RESUMO
BACKGROUND: The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released. OBJECTIVE: To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI). METHODS: This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: <20 package*years users, Group 3: 20-40 package*years users, Group 4: >40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant. RESULTS: There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634). CONCLUSION: Smoking gradually increases the risk of all-cause mortality after STEMI.
FUNDAMENTO: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. OBJETIVO: Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). MÉTODOS: Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. RESULTADOS: Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (Grupo 2 vs. Grupo 1: RR: 1,141; IC95%: 0,599 a 2.171; Grupo 3 vs. Grupo 1: RR: 2,130; IC95%: 1,236 a 3,670; Grupo 4 vs. Grupo 1: RR: 2,602; IC95%: 1,461 a 4,634). CONCLUSÃO: O hábito de fumar gradualmente aumenta o risco de mortalidade por todas as causas após STEMI.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio/diagnóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Fumar/efeitos adversos , Resultado do TratamentoRESUMO
Resumo Fundamento O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. Objetivo Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). Métodos Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. Resultados Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (Grupo 2 vs. Grupo 1: RR: 1,141; IC95%: 0,599 a 2.171; Grupo 3 vs. Grupo 1: RR: 2,130; IC95%: 1,236 a 3,670; Grupo 4 vs. Grupo 1: RR: 2,602; IC95%: 1,461 a 4,634). Conclusão O hábito de fumar gradualmente aumenta o risco de mortalidade por todas as causas após STEMI.
Abstract Background The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released. Objective To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI). Methods This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: <20 package*years users, Group 3: 20-40 package*years users, Group 4: >40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant. Results There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634). Conclusion Smoking gradually increases the risk of all-cause mortality after STEMI.
Assuntos
Humanos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Infarto do Miocárdio/diagnóstico , Fumar/efeitos adversos , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do TratamentoRESUMO
SUMMARY OBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.
RESUMO OBJETIVO: Diferentes parâmetros de eletrocardiograma (ECG) têm sido investigados para predizer mortalidade e arritmia em pacientes com embolia pulmonar aguda (EPA). O efeito agudo da terapia trombolítica (TT) nesses parâmetros ainda não foi investigado. MÉTODOS: Examinamos os dados de 83 pacientes avaliados com EPA de alto risco e que receberam alta hospitalar após TT. Primeiramente, comparamos os ECGs dos pacientes com EPA de alto risco com os de indivíduos saudáveis (n = 55). Os ECGs dos pacientes com EPA foram comparados logo após a internação e 24 horas mais tarde. A frequência cardíaca, a morfologia da onda P, a duração do QRS, o intervalo QT, Tp-e e o índice de equilíbrio eletrofisiológico cardíaco (iCEB) foram analisados. RESULTADOS: Embora o valor máximo de P não tenha sido diferente entre os grupos no ECG, a frequência cardíaca, QT, intervalo QTc (QT corrigido), intervalos Tpe, razão TP-e/QT e dispersão da onda P foram significativamente mais elevados no grupo de EPA (valores de P < 0,031). Os valores do iCEB ou iCEBc (iCEB corrigido) foram inferiores no grupo de APE (P < 0,001). Após a TT, observamos uma diminuição da frequência cardíaca, do intervalo TP-e e da razão TP-e/QT ( P < 0,001). Apesar de termos observado uma diminuição do intervalo QT e QTc e da dispersão do QT (QTd), o valor de QTd não apresentou uma diferença estatisticamente significativa (respectivamente, valor de P 0,013, 0,029 e 0,096). Os níveis do iCEB e iCEBc foram menores após a TT (valor de P 0,035 e 0,044, respectivamente). CONCLUSÃO: Os valores de QT, QTc, intervalo Tp-e, razão Tp-e/QTc, iCEB e iCEBc diminuíram significativamente após TT. Pode-se concluir que a TT eficaz causa uma melhora parcial da repolarização ventricular no período inicial.
Assuntos
Humanos , Embolia Pulmonar/tratamento farmacológico , Eletrocardiografia , Arritmias Cardíacas/tratamento farmacológico , Terapia Trombolítica , Frequência CardíacaRESUMO
Transfemoral aortic valve implantation has become an almost routine interventional procedure for severe aortic stenosis in high-risk patients. Over time an increased number of experiences has led to unusual procedures. In this report, we present a successful valve-in-valve transfemoral aortic valve implantation in a patient with aortic regurgitation, who previously had debranching and thoracic endovascular aortic repair operations.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/cirurgia , Substituição da Valva Aórtica Transcateter/instrumentação , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Feminino , Artéria Femoral , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Reoperação , Tomografia Computadorizada por Raios XAssuntos
Valva Aórtica , Doenças das Valvas Cardíacas/cirurgia , Trombose/cirurgia , Arritmias Cardíacas/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Radiografia , Reoperação , Trombose/complicações , Trombose/diagnóstico por imagemAssuntos
Cardiomiopatia Dilatada/diagnóstico , Síndrome de Sturge-Weber/diagnóstico , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Síndrome de Sturge-Weber/complicações , Síndrome de Sturge-Weber/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. HYPOTHESIS: The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. METHODS: This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. RESULTS: The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. CONCLUSIONS: Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking.
Assuntos
Angiografia Coronária , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Fumar/mortalidade , Idade de Início , Idoso , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/efeitos adversos , Fatores de Tempo , Turquia/epidemiologiaRESUMO
OBJECTIVE: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). METHODS: This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A--age = or <44 years; Group B--age 45-64 years; and Group C--age = or >65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated. RESULTS: The mean age was 58+/- 11 years (range 24-96 years). Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DM (p<0.001). Prevalence of smoking was the highest in young patients and males (p<0.001). Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001). Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average. CONCLUSIONS: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors.
Assuntos
Unidades de Cuidados Coronarianos/estatística & dados numéricos , Lipídeos/sangue , Infarto do Miocárdio/epidemiologia , Fumar/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Prevalência , Fatores de Risco , Fatores Sexuais , Turquia/epidemiologia , Adulto JovemRESUMO
The effects of therapy with aspirin 300 mg/day and with combined aspirin 100 mg/day plus clopidogrel 75 mg/day on platelet function were compared in patients with diabetes mellitus and coronary artery disease and impaired antiplatelet responses to aspirin 100 mg/day. The study population consisted of 151 outpatients with type II diabetes mellitus and coronary artery disease who were taking aspirin 100 mg/day. Of the 151 patients, a subgroup of subjects with impaired aspirin response were selected on the basis of the results of platelet aggregometry. Nonresponsiveness to aspirin was defined as mean aggregation > or =69% with 3 micromol/L adenosine diphosphate and mean aggregation > or =70% with 2 micromol/L collagen. Aspirin semiresponders were defined as meeting 1 but not both of these criteria. Nonresponders and semiresponders were randomized equally to aspirin 300 mg/day and aspirin 100 mg/day plus clopidogrel 75 mg/day, and aggregation tests were repeated after 2 weeks. Sixty of the 151 patients with diabetes (40%) were found to respond to aspirin inadequately. Platelet aggregation induced by adenosine diphosphate and collagen decreased significantly after aspirin 300 mg/day or combined therapy. Combined treatment was found to have a stronger inhibitory effect on platelet aggregation induced by adenosine diphosphate than aspirin 300 mg/day (p = 0.002). Impaired aspirin response was resolved by increasing the aspirin dose or adding clopidogrel to aspirin (p <0.0001 for each). However, desired platelet inhibition was achieved in significantly more patients by combined treatment than by aspirin 300 mg/day (p <0.05). In conclusion, aspirin 100 mg/day does not inhibit platelet function adequately in a significant number of patients with diabetes mellitus and coronary artery disease. Increasing the aspirin dose to 300 mg/day or adding clopidogrel to aspirin can provide adequate platelet inhibition in a significant number of those patients with impaired responses to low-dose aspirin.
Assuntos
Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Doença da Artéria Coronariana/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Aspirina/administração & dosagem , Clopidogrel , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/complicações , Diabetes Mellitus Tipo 2/sangue , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Ticlopidina/uso terapêutico , Falha de TratamentoRESUMO
OBJECTIVES: The purpose of this study was to investigate the relationship between endogen sex hormone levels and myocardial performance in two different phases of menstrual cycle. BACKGROUND: The relationships between cardiac performance and sex hormone levels in menstrual cycle have not yet been clearly identified. METHODS: Twenty-seven women at the age of 19-42 years (mean 24.11+/-6.02) with regular menstrual cycles (28-31 days) were enrolled in this study. Cardiac performance was evaluated by tissue Doppler imaging (TDI) derived myocardial performance index (MPI) in the menstrual and the luteal phases of the menstrual cycle. RESULTS: Left ventricular MPI were statistically significant between the menstrual phase and luteal phase of the menstrual cycle (Inferior 0.53+/-0.10 versus 0.44+/-0.09, P<0.001; Anterior 0.54+/-0.13 versus 0.45+/-0.10, P<0.008; Lateral 0.50+/-0.09 versus 0.44+/-0.12, P<0.03; Septum 0.54+/-0.07 versus 0.46+/-0.10, P<0.005; Global 0.52+/-0.06 versus 0.44+/-0.09, P<0.001). Right ventricle MPI between the two periods was also significantly different (0.49+/-0.10 versus 0.42+/-0.10, P<0.01). There was a moderate correlation between estrogen levels and global MPI (r=0.46, P=0.001), but no correlation was found between progesterone levels and global MPI (r=0.22, P=NS). CONCLUSION: We firstly demonstrated that endogen estrogen or progesterone improved the combined systolic and diastolic function in both left and right ventricle during luteal phases of menstrual cycle. Considering the previous studies and our results, estrogen may be responsible for this improvement.