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Background and aims STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared to usual care (UC). The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration. Methods A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. admission) to randomization (i.e. pre-discharge), were included. Patients in HIC were stratified by further NT-proBNP changes from randomization to 1 week later as decreased (≥30% decrease), stable (10% increase). The primary endpoint was 180-day HF readmission or death. Results The effect of HIC vs. UC was independent of baseline NT-proBNP. Patients in the HIC group with stable or increased NT-proBNP were older, with more severe acute HF and worse renal and liver function. Per protocol, patients with increased NT-proBNP received more diuretics and were up-titrated more slowly during the first weeks after discharge. However, by 6 months they reached 70.4% optimal GRMT doses, compared with 80.3% for those with NT-proBNP decrease. As a result, the primary endpoint at 60 and 90 days occurred in 8.3% and 11.1% of patients with increased NT-proBNP vs 2.2% and 4.0% in those with decreased NT-proBNP (p=0.039 and p=0.045, respectively). However, no difference in outcome was found at 180 days (13.5% vs. 13.2%; p=0.93). Conclusions Among patients with acute HF enrolled in STRONG-HF, HIC reduced 180-day HF readmission or death regardless of baseline NT-proBNP. GRMT up-titration early post-discharge utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the GRMT up-titration rate resulted in the same 180-day outcomes regardless of early post-discharge NT-proBNP change.

Introduccion Existen antecedentes en la bibliografia cientifica que indican que las mujeres con enfermedad coronaria tienen peor pronostico que los hombres y se observa asimismo una utilizacion menor de metodos diagnosticos e intervenciones en ellas, por lo que resulta de interes establecer si esta tendencia existe en nuestro pais y las posibles asociaciones de valor pronostico. Objetivos Investigar en una cohorte argentina de sindromes coronarios agudos las caracteristicas clinicas, los tratamientos y la evolucion a 2 anos de seguimiento. Material y metodos Componente argentino del estudio cooperativo GRACE de 4.708 hombres y 2.027 mujeres con sindromes coronarios agudos sin supradesnivel persistente del segmento ST. Se analizaron antecedentes, tipo de presentacion, diagnostico definitivo, tratamientos farmacologicos, aplicacion de revascularizacion e incidencia acumulativa de muerte e infarto recurrente en la etapa hospitalaria y a los 6 meses y a los 2 anos de seguimiento. Resultados Las mujeres fueron mayores (69,4 ± 12,3 vs. 63,1 ± 11,9 anos; p < 0,01), con mayor prevalencia de insuficiencia cardiaca e hipertension. La proporcion de signos de isquemia miocardica en el electrocardiograma, asi como la de enzimas miocardicas en rango anormal fue similar para ambos generos, con un uso significativamente menor de aspirina, clopidogrel y betabloqueantes en las mujeres, quienes tuvieron la mitad de chance de angioplastia (OR: 0,55, IC 95% 0,48-0,62) y de cirugia de revascularizacion (OR: 0,49, IC 95% 0,36-0,67), con mayores incidencias crudas de muerte e infarto en agudo y a los 2 anos, pero sin diferencia en el riesgo relativo de eventos mayores una vez ajustado por edad y otras covariables. Conclusiones A pesar de un riesgo clinico similar en mujeres y hombres, las primeras recibieron menos intervenciones durante la fase hospitalaria. Nuestros resultados llaman a un adecuado alerta e intervenciones ajustadas al riesgo para el sexo femenino.