Papel de biomarcadores y escalas pronósticas en la atención prehospitalaria de las enfermedades cardiovasculares agudas

In this thesis by compendium of publications, three studies have been carried out and published. The main objective of these studies is to demonstrate the usefulness of serum biomarkers measured at the point of care (troponins and mSOFA), as well as the mSOFA risk scale, in predicting mortality at the pre-hospital level in patients treated for acute cardiovascular pathology: 1. Cardiac troponines determined at the point of care are an excellent predictor of in-hospital mortality 28 days after the index event in patients treated for acute pathologies of any cause. 2. Cardiac troponin performance was not affected by gender, age or patient diagnosis, although higher levels were found in patients aged 18-49 years and in those with a diagnosis of acute cardiovascular disease. 3. Pre-hospital NT-proBNP had a very good ability to predict in-hospital mortality from acute cardiovascular disease at 2 and 28 days after the index event. 4. NT-proBNP proved useful in predicting mortality in patients with suspected ischaemic heart disease and arrhythmias, but especially in patients with suspected syncope. However, this biomarker does not appear to be useful for predicting prognosis in patients with acute heart failure. 5. The mSOFA is a prognostic scale with an excellent ability to predict mortality at both 2 and 90 days in patients treated for acute cardiovascular disease in the pre-hospital setting. 6. Although the TIMI Risk Index (TIMI), the Modified Shock Index (MSI), the Cardiac Arrest Risk Triage (CART) and the National Early Warning Score 2 (NEWS2) demonstrated an acceptable ability to predict 2- and 90-day mortality in patients with acute cardiovascular disease, the mSOFA scale was superior to all of them. 7. The mSOFA had a very good ability to predict mortality in the 4 acute cardiovascular disease diagnostic groups studied: acute heart failure, ischaemic heart disease, arrhythmia and syncope. ; En esta tesis por compendio de publicaciones se han llevado a cabo y publicado tres estudios en los que se pretende ...