Heparin pretreatment in ST segment elevation myocardial infarction: a systematic review and meta-analysis.

BACKGROUND: Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention in patients with ST segment elevation myocardial infarction (STEMI). Current guidelines, however, do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterization laboratory. METHODS: Between June and July 2023, we systematically searched PubMed, Embase, and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A random-effects meta-analysis and meta-regression analyses were performed. RESULTS: Fourteen studies were included, of which four were randomized clinical trials. A total of 76 446 patients were included: 31 238 in the pretreatment group and 39 208 in the control group. Our meta-analysis revealed lower all-cause mortality for the pretreatment strategy when compared with the control group, albeit with high heterogeneity [pooled odds ratio (OR) = 0.61, 95% confidence interval (CI): 0.49-0.76, P < 0.01; I2 = 77%]; lower in-hospital cardiogenic shock (pooled OR = 0.68, 95% CI: 0.58-0.78, P < 0.21; I2 = 27%) and a higher rate of spontaneous reperfusion events (pooled OR = 1.68, 95% CI: 1.47-1.91, P < 0.01; I2 = 79%). In terms of major bleeding, the UFH pretreatment strategy further revealed a decreased rate of events (pooled OR = 0.85, 95% CI: 0.73-0.99, P = 0.40; I2 = 4%). CONCLUSION: Our study suggests that UFH pretreatment in patients with STEMI undergoing primary percutaneous coronary intervention was associated with reduced all-cause mortality, cardiogenic shock, enhancing reperfusion rates while diminishing major bleeding events.

Perfil sócio demográfico e clínico de pacientes com Câncer Gástrico atendidos em um hospital de referência no interior de Minas Gerais / Socio-demographic and clinical profile of Gastric Cancer patients attended at a reference hospital in the interior of Minas Gerais

Introdução: O câncer gástrico é uma doença multifatorial de grande incidência no Brasil e de índices de mortalidade alarmantes. Por esse motivo, são essenciais as investigações epidemiológicas ao seu respeito para a definição da profilaxia adequada e do rastreio eficaz da doença. Associado a isso, a maior parte dos diagnósticos são feitos em fases avançadas da doença e sabe-se que as taxas de sobrevida em 5 anos são maiores em pacientes nos estágios iniciais. Objetivo: O presente estudo teve como objetivo caracterizar o perfil sócioepidemiográfico dos pacientes com câncer gástrico tratados na região ampliada de saúde do centro sul de Minas Gerais. Métodos: Foi conduzido um estudo de coorte retrospectivo a partir da análise de 456 prontuários de pacientes diagnosticados com câncer gástrico no Hospital Ibiapaba CEBAMS, em Barbacena, MG, no período de 2000 a 2017. Resultados: Os pacientes eram em sua maioria do sexo masculino (73,90%), acima dos 60 anos de idade (68,20%), leucodermos (63,52%), baixo nível educacional (74,19%), com relato de exposição prévia ao tabagismo (55,27%) e não etilistas (61,71%). O tipo histológico mais comum foi o Adenocarcinoma do tipo intestinal de Lauren (49,50%) e o estadiamento mais diagnosticado foi o estágio IV (40,80%). Conclusão: Dessa forma, foi ressaltada no estudo a importância da investigação da neoplasia gástrica na atenção primária, especialmente em pacientes com característica descritas nesse perfil e/ou com outras já descritas pela literatura. (AU)

Introduction: Gastric cancer (GC) is a multifactorial disease of high incidence in Brazil and with alarming mortality rates. For this reason, epidemiological investigations are essential for prophylaxis and effective screening of the disease. In addition, most diagnoses are in advanced stages of the disease and it is known that 5-year survival rates are higher in patients in the early stages. Objectives: The present study aimed to characterize the socio demographic profile of gastric cancer patients treated in the South Center health region of Minas Gerais. Methods: The authors ran a retrospective cohort study based on the analysis of 456 medical records of patients diagnosed with CG at the Ibiapaba CEBAMS Hospital, Barbacena, MG, from 2000 to 2017. Results: The patients were mostly males (73.90 %), above 60 years of age (68.20%), self-identified as white skin (63.52%), low educational level (74.19%), with previous exposure to smoking (55.27%) and non-alcoholic (61.71%). The most common histological type was intestinal adenocarcinoma (49.50%) and the most diagnosed stage was stage IV (40.80%). Conclusion: Accordingly, the study emphasized the importance of primary care investigation of the GC, especially in patients with the described profile or others risk factors already described in the literature. (AU)