RESUMO
OBJECTIVE: Myocardial damage that is associated with percutaneous coronary intervention (PCI) partially affects the results of the procedure, and is related to medium-term cardiovascular death. Remote postischemic conditioning might reduce the myocardial lesions that are associated with PCI, but perhaps less so in diabetics. The aim of this study was to evaluate the protective effect of remote postischemic conditioning in patients undergoing elective PCI for stable angina or non-ST elevation acute coronary syndrome with troponin <1 ng/ml at the time of randomization. METHODS: This randomized single-blinded single-center clinical trial involved 320 patients undergoing elective PCI who were randomized to either receive three 5-min cycles of ischemia by inflation of a cuff on the non-dominant arm to 200 mm Hg (remote postischemic conditioning) or to placebo (uninflated cuff). The primary outcome variable was the maximum increase in troponin in the first 24 h. The secondary outcome variable was readmission due to heart failure or cardiovascular mortality after 1 year of follow-up. In addition, a diabetic population was studied. CONCLUSIONS: This clinical trial evaluated the possible reduction in intervention-related myocardial damage that was attributable to remote postischemic conditioning.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Pós-Condicionamento Isquêmico/métodos , Infarto do Miocárdio/terapia , Isquemia Miocárdica/prevenção & controle , Análise de Variância , Angioplastia Coronária com Balão/métodos , Intervalos de Confiança , Angiografia Coronária/métodos , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Seleção de Pacientes , Prognóstico , Estudos Prospectivos , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Método Simples-Cego , Análise de Sobrevida , Resultado do TratamentoRESUMO
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Assuntos
Idoso , Masculino , Humanos , Sarcoidose Pulmonar , Prurido , HipercalcemiaRESUMO
INTRODUCTION AND OBJECTIVES: The implications of early angina on the prognosis of myocardial infarction are controversial. The aim of this study was to assess the effect of angina one week before the first myocardial infarction on short and medium-term prognosis. PATIENTS AND METHOD: A total of 290 consecutive patients (107 with previous angina and 183 without it) with the first myocardial infarction were studied to determine the effect of preceding angina on short and medium-term prognosis. Further criteria for inclusion were no previous history of angina > 1 week before the first myocardial infarction, and no evidence of prior structural cardiopathy. The end points studied were death and congestive heart failure in the acute phase of myocardial infarction and during the follow-up. RESULTS: Patients with a history of prodromal angina were less likely to experience in-hospital death, heart failure or combined end-point (3.7 vs 11.5%; 4.6 vs 15.8%; 7.5 vs 21.3%) (p = 0.002). There was also a difference between groups in the follow-up (4.1 vs 13.2%; p = 0.03). Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of death and heart failure in the acute phase of myocardial infarction as well as in the follow-up. CONCLUSIONS: The occurrence of angina one week before the first myocardial infarction protects against death and heart failure in the acute phase of myocardial infarction as well as in the medium follow-up.
