RESUMO
Background and objectives. Whilst traditional studies have shown that obese individuals are at a higher risk of cardiovascular events compared to lean subjects, recent studies in patients with acute myocardial infarction (AMI) have suggested that obesity may exert protective effects (the "obesity paradox"). We sought to assess the relationship between body mass index (BMI) and the BARI score (BARIsc), a validated tool used to assess myocardium at risk, in patients with acute coronary syndrome. Patients and methods. Participants were 116 consecutive patients (mean age, 60.6 years; 97 men) with AMI (68 ST elevated myocardial infarction, STEMI; 48 non-ST elevated myocardial infarction, NSTEMI). Demographics, BMI, risk factors, biochemistry data, left ventricular function, angiographic data and the BARIsc were assessed in every patient. Results. Multiple linear regression analyses showed that BMI significantly correlated with BARIsc; β=.23, p<0.02. This was found only in the overweight/obese patients, β=.27, p<0.01, but not in patients with normal BMIs, β=0.08, p=0.71. Conclusions. An increased body weight is associated with an increased area of myocardium at risk in patients with ACS (AU)
Introducción y objetivos. Algunos estudios han demostrado que los pacientes obesos presentan un mayor riesgo cardiovascular, pero estudios más recientes en pacientes con infarto agudo de miocardio (IAM) han sugerido que la obesidad puede ejercer un efecto protector (efecto conocido como la "paradoja de la obesidad"). Hemos examinado la relación entre el índice de masa corporal (IMC) y la puntuación ofrecida por el BARI (BARIsc), una herramienta validada para determinar la cantidad de miocardio en riesgo en los pacientes con síndrome coronario agudo. Pacientes y métodos. Se incluyeron 116 pacientes de forma consecutiva (edad media, 60.6 años; 97% varones) con IAM (68 con un síndrome coronario agudo con elevación de ST [SCACEST], y 48 con síndrome coronario agudo sin elevación de ST [SCASEST]). En todos ellos se determinaron las variables demográficas y analíticas, los factores de riesgo cardiovascular, el IMC, la función ventricular, los datos angiográficos, y el BARIsc. Resultados. El análisis de regresión lineal múltiple mostró que el IMC se correlacionaba significativamente con el BARIsc, β=,23; p<0,02. Esto se demostró únicamente en los pacientes con sobrepeso u obesidad, β=,27; p<0,01, pero no en los que presentaban IMC normal β=0,08; p=0,71. Conclusiones. El aumento de peso se asocia a la cantidad de miocardio en riesgo en pacientes que con un SCA (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/prevenção & controle , Fatores de Risco , Obesidade/complicações , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio , Miocárdio/patologia , Índice de Massa Corporal , Modelos Lineares , Angiografia/métodos , Angiografia/tendênciasRESUMO
BACKGROUND AND OBJECTIVES: Whilst traditional studies have shown that obese individuals are at a higher risk of cardiovascular events compared to lean subjects, recent studies in patients with acute myocardial infarction (AMI) have suggested that obesity may exert protective effects (the "obesity paradox"). We sought to assess the relationship between body mass index (BMI) and the BARI score (BARIsc), a validated tool used to assess myocardium at risk, in patients with acute coronary syndrome. PATIENTS AND METHODS: Participants were 116 consecutive patients (mean age, 60.6 years; 97 men) with AMI (68 ST elevated myocardial infarction, STEMI; 48 non-ST elevated myocardial infarction, NSTEMI). Demographics, BMI, risk factors, biochemistry data, left ventricular function, angiographic data and the BARIsc were assessed in every patient. RESULTS: Multiple linear regression analyses showed that BMI significantly correlated with BARIsc; ß=.23, p<0.02. This was found only in the overweight/obese patients, ß=.27, p<0.01, but not in patients with normal BMIs, ß=0.08, p=0.71. CONCLUSIONS: An increased body weight is associated with an increased area of myocardium at risk in patients with ACS.
Assuntos
Síndrome Coronariana Aguda/epidemiologia , Miocárdio/patologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Síndrome Coronariana Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Stable angina pectoris is the most common clinical manifestation of chronic ischemic heart disease, the prognosis of which depends on many factors. The authors have analyzed the incidence, evolution and prognosis of this problem in Spain and have reviewed the methods to determine the diagnosis and degree of clinical severity. A careful clinical history, an electrocardiogram, and the evaluation of the severity of the ischemia and left ventricle systolic function are, in most cases, useful to determine the degree of disease severity and establish the prognosis. In other cases, more sophisticated or complex diagnostic techniques such as perfusion tests, stress echocardiography and lastly coronary arteriography, which is the only method currently available to study coronary anatomy are required to carry out an adequate study of the patient. At present, the therapeutic arsenal for the treatment of ischemic coronary disease is extensive, from both a pharmacological and revascularization point of view. Nonetheless it is essential to carry out aggressive therapy to control the risk factors. The decision as to the type of treatment required mainly depends on the severity of the ischemia and in the case of revascularization, on the clinical and anatomical factors as well as on the preferences of the patient and the experience and results of the medical-surgical group involved in the therapy of these patients.
Assuntos
Angina Pectoris , Angina Pectoris/classificação , Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Feminino , Humanos , Incidência , Masculino , Prevalência , PrognósticoRESUMO
This report reflects the interest of the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology in increasing quality, safety and applicability of percutaneous procedures, by giving scientific keys aimed at improving related functions of teaching or planning in this field and enhancing competence and prestige of Spanish interventional cardiologists. The purpose of the document is to describe the importance of current interventional cardiology, to identify quality references and to establish minimum acceptable requirements for assessing and maintaining the competence of practicing or providing advanced training in this discipline. To achieve this goal, a search for a gold standard of the different techniques of general interventional practice was carried out, and predictors of postprocedural outcome were analyzed, as well as their relation with different kinds of circumstances. This analysis identified coronary angioplasty as the standard on which recommendations regarding competence in overall interventional cardiology standards of quality and assessment and maintenance of proficiency must be based. On the other hand, the strong influence of experience and knowledge of results has been documented, especially in high-risk or high-complexity settings. On this basis, the report establishes specific recommendations about proficiency for practice and advanced training. It also suggests that interventional cardiology should be considered as a subspecialty, of cardiology requiring specific credentials.
Assuntos
Cardiologia/educação , Cardiologia/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Médicas , EspanhaRESUMO
We report a case of spontaneous dissection of right coronary artery diagnosed in a 31-year-old woman in the postpartum period, presenting with prolonged angina and ST segment elevation in the ECG, a rare manifestation of this extremely uncommon anatomico-clinic entity. We described the clinical presentation, the findings derived from transthoracic echocardiography and coronary arteriography, and the clinical course with medical therapy.