RESUMO
The purpose of this study was to analyse secular trend in handgrip strength (HGS) in adolescents using an allometric approach and identify the factors associated. The sample comprised 657 and 1004 adolescents (14 to 19 years) in 2007 and 2017/2018, respectively, of public schools in Florianópolis, Brazil. The dependent variable was HGS normalised to body mass and height. Covariance analysis was used to examine secular trends in HGS, and multiple linear regression was used to identify associated factors. The independent variables were sociodemographic, biological, and behavioural factors. Comparison of HGS between surveys indicated a negative secular trend in both sexes (p < 0.001). In boys, there was a positive association of HGS with age and FFM in both surveys. In 2017/18, there was a positive association with sexual maturation and a negative association with sitting time and fat percentage. In girls, FFM was positively associated with HGS in both surveys. In 2007, there were positive associations of HGS with age and vigorous physical activity, whereas, in 2017/18, negative associations were observed with economic level and sitting time. The findings of the present study show a decline in adolescent HGS. And behavioural changes appear to be contributing to declines in HGS.
Assuntos
Força da Mão , Humanos , Adolescente , Masculino , Força da Mão/fisiologia , Feminino , Brasil , Adulto Jovem , Exercício Físico/fisiologia , Maturidade Sexual/fisiologia , Fatores Etários , Fatores Sexuais , Postura Sentada , Fatores Sociodemográficos , Estudos Transversais , Fatores Socioeconômicos , Índice de Massa Corporal , Comportamento SedentárioRESUMO
OBJECTIVE: The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents. METHODS: In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression. RESULTS: Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34). CONCLUSIONS: Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.
Assuntos
Tempo de Tela , Comportamento Sedentário , Masculino , Feminino , Humanos , Adolescente , Estudos Transversais , Exercício Físico , Inquéritos e QuestionáriosRESUMO
Abstract Objective: The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents. Methods: In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression. Results: Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34). Conclusions: Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.
RESUMO Objetivo: Analisar a associação isolada e combinada do tempo excessivo de tela e inatividade física com a autopercepção negativa de saúde, de acordo com o sexo, em adolescentes estudantes. Métodos: Estudo transversal conduzido em 2.517 adolescentes amazonenses, os quais foram questionados sobre a autopercepção de saúde: "Como você considera a sua saúde?", dicotomizada em positiva (excelente, boa) e negativa (regular, ruim, péssima). Informações sobre sexo, faixa etária, renda familiar, atividade física e tempo excessivo de tela (assistindo TV, usando o computador ou jogando videogame) foram coletadas mediante questionário autoadministrado. Aqueles classificados, simultaneamente, como fisicamente inativos (<60 min/dia) e com tempo excessivo de tela (>2 horas/dia) foram considerados com dois fatores de risco. Os dados foram analisados utilizando-se a regressão logística binária. Resultados: Dois em cada dez adolescentes apresentaram autopercepção negativa de saúde. Após o ajuste pelas variáveis idade e renda familiar, não foram observadas, no sexo feminino, associações da inatividade física e do tempo excessivo de tela, de maneira isolada ou agrupada, com a autopercepção negativa de saúde. No sexo masculino, a percepção negativa de saúde foi associada com os níveis insuficientes de atividade física (odds ratio — OR: 2,39; intervalo de confiança — IC95% 1,03-5,59) e com o acúmulo de dois fatores de risco (OR: 1,61; IC95% 1,10-2,34). Conclusões: Ser insuficientemente ativo e associar a inatividade física com tempo excessivo de tela tornam-se fatores de exposição à percepção negativa em saúde de meninos adolescentes.
RESUMO
ABSTRACT Objective: Assess the agreement and validity between relative body fat percentages estimated using anthropometric measurements and air displacement plethysmography (ADP). Methods: A cross-sectional study was conducted on 118 adolescents (60 females) aged 10 to 14 years (x̄=12.19, sd=1.18). Adolescents were classified as eutrophic or with overweight according to body mass index (body weight/height2) (x̄=20,12, sd=3,56). Measurements of skinfold thickness (triceps and medial calf) were collected and used to estimate relative body fat by the Slaughter equation. ADP was used as a reference method for the estimation of relative body fat. Agreement between body fat measurement methods (anthropometry × ADP) was analyzed by the Bland-Altman method. The mean error (ME) was calculated by subtracting the body fat percentage estimated by the Slaughter equation from the body fat percentage estimated by ADP. Validity was tested with the concordance correlation coefficient (CCC). Results: There was no agreement between the methods, regardless of sex and weight status. For boys with overweight (ME = 4.52; p = 0.007), eutrophic girls (ME = 6.37; p < 0.001), and girls with overweight (ME = 5.55; p < 0.001), the Slaughter equation resulted in overestimation of body fat compared with ADP. Skinfold equations did not demonstrate validity when compared with ADP. Conclusion: Slaughter's skinfold equations did not demonstrate agreement and validity compared with ADP in either sex or weight status. Skinfold equations should be used with caution and, whenever possible, in combination with other body composition indicators.
RESUMO Objetivo: Avaliar a concordância e validade entre os percentuais de gordura corporal estimados usando medidas antropométricas e pletismografia por deslocamento de ar (PDA). Métodos: Um estudo transversal foi conduzido em 118 adolescentes (60 meninas) com idade entre 10 e 14 anos (x̄=12,19, dp=1,18). Os adolescentes foram classificados como eutróficos ou com sobrepeso de acordo com o índice de massa corporal (peso/altura2) (x̄=20,12, dp=3,56). Medidas de dobras cutâneas (tríceps e panturrilha medial) foram coletadas e utilizadas para estimar a gordura corporal relativa pela equação de Slaughter. A PDA foi utilizada como método de referência para a estimativa da gordura corporal relativa. A concordância entre os métodos de medida de gordura corporal (antropometria × PDA) foi analisada pelo método de Bland-Altman. O erro médio (EM) foi calculado subtraindo o percentual de gordura corporal estimado pela equação de Slaughter do percentual de gordura corporal estimado pela PDA. A validade foi testada com o coeficiente de correlação de concordância (CCC). Resultados: Não houve concordância entre os métodos, independente do sexo e status de peso. Para meninos com excesso de peso (EM = 4,52; p = 0,007), meninas eutróficas (EM = 6,37; p < 0,001) e meninas com excesso de peso (EM = 5,55; p < 0,001), a equação de Slaughter resultou em superestimação da gordura corporal comparada com PDA. As equações de dobras cutâneas não demonstraram validade quando comparadas ao PDA. Conclusão: As equações de dobras cutâneas de Slaughter não demonstraram concordância e validade em comparação com PDA em ambos os sexos ou status de peso. As equações de dobras cutâneas devem ser utilizadas com cautela e, sempre que possível, acompanhada de outros indicadores de composição corporal.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Pletismografia , Dobras Cutâneas , Composição Corporal , Adolescente/fisiologia , Peso Corporal , Índice de Massa Corporal , SobrepesoRESUMO
The clinical benefit of thrombus aspiration (TA) in patients presenting with acute ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI) is not well defined. Furthermore, there is a large variation in the use of TA in real-world registries. Between 2005 and 2008, a total of 7146 consecutive patients with acute STEMI undergoing primary PCI were prospectively enrolled into the PCI Registry of the Euro Heart Survey Programme. For the present analysis, patients treated additionally with TA (n = 897, 12.6 %) were compared with those without TA (n = 6249, 87.4 %). Patients with hemodynamic instability at initial presentation (15.1 vs. 11.0 %; p < 0.001) and resuscitation prior to PCI (10.4 vs. 7.4 %; p = 0.002) were more frequently treated with TA. TIMI flow grade 0/1 before PCI was more often found among those with TA (73.5 vs. 58.6 %; p < 0.001). After adjustment for confounding factors in the propensity score analysis, TA was not associated with improved in-hospital survival (risk difference -1.1 %, 95 % confidence interval -2.7 to 0.6 %). In this European real-world registry, the rate of TA use was low. Hemodynamically unstable patients were more likely to be treated with TA. Consistent with the results of the TASTE study and the TOTAL trial, TA was not associated with a significant reduction in short-term mortality.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombectomia , Idoso , Angiografia Coronária , Circulação Coronária , Europa (Continente) , Feminino , Hemodinâmica , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality.
Assuntos
Tamponamento Cardíaco/etiologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/lesões , Mortalidade Hospitalar , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Índice de Massa Corporal , União Europeia/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Antimicrobial resistance in bacterial porcine respiratory pathogens has been shown to exist in many countries. However, little is known about the variability in antimicrobial susceptibility within a population of a single bacterial respiratory pathogen on a pig farm. This study examined the antimicrobial susceptibility of Actinobacillus pleuropneumoniae using multiple isolates within a pig and across the pigs in three different slaughter batches. Initially, the isolates from the three batches were identified, serotyped, and subsample genotyped. All the 367 isolates were identified as A. pleuropneumoniae serovar 1, and only a single genetic profile was detected in the 74 examined isolates. The susceptibility of the 367 isolates of A. pleuropneumoniae to ampicillin, tetracycline and tilmicosin was determined by a disc diffusion technique. For tilmicosin, the three batches were found to consist of a mix of susceptible and resistant isolates. The zone diameters of the three antimicrobials varied considerably among isolates in the second sampling. In addition, the second sampling provided statistically significant evidence of bimodal populations in terms of zone diameters for both tilmicosin and ampicillin. The results support the hypothesis that the antimicrobial susceptibility of one population of a porcine respiratory pathogen can vary within a batch of pigs on a farm.
Assuntos
Infecções por Actinobacillus/microbiologia , Infecções por Actinobacillus/veterinária , Actinobacillus pleuropneumoniae/efeitos dos fármacos , Doenças dos Suínos/microbiologia , Animais , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Genótipo , Pulmão/microbiologia , Testes de Sensibilidade Microbiana , Pleuropneumonia/microbiologia , Pleuropneumonia/veterinária , SuínosRESUMO
BACKGROUND/OBJECTIVES: Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction. METHODS AND RESULTS: Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n=1100, 54.7%) were compared to those with LCX-related NSTEMI (n=910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P<0.001) or had been resuscitated (8.5 versus 2.7%, P<0.0001). TIMI 0-1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P<0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P=0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08-2.72, P<0.05). CONCLUSIONS: Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI.
Assuntos
Vasos Coronários , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/mortalidade , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/mortalidade , Angina Pectoris/terapia , Coleta de Dados , Eletrocardiografia , Europa (Continente)/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Tempo para o Tratamento/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND: Stroke is a rare but serious complication of percutaneous coronary interventions (PCIs). So far, scant information is available about the incidence and outcome of patients developing stroke after PCI for stable angina or acute coronary syndrome (ACS) in daily clinical practice in Europe today. METHODS AND RESULTS: Between 2005 and 2008, 46888 patients undergoing PCI were enrolled into the PCI Registry of the Euro Heart Survey Programme (176 centers in 33 European countries) to document patient's characteristics, PCI details, and hospital complications in different PCI indications. Stroke was observed in 0.4% of the procedures in the total population, in 0.3% of PCIs in elective patients, and in 0.6% in PCIs performed for ACS. The overall in-hospital mortality was 19.2% for patients who developed stroke (elective PCIs, 10.0%; PCI for ACS, 23.2%) compared with 1.3% for those without stroke (elective PCIs, 0.2%; PCI for ACS, 2.3%). In multivariate analysis hemodynamic instability, age ≥ 75 years, history of stroke, and congestive heart failure were found to be independent predictors for periprocedural stroke in ACS, whereas only PCI of a bypass graft and renal failure could be identified as independent predictors for stroke in elective patients. CONCLUSIONS: Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, peri-interventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research.
Assuntos
Intervenção Coronária Percutânea/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Síndrome Coronariana Aguda/terapia , Idoso , Angina Estável/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de RegistrosRESUMO
Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.
Assuntos
Doença da Artéria Coronariana/terapia , Tomada de Decisões , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Ponte de Artéria Coronária/estatística & dados numéricos , Humanos , Revascularização Miocárdica/estatística & dados numéricos , Variações Dependentes do Observador , Intervenção Coronária Percutânea/estatística & dados numéricos , Procedimentos DesnecessáriosRESUMO
BACKGROUND: The role of adhoc multi-vessel percutaneous coronary intervention (MV-PCI) in patients with ST elevation myocardial infarction (STEMI) and non ST elevation acute coronary syndromes (NSTE-ACS) has not fully defined yet. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcome of patients with MV disease presenting with ACS. METHODS AND RESULTS: We evaluated 4, 457 haemodynamically stable patients with ACS and at least two major epicardial vessels with ≥70% stenosis of the contemporary Euro Heart Survey PCI registry. They were stratified into four categories: 419 STEMI and 734 NSTE-ACS patients undergoing MV-PCI and 2,118 STEMI and 1,186 NSTE-ACS patients undergoing culprit lesion (CL)-PCI only, respectively. In comparison to patients with CL-PCI hospital mortality was numerically lower among those undergoing MV-PCI for STEMI (1.4 versus 3.4%, P=0.03) and for NSTE-ACS (1.1 versus 2.1%, P=0.10). After adjustment for confounding variables no significant mortality difference was observed among patients treated with MV-PCI for STEMI (OR 0.48, 95%-CI 0.21-1.13) and for NSTE-ACS (OR 0.54, 95%-CI 0.24-1.22). However, the risk for non-fatal postprocedural myocardial infarction was markedly increased among patients undergoing MV-PCI for STEMI (8.8 versus 1.6%, P<0.0001) and for NSTE-ACS (5.3 versus 1.8%, P<0.0001). CONCLUSIONS: In clinical practice MV-PCI in haemodynamically stable with ACS is used only in a minority of patients. There was no significant difference in hospital mortality between patients treated with MV- and CL-PCI, but MV-PCI was associated with a higher rate of postprocedural myocardial infarction.
Assuntos
Síndrome Coronariana Aguda/cirurgia , Hemodinâmica/fisiologia , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: To assess the face and content validity of a novel, full physics, full procedural, virtual reality simulation housed in a hybrid procedure suite. METHODS AND MATERIALS: After completing 60 minutes of hands-on training in uterine artery embolization and coronary angioplasty, 24 radiologists and 18 cardiologists with mean 10 years of endovascular experience assessed the functionality of a comprehensive hybrid procedure suite simulation (Orcamp; Orzone, Gothenburg, Sweden). RESULTS: C-arm and operating table functionality and realism were reliably (α = 0.0.89-0.92) rated highly (80/100). Performance realism of the catheter, guide wire, fluoroscopy image, electrocardiogram, and vital signs readout also reliably and statistically significantly predicted subjects' overall positive assessment (mean = 87/100) of the simulation experience in a multiple regression model (α = .83; r = 0.85 and r(2) = 0.67; P < .0001). CONCLUSIONS: This study reports a quantitative evaluation of a comprehensive simulation of an authentic procedure suite for image-guided intravascular procedures. This new facility affords the opportunity for trainers to provide higher fidelity training of operative technical, procedural, and management skills in the realistic context of a complete procedure suite with all its complexities and potential distractions.
Assuntos
Angioplastia/educação , Simulação por Computador , Instrução por Computador , Educação de Pós-Graduação em Medicina/métodos , Embolização da Artéria Uterina/educação , Adulto , Angioplastia/instrumentação , Cateterismo Cardíaco , Cateterismo Periférico , Competência Clínica , Instrução por Computador/instrumentação , Eletrocardiografia , Desenho de Equipamento , Feminino , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Radiografia Intervencionista , Análise e Desempenho de Tarefas , Embolização da Artéria Uterina/instrumentaçãoRESUMO
The value of multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock (CS) and multivessel disease (MVD) is still unclear because randomized controlled trials are missing. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcomes of patients with MVD presenting with CS: 336 patients with acute myocardial infarction complicated by CS and ≥70% stenoses in ≥2 major epicardial vessels were included in this analysis of the Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 82, 24%) were compared to those with single-vessel PCI (n = 254, 76%). The rate of 3-vessel disease (60% vs 57%, p = 0.63) was similar in the 2 cohorts. Presentation with resuscitation (48 vs 46%, p = 0.76) and ST-segment elevation myocardial infarction (83 vs 87%, p = 0.31) was frequent in patients with MV-PCI and single-vessel PCI. Patients with ventilation were more likely to receive MV-PCI (30% vs 19%, p = 0.05). There was a tendency toward a higher hospital mortality in patients with MV-PCI (48.8% vs 37.4%, p = 0.07). After adjustment for confounding variables, no significant difference for in-hospital mortality (odd ratio [OR] 1.28, 95% confidence interval [CI] 0.72 to 2.28) could be observed between the 2 groups. Age (OR 1.41, 95% CI 1.13 to 1.77), 3-vessel disease (OR 1.78, 95% CI 1.04 to 3.03), ventilation (OR 3.01, 95% CI 1.59 to 5.68), and previous resuscitation (OR 2.55, 95% CI 1.48 to 4.39) were independent predictors of hospital death. In conclusion, MV-PCI is currently used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not associated with a survival benefit in these high risk patients.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Síndrome Coronariana Aguda/terapia , Idoso , Algoritmos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Intervalos de Confiança , Doença da Artéria Coronariana/terapia , Vasos Coronários/patologia , Europa (Continente)/epidemiologia , União Europeia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Choque Cardiogênico/terapia , Resultado do TratamentoRESUMO
A percutaneous coronary intervention (PCI) is a unique condition to study the effects of ischemia and reperfusion in patients with severe coronary atherosclerosis when coronary vasomotor function is compromised by loss of endothelial and autoregulatory vasodilation. We studied the effects of intracoronary non-selective α-, as well as selective α(1)- and α(2)-blockade in counteracting the observed vasoconstriction in patients with stable and unstable angina and in patients with acute myocardial infarction. Coronary vasoconstriction in our studies was a diffuse phenomenon and involved not only the culprit lesion but also vessels with angiographically not visible plaques. Post-PCI vasoconstriction was reflected by increased coronary vascular resistance and associated with decreased LV-function. α (1)-Blockade with urapidil dilated epicardial coronary arteries, improved coronary flow reserve and counteracted LV dysfunction. Non-selective α-blockade with phentolamine induced epicardial and microvascular dilation, while selective α(2)-blockade with yohimbine had only minor vasodilator and functional effects. Intracoronary α-blockade also attenuated the no-reflow phenomenon following primary PCI. This article is part of a Special Issue entitled "Coronary Blood Flow".
Assuntos
Circulação Coronária/fisiologia , Fenômeno de não Refluxo/fisiopatologia , Angioplastia Coronária com Balão , Humanos , Fenômeno de não Refluxo/terapia , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologiaRESUMO
The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes of patients undergoing elective multivessel percutaneous coronary intervention (MV-PCI) in Europe. A total of 7113 patients with stable coronary artery disease and at least two major epicardial vessels with ≥ 70% stenosis were included in this analysis of the contemporary Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 3376, 47.5%) were compared with those with single-vessel PCI (SV-PCI) (n = 3737, 52.5%). Patients with MV-PCI were more likely to have congestive heart failure, whereas those with SV-PCI more often suffered from noncardiac comorbidities. Hospital mortality (0.1% vs 0.3%) and the incidence of nonfatal postprocedural myocardial infarction (1.0% vs 0.7%) were low in patients with MV-PCI and SV-PCI. In the multivariate analysis, no significant difference in the incidence of hospital death (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.15-1.27) could be observed between the two groups. However, the risk for postprocedural myocardial infarction (OR 1.57, 95% CI 0.93-2.67) tended to be higher among patients undergoing MV-PCI. Independent determinants for performing MV-PCI were age, comorbidities, and coronary anatomy. In Europe almost half of all patients with multivessel disease were treated with MV-PCI. Hospital complications were low, but a trend toward a higher rate of postprocedural myocardial infarctions was seen in patients with MV-PCI.
Assuntos
Angina Estável/cirurgia , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Idoso , Angina Estável/diagnóstico por imagem , Angina Estável/mortalidade , Intervalos de Confiança , Angiografia Coronária , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Taxa de Sobrevida/tendências , Resultado do TratamentoRESUMO
AIMS: The intra-aortic balloon pump (IABP) is recommended by current guidelines as adjunct in patients with cardiogenic shock, despite the lack of larger clinical trials. We sought to investigate the use and impact on mortality of IABP in current practice of percutaneous coronary interventions in Europe. METHODS AND RESULTS: Between May 2005 and April 2008 a total of 47,407 consecutive patients undergoing percutaneous coronary intervention (PCI) in 176 centres in 33 countries in Europe and the Mediterranean basin were enrolled into the registry. From these, 8,102 had ST-elevation myocardial infarction and 7,999 non-ST elevation myocardial infarction and cardiogenic shock was observed in 7.9% and 2.1%, respectively. Of the 653 patients with cardiogenic shock 25% were treated with an IABP. In-hospital mortality, with and without IABP, was 56.9% and 36.1%. In the multivariate analysis the use of IABP was not associated with an improved survival (odds ratio 1.47; 95% CI 0.97-2.21, p=0.07). CONCLUSIONS: In current clinical practice in Europe, IABP is used only in one quarter of patients with cardiogenic shock treated with primary PCI. However, there was no hint of a beneficial effect of IABP on outcome. Therefore, a large randomised clinical trial is urgently needed to define the role of IABP in patients with PCI for shock.