RESUMO
Of 577 patients, mean age 74 years, undergoing noncardiac vascular surgery, 300 (52%) had carotid endarterectomy, 179 (31%) had lower extremity revascularization, and 98 (17%) had abdominal aortic aneurysm repair. Of the 577 patients, 302 (52%) were treated with statins. Perioperative myocardial infarction (MI) occurred in 18 of 302 patients (6%) treated with statins and in 38 of 275 patients (14%) not treated with statins (p=0.001). Two-year mortality occurred in 18 of 302 patients (6%) treated with statins and in 43 of 275 patients (16%) not treated with statins (p=0.0002). Perioperative MI or mortality occurred in 34 of 302 patients (11%) treated with statins and in 74 of 275 patients (27%) not treated with statins (p<0.0001). Stepwise Cox regression analysis showed that significant independent prognostic factors for perioperative MI or death were use of statins (risk ratio=RR=0.43, p<0.0001), use of beta blockers (RR=0.55, p=0.002), carotid endarterectomy (RR=0.60, p=0.009), and diabetes (RR=1.5, p=0.045). In conclusion, patients undergoing noncardiac vascular surgery treated with statins had a 57% less chance of having perioperative MI or death at 2-year follow-up after controlling for other variables.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/mortalidade , Assistência Perioperatória/mortalidade , Procedimentos Cirúrgicos Vasculares/mortalidade , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Comorbidade , Diabetes Mellitus/epidemiologia , Endarterectomia das Carótidas/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Extremidade Inferior/irrigação sanguínea , Masculino , Infarto do Miocárdio/prevenção & controle , Doenças Vasculares Periféricas/cirurgia , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Resultado do TratamentoRESUMO
During implantation and during 38-month follow-up of 1060 consecutive patients who had implantable cardioverter-defibrillators, complications occurred in 60 (5.7%) of 1060 patients. These complications consisted of fractured leads requiring lead revision in 36 (3.4%) patients, lead infection requiring antibiotics in 5 (0.5%) patients, device replacement because of malfunction in 5 (0.5%) patients, repositioning of leads in 3 (0.3%) patients, a hematoma at the time of implantation in 3 (0.3%) patients, pneumothorax at the time of implantation in 2 (0.2%) patients, repair of a defective generator in 1 (0.1%) patient, replacement of the device because of atrophy of the skin over the device in 1 (0.1%) patient, a transient ischemic attack because of atrial fibrillation developing during implantation in 1 (0.1%) patient, device replacement because of a recall from Guidant in 1 (0.1%) patient, pocket revision because of pain when lying on the side of the pacemaker in 1 (0.1%) patient, and pacemaker infection in 1 (0.1%) patient.
Assuntos
Desfibriladores Implantáveis/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prevalência , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologiaRESUMO
Of 529 patients with heart failure and a mean left ventricular ejection fraction of 29%, 209 (40%) were treated with cardiac resynchronization therapy (CRT) plus an implantable cardioverter-defibrillator (ICD) and 320 (60%) with an ICD. Mean follow-up was 34 months for both groups. Stepwise logistic regression analysis showed that significant independent variables for appropriate ICD shocks were statins (risk ratio = 0.35, P < .0001), smoking (risk ratio = 2.52, P < .0001), and digoxin (risk ratio = 1.92, P = .0001). Significant independent variables for time to deaths were use of CRT (risk ratio = 0.32, P = .0006), statins (risk ratio = 0.18, P < .0001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (risk ratio = 0.10, P < .0001), hypertension (risk ratio = 24.15, P < .0001), diabetes (risk ratio = 2.54, P = .0005), and age (risk ratio = 1.06, P < .0001). In conclusion, statins reduced and smoking and digoxin increased appropriate ICD shocks. Use of CRT, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers reduced mortality and hypertension, diabetes, and older age increased mortality.
Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ecocardiografia , Feminino , Seguimentos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Fumar/efeitos adversos , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
We investigated in 277 consecutive patients, mean age 63 years, with ST-segment elevation acute myocardial infarction transferred from 25 community hospitals to a tertiary percutaneous coronary intervention (PCI) center from a median distance of 21 miles the incidences of in-hospital mortality, stroke, and recurrent myocardial infarction associated with transfer times. Of the 277 patients, 158 (57%) had thrombolytic therapy at the referring hospital. Of the 277 patients, 63 (23%) had adjunctive PCI, 119 (43%) had primary PCI, and 95 (34%) had rescue PCI. Of the 277 patients, 42 (15%) were hemodynamically unstable. Median transfer times were 102 minutes with primary PCI, 119 minutes with rescue PCI, and 144 minutes for adjunctive PCI (P < 0.0001 for adjunctive PCI versus primary PCI; P = 0.011 for adjunctive PCI versus rescue PCI). Median transfer time was 98 minutes for hemodynamically unstable patients and 121 minutes for hemodynamically stable patients (P = 0.005). In-hospital death occurred in eight of 277 patients (3%). In-hospital stroke occurred in three of 277 patients (1%). In-hospital recurrent myocardial infarction occurred in none of 277 patients (0%). There was no association of transfer times with in-hospital mortality or stroke. In-hospital mortality occurred in three of 112 patients (3%) who had bare metal stents and in five of 165 patients (3%) who had drug-eluting stents.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Transferência de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Recidiva , Acidente Vascular Cerebral/epidemiologia , Terapia TrombolíticaRESUMO
Of 209 patients with heart failure treated with combined cardiac resynchronization therapy and implantable cardioverter-defibrillator therapy, appropriate cardioverter-defibrillator shocks occurred at 34-month follow-up in 22 of 121 patients (18%) on statins and in 30 of 88 patients (34%) not on statins (P = .009). Deaths occurred in 3 of 121 patients (2%) on statins and in 9 of 88 patients (10%) not on statins (P = .017). Stepwise Cox regression analysis showed that significant independent prognostic factors for appropriate shocks were use of statins (risk ratio = 0.46), smoking (risk ratio = 3.5), and diabetes (risk ratio = 0.34). Significant independent prognostic factors for the time to mortality were use of statins (risk ratio = 0.05), use of digoxin (risk ratio = 4.2), systemic hypertension (risk ratio = 14.2), diabetes (risk ratio = 4.3), and left ventricular ejection fraction (risk ratio = 1.1).
Assuntos
Estimulação Cardíaca Artificial , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Taquicardia Ventricular/prevenção & controle , Fibrilação Ventricular/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Cardiotônicos/efeitos adversos , Terapia Combinada , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Digoxina/efeitos adversos , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Volume Sistólico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/mortalidade , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/mortalidade , Função Ventricular EsquerdaRESUMO
We discuss a patient who presented with symptoms classic for variant angina with dramatic 31-mm ST elevation secondary to exercise testing in the chest pain unit, in whom neither myocardial infarction nor severe arrhythmia resulted. Although exercise testing is deemed generally safe, it has not been studied for safety per se in patients with variant angina. Further studies are needed to determine if the magnitude of ST elevation during exercise testing carries prognostic significance.
Assuntos
Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Teste de Esforço/efeitos adversos , Infarto do Miocárdio/diagnóstico , Angina Pectoris/prevenção & controle , Arritmias Cardíacas/prevenção & controle , Teste de Esforço/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVE: . To assess the efficacy and tolerability of bosentan in pulmonary arterial hypertension secondary to systemic sclerosis (SSc-PAH) including patients with restrictive lung disease. METHODS: We retrospectively reviewed 23 SSc-PAH patients with PAH at baseline [PA systolic pressure (PASP) >or= 45 mm Hg by echocardiogram or mean PA pressure > 25 mm Hg at rest by cardiac catheterization], World Health Organization (WHO) functional classes II-IV, and with data available for 18 months. Bosentan dose was 62.5 mg twice daily for 1 month then 125 mg twice daily. Outcomes were WHO functional class, PASP, and pulmonary function tests (PFT) at 3-month intervals for 18 months. RESULTS: WHO class at baseline 3.1 +/- 0.1 (mean +/- SE); 3 months, 2.5 +/- 0.2*; 6 months, 2.4 +/- 0.2*; 9 months, 2.5 +/- 0.2* (*p < 0.02 vs baseline, n = 21 to 23), indicating clinical improvement at 9 months. After 9 months, results were not significant versus baseline. Reduction in WHO class by at least one rank was 57% at 3 months; none worsened. After 9 months, WHO class tended to worsen compared to baseline. Baseline PASP was 54 +/- 2 mm Hg (n = 23) and did not change significantly with therapy. Restriction (total lung capacity 76% +/- 4% of predicted) and reduced diffusing capacity (39% +/- 3% of predicted) were unchanged during therapy. Abnormal transaminases in 2 patients (9%) necessitated discontinuing drug in both. CONCLUSION: Bosentan is clinically beneficial in patients with SSc-PAH including patients with restrictive lung disease, but pulmonary hemodynamics and PFT results remained stable during treatment.