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1.
Clinics (Sao Paulo) ; 74: e1222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576918

RESUMO

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31400191

RESUMO

AIMS: Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). METHODS AND RESULTS: BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified "cluster sampling" methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. 1,150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% ± 20.1%. Teaching institutions had a significantly higher PS (71.4% ± 16.9%) compared to non-teaching hospitals (63.4% ± 21%; p <0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS - per point increase (OR=0.97, 95% CI 0.95-0.98, p<0.001), age - per year (OR=1.06, 95% CI 1.03-1.09, p<0.001), chronic kidney disease (OR=3.12, 95% CI 1.08-9.00, p=0.036), and prior angioplasty (OR=0.25, 95% CI 0.07-0.84, p=0.025). CONCLUSION: In BRACE, adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.

3.
Clinics ; 74: e1222, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1039547

RESUMO

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

4.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.571-603.
Monografia em Português | LILACS | ID: biblio-971556
6.
Arq. bras. cardiol ; 105(3): 214-227, 2015. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-32564

RESUMO

Unstable angina (UA) is still one of the major cardiovascular causes of hospital admission. Some patients with UA develop elevations in biochemical markers of myocardial injury, characterizing myocardial infarction (MI) without ST-segment elevation (NSTEMI). Those two entities (UA and NSTEMI) make up the non-ST-elevation acute coronary syndromes(NSTE-ACS), the object of this guideline...(AU)


Assuntos
Angina Instável , Infarto do Miocárdio
7.
Arq. bras. cardiol ; 103(3): 183-191, 09/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-723821

RESUMO

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset. .


Fundamento: Dados de mais de 4 décadas relataram maior incidência de infarto silencioso entre os pacientes com diabetes mellitus (DM), mas publicações recentes mostraram resultados conflitantes quanto à correlação entre DM e presença de dor em pacientes com síndromes coronárias agudas (SCA). Objetivo: Nosso objetivo principal foi analisar a associação entre dor precordial e DM na chegada ao hospital. Análises secundárias avaliaram a associação entre hiperglicemia e dor precordial na apresentação, e o subgrupo de pacientes que se apresentaram em até 6 horas após o início dos sintomas. Métodos: Analisamos um registro prospectivo de 3.544 pacientes com SCA internados em unidade coronária de um hospital terciário. Desenvolvemos modelos multivariados para ajustar potenciais fatores de confusão. Resultados: Os pacientes com dor precordial eram menos propensos a ter DM (30,3%) do que aqueles sem dor (34,0 %, p não ajustado = 0,029), mas essa diferença não foi significativa após ajuste multivariado, para a população global (p = 0,84), e para o subgrupo de pacientes que se apresentaram dentro do período de 6 horas após o início dos sintomas (p = 0,51). Em contraste, a dor precordial era mais provável entre os pacientes com hiperglicemia (41,2% vs. 37,0% sem hiperglicemia, p = 0,035) na população total, e também entre aqueles que se apresentaram no período de 6 horas (41,6% vs. 32,3%, p = 0,001). Modelos ajustados mostraram uma associação independente entre hiperglicemia e dor na apresentação, especialmente entre os pacientes que se apresentaram no período de até 6 horas (OR = 1,41, p = 0,008). Conclusão: Nesta população não-selecionada com SCA, não houve correlação entre DM e a ...


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/fisiopatologia , Dor no Peito/fisiopatologia , Cardiomiopatias Diabéticas/fisiopatologia , Limiar da Dor/fisiologia , Dor no Peito/etiologia , Mortalidade Hospitalar , Análise Multivariada , Admissão do Paciente , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo
8.
Arq Bras Cardiol ; 103(3): 183-91, 2014 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25076180

RESUMO

BACKGROUND: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). OBJECTIVE: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. METHODS: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. RESULTS: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). CONCLUSION: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Dor no Peito/fisiopatologia , Cardiomiopatias Diabéticas/fisiopatologia , Limiar da Dor/fisiologia , Idoso , Dor no Peito/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Admissão do Paciente , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo
9.
Arq. bras. cardiol ; 101(6): 511-518, dez. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-701279

RESUMO

FUNDAMENTO: A ocorrência de sangramento aumenta a mortalidade intra-hospitalar em pacientes com síndromes coronarianas agudas (SCAs), e há uma boa correlação entre os escores de risco de sangramento e a incidência de eventos hemorrágicos. No entanto, o papel dos escores de risco de sangramento como fatores preditivos de mortalidade é pouco estudado. OBJETIVO: Analisar o papel do escore de risco de sangramento como fator preditivo de mortalidade intra-hospitalar numa coorte de pacientes com SCA tratados num centro terciário de cardiologia. MÉTODOS: Dos 1.655 pacientes com SCA (547 com SCA com supra de ST e 1.118 com SCA sem supra de ST), calculou-se o escore de risco de sangramento ACUITY/HORIZONS prospectivamente em 249 pacientes e retrospectivamente nos demais 1.416. Informações sobre mortalidade e complicações hemorrágicas também foram obtidas. RESULTADOS: A idade média da população estudada foi 64,3 ± 12,6 anos e o escore de risco de sangramento médio foi 18 ± 7,7. A correlação entre sangramento e mortalidade foi altamente significativa (p < 0,001; OR = 5,29), assim como a correlação entre escore de sangramento e hemorragia intra-hospitalar (p < 0,001; OR = 1,058), e entre escore de sangramento e mortalidade intra-hospitalar (OR ajustado = 1,121, p < 0,001, área sob a curva ROC 0,753; p < 0,001). O OR ajustado e a área sob a curva ROC para a população com SCA com supra de ST foram 1,046 (p = 0,046) e 0,686 ± 0,040 (p < 0,001), respectivamente, e para SCA sem supra de ST foram 1,150 (p < 0,001) e 0,769 ± 0,036 (p < 0,001), respectivamente. CONCLUSÃO: O escore de risco de sangramento é um fator preditivo muito útil e altamente confiável para mortalidade intra-hospitalar em uma grande variedade de pacientes com SCAs, especialmente aqueles com angina instável ou infarto agudo do miocárdio sem supra de ST.


BACKGROUND: It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. OBJECTIVE: The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. METHODS: Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. RESULTS: Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001). CONCLUSIONS: Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/mortalidade , Mortalidade Hospitalar , Hemorragia/mortalidade , Infarto do Miocárdio/mortalidade , Angioplastia , Síndrome Coronariana Aguda/complicações , Brasil/epidemiologia , Fibrinolíticos/administração & dosagem , Hemorragia/complicações , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco , Curva ROC
10.
Arq Bras Cardiol ; 101(6): 511-8, 2013 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24217405

RESUMO

BACKGROUND: It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. OBJECTIVE: The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. METHODS: Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. RESULTS: Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001). CONCLUSIONS: Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Hemorragia/mortalidade , Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/complicações , Adulto , Idoso , Angioplastia , Brasil/epidemiologia , Feminino , Fibrinolíticos/administração & dosagem , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Curva ROC , Estudos Retrospectivos , Medição de Risco
11.
Arq. bras. cardiol ; 100(5): 404-411, maio 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-675601

RESUMO

FUNDAMENTO: Hiperglicemia na fase aguda do infarto do miocárdio é importante fator prognóstico. Entretanto, sua fisiopatologia não está completamente elucidada. OBJETIVO: Analisar simultaneamente correlação entre hiperglicemia e marcadores bioquímicos relacionados ao estresse,metabolismo glicídico e lipídico, coagulação, inflamação e necrose miocárdica. MÉTODOS: Oitenta pacientes com infarto agudo do miocárdio foram incluídos prospectivamente. Os parâmetros analisados foram: glicose, hormônios do estresse (cortisol e norepinefrina), fatores do metabolismo glicídico [hemoglobina glicada (HbA1c), insulina], lipoproteínas (colesterol total, LDL, HDL, LDL eletronegativa minimamente modificada e adiponectina), glicerídeos (triglicérides, VLDL e ácido graxo), fatores da coagulação (fator VII, fibrinogênio,inibidor do ativador do plasminogênio-1), inflamação (proteína C reativa ultrassensível) e necrose miocárdica (CK-MB e troponina). Variáveis contínuas foram convertidas em graus de pertinência por intermédio de lógica fuzzy. RESULTADOS: Houve correlação significativa entre hiperglicemia e metabolismo glicídico (p < 0,001), lipoproteínas (p = 0,03) e fatores de necrose (p = 0,03). Na análise multivariada, somente metabolismo glicídico (OR = 4,3; IC = 2,1-68,9 e p < 0,001) e necrose miocárdica (OR = 22,5; IC = 2-253 e p = 0,012) mantiveram correlação independente e significativa.Para análise da influência da história de diabetes mellitus , modelo de regressão, incluindo somente pacientes sem diabetes mellitus foi desenvolvido, e os resultados não alteraram. Finalmente, no modelo ajustado para idade, sexo e variáveis clínicas(história de diabetes mellitus, hipertensão arterial e dislipidemia), três variáveis mantiveram associação significativa e independente com hiperglicemia: metabolismo glicídico (OR = 24,1; IC = 4,8-122,1 e p < 0,001) necrose miocárdica (OR = 21,9; IC = 1,3-360,9 e p = 0,03) e história de DM (OR = 27, IC = 3,7-195,7 e p = 0,001). CONCLUSÃO: Marcadores do metabolismo glicídico e necrose miocárdica foram os melhores preditores de hiperglicemia em pacientes com infarto agudo do miocárdio.


BACKGROUND: Hyperglycemia in the acute phase of myocardial infarction is an important prognostic factor. However, its pathophysiology is not fully understood. OBJECTIVE: To analyze simultaneously the correlation between hyperglycemia and biochemical markers related to stress, glucose and lipid metabolism, coagulation, inflammation, and myocardial necrosis. METHODS Eighty patients with acute myocardial infarction were prospectively included. The following parameters were analyzed: blood glucose; stress hormones (cortisol and norepinephrine); glucose metabolism factors [glycated hemoglobin (HbA1c); insulin]; lipoproteins (total cholesterol, LDL, HDL, minimally modified electronegative LDL, and adiponectin); glycerides (triglycerides, VLDL and fatty acids); coagulation factors (factor VII, fibrinogen, plasminogen activator inhibitor-1); inflammation (high-sensitivity C reactive protein); and myocardial necrosis (CK-MB and troponin). Continuous variables were converted into degrees of relevance using fuzzy logic. RESULTS: Significant correlation was observed between hyperglycemia and glucose metabolism (p < 0.001), lipoproteins (p = 0.03), and necrosis factors (p = 0.03). In the multivariate analysis, only glucose metabolism (OR = 4.3; CI = 2.1-68.9; and p < 0.001) and myocardial necrosis (OR = 22.5; CI = 2-253; and p = 0.012) showed independent and significant correlation. For the analysis of the influence of history of diabetes mellitus, a regression model including only patients without diabetes mellitus was developed, and the results did not change. Finally, in the model adjusted for age, gender, and clinical variables (history of diabetes mellitus, hypertension and dyslipidemia), three variables maintained a significant and independent association with hyperglycemia: glucose metabolism (OR = 24.1; CI = 4.8-122.1; and p < 0.001), myocardial necrosis (OR = 21.9; CI = 1.3-360.9; and p = 0.03), and history of DM (OR = 27; CI = 3.7-195.7; and p = 0.001). CONCLUSION: Glucose metabolism and myocardial necrosis markers were the best predictors of hyperglycemia in patients with acute myocardial infarction.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus/diagnóstico , Hiperglicemia/diagnóstico , Infarto do Miocárdio/sangue , Troponina/sangue , Biomarcadores/sangue , Coagulação Sanguínea/fisiologia , Creatina Quinase Forma MB/sangue , Diabetes Mellitus/sangue , Métodos Epidemiológicos , Hemoglobina A Glicada/análise , Hiperglicemia/sangue , Inflamação/sangue , Insulina/sangue , Lipoproteínas/sangue , Infarto do Miocárdio/patologia , Necrose , Estresse Fisiológico/fisiologia
12.
Arq Bras Cardiol ; 100(5): 404-11, 2013 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23598457

RESUMO

BACKGROUND: Hyperglycemia in the acute phase of myocardial infarction is an important prognostic factor. However, its pathophysiology is not fully understood. OBJECTIVE: To analyze simultaneously the correlation between hyperglycemia and biochemical markers related to stress, glucose and lipid metabolism, coagulation, inflammation, and myocardial necrosis. METHODS Eighty patients with acute myocardial infarction were prospectively included. The following parameters were analyzed: blood glucose; stress hormones (cortisol and norepinephrine); glucose metabolism factors [glycated hemoglobin (HbA1c); insulin]; lipoproteins (total cholesterol, LDL, HDL, minimally modified electronegative LDL, and adiponectin); glycerides (triglycerides, VLDL and fatty acids); coagulation factors (factor VII, fibrinogen, plasminogen activator inhibitor-1); inflammation (high-sensitivity C reactive protein); and myocardial necrosis (CK-MB and troponin). Continuous variables were converted into degrees of relevance using fuzzy logic. RESULTS: Significant correlation was observed between hyperglycemia and glucose metabolism (p < 0.001), lipoproteins (p = 0.03), and necrosis factors (p = 0.03). In the multivariate analysis, only glucose metabolism (OR = 4.3; CI = 2.1-68.9; and p < 0.001) and myocardial necrosis (OR = 22.5; CI = 2-253; and p = 0.012) showed independent and significant correlation. For the analysis of the influence of history of diabetes mellitus, a regression model including only patients without diabetes mellitus was developed, and the results did not change. Finally, in the model adjusted for age, gender, and clinical variables (history of diabetes mellitus, hypertension and dyslipidemia), three variables maintained a significant and independent association with hyperglycemia: glucose metabolism (OR = 24.1; CI = 4.8-122.1; and p < 0.001), myocardial necrosis (OR = 21.9; CI = 1.3-360.9; and p = 0.03), and history of DM (OR = 27; CI = 3.7-195.7; and p = 0.001). CONCLUSION: Glucose metabolism and myocardial necrosis markers were the best predictors of hyperglycemia in patients with acute myocardial infarction.


Assuntos
Diabetes Mellitus/diagnóstico , Hiperglicemia/diagnóstico , Infarto do Miocárdio/sangue , Troponina/sangue , Biomarcadores/sangue , Coagulação Sanguínea/fisiologia , Creatina Quinase Forma MB/sangue , Diabetes Mellitus/sangue , Métodos Epidemiológicos , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Inflamação/sangue , Insulina/sangue , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Necrose , Estresse Fisiológico/fisiologia
14.
Arq Bras Cardiol ; 98(5): 375-83, 2012 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22858653

RESUMO

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doença Aguda , Brasil , Insuficiência Cardíaca/mortalidade , Humanos
16.
Diabetes Care ; 35(1): 150-2, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22028280

RESUMO

OBJECTIVE: To assess the impact of hyperglycemia in different age-groups of patients with acute myocardial infarction (AMI). RESEARCH DESIGN AND METHODS: A total of 2,027 patients with AMI were categorized into one of five age-groups: <50 years (n = 301), ≥50 and <60 (n = 477), ≥60 and <70 (n = 545), ≥70 and <80 (n = 495), and ≥80 years (n = 209). Hyperglycemia was defined as initial glucose ≥115 mg/dL. RESULTS: The adjusted odds ratios for hyperglycemia predicting hospital mortality in groups 1-5 were, respectively, 7.57 (P = 0.004), 3.21 (P = 0.046), 3.50 (P = 0.003), 3.20 (P < 0.001), and 2.16 (P = 0.021). The adjusted P values for correlation between glucose level (as a continuous variable) and mortality were 0.007, <0.001, 0.043, <0.001, and 0.064. The areas under the ROC curves (AUCs) were 0.785, 0.709, 0.657, 0.648, and 0.613. The AUC in group 1 was significantly higher than those in groups 3-5. CONCLUSIONS: The impact of hyperglycemia as a risk factor for hospital mortality in AMI is more pronounced in younger patients.


Assuntos
Mortalidade Hospitalar , Hiperglicemia/mortalidade , Infarto do Miocárdio/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 20(3): 397-404, jul.-set. 2010. ilus, tab
Artigo em Português | LILACS | ID: lil-574287

RESUMO

Em tempos recentes vêm ocorrendo grandes avanços no conhecimento da fisiopatologia principalmente por conta do tratamento antitrombóticos das síndromes isquêmicas miocárdica instabilização da placa aterosclerótica e consequente desencadeamento das síndromes isquêmica miocárdicas instáveis. Com os concomitantes avanços terapêuticos,principalmente por conta do tratamento antitrombótica das síndromes isquêmicas miocárdicas instáveis, tem-se conseguido melhorar de forma clara a evolução desses pacientes. Por outro lado, dentre os antitrombóticos, os agentes antiplaquetários têm papel de destaque. Sendo o objetivo principal da terapia antitrombótica nos pacientes com síndromes isquêmicas miocárdicas instáveis o melhor equilíbrio entre a redução de eventos isquêmicos e o risco de complicações hemorrágicas, diversos estudos clínicos com agentes antiplaquetários têm avaliado a possibilidade de aperfeiçoar esse equilíbrio, melhor entendendo a complexa relação entre inibição da agregação plaquetária, eventos isquêmicos e sangramento. Nesta revisão serão discutidos estudos recentes que testaram novos agentes antiplaquetários (prasugrel, ticagrelor e antagonista do receptor da trombina) desenvolvidos a partir da constatação de que o clopidogrel apresenta diversas limitações, como tempo longo para o início de sua ação e bloqueio da agregabilidade plaquetária relativamente pobre e muito variável de indivíduo para indivíduo.


There have been important advances regarding the pathophysiology process of atherosclerotic plaque instability and consequent triggering of acute coronary syndromes in recent times. Concomitant advances in the medical treatment, mainly due to antithrombotic therapy of acute coronary syndromes, have clearly improved the outcome of these patients. On the other hand, antiplatelet agents play a key role among antithrombotic agents. As the main goal of antithrombotic therapy in patients with acute coronary syndromes is a better balance between the reduction of ischemic events and the risk of bleeding complications, several clinical trials have evaluated antiplatelet agents to further improve this balance, and better understand the complex relationship between platelet aggregation inhibition, ischemic events and bleeding. This review will discuss recent studies testing new antiplatelet agents (prasugrel, ticagrelor and thrombin receptor antagonist), developed based on the observation that clopidogrel has several limitations, such as the long time for the onset of action, poor platelet aggregation inhibition and a high variability of response from one individual to another.


Assuntos
Humanos , Fibrinolíticos/uso terapêutico , Inibidores da Agregação de Plaquetas/administração & dosagem , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Trombose/complicações , Trombose/diagnóstico
18.
In. Nicolau, José Carlos; Tarasoutchi, Flávio; Rosa, Leonardo Vieira da; Machado, Fernando de Paula. Condutas práticas em cardiologia. São Paulo, Manole, 2010. p.162-168.
Monografia em Português | LILACS | ID: lil-534679
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 19(2): 175-186, abr.-jun. 2009. tab
Artigo em Espanhol | LILACS | ID: lil-525964

RESUMO

Grandes avanços ocorreram no conhecimento da fisiopatologia e no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST em tempos recentes; porém, a morbidade e a mortalidade dessa doença ainda são um grande desafio, apesar dos índices decrescentes observados a partir dos anos 60, quando do início da implantação das Unidades Coronárias de Terapia Intensiva. A partir da década de 80, credita-se a diminuição da mortalidade observada no infarto agudo do miocárdio, fundamentalmente, ao desenvolvimento dos métodos terapêuticos de recanalização/reperfusão coronária, inicialmente terapia fibrinolítica e, mais recentemente, intervenção coronária percutânea primária. Assim, promover a recanalização coronária precoce, seja mecânica (preferencialmente) ou farmacológica, permanece como o maior objetivo nos pacientes com infarto agudo do miocárdio até 12 horas de evolução. Por outro lado,...


Assuntos
Humanos , Fibrinolíticos/administração & dosagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Fatores de Risco
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