Complicações da síndrome coronariana e de acidente vascular encefálico em estudo de coorte / Complications of coronary syndrome and stroke in cohort study

Fundamentos: Os componentes da síndrome coronariana aguda e do acidente vascular encefálico apresentamem sua etiologia o envolvimento de processo aterotrombótico. Ambas as doenças apresentam fatores de risco em comum e grande parte deles é modificável. O entendimento de que essas doenças são consequências do processo vascular subjacente possibilita o desenvolvimento de novas intervenções terapêuticas e pode ajudar a identificar pacientes de risco e, portanto, prevenir manifestações da aterotrombose.Objetivos: Verificar a incidência de complicações da síndrome coronariana aguda ou de acidente vascular encefálico e seus fatores de risco em uma coorte, durante um ano de acompanhamento. Métodos: Estudo de coorte, prospectivo, que incluiu pacientes de ≥30 anos, de ambos os sexos, com diagnóstico de síndrome coronariana aguda ou de acidente vascular encefálico, internados em hospital na cidade de Porto Alegre, RS. O desfecho foi a presença de complicações até um ano após a alta hospitalar. Foram consideradas complicações: a ocorrência de novo episódio de AVE, de reinfarto, de insuficiência cardíaca ou de óbito. Utilizou-se regressão de Poisson com variância robusta para a análise ajustada. Resultados: De 512 participantes, 130 apresentaram complicações (27,6%; IC95% 23,6-31,7). Os participantes com≥80 anos (p=0,01), cor da pele não branca (p=0,008), com hábito de fumar (p=0,01) e diabetes mellitus (p=0,02)apresentaram maior incidência de complicações. Conclusões: A incidência de complicações por SCA ou AVE foi elevada. As doenças confirmaram sua condição de gravidade, sendo a ocorrência de óbitos a complicação mais incidente no acompanhamento. Observou-se importante associação do diabetes mellitus e do tabagismo com a ocorrência de complicações mesmo com ocontrole para idade e cor da pele.

Background: The components of acute coronary syndrome and stroke have the involvement of atherothrombotic process in their etiology. Both diseases have risk factors in common and most of them are modifiable. Understanding that these diseases are consequences of the underlying vascular process enables the development of new therapeutic interventions and can help identify patients at risk and thus prevent manifestations of atherothrombosis. Objectives: To check the incidence of complications of acute coronary syndrome or stroke and its risk factors in a cohort over on eyear of follow-up. Methods: Cohort prospective study that included patients aged ≥ 30 years, of both sexes, diagnosed with acute coronary syndrome or stroke admitted to the hospital in Porto Alegre, state of Rio Grande do Sul. The outcome was the presence of complications up toone year after hospital discharge. The following were considered complications: the occurrence of new episode of stroke, reinfarction, heart failure or death. We used Poisson regression with robust variance in the adjusted analysis. Results: Of 512 participants, 130 had complications (27.6%; 95% CI 23.6-31.7). Participants aged ≥ 80 (p=0.01), white color(p=0.008), smokers (p=0.01) and with diabetes mellitus (p=0.02) presented greater incidence of complications. Conclusions: The incidence of complications for ACS or stroke was high. Diseases confirmed the severity of condition. The occurrenceof deaths was the most frequent complication in the follow-up. There was an important association of diabetes mellitus and smoking with the occurrence of complications, even controlling for age and skin color.

Use of medicines recommended for secondary prevention of acute coronary syndrome.

OBJECTIVE: To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS: In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS: More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS: The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

Use of medicines recommended for secondary prevention of acute coronary syndrome / Uso de medicamentos recomendados na prevenção secundária da síndrome coronariana aguda

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

RESUMO OBJETIVO : Analisar se variáveis demográficas e socioeconômicas e intervenção coronária percutânea estão associadas ao uso de medicamentos para prevenção secundária da síndrome coronariana aguda. MÉTODOS : Neste estudo de coorte, foram incluídos 138 pacientes com síndrome coronariana aguda, com idade igual ou superior a 30 anos e de ambos os sexos. Os dados foram coletados no momento da alta hospitalar e após seis e 12 meses da alta. O desfecho do estudo foi o uso simultâneo dos medicamentos recomendados para prevenção secundária da síndrome coronariana aguda: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina. As variáveis independentes foram: sexo, idade, escolaridade em anos de estudo, renda mensal em tercis e intervenção coronária percutânea. Descreveu-se a prevalência do uso de cada grupo de medicamento com respectivos intervalos de confiança de 95%, bem como o uso simultâneo dos quatro, em todos os períodos analisados. Na análise bruta verificou-se a associação do desfecho com as variáveis independentes para cada período por meio do teste Qui-quadrado. A análise ajustada foi realizada por Regressão de Poisson. RESULTADOS : Mais de um terço dos pacientes (36,2%; IC95% 28,2;44,3) recebeu prescrição dos quatro medicamentos, simultaneamente, no momento da alta. Não foram observadas diferenças nas prevalências de uso na comparação com os dois períodos de seguimento. A classe de medicamento mais prescrita na alta foi antiagregante plaquetário (91,3%). Na análise bruta, as variáveis demográficas e socioeconômicas não se associaram ao desfecho em nenhum dos três períodos. CONCLUSÕES : A prevalência de uso simultâneo dos medicamentos na alta e nos seguimentos apontou para a subutilização dessa terapêutica na prática clínica. São necessárias estratégias de intervenção para melhoria da qualidade da atenção dada aos pacientes que se estendam além da alta hospitalar, um ponto crítico de transição no cuidado.