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Arq. bras. cardiol ; 121(1): e20230258, jan. 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1533724


Resumo Fundamento A infecção concomitante por coronavírus 2019 (COVID-19) e o infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) estão associados ao aumento de desfechos adversos hospitalares. Objetivos O estudo teve como objetivo avaliar as diferenças angiográficas, de procedimentos, laboratoriais e prognósticas em pacientes positivos e negativos para COVID-19 com IAMCSST submetidos à intervenção coronária percutânea primária (ICP). Métodos Realizamos um estudo observacional retrospectivo e unicêntrico entre novembro de 2020 e agosto de 2022 em um hospital de nível terciário. De acordo com o seu estado, os pacientes foram divididos em dois grupos (positivo ou negativo para COVID-19). Todos os pacientes foram internados por IAMCSST confirmado e foram tratados com ICP primária. Os desfechos hospitalares e angiográficos foram comparados entre os dois grupos. P-valores bilaterais <0,05 foram aceitos como estatisticamente significativos. Resultados Dos 494 pacientes com IAMCSST inscritos nesse estudo, 42 foram identificados como positivos para COVID-19 (8,5%) e 452, como negativos. Os pacientes que testaram positivos para COVID-19 tiveram um tempo isquêmico total maior do que os pacientes que testaram negativos para COVID-19 (p = 0,006). Além disso, esses pacientes apresetaram um aumento na trombose de stent (7,1% vs. 1,7%, p = 0,002), no tempo de internação (4 dias vs. 3 dias, p = 0,018), no choque cardiogênico (14,2% vs. 5,5%, p = 0,023) e na mortalidade hospitalar total e cardíaca (p <0,001 e p = 0,032, respectivamente). Conclusões Pacientes com IAMCSST com infecções concomitantes por COVID-19 foram associados ao aumento de eventos cardíacos adversos maiores. Mais estudos são necessários para compreender os mecanismos exatos dos desfechos adversos nesses pacientes.

Abstract Background Concomitant coronavirus 2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) are associated with increased adverse in-hospital outcomes. Objectives This study aimded to evaluate the angiographic, procedural, laboratory, and prognostic differences in COVID-19-positive and negative patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods A single-center, retrospective, observational study was conducted between November 2020 and August 2022 in a tertiary-level hospital. According to their status, patients were divided into two groups (COVID-19 positive and negative). All patients were admitted due to confirmed STEMI and treated with primary PCI. In-hospital and angiographic outcomes were compared between the two groups. Two-sided p-values < 0.05 were accepted as statistically significant. Results Of the 494 STEMI patients enrolled in this study, 42 were identified as having a positive dagnosis for COVID-19 (8.5%), while 452 were negative. The patients who tested positive for COVID-19 had a longer total ischemic time than did those who tested negative for COVID-19 (p=0.006). Moreover, these patients presented an increase in stent thrombosis (7.1% vs. 1.7%, p=0.002), length of hospitalization (4 days vs. 3 days, p= 0.018), cardiogenic shock (14.2% vs. 5.5 %, p= 0.023), and in-hospital total and cardiac mortality (p<0.001 and p=0.032, respectively). Conclusions Patients with STEMI with concomitant COVID-19 infections were associated with increased major adverse cardiac events. Further studies are needed to understand the exact mechanisms of adverse outcomes in these patients.

Chinese Journal of Experimental Traditional Medical Formulae ; (24): 134-142, 2024.
Article in Chinese | WPRIM | ID: wpr-1005262


ObjectiveTo explore the establishment and evaluation methods of the rat model of acute myocardial infarction (AMI) in coronary heart disease with the syndrome of Qi and Yin deficiency by sleep deprivation (SD) combined with isoproterenol (ISO) and preliminarily explore its biological basis. MethodForty SD rats were assigned into normal (no treatment), SD (treatment in modified multi-platform water environment for 96 h), ISO (subcutaneous injection of ISO at 100 mg·kg-1 once every other day for a total of 2 times), and SD+ISO (injection of 100 mg·kg-1 ISO after SD for 72 h and 96 h) groups. The cardiac function was detected by small animal echocardiography. The serum levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), and cardiac troponin T (cTnT) were measured by biochemical methods. The pathological changes of the myocardial tissue were observed by hematoxylin-eosin staining. The general state, body weight, grip strength, body temperature, behaviors in open field test, serum levels of cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), cAMP/cGMP ratio, red (R), green (G), blue (B) values of the tongue surface, and pulse amplitude were observed and measured to evaluate the modeling results. Enzyme-linked immunosorbent assay was employed to determine the serum levels of interleukin-18 (IL-18), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), malondialdehyde (MDA), corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH), triiodothyronine (T3), tetraiodothyronine (T4), cluster of differentiation 4 (CD4), and cluster of differentiation 8 (CD8). ResultIn terms of disease indicators, the ISO and SD+ISO groups had lower cardiac function indicators than the normal group (P<0.01). The levels of CK, CM-MB, LDH and cTnT elevated in each model group compared with the normal group (P<0.01). The pathological changes of myocardial tissue were obvious in the ISO and SD+ISO groups. In terms of syndrome indicators, compared with the normal group, the SD and SD+ISO groups showed decreased body weight at each time point (P<0.01), and the ISO group showed decreased body weight at the time points of 48 h and 72 h (P<0.05, P<0.01). The paw temperature and rectal temperature increased in the SD group (P<0.01). The model groups showed weakened grasp strength, lowered R, G, and B values of the tongue surface (P<0.01), prolonged immobility time (P<0.01), reduced total distance and number of entering the central area (P<0.01), decreased average speed (P<0.05, P<0.01), and increased cAMP and cGMP (P<0.05, P<0.01). The cAMP/cGMP ratio was increased in the SD+ISO group (P<0.01), and the pulse amplitude was decreased in the SD and SD+ISO groups (P<0.01). In terms of serological indicators,compared with the normal group, the levels of IL-18, TNF-α, SOD and MDA were significantly increased in the ISO and SD+ISO groups (P<0.01), the CRF, ACTH, CORT, T3, T4, CD4 and CD8 in the model groups were increased (P<0.05, P<0.01). ConclusionSleep deprivation for 96 h combined with high-dose ISO can successfully establish a rat model of acute myocardial infarction in coronary heart disease with the syndrome of Qi and Yin deficiency. The model evaluation system can be built with disease indicators of western medicine, histopathological indicators, macroscopic indicators of traditional Chinese medicine, and serological indicators.

Int. j. cardiovasc. sci. (Impr.) ; 37: e20230070, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1550290


Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.

Int. j. cardiovasc. sci. (Impr.) ; 37: e20220203, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1534610


Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment-elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.

Rev. bras. cir. cardiovasc ; 39(2): e20230076, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1535547


ABSTRACT Objective: The purpose of present study was to comprehensively explore the efficacy and safety of prothrombin complex concentrate (PCC) to treat massive bleeding in patients undergoing cardiac surgery. Methods: PubMed®, Embase, and Cochrane Library databases were searched for studies investigating PCC administration during cardiac surgery published before September 10, 2022. Mean difference (MD) with 95% confidence interval (CI) was applied to analyze continuous data, and dichotomous data were analyzed as risk ratio (RR) with 95% CI. Results: Twelve studies were included in the meta-analysis. Compared with other non-PCC treatment regimens, PCC was not associated with elevated mortality (RR=1.18, 95% CI=0.86-1.60, P=0.30, I2=0%), shorter hospital stay (MD=-2.17 days; 95% CI=-5.62-1.28, P=0.22, I2=91%), reduced total thoracic drainage (MD=-67.94 ml, 95% CI=-239.52-103.65, P=0.44, I2=91%), thromboembolic events (RR=1.10, 95% CI=0.74-1.65, P=0.63, I2=39%), increase in atrial fibrillation events (RR=0.73, 95% CI=0.52-1.05, P=0.24, I2=29%), and myocardial infarction (RR=1.10, 95% CI=0.80-1.51, P=0.57, I2=81%). However, PCC use was associated with reduced intensive care unit length of stay (MD=-0.81 days, 95% CI=-1.48- -0.13, P=0.02, I2=0%), bleeding (MD=-248.67 ml, 95% CI=-465.36- -31.97, P=0.02, I2=84%), and intra-aortic balloon pump/extracorporeal membrane oxygenation (RR=0.65, 95% CI=0.42-0.996, P=0.05, I2=0%) when compared with non-PCC treatment regimens. Conclusion: The use of PCC in cardiac surgery did not correlate with mortality, length of hospital stay, thoracic drainage, atrial fibrillation, myocardial infarction, and thromboembolic events. However, PCC significantly improved postoperative intensive care unit length of stay, bleeding, and intra-aortic balloon pump/ extracorporeal membrane oxygenation outcomes in patients undergoing cardiac surgery.

PAMJ clin. med ; 14(33): 1-13, 2024. figures, tables
Article in English | AIM | ID: biblio-1552707


Introduction: African countries are facing an epidemic of cardiovascular diseases. Information on the quality of acute coronary syndrome care offered in underserved communities in Ghana is limited. Using objective criteria, we examined the quality of acute coronary syndrome care offered to patients presenting to a tertiary referral center in Northern Ghana. Methods: we conducted a retrospective review of patients ≥ 18 years old with acute coronary syndrome managed in Tamale Teaching Hospital. We assessed in-hospital outcomes and the extent of compliance to key performance and quality indicators as contained in the 2017 American Heart Association/American College of Cardiology guideline for adults with myocardial infarction. Results: sixty-two (62) patients with a mean age of 56.0 ± 16.1 years were recruited. The median delay to presentation was 24 hours (IQR 15-96 hours). 33.9% had ST-elevation myocardial infarction, of which only 14.3% received reperfusion therapy. About three-quarters of patients received dual antiplatelet therapy at discharge, with fewer patients receiving recommended high-intensity statin therapy (65.5%) or beta-blockers (69.1%). Only 38.2% of patients had their left ventricular ejection fraction documented. No cardiac rehabilitation program existed. Risk stratification of patients with non-ST-elevation myocardial infarction or stress testing for conservatively managed patients was not part of routine practice. Conclusion: acute coronary syndrome management remains a challenging issue in Northern Ghana. Several gaps exist in the care quality, timeliness of interventions and rehabilitation of affected patients. There is an urgent need for measures to improve the delivery of acute coronary syndrome care alongside primary prevention strategies.

Acute Coronary Syndrome , Prevalence
Rev. Finlay ; 13(4)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550670


Fundamento: más de siete millones de personas mueren cada año como consecuencia de la cardiopatía isquémica. La incidencia de factores de riesgo constituye una sobrecarga de actividad para el corazón lo que presupone un incremento en la ocurrencia de infarto del miocardio. Objetivo: determinar la epidemiología del infarto agudo de miocardio y factores de riesgo predisponentes. Método: se realizó un estudio descriptivo, analítico, longitudinal, retrospectivo de serie de casos a partir de la población con diagnóstico de infarto agudo de miocardio evaluados en el Servicio de Urgencias Médicas del Hospital Docente Clínico Quirúrgico Carlos Enrique Font de Banes, provincia Holguín durante el período mayo 2022- 2023. El universo abarcó 57 individuos diagnosticados. Por muestreo probabilístico aleatorio simple, se obtuvo la muestra de 38 casos. Se operacionalizaron las variables: edad, sexo, modalidad de infarto, factores de riesgo, riesgo cardiovascular global. Fueron utilizados los estadígrafos: Chi cuadrado de Pearson, Odd Ratio (OR), incluidos p e intervalo de confianza. Resultados: el sexo masculino prevaleció en un 63,1 %. El grupo de edades 60-69 años resultó el más afectado con un 31,6 %. El infarto agudo de miocardio doloroso fue de 71,1 % (OR=6), con elevación del ST 76,3 % (OR=10,3) y de cara posterior un 39,5 % obtuvo valores estadísticos elevados. Los factores de riesgo, hipertensión arterial (X2=25,4 OR=14 IC95 % (4,6; 42,3) y los antecedentes familiares de enfermedad cardiovascular (X2=5,2 OR=2,9 IC95 % (1,1; 7,4)) expresaron asociación altamente significativa para infarto agudo de miocardio. El riesgo cardiovascular global medio predominó (52,6 % OR=1,23 X2=0,21). Conclusiones: los individuos con infarto agudo de miocardio muestran un riesgo cardiovascular global medio a expensas de factores de riesgo prevenibles.

Foundation: more than seven million people die each year as a result of ischemic heart disease. The incidence of risk factors constitutes an overload of activity for the heart, which presupposes an increase in the occurrence of myocardial infarction. Objective: determine the epidemiology of acute myocardial infarction and predisposing risk factors. Method: a descriptive, analytical, longitudinal, retrospective study of a series of cases was carried out from the population with a diagnosis of acute myocardial infarction evaluated in the Medical Emergency Service of the Carlos Enrique Font Banes Clinical Surgical Teaching Hospital, Holguín province during the period May 2022-2023. The universe covered 57 diagnosed individuals. By simple random probabilistic sampling, a sample of 38 cases was obtained. The variables were operationalized: age, sex, type of infarction, risk factors, global cardiovascular risk. The following statisticians were used: Pearson's Chi square, Odd Ratio (OR), including p and confidence interval. Results: the male sex prevailed in 63.1 %. The age group 60-69 years old was the most affected with 31.6 %. Painful acute myocardial infarction was 71.1 % (OR=6), with ST elevation 76.3 % (OR=10.3) and on the posterior side 39.5 % obtained high statistical values. The risk factors, arterial hypertension (X2=25.4 OR=14 95 % CI (4.6; 42.3) and family history of cardiovascular disease (X2=5.2 OR=2.9 95 % CI (1, 1; 7.4)) expressed a highly significant association for acute myocardial infarction. The mean global cardiovascular risk predominated (52.6 % OR=1.23 X2=0.21). Conclusions: individuals with acute myocardial infarction show an average global cardiovascular risk at the expense of preventable risk factors.

Rev. argent. cardiol ; 91(5): 331-338, dic. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550696


RESUMEN Introducción y objetivos: El alta hospitalaria temprana (dentro de las primeras 48 horas) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratados con angioplastia coronaria primaria con stent (ATCp) ha sido adoptada en países desarrollados. Sin embargo, su implementación en Sudamérica ha sido dispar. Material y métodos: Estudio piloto de intervención no controlado, argentino, de pacientes con IAMCEST de bajo riesgo tratados con ATCp, para evaluar tasa de alta temprana y comparar la incidencia de eventos cardiovasculares adversos mayores (MACE) con la que ocurre en pacientes externados en forma no temprana. Resultados: Desde 2013 hasta 2021 se trataron con ATCp 320 pacientes con IAMCEST, de los que 158 fueron de bajo riesgo. Alta temprana en 63,9% (IC 95% 55,9-71,4%). La diabetes (OR 0,31; IC 95% 0,12-0,83) y el IAMCEST anterior (OR 0,34; IC 95% 0,16-0,69) se asociaron en forma independiente con menor probabilidad de alta temprana. Durante una mediana de seguimiento de 27,2 meses, la razón de tasas de incidencia de MACE entre los grupos de alta temprana y no temprana fue de 0,77 (IC 95 % 0,25-2,58; p = 0,61). Las variables asociadas de forma independiente con MACE fueron la revascularización completa (HR 0,18; IC 95% 0,03-0,95) y el tiempo de fluoroscopía (HR 1,02; IC 95% 1,01-1,05). No hubo diferencias significativas en las complicaciones del acceso vascular, las tasas de reingreso a 30 días y sobrevida global entre los grupos. Conclusiones: El alta temprana en pacientes con IAMCEST de bajo riesgo tratados con ATCp puede ser factible incluso en países en desarrollo, sin aumento significativo de la morbimortalidad.

ABSTRACT Background and objectives: Early discharge (within the first 48 hours) in patients with ST-segment elevation myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (PCI) with stenting is a strategy that has been adopted in developed countries. However, its implementation in South America has been uneven. Methods: We conducted an uncontrolled intervention pilot study on low-risk STEMI patients managed with primary PCI to evaluate the early discharge rate and compare the incidence of major adverse cardiovascular events (MACE) with those occurring in patients discharged later. Results: Of 320 STEMI patients managed with primary PCI from 2013 to 2021, 158 were low-risk patients and 63.9% (95% CI 55.9-71,4%) of them were discharged early. Diabetes (OR 0.31, 95% CI 0.12-0.83), and anterior wall STEMI (OR 0.34, 95% CI 0.16-0.69) were independently associated with lower probability of early discharge. During a median follow-up period of 27.2 months, the incidence rate ratio of MACE between the early discharge and non-early discharge groups was 0.77 (95% CI 0.25-2.58; p = 0.61). The variables independently associated with MACE were complete revascularization (HR 0.18, 95% CI 0.03-0.95) and fluoroscopy time (HR 1.02, 95% CI 1.01-1.05). There were no significant differences in vascular access complications, 30-day readmission rate and overall survival between groups. Conclusions: Early discharge in low-risk STEMI patients managed with primary PCI may be feasible even in developing countries, without significantly increasing morbidity and mortality.

Rev. argent. cardiol ; 91(5): 339-344, dic. 2023. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550697


RESUMEN Introducción: La Organización Mundial de la Salud (OMS) considera adulto mayor (AM) a las personas que tienen 60 años o más. Es sabido que la mortalidad por infarto agudo de miocardio (IAM) aumenta a edades más avanzadas, pero siempre se han utilizado umbrales de edad mayores que el propuesto por la OMS, por lo cual describir las características y evolución intrahospitalaria de este subgrupo (de acuerdo con la definición de la OMS) se torna relevante. Objetivos: 1) conocer la prevalencia de los AM según la OMS, con IAM con elevación del segmento ST en Argentina y 2) com- parar sus características, tratamientos de reperfusión y mortalidad con los adultos jóvenes. Material y métodos: Se analizaron los pacientes ingresados en el Registro Nacional de Infarto (ARGEN-IAM-ST). Se compara- ron las características clínicas, tratamientos y evolución de los AM y los adultos jóvenes. Resultados: Se incluyeron 6676 pacientes, de los cuales 3626 (54,3%) eran AM. Los AM fueron más frecuentemente mujeres (37,6% vs. 31,4%, p <0,001), hipertensos (67,8% vs. 47%, p <0,001), diabéticos (26,1% vs. 19,9%, p <0,001), dislipidémicos (45,4% vs. 37%, p <0,001), y tuvieron más antecedentes coronarios (16% vs. 10,3%, p <0,001). El tiempo a la consulta de los AM fue mayor (120 min vs. 105 min, p <0,001) con similar tiempo total de isquemia (314 min vs. 310 min, p = 0,33). Recibi- eron menos tratamiento de reperfusión (89,9% vs. 88,6%, p = 0,04) y más angioplastia primaria (91 % vs. 87,4%, p <0,001). Tuvieron más insuficiencia cardíaca (27,3% vs. 18,5%, p <0,001), similar incidencia de sangrado (3,7 vs. 3,1%, p = 0,33) y una mortalidad significativamente mayor (11,4% vs. 5,5%, p <0,001). Ser AM fue predictor independiente de mortalidad. Conclusiones: Más de la mitad de los IAM en nuestro país ocurren en AM. Los pacientes mayores tienen menor probabilidad de recibir reperfusión, más insuficiencia cardíaca y el doble de la mortalidad que los pacientes menores de 60 años.

ABSTRACT Background: The World Health Organization (WHO) defines an Older Adult (OA) as any individual aged 60 or older. It is known that mortality due to acute myocardial infarction (AMI) increases with age, but age thresholds higher than those proposed by the WHO have been consistently used; therefore, describing the characteristics and in-hospital progress of this subgroup of patients, in accordance with the WHO definition, becomes relevant. Objectives: 1) To know the prevalence of OA with acute ST-elevation myocardial infarction (STEMI) in Argentina according to the WHO, and 2) to compare their characteristics, reperfusion treatments, and mortality against those in young adults. Methods: Patients included in the National Registry of ST- Elevation Myocardial Infarction (Registro Nacional de Infarto con Elevación del ST, ARGEN-IAM-ST) were analyzed. Clinical features, therapies, and progress were compared in OA versus young adults. Results: A total of 6676 patients were enrolled, 3626 of which (54.3%) were OA. OA were mostly female (37.6% vs 31.4%, p <0.001), had hypertension (67.8% vs 47%, p <0.001), diabetes (26.1% vs 19.9%, p <0.001), dyslipidemia (45.4% vs 37%, p <0.001), and a longer coronary artery disease history (16% vs 10.3%, p < 0.001). The time to consultation in OA was longer (120 min vs 105 min, p <0.001), with a similar total ischemic time (314 min vs 310 min, p = 0.33). They received less reperfu- sion treatment (89.9% vs 88.6%, p = 0.04) and more primary angioplasty (91% vs 87.4%, p <0.001). Heart failure was more common in OAs (27.3% vs 18.5%, p <0.001), with a similar bleeding incidence (3.7% vs 3.1%, p = 0.33), and significantly higher mortality (11.4% vs 5.5%, p<0.001). Being an OA was an independent mortality predictor. Conclusions: More than half the cases of AMI in our country occur in OA. Older patients are less likely to receive reperfusion, more likely to have heart failure, and show twice the rate of mortality as compared to patients under 60.

Rev. argent. cardiol ; 91(5): 359-364, dic. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550700


RESUMEN La cardiopatía isquémica es la causa más frecuente de insuficiencia cardíaca, con una alta incidencia de esta a pesar de la revascularización precoz y la modulación neurohormonal. En el contexto del infarto agudo de miocardio los cardiomiocitos necrosados inducen la activación del sistema inmune innato, con aumento de la concentración de células inflamatorias que ayudan a eliminar las células muertas, e iniciar una respuesta correctiva que permite la formación adecuada de tejido cicatrizal.La prolongación o expansión de la respuesta inflamatoria posterior al infarto contribuye al remodelado adverso ventricular y al desarrollo de insuficiencia cardíaca.Entender los mecanismos inflamatorios que se desarrollan producto del infarto, y su impacto en el remodelado adverso que aumenta el número de eventos cardiovasculares mayores, permite comprender a la inflamación como un objetivo terapéutico.

ABSTRACT Ischemic heart disease is the most common cause of heart failure, with a high incidence of heart failure despite early revascularization and neurohormonal modulation.In the acute myocardial infarction setting, necrotized cardiomyocytes induce activation of the innate immune system, increasing the levels of inflammatory cells to help remove dead cells and initiate a corrective response, which allows for proper scar tissue formation.A prolonged or expanded inflammatory response after infarction contributes to adverse ventricular remodeling and development of heart failure.Understanding the inflammatory mechanisms that emerge as a result of myocardial infarction and their impact on adverse remodeling that leads to an increased.

Arch. cardiol. Méx ; 93(4): 442-450, Oct.-Dec. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1527722


Resumen Antecedentes y objetivo: El infarto prematuro tiene un alto impacto socioeconómico y carecemos de estudios contemporáneos que analicen las características asociadas al desarrollo de estos eventos y a su evolución Material y meéodos: En un estudio observacional sobre una cohorte retrospectiva que incluyó pacientes menores de 46 años con un infarto entre junio de 2012 y junio de 2022, se analizaron las características sociodemográficas, factores de riesgo cardiovasculares, tóxicos, características del infarto, datos sobre infección e inmunización por SARS-CoV-2, se realizó un seguimiento retrospectivo a un anÌo mediante la historia electrónica y se compararon los resultados con los reportados en la literatura. Resultados: El 12.1% de las angioplastias primarias corresponded a infartos prematuros (103). Entre los factores de riesgo clásicos destacaron la dislipidemia y el sobrepeso. La hipertensión y la diabetes fueron significativamente menores que las cifras reportadas en población mayor. El consumo de tabaco fue significativamente mayor, aí como el de otros tóxicos entre los que destacaron el cannabis y la ocaína. Los antecedentes familiares estuvieron presentes en 27 pacientes. El 27.2% (28) tuvieron complicaciones durante el ingreso y la mortalidad fue del 4.9% (5). No se identificaron diferencias significativas entre los pacientes que iniciaron con un evento antes o despuéde la pandemia, a excepción de una tendencia a la disminción del hábito tabáquico. Conclusiones: El infarto prematuro es una patología al alza con una morbimortalidad considerable. La concienciación sobre los hábitos tóxicos y prevención de los factores de riesgo clásicos son tareas prioritarias en nuestro medio.

Abstract Background and purpose: Premature infarction has a high socioeconomic impact and we lack contemporary studies that analyze the characteristics associated with its development and evolution. Material and methods: In an observational study on a retrospective cohort of patients younger than 46 years old, who had suffered from an infarction from June 2012 to June 2022, sociodemographic characteristics, cardiovascular and toxic risk factors, infarction characteristics, SARS-CoV-2 infection and immunization data were investigated. Indeed, a one-year retrospective follow-up was performed through their electronic health record and results were compared with the ones reported in literature. Results: 12.1% of primary angioplasties corresponded to premature infarctions (103). Among classical risk factors, dyslipidemia and overweight stood out, while hypertension and diabetes incidence was significantly lower than the one reported in older population. The consumption of tobacco and other drugs (especially cannabis and cocaine) was higher than that reported at older ages. Twenty-seven patients had a family history of ischemic cardiopathy or sudden cardiac death, 27.2% (28) had complications during admission and mortality was 4.9% (5). No significant differences were identified between the patients who debuted with an event before or after the pandemic, except for a tendency to smoking cessation. Conclusions: Premature infarction is a rising pathology with considerable morbidity and mortality. Raising awareness about toxic habits and prevention of the classical risk factors are priority tasks in this setting.

Rev. chil. cardiol ; 42(3)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1529986


El precondicionamiento isquémico remoto es una manera eficaz de disminuir el daño por isquemia y reperfusión en el corazón y otros órganos como cerebro o riñón, en modelos experimentales. Este consiste en realizar entre 3 y 5 ciclos de 5 minutos de isquemia seguidos del mismo tiempo de reperfusión, en un tejido alejado del que se quiere proteger, normalmente una extremidad. Estudios preclínicos en animales indican que la isquemia precondicionante inicia señales nerviosas y humorales en el tejido isquémico remoto, que en el corazón activan mecanismos de protección. La señal nerviosa se origina en fibras sensoriales que a nivel cerebral producen una activación del sistema parasimpático. El nervio vago activa ganglios cardíacos intrínsecos del corazón lo que induce protección. Además, desde el tejido isquémico se liberan a la circulación diferentes mediadores que viajan en forma libre o en vesículas lipídicas (exosomas) que inician vías de señalización protectoras en el corazón. A pesar del éxito del precondicionamiento isquémico remoto en animales de experimentación, su aplicación en seres humanos no ha tenido resultados claros. Esta discrepancia puede deberse a una diversidad de factores tales como la edad, la existencia de otras patologías, uso de fármacos u otros tratamientos que afectan la respuesta de los pacientes. Se requiere un mayor conocimiento de las bases moleculares de este mecanismo de protección para que su aplicación en clínica sea exitosa.

In experimental models, remote ischemic preconditioning effectively decreases ischemia reperfusion injury to the heart and other organs such as the brain or kidney. It consists of 3 to 5 cycles of 5 minutes of ischemia followed by 5 minutes of reperfusion, in a remote tissue, usually a limb. Preclinical studies in animals indicate that preconditioning ischemia initiates neural and humoral signals in the remote ischemic tissue, which activate protective mechanisms in the heart. The nervous signal originates in sensory fibers that activate the parasympathetic system in the brain. The vagus nerve activates the intrinsic cardiac ganglia of the heart, leading to protection from ischemic injury. Furthermore, mediators are released from the ischemic tissue into the circulation that travels freely or in lipid vesicles (exosomes) to the heart where they initiate protective signaling pathways. Despite the success of remote ischemic preconditioning in experimental animals, its application in humans has not produced clear results. This discrepancy may be due to a variety of factors such as age, the existence of other pathologic processes, or the use of drugs or other treatments that affect the patient´s response. An increased knowledge of the molecular bases of this protective mechanism is required for its clinical application to be successful.

Rev. cuba. estomatol ; 60(4)dic. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1550851


Introducción : La predicción del riesgo cardiovascular favorece la prevención de eventos cardiovasculares. Objetivo : Estimar el riesgo cardiovascular y determinar la condición periodontal de pacientes con síndrome coronario agudo. Método : Se realizó un estudio transversal en 60 sujetos admitidos en la Unidad de Cuidados Coronarios del Hospital Provincial Vladimir Ilich Lenin, con diagnóstico de síndrome coronario agudo, que a su vez cumplieron con los criterios de inclusión. Se tuvieron en cuenta los principios de ética médica, se empleó el índice Periodontal de Russell y se determinó el riesgo cardiovascular según las Tablas de Predicción de Riesgo Cardiovascular aprobadas para Cuba. Se evaluaron las variables incluidas en dichas tablas. Resultados : El infarto agudo de miocardio se presentó en el 58,3 por ciento. El 55,0 por ciento eran del sexo masculino, 35,0 por ciento se encontraban en el grupo de edad de 55 a 64 años. En relación con la condición periodontal, el 76,7 por ciento presentó periodontitis. Según los factores de riesgo explorados la adicción tabáquica estuvo presente en el 71,7 por ciento y la hipertensión arterial en el 65,0 por ciento de los sujetos. El 25,0 por ciento de los pacientes con riesgo cardiovascular bajo presentaba periodontitis. Conclusiones : Según las tablas de predicción de riesgo cardiovascular empleadas, más de la mitad de los pacientes con síndrome coronario agudo presentaron riesgo cardiovascular bajo o moderado, sin embargo, la mayoría de estos presentaban periodontitis(AU)

Introduction : Prediction of cardiovascular risk favors prevention of cardiovascular events. Objective : To estimate cardiovascular risk and determine the periodontal condition of patients with acute coronary syndrome. Methods : A cross-sectional study was carried out with 60 subjects admitted to the coronary care unit at Hospital General Docente Vladimir Ilich Lenin, with a diagnosis of acute coronary syndrome and, in turn, meeting with the inclusion criteria. The principles of medical ethics were taken into account, the Russell's Periodontal Index was used, and cardiovascular risk was determined according to the cardiovascular risk prediction tables approved for Cuba. The variables included in these tables were evaluated. Results : Acute myocardial infarction occurred in 58.3 percent of the patients. 55.0 percent were male, and 35.0 percent were in the age group 55-64 years. Regarding their periodontal condition, 76.7 percent presented periodontitis. According to the explored risk factors, tobacco addiction was present in 71.7 percent, while arterial hypertension was present in 65.0 percent of the subjects. 25.0 percent of the patients with low cardiovascular risk had periodontitis. Conclusions : According to the used cardiovascular risk prediction tables, more than half of the patients with acute coronary syndrome presented low or moderate cardiovascular risk; however, most of these had periodontitis(AU)

Humans , Male , Middle Aged
Saude e pesqui. (Impr.) ; 16(4): 11413, out./dez. 2023.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1518419


Essa pesquisa teve como objetivo analisar os impactos da assistência fisioterapêutica no tempo de hospitalização e capacidade de deambulação de pacientes submetidos à cirurgia de revascularização do miocárdio (CRVM), entre os anos de 2019 a 2020. Trata-se de um estudo de coorte, retrospectivo e de caráter documental, que foi realizado no Hospital Universitário Nova Esperança (HUNE). A amostra foi composta por 273 prontuários aceitos após os critérios de exclusão e perdas. A análise de regressão demonstrou que o déficit motor, alteração de tônus e procedimento de aspiração foram responsáveis por 25% da variação do tempo de hospitalização. Uma segunda análise de regressão foi realizada com o desfecho deambulação na alta hospitalar, e revelou que as condutas de bipedestação, cicloergometro, posicionamento e sedestação na alta hospitalar foram responsáveis por 67% de variação deste desfecho. A atuação da fisioterapia esteve associada a um menor tempo de hospitalização e capacidade de deambulação.

This research aimed to analyze the impacts of physiotherapeutic assistance on the length of hospitalization and walking ability of patients undergoing coronary artery bypass grafting (CABG) between the years 2019 to 2020. This is a cohort study, retrospective and documentary in nature, which was carried out at the Nova Esperança University Hospital (HUNE). The sample consisted of 273 medical records accepted after the exclusion and loss criteria. The regression analysis showed that motor deficit, tonus alteration and aspiration procedure were responsible for 25% of the variation in hospitalization time. A second regression analysis was performed with the outcome ambulation at hospital discharge, and revealed that the behaviors of standing upright, cycle ergometer, positioning and sitting at hospital discharge were responsible for 67% of the variation in this outcome. The performance of physiotherapy was associated with a shorter hospital stay and ability to walk.

Rev. argent. cardiol ; 91(4): 290-297, nov. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535507


RESUMEN Introducción: Los protocolos de diagnóstico acelerado de dolor torácico, con el avance de la troponina de alta sensibilidad, permiten identificar a los pacientes que ingresan al servicio de urgencias con dolor torácico de bajo riesgo para un evento cardiovascular adverso mayor, que podrían ser dados de alta de forma temprana y segura, con ahorro de tiempo y recursos. Objetivo: Evaluar ensayos clínicos que utilicen protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad. Material y métodos: se realizó una búsqueda de ensayos clínicos aleatorizados que evaluaran protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en los servicios de urgencias, en las bases de datos MEDLINE/Ovid, Cochrane y EMBASE utilizando los criterios de evaluación del manual Cochrane y la estrategia PRISMA Resultados: Tras una tamización de 3509 estudios se incluyeron 5 ensayos clínicos que incluyeron 1513 pacientes; se identificaron 409 (27%) altas tempranas, el 91% para el protocolo 0/3 h ESC, 72% para el 0/1 h, 48% para el EDACS, 40% para el HEART, 19 y 32% para ADAPT y 8 y 18% para el cuidado usual. El valor predictivo negativo fue alto, en un rango de 99,1 al 100% La duración media de la estancia hospitalaria fue más baja para los protocolos 0/1 h y 0/3 h ESC, con 4,6 y 5,6 horas respectivamente. Conclusiones: Los protocolos de diagnóstico acelerado en dolor torácico que implementan el uso de troponina de alta sensibilidad permiten lograr alta proporción de altas tempranas con baja tasa de eventos cardiovasculares mayores, con disminución del tiempo de estancia y recursos consumidos.

ABSTRACT Background: Accelerated diagnostic protocols for chest pain, with the advancement of high-sensitivity troponin, make it possible to identify patients admitted to the emergency department with chest pain and low risk for a major adverse cardiovascular event, who could be discharged immediately, early and safely, saving time and resources. Objective: The aim of this study was to assess clinical trials using accelerated diagnostic protocols based on high-sensitivity troponin. Methods: A search of randomized clinical trials evaluating accelerated diagnostic protocols based on high-sensitivity troponin in emergency services was carried out in MEDLINE/Ovid, Cochrane and EMBASE database, using the assessment criteria of the Cochrane manual and the PRISMA strategy. Results: After screening 3509 studies, 5 clinical trials, including 1513 patients, were analyzed. Early discharges were identified in 409 (27%) of patients, in 91% of cases for ESC 0/3-h protocols, 72% for 0/1-h, 48% for EDACS, 40% for HEART, 19% and 32% for ADAPT and 8% and 18% for standard care protocols. The negative predictive value was high, in the 99.1-100% range. Mean length of hospital stay was lower for the 0/1-h and ESC 0/3-h protocols, with 4.6 and 5.6 hours, respectively. Conclusions: Accelerated diagnostic protocols in chest pain using high-sensitivity troponin allow a higher proportion of early discharges with a low rate of major cardiovascular events, with reduction in length of hospital stay and resources used.

Rev. medica electron ; 45(5)oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1522054


Introducción: Dentro de las enfermedades cardiovasculares, el infarto agudo de miocardio es una de las causas de muerte más importante en Cuba, con tendencia creciente en el período 2019-2020. Objetivo: Identificar las variables asociadas a la morbimortalidad precoz por infarto agudo de miocardio, en la unidad coronaria del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, en el período 2019-2020. Materiales y métodos: Estudio observacional, descriptivo, de corte transversal que incluyó a 150 pacientes. Se analizaron variables cualitativas y cuantitativas, se aplicó el Chi-cuadrado o t de Student, y se realizó regresión logística binaria. Se empleó un nivel de significación estadístico de p < 0,05. Resultados: El 27 % de los pacientes presentaron complicaciones, y la mortalidad fue del 6 %. Las variables que se relacionaron con las complicaciones fueron la edad de 60 años o más (OR = 3,27; p = 0,004), la localización del infarto en cara anterior (OR = 2,63; p = 0,013) y la fracción de eyección del ventrículo izquierdo menor del 40 % (OR = 4,82; p = 0,005). Conclusiones: La edad avanzada, la localización del infarto en cara anterior y la disfunción ventricular sistólica se asociaron a una morbimortalidad precoz superior.

Introduction: Within cardiovascular diseases, acute myocardial infarction is one of the most important causes of death in Cuba, with a growing trend in the period 2019-2020. Objective: To identify the variables associated with early morbidity and mortality due to acute myocardial infarction, in the coronary unit of the Clinical Surgical University Hospital Faustino Pérez Hernández, in the period 2019-2020. Materials and methods: Observational, descriptive, and cross-sectional study that included 150 patients. Qualitative and quantitative variables were analyzed, Chi-square or T-student tests were applied to them, and a binary logistic regression was performed. A statistical significance level of p<0.05 was used. Results: 27 % of the patients presented complications, and mortality was 6%. The variables that were related to complications were age 60 years or older (OR=3.27; p=0.004), location of the infarct on the anterior wall (OR=2.63; p=0.013) and the left ventricular ejection fraction less than 40% (OR=4.82, p=0.005). Conclusions: Advanced age, location of the infarct on the anterior wall, and systolic ventricular dysfunction were associated with higher early morbidity and mortality.

Gac. méd. Méx ; 159(5): 434-438, sep.-oct. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1534471


Resumen Antecedentes: En los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST), el acondicionamiento isquémico puede ayudar a limitar la remodelación ventricular. Objetivos: Investigar el efecto del posacondicionamiento isquémico remoto (PAIR) en la función del ventrículo izquierdo durante la intervención coronaria percutánea primaria (ICPP) en pacientes con IAMCEST. Material y métodos: Estudio de intervención pre y posprueba con un total de 60 pacientes con IAMCEST. Los pacientes fueron divididos en dos grupos: con y sin PAIR. Resultados: En el seguimiento de seis meses se observó una diferencia significativa en la fracción de eyección del ventrículo izquierdo en pacientes con ICPP, la cual fue mayor en el grupo con PAIR en comparación con el grupo sin PAIR: 1.0 (−1.0 a 4.3) versus −1.0 (−4.0 a –1.3), p = 0.033. En la medición de seis meses, el volumen sistólico final del ventrículo izquierdo en los pacientes sin PAIR fue mayor en comparación con el grupo homólogo: 79.3 ± 30.5 mL versus 64.4 ± 21.4 mL, p = 0.032. Conclusiones: PAIR muestra efectos favorables en la función ventricular izquierda y, por lo tanto, en el futuro podría ser una estrategia cardioprotectora potencial contra la lesión por isquemia-reperfusión en pacientes con IAMCEST.

Abstract Background: Ischemic conditioning may help patients with ST-segment elevation myocardial infarction (STEMI) to limit ventricular remodeling. Objectives: To investigate the effect of remote ischemic postconditioning (RIPC) on left ventricular function during primary percutaneous coronary intervention (PPCI) in patients with STEMI. Material and methods: Pre- and post-test intervention study with a total of 60 STEMI patients. Patients were divided in two groups: with and without RIPC. Results: At 6-month follow-up evaluation, a significant difference in left ventricular ejection fraction was observed in patients who underwent PPCI, which was higher in the group with RIPC in comparison with the group without RIPC: 1.0 (−1.0 to 4.3) vs. −1.0 (−4.0 to –1.3), p = 0.033. In addition, at 6-month measurement, left ventricular end-systolic volume in patients without RIPC: was higher in comparison with their counterparts: 79.3 ± 30.5 mL versus 64.4 ± 21.4 mL, p = 0.032. Conclusions: RIPC shows favorable effects on left ventricular function and, therefore, in the future, it could be a potential cardioprotective strategy against ischemia-reperfusion injury in STEMI patients.

Rev. argent. cardiol ; 91(3): 184-189, oct. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535481


RESUMEN Introducción : La angioplastia primaria (ATCp) es el tratamiento de elección para el infarto agudo de miocardio con elevación del segmento ST (IAMCEST). En nuestro país, de tanta extensión territorial y con tiempos a la reperfusión subóptimos, la estrategia farmacoinvasiva (Finv) podría considerarse. Material y métodos : El ARGEN-IAM-ST es un registro prospectivo, multicéntrico, nacional y observacional. Se incluyen pacien tes con IAMCEST dentro de las 36 horas de evolución. Se definió en el mismo la utilización de Finv y las variables asociadas. Resultados : Se analizaron 4788 pacientes de los cuales en el 88,56 % se realizó ATCp, en el 8,46 % trombolíticos con reperfusión positiva (TL+), y solo en un 2,98% Finv. La mediana y rango intercuartílico (RIC) del tiempo total de isquemia fueron menores en aquellos que recibieron TL+ (165 min, RIC 100-269) y los que fueron a Finv (191 min, RIC 100-330) que en aquellos que fueron a ATCp (280 min, RIC 179- 520), p <0,001. No existieron diferencias en mortalidad intrahospitalaria, en el grupo Finv 4,9%, 5,2% en el grupo TL + y en el grupo ATCp 7,8% (p = 0,081). No hubo diferencias en término de sangrados mayores. Se observó que un 57% de los pacientes con TL+ reunían características de alto riesgo, y no recibieron Finv acorde a lo recomendado Conclusiones : Solo 3 de cada 100 pacientes con IAMCEST que se reperfunden reciben Finv. Su implementación no está ligada en forma sistemática al alto riesgo de eventos. Pese a esta subutilización, por presentar un menor tiempo total de isquemia que la ATCp, sin aumento en los sangrados clínicamente relevantes persiste como una opción a considerar en nuestra realidad.

ABSTRACT Background : Primary percutaneous coronary intervention (PPCI) is the treatment of choice for acute ST-elevation myocardial infarction (STEMI). In Argentina, a country with a large area and suboptimal reperfusion times, the pharmacoinvasive (PI) strategy might be considered. Methods : ARGEN-IAM-ST is a national prospective, multicenter, and observational registry that includes STEMI patients with less than 36 hours of progression. The PI strategy usage and its associated variables were defined. Results : In this registry, 4788 patients were analyzed, of which 88.56% underwent PPCI, 8.46% received thrombolytics with positive reperfusion (TL+), and only 2.98% received PI strategy. Median and interquartile range (IQR) of total ischemia time were lower in patients receiving TL+ (165 min, IQR 100-269) and PI (191 min, IQR 100-330) than in patients undergoing PPCI (280 min, IQR 179-520), p <0.001. No differences in intra-hospital mortality were observed: 4.9% in the PI strategy group, 5.2% in the TL+ group and 7.8% in the PPCI group (p = 0.081). No differences in major bleeding events were observed. It was observed that 57% of the TL+ patients met the criteria for high cardiovascular risk, but they did not receive PI strategy, as recommended. Conclusions : Only 3 out of 100 reperfused STEMI patients received PI strategy. Its administration is not systematically associated to high cardiovascular risk. Despite the under-usage, it remains an option to be considered due to its total ischemia time lower than in the PPCI, with no increase in clinically significant bleedings.