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1.
Rev. clín. esp. (Ed. impr.) ; 216(6): 301-307, ago.-sept. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-154668

RESUMO

Objetivo. La paradoja del tabaco es un fenómeno insuficientemente explicado en estudios previos. Este estudio analiza el papel pronóstico del tabaquismo previo o activo en pacientes con síndrome coronario agudo. Métodos. Obtuvimos los datos del registro ARIAM, entre 2001 y 2012. Se incluyó a 42.827 pacientes con síndrome coronario agudo (edad media 65±13 años, 26,4% mujeres). Se analizó la influencia del hábito tabáquico o de la condición de exfumador en la mortalidad mediante análisis multivariados. Resultados. Los fumadores eran más jóvenes, más frecuentemente hombres, tenían menos diabetes, hipertensión e historia previa de insuficiencia cardiaca, ictus, arritmia e insuficiencia renal, así como más frecuentemente elevación del ST e historia familiar. Los exfumadores presentaban más dislipidemia e historia de angina, infarto de miocardio, cardiopatía isquémica, vasculopatía periférica y broncopatía crónica. Fumadores y exfumadores desarrollaron menos frecuentemente shock cardiogénico (fumadores 4,2%, exfumadores 4,7% y no fumadores 6,9%, p<0,001). La mortalidad hospitalaria fue del 7,8% en los no fumadores, un 4,9% en los exfumadores y un 3,1% en los fumadores (p<0,001). En el análisis multivariado, el carácter fumador perdió su influencia en el pronóstico (-0,26%, p = 0,52 mediante cálculo de probabilidad inversa; y +0,26%, p=0,691 mediante análisis de propensión). Sin embargo, el carácter exfumador mostró una reducción significativa de la mortalidad en ambos test (-2,4% en el análisis de probabilidad inversa, p < 0,001, y -1,5% en el análisis de propensión, p = 0,005). Conclusiones. La paradoja del tabaco es un hallazgo que puede explicarse por otros factores pronósticos. El abandono del hábito tabáquico previo a un ingreso por síndrome coronario agudo se asocia a un mejor pronóstico (AU)


Objective. The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. Methods. We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. Results. The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). Conclusions. The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis (AU)


Assuntos
Humanos , Masculino , Feminino , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/prevenção & controle , Abandono do Uso de Tabaco/métodos , Abandono do Uso de Tabaco/estatística & dados numéricos , Prognóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Fatores de Risco , Insuficiência Cardíaca/epidemiologia , Pontuação de Propensão , Declaração de Helsinki , 28599 , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Renal/complicações
2.
Rev Clin Esp (Barc) ; 216(6): 301-7, 2016.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27118137

RESUMO

OBJECTIVE: The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. METHODS: We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. RESULTS: The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). CONCLUSIONS: The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis.

4.
Rev Esp Cardiol ; 50(2): 92-7, 1997 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-9092008

RESUMO

INTRODUCTION: Masquerading bundle branch block is a right bundle branch block with a left anterior hemiblock which appears similar to a left bundle branch block in the frontal plane leads. MATERIAL AND METHODS: We have followed 22 patients with such a pattern in the electrocardiogram for 3 years. RESULTS: Thirteen patients (59%) developed high degree atrioventricular block. During this period, there were 4 deaths, 3 from heart failure and 1 due to sepsis. CONCLUSIONS: We conclude that progression to high degree atrioventricular block is quite common in the presence of this kind of branch block. It is frequently associated to advanced heart failure, so the prognosis is usually poor.


Assuntos
Bloqueio de Ramo/diagnóstico , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
5.
Rev Esp Cardiol ; 50(9): 662-6, 1997 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-9380937

RESUMO

Antiarrhythmic drugs administered intravenously run the risk of producing a hemodynamic collapse even when used by expert and well trained hands. The arrhythmias in the focal point of a preexcitation syndrome constitute a very special situation in which extreme caution must be used when using intravenous drugs, because the conduction through accessory channels can vary, depending on multiple factors. We describe a case of a patient with an accessory atrioventricular pathway and orthodromic tachycardia who developed cardiac arrest by wide QRS tachycardia after receiving intravenous amiodarone.


Assuntos
Parada Cardíaca/induzido quimicamente , Taquicardia Paroxística/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/tratamento farmacológico , Amiodarona/efeitos adversos , Amiodarona/uso terapêutico , Antiarrítmicos/efeitos adversos , Antiarrítmicos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Propafenona/efeitos adversos , Propafenona/uso terapêutico
6.
Rev Esp Cardiol ; 48(9): 628-30, 1995 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-7569265

RESUMO

A 54 years-old man with a history of migraine, suffered from chest pain together with ST-segment elevation related to the intake of drugs against migraine attacks. The coronary arteriography showed normal coronary arteries. We suggest coronary artery spasm as the most probable cause of ischemia. We conclude that vasoactive drugs against migraine must be utilized with caution, or even avoided in patients with chest pain suggestive of myocardial ischemia.


Assuntos
Angina Pectoris Variante/induzido quimicamente , Ergotamina/efeitos adversos , Transtornos de Enxaqueca/tratamento farmacológico , Vasoconstritores/efeitos adversos , Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Angina Pectoris Variante/diagnóstico , Combinação de Medicamentos , Ecocardiografia , Eletrocardiografia , Ergotamina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Supositórios , Vasoconstritores/administração & dosagem
7.
Rev Esp Cardiol ; 47(6): 410-2, 1994 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-8066314

RESUMO

We describe a patient with effort angina in whom the coronary arteriography revealed a rare type of coronary arterial fistula. All three major coronary arteries communicated with the left ventricle through a plexus of thin vessels. Both exercise stress test and thallium-dipiridamol demonstrated reversible myocardial ischemia. We think this case supports the clinical significance of the coronary steal phenomenon induced by the coronary arterial fistulae.


Assuntos
Fístula Arteriovenosa/complicações , Anomalias dos Vasos Coronários/complicações , Isquemia Miocárdica/etiologia , Angiografia Coronária , Humanos , Masculino , Pessoa de Meia-Idade
8.
An Med Interna ; 11(3): 114-8, 1994 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-8011869

RESUMO

We have analyzed 44 consecutive patients with significant ST-segment depression during the exercise stress test, with the aim of testing the ability of localizing the coronary stenoses. There was a significant correlation only between maximal ST-segment depression in V1-V4 and stenosis in the left anterior descending artery (r = 0.402, p = 0.0067), but the accuracy of the presence of ischemic ST depression in anterior leads to detect disease of the left anterior descending artery was 59% (26 correct, 18 wrong). The low lateral leads (V5 and V6) were the more accurate to detect coronary disease, as much for the left anterior descending artery as for the right or the circumflex coronary arteries. We conclude that ST segment depressions are of little value to localize the coronary stenoses.


Assuntos
Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Constrição Patológica , Teste de Esforço , Humanos , Valor Preditivo dos Testes
9.
An Med Interna ; 10(5): 217-20, 1993 May.
Artigo em Espanhol | MEDLINE | ID: mdl-8518336

RESUMO

We have analyzed coronary arteriographies of 170 patients, 120 with isolated aortic stenosis and 50 with isolated aortic failure. Patients with stenosis showed higher frequency of angina (73% versus 54%, p = 0.0223). No significant differences were observed with respect to the incidence of the coronary artery disease (26.7% versus 31.8%, p = 0.18). The presence of angina was significantly more specific in aortic failure (specificity 52.4% versus 31.8% in aortic stenosis, p = 0.039). Among the patients with less than 56 years of age, the probability of developing coronary artery disease in absence of angina was 6.3% (1 out of 16), the confidence interval ranging from 1.5% to 30.2%. Our results do not support any modification of the conventional criteria for conducting coronary arteriographies in patients with aortic valvulopathy.


Assuntos
Angina Pectoris/etiologia , Doenças das Valvas Cardíacas/fisiopatologia , Idoso , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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