Original article
High-sensitivity C-reactive protein predicts adverse outcomes after non-ST-segment elevation acute coronary syndrome regardless of GRACE risk score, but not after ST-segment elevation myocardial infarction
O valor do teste de alta sensibilidade da proteína C-reativa como preditor de resultados adversos em doentes com síndrome coronária aguda
Sergio Raposeiras Roubína,
, Cristina Barreiro Pardalb, Filomena Roubín-Camiñac, Raymundo Ocaranza Sancheza, Ezequiel Álvarez Castroa, Beatriz Paradela Dobarroa, Jose María García-Acuñaa, Pablo Aguiar Soutoa, Michel Jacquet Herveta, Maria José Castromána, Isabel Arufea, Belén Outesa, María Victoria Reino-Maceirasa, Emad Abu Assia, José Ramón González-Juanateya
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"aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Cardiology, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Anethesiology, Montecelo Hospital, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Laboratory Unit, Meixoeiro Hospital, Vigo, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O valor do teste de alta sensibilidade da proteína C-reativa como preditor de resultados adversos em doentes com síndrome coronária aguda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1535 "Ancho" => 1562 "Tamanyo" => 67469 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve for high-sensitivity C-reactive protein in predicting follow-up outcomes (cardiac death and re-infarction). Area under the curve: 0.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0035" class="elsevierStylePara elsevierViewall">Inflammation plays a pivotal role in the pathogenesis of atherosclerosis and its complications. In particular, atherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> C-reactive protein (CRP) is an acute phase protein that appears in the circulation in response to inflammatory cytokines, such as interleukin-6, and serves as a biomarker for systemic inflammation.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> There are also increased concentrations of acute-phase serum reactants such as CRP in patients with ACS.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The high-sensitivity CRP (hsCRP) assay is increasingly used as a marker for cardiac risk assessment and as a prognostic tool in heart disease.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> The aim of this study was to analyze the prognostic value of hsCRP values to predict follow-up outcomes in ACS patients regardless of the GRACE (Global Registry of Acute Coronary Events) risk score.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population</span><p id="par0045" class="elsevierStylePara elsevierViewall">We included 151 consecutive patients admitted to the coronary care unit with a diagnosis of ACS. Patients with previous ACS, peripheral arterial disease and impaired renal function (estimated glomerular filtration rate by the MDRD-4 equation <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) were excluded. We also excluded patients under treatment with anti-inflammatory drugs and those with concomitant inflammatory diseases, cancer, or other significant heart disease. The study was approved by the ethics committee of the University Clinical Hospital of Santiago de Compostela, and all patients gave their written informed consent to participate.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study design</span><p id="par0050" class="elsevierStylePara elsevierViewall">All patients were treated invasively by catheterization. The use of beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, antiplatelets, diuretics and inotropic drug support was left to the discretion of the coronary care unit cardiologists according to our clinical protocols based on international guidelines. For each patient we estimated the risk of follow-up mortality and coronary events according to the 6-month mortality GRACE score.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Complete clinical data and blood samples for laboratory measurements were collected on admission. We performed an echocardiographic evaluation of left ventricular ejection fraction (LVEF) in all subjects within 24<span class="elsevierStyleHsp" style=""></span>hours of admission. Serum hsCRP levels were measured on admission.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Definitions and endpoints</span><p id="par0055" class="elsevierStylePara elsevierViewall">The ACS diagnosis was validated if the patient met any of the following criteria: new-onset angina with cardiac biomarkers above the highest normal laboratory limit, ST-segment deviation on the electrocardiogram, in-hospital stress testing showing ischemia, or a known history of coronary disease. Patients were classified as having myocardial infarction with ST-segment elevation (STEMI) or non-ST-segment elevation ACS (NSTE-ACS) (unstable angina or non-ST elevation myocardial infarction). Diabetes was defined as increased fasting plasma glucose concentration of ≥126<span class="elsevierStyleHsp" style=""></span>mg/dl, HbA1c of ≥6.5%, or treatment with insulin or hypoglycemic agents. Hypertension was defined as systolic/diastolic blood pressure<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>140/90<span class="elsevierStyleHsp" style=""></span>mmHg or current use of any antihypertensive medication. LVEF<span class="elsevierStyleHsp" style=""></span><45% was considered to be depressed.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The primary endpoint was the combination of cardiac death and myocardial reinfarction during the follow-up period (median 19.8 months, interquartile range 16.3–23.7 months). Reinfarction was defined as the appearance of new symptoms of myocardial ischemia or electrocardiographic ischemic changes accompanied by re-elevation of cardiac biomarkers (high-sensitivity troponin I).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Determination of CRP</span><p id="par0065" class="elsevierStylePara elsevierViewall">Blood samples were stored in evacuated tubes at −20<span class="elsevierStyleHsp" style=""></span>°C and were processed within 24<span class="elsevierStyleHsp" style=""></span>hours by automated microparticle immunoassay (ELISA). The CRP detection range corresponds to values of 0.1–12.0<span class="elsevierStyleHsp" style=""></span>mg/dl, with an interassay variation coefficient of <5% (normal values<span class="elsevierStyleHsp" style=""></span><0.3<span class="elsevierStyleHsp" style=""></span>mg/dl).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">All information was prospectively recorded in a database created with Microsoft Office Access 2007. The statistical analyses were performed with SPSS (Statistical Package for the Social Sciences) version 17.0. Categorical or dichotomous variables are expressed as absolute values and percentages, and were compared with Pearson's chi-square test. Continuous variables with a normal distribution are expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, and the Student's <span class="elsevierStyleItalic">t</span> test was used for comparisons between groups. Continuous variables without normal distribution are expressed as median and interquartile range. Pearson's test was used to study the correlation between quantitative variables. A multivariate logistic regression model was used to evaluate the independent contribution of hsCRP levels to the risk of new events during follow-up. Univariate predictors of potential significance and hsCRP values were included in multivariate analysis (backward stepwise Cox proportional hazard analysis). Adjusted hazard ratios and 95% confidence intervals (CI) are presented. Kaplan–Meier curves were constructed to evaluate the prognostic value of hsCRP during follow-up. A p value<span class="elsevierStyleHsp" style=""></span><0.05 was considered statistically significant.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Baseline characteristics</span><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the baseline characteristics of the population. CRP values (median and 25–75% interquartile range) on admission were 0.9 (0.3–1.9)<span class="elsevierStyleHsp" style=""></span>mg/dl. Of the patients recruited, 80 had STEMI. Although hsCRP values were higher in patients with STEMI (2.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.2<span class="elsevierStyleHsp" style=""></span>mg/dl), there was no statistically significant difference compared with NSTE-ACS patients (1.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.9<span class="elsevierStyleHsp" style=""></span>mg/dl, p=0.161).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Correlation with in-hospital events</span><p id="par0080" class="elsevierStylePara elsevierViewall">During the follow-up period, 18 (11.9%) patients presented cardiac events (six cardiac deaths, 11 re-infarctions). These patients had a higher percentage of diabetes, higher Killip functional class, greater proportion of depressed LVEF and higher GRACE risk score. The occurrence of follow-up events was significantly related to admission hsCRP level, which was an excellent predictor of cardiac death and re-infarction during follow-up (HR 1.091, 95% CI 1.014–1.174; p=0.019). Stratifying the population based on type of ACS, we found that hsCRP predicted outcome only in the NSTE-ACS group (HR 1.174, 95% CI 1.076–1.280; p=0.004), not in patients with STEMI (HR 0.999, 95% CI 0.859–1.163; p=0.990). Likewise hsCRP and GRACE risk score at discharge showed a significant positive correlation (r=0.226, p=0.005) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In ROC analysis, the area under the curve for hsCRP in predicting follow-up outcomes was 0.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.05. The best cutoff level of hsCRP was 1.1<span class="elsevierStyleHsp" style=""></span>mg/dl, with sensitivity of 77.8% and specificity of 63.2% (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the Kaplan–Meier survival curves according to hsCRP levels above and below this cutoff (1.1<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Multivariate analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">In our model (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), adjusted by variables associated with cardiac events (hsCRP, diabetes, depressed LVEF and GRACE risk score), hsCRP (as a continuous variable) was an independent predictor of follow-up outcomes only in NSTE-ACS patients (HR 1.217, 95% CI: 1.093–1.356, p<0.001).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">In this single-center study we showed that hsCRP was significantly associated with adverse follow-up outcomes in patients with NSTE-ACS, independently of GRACE risk score, but not in patients with STEMI.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Many studies have assessed the prognostic value of CRP in the hospital phase of ACS.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a> However, fewer studies have examined its prognostic value in follow-up, and very few have investigated its prognostic role over the entire spectrum of ACS patients, classified as NSTE-ACS or non-STEMI.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The hypothesis that inflammatory reactions promote plaque fissuring, erosion, ulceration, and rupture of the plaque surface should in most cases be applicable to both settings of ACS.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">13,14</span></a> They may share the same underlying pathophysiologic processes, with coronary plaque disruption and consequent platelet aggregation and thrombosis. However, the differences found in our study between the two types of ACS were in agreement with previous studies in which hsCRP was a predictor of negative outcome, especially in patients with unstable angina and non-STEMI. Kuch et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">15</span></a> reported data on an unselected sample of patients with myocardial infarction admitted to a community hospital, showing that CRP was significantly associated with adverse short-term outcome. Their multivariate analysis showed that both troponin positivity and CRP positivity were associated with a 2-fold increased risk of dying within 28 days after the acute event for all patients with myocardial infarction. Stratifying by myocardial infarction type showed that in patients with STEMI, troponin positivity, but not CRP positivity, independently predicted 28-day case fatality, while in patients with non-STEMI, CRP positivity, but not troponin positivity, predicted outcome. They concluded that admission CRP is a powerful parameter for risk stratification of patients with myocardial infraction, with better stratification in patients with non-STEMI.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Morrow et al., using a cutoff of 1.5<span class="elsevierStyleHsp" style=""></span>mg/dl (similar to ours), observed that elevated CRP at admission was associated with higher mortality at 14 days. Schoos et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> demonstrated that preprocedure hsCRP is an independent and strong predictor of a composite endpoint of death, nonfatal recurrent myocardial infarction, and stent thrombosis after percutaneous intervention with coronary stent implantation. Abbate et al. confirmed the prognostic value of CRP in predicting short- and long-term outcomes after ACS. Our group has shown that hsCRP was a predictor of adverse outcomes in the in-hospital phase of ACS independently of GRACE risk score. However, to date, no studies have analyzed the follow-up prognostic value of hsCRP regardless of GRACE risk score at discharge.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There is an intracardiac inflammatory response in ACS that appears to be the result of the evolution of myocardial necrosis, as shown by higher CRP, TNFα and IL-6 levels in patients with major adverse cardiac events. Patients with ACS and higher CRP may represent a group with hyperresponsiveness of the inflammatory system, which might exaggerate the acute-phase reaction and increase immune system activation, which may in turn mediate myocardial damage and promote cardiac complications.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–20</span></a> This may be more pronounced in patients with NSTE-ACS than in those with STEMI, due to a higher atherosclerotic burden.</p><p id="par0120" class="elsevierStylePara elsevierViewall">hsCRP measurement, as a marker of inflammatory activity, has several advantages. Firstly, it is a stable compound and secondly, it can be measured at any time of day without regard for the biological clock, since unlike measurements of cytokines such as IL-6, no circadian variation appears to exist for hsCRP.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">Although the GRACE risk score is routinely used for stratification of patients with acute coronary syndrome, assessment of hsCRP may provide additional prognostic value. High hsCRP values were an independent and strong predictor of a composite endpoint of death and nonfatal recurrent myocardial infarction. These findings highlight the importance of determining levels of this biomarker for risk stratification of these patients during follow-up.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres177655" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec166309" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres177654" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusão" ] ] 3 => array:2 [ "identificador" => "xpalclavsec166308" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Definitions and endpoints" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Determination of CRP" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Correlation with in-hospital events" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Multivariate analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0070" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack45566" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-05-12" "fechaAceptado" => "2012-05-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec166309" "palabras" => array:3 [ 0 => "High-sensitivity C-reactive protein" 1 => "Acute coronary syndrome" 2 => "GRACE risk score" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec166308" "palabras" => array:3 [ 0 => "Elevada sensibilidade de proteína C-reativa" 1 => "Síndrome coronária aguda" 2 => "<span class="elsevierStyleItalic">Score</span> de risco GRACE" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS). C-reactive protein (CRP) is an acute phase protein that appears in the circulation in response to inflammatory cytokines. The present study investigated the association between high-sensitivity C-reactive protein (hsCRP) on admission and follow-up prognosis after an ACS.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included 151 consecutive patients admitted to the coronary care unit with a diagnosis of ACS (47% ST-segment elevation myocardial infarction [STEMI]). The primary endpoint was the combination of cardiac death and myocardial reinfarction during the follow-up period (median 19.8 months, interquartile range 16.3–23.7 months).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The occurrence of follow-up events was significantly related to admission hsCRP level, which was an excellent predictor of cardiac death and reinfarction during follow-up (HR 1.091, 95% CI 1.014–1.174; p=0.019). Stratifying the population based on type of ACS, adjusted by variables associated with cardiac events in univariate analysis (hsCRP, diabetes, depressed ejection fraction and GRACE risk score), hsCRP proved to be an independent predictor of follow-up outcomes only in non-STEMI patients (HR 1.217, 95% CI: 1.093–1.356, p<0.001), not in STEMI patients. The best cutoff level of hsCRP to predict follow-up outcomes was 1.1<span class="elsevierStyleHsp" style=""></span>mg/dl, with sensitivity of 77.8% and specificity of 63.2%.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Although the GRACE risk score is routinely used for stratification of patients with ACS, assessment of hsCRP may provide additional prognostic value in the follow-up of non-STEMI patients.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A aterosclerose é um processo ativo e a sua componente inflamatória parece estar particularmente relacionada com o desenvolvimento de síndromes coronárias agudas (SCA). A proteína C-reativa (PCR) é uma proteína que aparece na circulação, na fase aguda do processo inflamatório. O presente estudo teve como objetivo analisar a associação entre o valor do teste de alta sensibilidade da proteína C-reativa (PCR-as) na admissão, com o prognóstico no seguimento, em doentes pós-SCA.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 151 doentes consecutivos, internados na unidade de cuidados coronários, com diagnóstico de SCA (47% com enfarte agudo do miocárdio com elevação do segmento ST – STEMI). O <span class="elsevierStyleItalic">end-point</span> estudado foi a variável composta pela morte associada a patologia cardíaca e re-enfarte miocárdio durante o período de seguimento (mediana de 19,8 meses, intervalo interquartil 16,3-23,7 meses).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A ocorrência de eventos apresentou uma forte relação com o valor de CPR-as registado na admissão, sendo por isso considerado como um bom preditor para a ocorrência de morte associada a patologia cardíaca e a re-enfarte no período de seguimento de doentes pós-SCA (HR 1,091, CI 95% 1,014-1,174; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,019). Após estratificação da população pelo tipo de SCA e ajustando as variáveis associadas à ocorrência de eventos cardíacos (análise univariada das variáveis valor de PCR-as, diabetes <span class="elsevierStyleItalic">mellitus</span>, fração de ejeção deprimida e <span class="elsevierStyleItalic">score</span> de risco GRACE), o valor de PCR-as destacou-se como preditor independente no seguimento dos doentes com EAM sem elevação ST (HR 1,217, IC 95%: 1,093-1,356, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). O valor de <span class="elsevierStyleItalic">cut-off</span> para o nível de PCR-as preditor foi de 1,1<span class="elsevierStyleHsp" style=""></span>mg/dl, com uma sensibilidade de 77,8% e uma especificidade de 63,2%.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Apesar de o <span class="elsevierStyleItalic">score</span> de risco GRACE ser utilizado, por rotina, para estratificar os doentes com SCA, a medição do valor de PCR-as pode acrescentar valor prognóstico no seguimento de doentes com EAM sem elevação e ST.</p>" ] ] "nomenclatura" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleSectionTitle">Abbreviations</span>" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:6 [ 0 => array:2 [ "termino" => "ACS" "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>" ] 1 => array:2 [ "termino" => "CRP" "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">C-reactive protein</p>" ] 2 => array:2 [ "termino" => "hsCRP" "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">high-sensitivity C-reactive protein</p>" ] 3 => array:2 [ "termino" => "LVEF" "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>" ] 4 => array:2 [ "termino" => "NSTE-ACS" "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">non-ST-elevation acute coronary syndrome</p>" ] 5 => array:2 [ "termino" => "STEMI" "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">ST-elevation myocardial infarction</p>" ] ] ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1278 "Ancho" => 1583 "Tamanyo" => 104382 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Positive correlations between 6-month mortality GRACE risk score and high-sensitivity C-reactive protein levels (r=0.226, p=0.005). hsCRP: high-sensitivity C-reactive protein.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1535 "Ancho" => 1562 "Tamanyo" => 67469 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve for high-sensitivity C-reactive protein in predicting follow-up outcomes (cardiac death and re-infarction). Area under the curve: 0.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3083 "Ancho" => 1583 "Tamanyo" => 156500 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier survival curves according to high-sensitivity C-reactive protein cutoff level of 1.1<span class="elsevierStyleHsp" style=""></span>mg/dl. NSTE-ACS: non-ST-elevation acute coronary syndrome; STEMI ST-elevation myocardial infarction.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ACEIs: angiotensin-converting enzyme inhibitors; ARBs: angiotensin receptor blockers; hsCRP: high-sensitivity C-reactive protein; LVEF: left ventricular ejection fraction; PCI: percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">All patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cardiac events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non-cardiac events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.095 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Female</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.416 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Diabetes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Hypertension</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.308 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">STEMI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.787 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Killip<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>I</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LVEF<span class="elsevierStyleHsp" style=""></span><45%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Multivessel disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.124 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">PCI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.771 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Troponin I (ng/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>81.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>26.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.151 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">hsCRP (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">GRACE risk score</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>32.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>28.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Discharge therapy</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aspirin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.248 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clopidogrel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.715 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.395 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACEIs/ARBs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.549 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.448 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272088.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics and comparison between groups with and without cardiac events.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">hsCRP: high-sensitivity C-reactive protein; LVEF: left ventricular ejection fraction; NSTE-ACS: non-ST-elevation acute coronary syndrome; STEMI: ST-elevation myocardial infarction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NSTE-ACS</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">STEMI</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.134 (0.231–5.567) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.877 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.079 (1.407–22.914) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF<span class="elsevierStyleHsp" style=""></span><45% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.514 (0.287–7.899) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.625 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.177 (1.787–28.826) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GRACE risk score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.028 (1.008–1.048) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.014 (0.994–1.033) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.366 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">hsCRP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.217 (1.093–1.350) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.934 (0.806–1.083) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.166 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272089.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 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Brugaletta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2004-815695" "Revista" => array:6 [ "tituloSerie" => "Semin Vasc Med" "fecha" => "2003" "volumen" => "3" "paginaInicial" => "375" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15199444" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic inflammation in unstable angina is the result of myocardial necrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Cusack" 1 => "M.S. Marber" 2 => "P.D. Lambiase" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2002" "volumen" => "39" "paginaInicial" => "1917" "paginaFinal" => "1923" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12084588" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of inflammatory biomarkers and cardiac troponin I with multifocal activation of coronary artery tree in the setting of non-ST-elevation acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.N. Zairis" 1 => "A.G. Lyras" 2 => "G.P. Bibis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.atherosclerosis.2005.01.039" "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis" "fecha" => "2005" "volumen" => "182" "paginaInicial" => "161" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16115487" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kinetics of C-reactive protein release in different forms of acute coronary syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.L. Sánchez" 1 => "M.V. Rodríguez" 2 => "E. Villacorta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2006" "volumen" => "59" "paginaInicial" => "441" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16750141" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack45566" "titulo" => "Acknowledgements" "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">We thank the medical residents and nurses of the coronary cardiac unit of the University Clinical Hospital of Santiago de Compostela for their assistance in this study.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000002/v1_201305171228/S2174204913000421/v1_201305171228/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000002/v1_201305171228/S2174204913000421/v1_201305171228/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000421?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 33 | 33 | 66 |
| 2024 September | 43 | 23 | 66 |
| 2024 August | 34 | 27 | 61 |
| 2024 July | 27 | 24 | 51 |
| 2024 June | 23 | 21 | 44 |
| 2024 May | 35 | 16 | 51 |
| 2024 April | 21 | 26 | 47 |
| 2024 March | 27 | 21 | 48 |
| 2024 February | 25 | 33 | 58 |
| 2024 January | 25 | 31 | 56 |
| 2023 December | 20 | 31 | 51 |
| 2023 November | 29 | 18 | 47 |
| 2023 October | 21 | 14 | 35 |
| 2023 September | 26 | 22 | 48 |
| 2023 August | 25 | 14 | 39 |
| 2023 July | 17 | 7 | 24 |
| 2023 June | 21 | 11 | 32 |
| 2023 May | 26 | 16 | 42 |
| 2023 April | 17 | 3 | 20 |
| 2023 March | 20 | 21 | 41 |
| 2023 February | 20 | 18 | 38 |
| 2023 January | 26 | 8 | 34 |
| 2022 December | 25 | 21 | 46 |
| 2022 November | 41 | 22 | 63 |
| 2022 October | 30 | 13 | 43 |
| 2022 September | 19 | 31 | 50 |
| 2022 August | 32 | 30 | 62 |
| 2022 July | 25 | 18 | 43 |
| 2022 June | 22 | 13 | 35 |
| 2022 May | 24 | 28 | 52 |
| 2022 April | 17 | 21 | 38 |
| 2022 March | 15 | 29 | 44 |
| 2022 February | 16 | 16 | 32 |
| 2022 January | 18 | 18 | 36 |
| 2021 December | 14 | 23 | 37 |
| 2021 November | 25 | 23 | 48 |
| 2021 October | 31 | 40 | 71 |
| 2021 September | 13 | 27 | 40 |
| 2021 August | 22 | 26 | 48 |
| 2021 July | 13 | 37 | 50 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 21 | 31 | 52 |
| 2021 April | 35 | 29 | 64 |
| 2021 March | 45 | 14 | 59 |
| 2021 February | 46 | 14 | 60 |
| 2021 January | 24 | 15 | 39 |
| 2020 December | 21 | 8 | 29 |
| 2020 November | 21 | 13 | 34 |
| 2020 October | 12 | 2 | 14 |
| 2020 September | 24 | 20 | 44 |
| 2020 August | 14 | 3 | 17 |
| 2020 July | 44 | 9 | 53 |
| 2020 June | 28 | 5 | 33 |
| 2020 May | 28 | 3 | 31 |
| 2020 April | 26 | 7 | 33 |
| 2020 March | 38 | 7 | 45 |
| 2020 February | 77 | 28 | 105 |
| 2020 January | 22 | 5 | 27 |
| 2019 December | 24 | 5 | 29 |
| 2019 November | 35 | 6 | 41 |
| 2019 October | 41 | 9 | 50 |
| 2019 September | 22 | 11 | 33 |
| 2019 August | 23 | 5 | 28 |
| 2019 July | 30 | 9 | 39 |
| 2019 June | 19 | 8 | 27 |
| 2019 May | 20 | 6 | 26 |
| 2019 April | 29 | 10 | 39 |
| 2019 March | 37 | 8 | 45 |
| 2019 February | 55 | 15 | 70 |
| 2019 January | 40 | 6 | 46 |
| 2018 December | 51 | 7 | 58 |
| 2018 November | 159 | 3 | 162 |
| 2018 October | 408 | 22 | 430 |
| 2018 September | 150 | 12 | 162 |
| 2018 August | 76 | 7 | 83 |
| 2018 July | 26 | 5 | 31 |
| 2018 June | 33 | 6 | 39 |
| 2018 May | 49 | 10 | 59 |
| 2018 April | 45 | 9 | 54 |
| 2018 March | 99 | 10 | 109 |
| 2018 February | 39 | 0 | 39 |
| 2018 January | 81 | 9 | 90 |
| 2017 December | 107 | 12 | 119 |
| 2017 November | 43 | 8 | 51 |
| 2017 October | 31 | 20 | 51 |
| 2017 September | 29 | 11 | 40 |
| 2017 August | 23 | 7 | 30 |
| 2017 July | 20 | 12 | 32 |
| 2017 June | 32 | 4 | 36 |
| 2017 May | 29 | 5 | 34 |
| 2017 April | 20 | 5 | 25 |
| 2017 March | 23 | 11 | 34 |
| 2017 February | 26 | 4 | 30 |
| 2017 January | 25 | 1 | 26 |
| 2016 December | 22 | 12 | 34 |
| 2016 November | 28 | 3 | 31 |
| 2016 October | 29 | 4 | 33 |
| 2016 September | 36 | 6 | 42 |
| 2016 August | 9 | 9 | 18 |
| 2016 July | 13 | 3 | 16 |
| 2016 June | 15 | 4 | 19 |
| 2016 May | 19 | 5 | 24 |
| 2016 April | 18 | 1 | 19 |
| 2016 March | 16 | 1 | 17 |
| 2016 February | 21 | 10 | 31 |
| 2016 January | 15 | 5 | 20 |
| 2015 December | 13 | 6 | 19 |
| 2015 November | 23 | 1 | 24 |
| 2015 October | 16 | 6 | 22 |
| 2015 September | 18 | 5 | 23 |
| 2015 August | 19 | 7 | 26 |
| 2015 July | 9 | 4 | 13 |
| 2015 June | 14 | 2 | 16 |
| 2015 May | 20 | 5 | 25 |
| 2015 April | 22 | 6 | 28 |
| 2015 March | 14 | 5 | 19 |
| 2015 February | 15 | 4 | 19 |
| 2015 January | 17 | 4 | 21 |
| 2014 December | 22 | 12 | 34 |
| 2014 November | 13 | 2 | 15 |
| 2014 October | 24 | 1 | 25 |
| 2014 September | 16 | 6 | 22 |
| 2014 August | 21 | 6 | 27 |
| 2014 July | 28 | 8 | 36 |
| 2014 June | 25 | 3 | 28 |
| 2014 May | 23 | 5 | 28 |
| 2014 April | 8 | 5 | 13 |
| 2014 March | 27 | 9 | 36 |
| 2014 February | 21 | 4 | 25 |
| 2014 January | 31 | 11 | 42 |
| 2013 December | 27 | 6 | 33 |
| 2013 November | 25 | 12 | 37 |
| 2013 October | 28 | 8 | 36 |
| 2013 September | 28 | 11 | 39 |
| 2013 August | 33 | 15 | 48 |
| 2013 July | 40 | 11 | 51 |
| 2013 June | 23 | 6 | 29 |
| 2013 May | 30 | 9 | 39 |
| 2013 April | 44 | 19 | 63 |
| 2013 March | 30 | 8 | 38 |
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