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1.
Circulation ; 116(25): 2944-51, 2007 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-18056527

RESUMO

BACKGROUND: The relation between coffee consumption and cardiovascular disease has been studied extensively, but results are still debated. In addition, little evidence is available on patients with established coronary heart disease. METHODS AND RESULTS: Prospectively ascertained information among 11,231 Italian patients (9584 males and 1647 females) with recent (< or = 3 months) myocardial infarction enrolled in the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevenzione trial was used. Usual dietary habits were assessed at baseline and updated at 0.5 and 1.5 years. Coffee consumption was categorized as never/almost never, < 2 cups per day, 2 to 4 cups per day, and > 4 cups per day. Medication use and fasting glucose were assessed at 0.5, 1, 1.5, 2.5, and 3.5 years. Risk was evaluated with Cox proportional hazards with time-varying covariates. The main outcome measure was the cumulative incidence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke). A total of 1167 cardiovascular events occurred during 36,961 person-years of follow-up. After multivariable adjustment for potential confounders in the time-dependent analysis, the relative risk of cardiovascular events across categories of coffee consumption was 1.02 (95% CI 0.87 to 1.20) for < 2 cups per day, 0.91 (95% CI 0.75 to 1.09) for 2 to 4 cups per day, and 0.88 (95% CI 0.64 to 1.20) for > 4 cups per day compared with abstainers (P for trend=0.18). Ultimately, coffee consumption did not change the risk of coronary heart disease events, stroke, and sudden death. CONCLUSIONS: No association between moderate coffee intake and cardiovascular events was observed in post-myocardial infarction patients.


Assuntos
Café , Comportamento Alimentar , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Idoso , Café/efeitos adversos , Morte Súbita/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia
2.
Monaldi Arch Chest Dis ; 66(1): 13-9, 2006 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-17125042

RESUMO

BACKGROUND: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. METHODS: 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. RESULTS: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. CONCLUSION: The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.


Assuntos
Envelhecimento , Sistema de Condução Cardíaco/fisiopatologia , Infarto do Miocárdio/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Estudos de Casos e Controles , Eletrocardiografia , Estudos de Avaliação como Assunto , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
3.
Am J Cardiol ; 93(7): 914-6, 2004 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-15050497

RESUMO

The clinical outcome of 48 consective patients with myocardial infarction who received tirofiban for unsuccessful thrombolysis was compared with that of 48 patients matched for age, gender, and infarct location who did not receive rescue treatment. Those who received tirofiban had more successful reperfusions, and there were few bleeding complications.


Assuntos
Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Tirosina/análogos & derivados , Tirosina/uso terapêutico , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento/métodos , Tirofibana , Falha de Tratamento
4.
Monaldi Arch Chest Dis ; 60(4): 314-7, 2003 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-15061606

RESUMO

Authors describe a case of partial atrio ventricular septal defect--cushion defect--with only a mitral valve cleft and mild valvular insufficiency. There were present also, since the childhood, an atrio ventricular primary block, and a left axis deviation. Late appeared a RBBB. The correct diagnosis has been done at the age of 67 years. The patient refers mean rhythm disorders and effort dyspnea. She refused surgical correction successful also in the late age.


Assuntos
Comunicação Interatrial/diagnóstico , Comunicação Interventricular/diagnóstico , Fatores Etários , Idoso , Ecocardiografia , Eletrocardiografia , Feminino , Humanos
5.
Monaldi Arch Chest Dis ; 62(2): 105-13, 2004 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-15552222

RESUMO

The lack of a multidisciplinary approach is certainly among the causes of the ineffectiveness of intervention in the field of cardiovascular secondary prevention. By multidisciplinary approach is meant involving cardiologists, nurses, rehabilitation therapists, dieticians as well as psychologists in the framing of interventions tailor made to patients needs. In particular, people working in the nursing area can play a very important role which can be summed up into three different levels: a technical level, aiming at the cooperation with cardiologists to carry out diagnostic examinations and give a portrait of patients in terms of risks; a second level consists in giving information, and helping to face the disease, as well as stepping in during its evolution, almost a health counsellor for the patients; finally the nurse can act as a psychological support both to the patient and his/her family during acute illnesses and reassure him/her that he/she is being treated properly and that successively will resume a good quality of life. Hospital represent an ideal place for secondary prevention, at least in the first phases of the intervention. The results collected during hospitalization would be rapidly lost if they were not followed and sustained in the medium-long term by structured follow-up programmes. The development of ambulatories might represent a link between hospitals and the territory, i.e. the specialist and one's personal physician. The staff of ambulatories should comprise a cardiologist and a trained professional nurse, this being specialized, specifically, in cardiology and cardiovascular prevention. Staff of the type described could work independently, co-ordinating ambulatories on the territory within the framework of standardized recognized protocols and relating information concerning patients, general practitioners and other surgeries. In this way, an essential link of the continuity in medical care would be guaranteed.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Papel do Profissional de Enfermagem , Humanos , Educação de Pacientes como Assunto
6.
Monaldi Arch Chest Dis ; 62(1): 12-6, 2004 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-15211731

RESUMO

Glycoprotein IIb/IIIa inhibitors have been recently proposed as a bridge to rescue transluminal coronary angioplasty in ST elevation myocardial infarction patients in whom thrombolysis fails; but data in its feasibility, safety and efficacy are still limited. In 47 consecutive acute myocardial infarction patients in whom thrombolysis failed to achieve 90 minute reperfusion, tirofiban was given at full regimen. Our results have been compared with those obtained in a control group of 48 consecutive acute myocardial infarction patients admitted two years before, period in which tirofiban and rescue angioplasty were not available in our hospital. Our preliminary data suggest this approach is feasible and safe, with possible clinical benefit in this high-risk subgroup of patients.


Assuntos
Fibrinolíticos/administração & dosagem , Tirosina/análogos & derivados , Tirosina/administração & dosagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Terapia Trombolítica , Tirofibana , Falha de Tratamento
7.
J Cardiovasc Med (Hagerstown) ; 8 Suppl 1: S34-7, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17876196

RESUMO

The GISSI-Prevenzione trial established the efficacy of n-3 polyunsaturated fatty acids (PUFAs) for reducing mortality in patients after recent myocardial infarction. The generalisability of such results to clinical practice could vary according to other individual patient characteristics. We analysed the GISSI-Prevenzione database to assess whether other major risk factors, comorbidities, dietary habits, or medications could interact with the efficacy of n-3 PUFA treatment to reduce total mortality. We found no evidence that concomitant disease states, habits, or interventions altered the therapeutic benefit of n-3 PUFA consumption in survivors of recent myocardial infarction.


Assuntos
Ácidos Graxos Ômega-3/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Diabetes Mellitus/epidemiologia , Suplementos Nutricionais , Humanos , Hipertensão/epidemiologia , Prevenção Secundária , Volume Sistólico , Complexos Ventriculares Prematuros/epidemiologia , Vitamina E/uso terapêutico , Vitaminas/uso terapêutico
8.
G Ital Cardiol (Rome) ; 9(4): 286-97, 2008 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-18543799
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