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1.
Rev. argent. cardiol ; 87(1): 16-20, feb. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003244

RESUMO

RESUMEN Objetivos: Comparar pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) incluidos en centros participantes de dos registros argentinos. Material y métodos: Se compararon pacientes con IAMCEST incluidos en 54 centros que participaron tanto en el registro SCAR (2011) como en el ARGEN-IAM-ST (2015). Resultados: Se analizaron 676 pacientes con IAMCEST; 222 del SCAR y 454 del ARGEN-IAM-ST No hubo cambios significativos en la edad y el género. Se observó una reducción significativa en el uso de fibrinolíticos, con un incremento de la angioplastia primaria. El shock cardiogénico se redujo a la mitad. No hubo diferencias en la mortalidad y de reinfarto durante la hospitalización. Conclusiones: Se observó una mayor indicación de angioplastia primaria y una disminución en el uso de fibrinolíticos. El shock cardiogénico se redujo significativamente en los últimos 5 años, sin cambios significativos en la mortalidad hospitalaria.


ABSTRACT Objectives: The aim of this study was to compare patientis with ST-segment elevation myocardial infarction (STEMI) included in centers participating of two registries in Argentina. Methods: STEMI patientis included in the 54 centers participating in the SCAR (2011) registry and in the ARGEN-IAM-ST (2015) registry were compared. Resultis: A total of 676 STEMI patientis were analyzed: 222 in the SCAR registry and 454 in the ARGEN-IAM-ST registry. There were no significant differences in age and sex. The use of fibrinolytic agentis was significantly lower and the use of primary percutaneous coronary intervention was significantly increased. The incidence of cardiogenic shock was 50% lower. There were no differences in mortality and reinfarction during hospitalization. Conclusions: The indication of primary percutaneous coronary intervention increased and the use of fibrinolytic agentis decreased. Cardiogenic shock decreased significantly in the last 5 years without significant changes in in-hospital mortality.

2.
Rev. argent. cardiol ; 86(4): 32-42, ago. 2018.
Artigo em Espanhol | LILACS-Express | ID: biblio-1003209

RESUMO

RESUMEN Introducción: Existe evidencia de que la reperfusión subóptima tiene impacto pronóstico a corto plazo en los pacientes con síndromes coronarios agudos con elevación del segmento ST, pero hay poca información sobre los factores vinculados a esta. Objetivos: Analizar los factores asociados a la reperfusión subóptima en pacientes con infarto agudo de miocardio con elevación del segmento S T, tratados con angioplastia primaria. Material y métodos: Se analizaron los pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST que recibieron tratamiento de revascularización con angioplastia primaria en el registro SCAR (Síndromes Coronarios Agudos en Argentina). Se analizó la asociación entre las variables clínicas clásicas, de laboratorio y el índice leucoglucémico con la reperfusión subóptima. Se definió reperfusión subóptima como TIMI III angiográfico pos-ATC con descenso del segmento ST en el ECG menor del 50%. Resultados: Se analizaron 258 pacientes con infarto agudo de miocardio con elevación del segmento ST, de los cuales 197 (76,4%) cumplieron los criterios de inclusión. De estos, el 8,6% (n = 17) tuvieron reperfusión subóptima. La incidencia de muerte intrahospitalaria entre los pacientes con reperfusión subóptima fue del 17,6% (n = 3) versus 1,7% (n = 3) en aquellos sin reperfusión subóptima (p = 0,007). En el análisis univariado, las variables asociadas a reperfusión subóptima fueron: diabetes (OR: 3,2 [IC95% 1,09-9,43] p = 0,026), revascularización previa (OR: 5,8 [1,74-19,07] p = 0,008), índice leucoglucé-mico (> 2159) (OR 3,7 [1,32-10,22] p = 0,009), y el tiempo dolor/balón (> 159 min) (OR: 6,9 [0,88-53] p = 0,045). El Killip-Kimbal al ingreso 3-4; la edad, mayor de 70 años; el sexo masculino, la hipertensión arterial, el tabaquismo, el infarto previo 0 anterior y el flujo TIMI 0-1 al ingreso no fueron significativos. Se estableció por curva ROC el mejor punto de corte para el índice leucoglucémico asociado a RSO en 2159 puntos (VPN = 94%), y el de tiempo dolor/balón en 159 min (VPN = 96%). En la regresión logística, solo la revascularización previa (OR: 5,3 [1,53-18,55]) y el índice leucoglucémico (OR: 3,2 [1,11-9,28]) estuvieron asociadas a reperfusión subóptima. Conclusiones: La reperfusión subóptima se asoció significativamente con mayor incidencia de muerte intrahospitalaria; mientras que la revascularización previa y el índice leucoglucémico (>2159) se asociaron con reperfusión subóptima.


ABSTRACT Background: Although there is evidence that suboptimal reperfusion has short-term prognostic impact in patients with ST-segment elevation acute coronary syndromes, there is little information about its associated factors. Objectives: The aim of this study was to analyze the factors associated with suboptimal reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: Patients from the SCAR (Acute Coronary Syndromes in Argentina) registry diagnosed with acute STEMI undergo-ing PCI were included in the study. The association of classical clinical and laboratory variables and the leuko-glycemic index with suboptimal reperfusion was analyzed. Suboptimal reperfusion was defined as post-PCI angiography TIMI III flow with less than 50% ST-segment decrease in the ECG. Results: Overall, 197 patients (76.4%) out of 258 patients with acute STEMI met the inclusion criteria. Among them, 8.6% (n: 17) had suboptimal reperfusion, with an incidence of in-hospital death of 17.6% (n: 3) versus 1.7% (n: 3) in patients without suboptimal reperfusion (p=0.007). In the univariate analysis, variables associated with suboptimal reperfusion were: diabetes [OR: 3.2 (1.09-9.43) p=0.026], previous revascularization [OR: 5.8 (1.74-19.07) p=0.008], leuko-glycemic index (> 2,159) [OR 3.7 (1.32-10.22) p=0.009], and pain-to-balloon time (>159 minutes) [OR: 6.9 (0.88- 53) p=0.045]. Age >70 years, male sex, high blood pressure, smoking, previous or anterior-wall infarction, and Killip and Kimball 3-4 and TIMI 0-1 flow on admission were not significantly different between patients with or without suboptimal reperfusion. Prior to the analysis, the cutoff point for the leuko-glycemic index associated with suboptimal reperfusion was established at 2,159 points by ROC curve analysis (NPV: 94%), and the pain-to-balloon time at 159 min (NPV: 96%). In logistic regression analysis, only previous revascular-ization [OR: 5.3 (1.53 -18.55)] and leuko-glycemic index [OR: 3.2 (1.11-9.28)] were associated with suboptimal reperfusion. Conclusions: Suboptimal reperfusion was significantly associated with a higher incidence of in-hospital death, while previous revascularization and the leuko-glycemic index (>2,159) were factors independently associated with suboptimal reperfusion.

3.
Med. UIS ; 29(3): 49-53, sep.-dic. 2016.
Artigo em Inglês | LILACS-Express | ID: biblio-954887

RESUMO

ABSTRACT Introduction: obesity is frequent in argentinian children and arterial hypertension affects 2.4% of scholars. Objective: the objectives of the present study are to evaluate the prevalence of obesity and hypertension and their association, and to analyze the ability of electrocardiograms to detect conditions in healthy children and adolescents who attended to request a medical certificate of fitness. Methods: 1030 children (47.9% females and 52.1% males) ranging from 1 to 18 years old who concurred for a check up between Janury and March 2012, were consecutively included. Their body mass index, blood pressure, weight, height, and electrocardiogram findings were calculated and evaluated by a pediatrician and a cardiologist. Results: obesity was detected in 12.1% of males and 9.9% of females, and malnutrition was found in 1.9% and 1.4, respectively. Overweight was more frequent in males, consistent across all age groups. Systolic hypertension (adjusted to the 95th height percentile) was observed in 8.8% males and 8.6% females, more prevalent in children ranging from 4 to 11 years old. A significant association between hypertension and high body mass index was observed. The ECG assessments resulted in six patients with pauses, one patient with asymptomatic Wenchebach AV block, three patients with asymptomatic sinus arrest, and one patient with ventricular bigeminy. Five cases of Wolf-Parkinson-White syndrome were diagnosed, and 2.7% children had long QTc segments. Conclusions: a high prevalence of hypertension was found, which was more frequent in obese children. The electrocardiogram analysis resulted in patients with potentially high risk conditions. MÉD.UIS. 2016;29(3):49-53.


RESUMEN Introducción: la obesidad es frecuente en niños argentinos y la hipertensión arterial afecta a 2,4% de los escolares. Objetivo: evaluar la prevalencia de obesidad e hipertensión y su asociación, y analizar la detección de anormalidades en el electrocardiograma en una población de niños sanos que concurrieron para certificado de estado físico. Materiales y método: se incluyeron 1030 niños (47,9% de sexo femenino y 52,1% masculinos), de 1 a 18 años, que concurrieron a control durante Enero y Marzo de 2012. Se les realizó un electrocardiograma y medición de presión arterial, peso y talla. Resultados: el 12,1% de los varones y 9,9% de las niñas tenían obesidad y el 1,9% y 1,4%, respectivamente, tenían desnutrición. Fue más frecuente el sobrepeso y la obesidad entre los varones que en las mujeres, con distribución homogénea entre las edades. El 8,8 % de los niños y el 8,6% de las niñas tuvieron valores de presión arterial sistólica por encima del percentil 95 según talla, especialmente entre los 4 y los 11 años, con una asociación estadísticamente significativa entre la hipertensión arterial y el índice de masa corporal elevado. En el electrocardiograma hubo seis pacientes con pausas, un bloqueo aurículoventricular tipo Wenchebach asintomático, tres pacientes con paro sinusal y un paciente con bigeminismo ventricular. Se diagnosticaron cinco Wolf Parkinson White y 2,7% de los niños presentaron QTc prolongado. Conclusiones: hubo alta prevalencia de hipertensión arterial, más frecuente en niños con obesidad. Se detectaron pacientes con trastornos potencialmente graves en el electrocardiograma. MÉD.UIS. 2016;29(3):49-53.Palabras clave: Riesgo. Sistema Cardiovascular. Hipertensión. Obesidad. Índice de Masa Corporal. Electrocardiografía.

4.
Expert Opin Pharmacother ; 12(10): 1499-509, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21568825

RESUMO

INTRODUCTION: The use of genomics to predict adverse drug reactions (ADRs) has been the subject of much research over the last decade. Concerns about the muscular safety of statins, a highly prescribed group of drugs, are partially related to their high exposure. Many studies have identified a variety of genetic markers related to statin-induced myopathy. However, only polymorphisms in the SLCO1B1 gene (which encodes the carrier responsible for the hepatic uptake of statins, which, in turn, contributes to the regulation of plasma levels of SLCO1B1) were strongly associated with statin-induced muscular adverse effects. These was found to be most prominent for simvastatin. The strength of these findings relies on the use of modern genetic approaches, such as well-designed, case-controlled and genome-wide association studies. Nevertheless, the clinical use of this information is far from known at present and needs to be evaluated. AREAS COVERED: The links between genetic polymorphisms (i.e., SLCO1B1 gene) and statin-induced muscle ADRs and the methodological issues involved in the establishment of such an association are explored. EXPERT OPINION: Despite there being a statin-gene association for myopathy, in the case of some statins the usefulness of this information still needs to be proven.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Farmacogenética , Marcadores Genéticos , Estudo de Associação Genômica Ampla , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacocinética , Fígado/metabolismo , Transportador 1 de Ânion Orgânico Específico do Fígado , Doenças Musculares/genética , Transportadores de Ânions Orgânicos/sangue , Transportadores de Ânions Orgânicos/genética , Polimorfismo Genético , Sinvastatina/efeitos adversos
5.
Am Heart J ; 160(6): 1004-14, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21146651

RESUMO

BACKGROUND: Peak VO2 has traditionally been used for prognostic evaluation in systolic heart failure. However, in the past years, VE/VCO2 slope has been shown to be similar or even superior in many studies. We performed a systematic review and a meta-analysis of diagnostic studies of VE/VCO2 slope to assess its ability to predict cardiovascular events in systolic heart failure. METHODS: We searched the published literature in PubMed and ISI Web of Science for VE/VCO2 slope in heart failure, and performed a systematic review and a meta-analysis of diagnostic studies in articles fulfilling previously established selection criteria. End points were serious cardiovascular events defined as death or the combined end point of death, ventricular assist device implantation, or heart transplant. A sub-analysis was also performed with those articles providing enough data to compare VE/VCO(2) slope prognostic ability to that of peak VO2. RESULTS: Four hundred ninety-one articles that are potentially relevant were identified, and 12 studies were selected based on our predefined criteria. No heterogeneity or evidence of publication bias was found. The 12 studies included a total of 2,628 patients with a mean follow-up of 31 months (95% CI 16-46 months). The combined event rate at 1 year was 11.2% (95% CI 7.8%-14.6%). Diagnostic odds ratio and area under the curve for serious cardiovascular events were 5.02 (95% CI 4.06-6.21) and 0.75 (95% CI 0.72-0.78), respectively. Six studies provided sufficient data for VE/VCO2 slope and peak VO2 comparison. Both variables showed similar performance, although VE/VCO(2) did present a trend to superiority. CONCLUSIONS: In this meta-analysis, VE/VCO2 slope represents a reasonable ability to predict serious cardiovascular events in systolic heart failure, and is at least as effective as peak VO2.


Assuntos
Dióxido de Carbono/metabolismo , Insuficiência Cardíaca Sistólica/diagnóstico , Consumo de Oxigênio/fisiologia , Troca Gasosa Pulmonar/fisiologia , Teste de Esforço , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Prognóstico , Índice de Gravidade de Doença
6.
Interact Cardiovasc Thorac Surg ; 10(6): 863-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20233808

RESUMO

A reduced platelet inhibitory response to acetyl salicylic acid (ASA) has been associated with an increased risk of graft thrombotic occlusion after coronary artery bypass grafting (CABG). We performed a prospective, observational study of 18 patients on 100 mg/day ASA before and after CABG. We assessed antiplatelet response to ASA and its relationship with platelet turnover, inflammatory markers, and soluble thrombomodulin (sTM) levels. All patients showed optimal response to ASA preoperatively but had higher values during follow-up. Platelet aggregation and platelet count in the perioperative period were significantly associated (P=0.05). Platelet turnover was defined as the average daily turnover (ADTO). The lowest inhibitory value (28% of patients > or =6 Omega) was recorded at the same time of the highest platelet turnover (>10% daily in 77.77% of patients), one week after CABG. ADTO >10% was associated with an increased risk of platelet aggregation > or =6 Omega. Levels of sTM were significantly higher one week after CABG (median 13 vs. 3 ng/ml preoperatively, P=0.0011). There is a transient impairment in ASA antiplatelet effect after CABG related to an increased platelet turnover caused by the inflammatory process. This could be responsible for the high risk of occlusive thrombosis.


Assuntos
Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Ponte de Artéria Coronária/efeitos adversos , Inflamação/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Trombose/etiologia , Idoso , Biomarcadores/sangue , Feminino , Humanos , Inflamação/sangue , Inflamação/imunologia , Mediadores da Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Prospectivos , Trombomodulina/sangue , Trombose/sangue , Trombose/imunologia , Fatores de Tempo , Resultado do Tratamento
7.
Acad Psychiatry ; 33(4): 296-301, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19690109

RESUMO

OBJECTIVE: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes. METHODS: The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory. RESULTS: One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group. CONCLUSION: Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.


Assuntos
Atitude do Pessoal de Saúde , Esgotamento Profissional/epidemiologia , Cardiologia/educação , Transtorno Depressivo/epidemiologia , Internato e Residência/estatística & dados numéricos , Estresse Psicológico , Adulto , Argentina/epidemiologia , Estudos Transversais , Despersonalização/diagnóstico , Despersonalização/epidemiologia , Despersonalização/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
9.
Clin Neurol Neurosurg ; 110(5): 472-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18374476

RESUMO

OBJECTIVES: To present a model of decision analysis that allows assessing the trade-off between the short-term risks of performing a carotid endarterectomy and the rate of preventable future events. METHODS: We used data from a systematic review to define values for a base case and perform a sensitivity analysis. The primary endpoint was a comparison of the fatal and disabling stroke-free survival during a 5-year period in a cohort of hypothetical patients who presented asymptomatic severe carotid stenosis and were treated with either immediate prophylactic carotid endarterectomy or medical treatment alone. RESULTS: The difference in estimated fatal and disabling stroke-free survival favoring endarterectomy in patients with asymptomatic severe carotid stenosis is less than 4 days over the course of 5 years. One-way sensitivity analysis demonstrated that if the perioperative rate of death or disabling stroke is greater than 2.1%, then medical treatment is better. A non-surgical strategy is also better if the risk of fatal and disabling stroke with medical treatment is less than 1.09% per year, or if the rate of fatal and disabling stroke beyond 30 days following endarterectomy is greater than 0.51% per year. CONCLUSIONS: In this model, immediate prophylactic carotid endarterectomy seems to offer a minimum net benefit in terms of fatal or disabling stroke-free survival over a 5-year period, when compared to medical treatment alone.


Assuntos
Estenose das Carótidas/cirurgia , Árvores de Decisões , Endarterectomia das Carótidas/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Estenose das Carótidas/complicações , Intervalo Livre de Doença , Humanos , Pessoa de Meia-Idade , Medição de Risco/métodos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia
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