured at hospital admission, 97 individuals with unstable angina or non-ST-elevation acute myocardial infarction were evaluated. In-hospital events, defined as death, non-fatal myocardial infarction or recurrent unstable angina, were significantly predicted by HDL-cholesterol (C-statistics=0.69; 95% CI=0.55-0.83, P=0.018), contrary to LDL-cholesterol (C-statistics=0.40; 95% CI=0.24-0.56, P=0.23) and triglycerides (C-statistics=0.48; 95% CI=0.31-0.65, P=0.83). The best HDL-cholesterol cut-off point was 32 mg/dl, with a 33% incidence of events in patients with HDL-cholesterol < or =32 mg/dl, compared with only 9% in those with HDL-cholesterol>32 mg/dl (P=0.003). Logistic regression analysis showed HDL-cholesterol< or =32 mg/dl (OR=3.6; 95% CI=1.0-14; P=0.05) and TIMI Risk Score (OR=2.3; 95% CI=1.4-2.9, P=0.001) as the independent predictors of events. Furthermore, the addition of HDL-cholesterol to TIMI Risk Score improved its C-statistic from 0.81 to 0.85. In conclusion, as opposed to LDL-cholesterol and triglycerides, HDL-cholesterol level adds prognostic value to the prediction of in-hospital recurrent events during non-ST-elevation acute coronary syndromes.
    International journal of cardiology 08/2008; 136(3):307-14. · 6.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score. Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score. A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, p<0.001). The additional value of the new score is demonstrated by a higher specificity (86% vs. 63%, p<0.001) and positive predictive value (39% vs. 19%) in relation to the TIMI-Risk Score. CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification.
    Clinica Chimica Acta 01/2007; 375(1-2):124-8. · 2.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Both increase and decrease of plasma triglycerides during acute coronary syndromes (ACS) are reported, however, a clinical relevance for these distinct metabolic responses is unclear. To test the association between distinct responses of lipid metabolism and cardiovascular risk, 39 subjects admitted with non-ST elevation ACS within 48 h of presentation had plasma lipids measured on the first and sixth days of hospitalization, and continuous electrocardiogram was performed during the first 2 days to quantify recurrent ischemia and heart rate variability. No lipid-lowering therapy was offered to the patients. During the first 5 days, half of them experimented a decrease in triglycerides (n=19, median: -18 mg/dl) and the other half presented triglyceride increase (n=20, median: +44 mg/dl). A higher incidence of recurrent ischemia (35% versus 5%, P=0.02) and greater ischemic burden/patient (123 +/- 286 mm min versus 47 +/- 212 mm min, P=0.02) were observed in subjects with triglyceride reduction, when compared with those with triglyceride increase. Individuals with heart rate variability below the median presented a median decrease in triglycerides during the 5-day period, as opposed to the counterparts (P=0.05). In conclusion, triglyceride reduction during ACS is associated with a greater incidence of recurrent ischemia and may constitute a sign of higher sympathetic activity.
    Atherosclerosis 12/2004; 177(1):71-6. · 3.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this randomized trial, C-reactive protein increased during the first 5 days of an acute coronary syndrome in patients treated with placebo, but this phenomenon was not observed in those randomized to atorvastatin 80 mg/day. This suggests that short-term statin therapy inhibits inflammation in patients with non-ST-elevation acute coronary syndromes.
    The American Journal of Cardiology 09/2003; 92(3):298-301. · 3.43 Impact Factor
  • The American Journal of Cardiology 07/2003; 91(11):1355-7. · 3.43 Impact Factor
  • The American Journal of Cardiology 08/2002; 90(2):162-4. · 3.43 Impact Factor
  • Journal of the American College of Cardiology 02/1996; 27(2):326-326. · 15.34 Impact Factor