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1.
Arq. bras. cardiol ; 106(3): 218-225, Mar. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-777106

RESUMO

Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.


Resumo Fundamento: O BNP foi exaustivamente avaliado para a determinação do prognóstico em curto e médio prazo em pacientes com síndrome coronariana aguda, mas o seu papel para a mortalidade a longo prazo é incerta. Objetivo: Determinar o papel prognóstico a muito longo prazo do peptídeo natriurético do tipo B (BNP) para a mortalidade por todas as causas em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST (SCASSST). Métodos: Coorte de 224 pacientes consecutivos com SCASSST, prospectivamente atendidos no setor de emergência, em que se mediu o BNP na chegada para estabelecer o prognóstico ao longo do seguimento mediano de 9,34 anos para a mortalidade por todas as causas. Resultados: Diagnosticou-se angina instável em 52,2% e infarto do miocárdio sem supradesnivelamento do segmento ST em 47,8%. A mediana do BNP da admissão foi de 81,9 pg/mL (intervalo IQ = 22,2; 225) e a taxa de mortalidade correlacionou-se com quartis crescentes de BNP: 14,3; 16,1; 48,2; e 73,2% (p < 0,0001). A curva ROC revelou 100 pg/mL como o melhor ponto de corte de BNP para a predição de mortalidade (área sob a curva = 0,789, 95% CI = 0,723-0,854) sendo um forte preditor de mortalidade tardia: BNP < 100 = 17,3% vs. BNP ≥ 100 = 65,0%, RR = 3,76 (IC 95% = 2,49-5,63, p < 0,001). Na análise de regressão logística, idade>72 anos (OR = 3,79, IC 95% = 1,62-8,86, p = 0,002), BNP ≥ 100 pg/mL (OR = 6,24, IC 95% = 2,95-13,23, p < 0,001) e taxa de filtração glomerular estimada (OR = 0,98, IC 95% = 0,97-0,99, p = 0,049) foram preditores independentes de mortalidade tardia. Conclusões: O BNP medido na admissão hospitalar em pacientes com SCASSST é um forte preditor independente de mortalidade por todas as causas de muito longo prazo. Este estudo permite que se levante a hipótese de que o BNP deva ser medido em todos os pacientes com SCASSST no evento-índice para a estratificação de risco a longo prazo.


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Peptídeo Natriurético Encefálico/sangue , Admissão do Paciente/estatística & dados numéricos , Angina Instável/sangue , Angina Instável/diagnóstico , Angina Instável/mortalidade , Biomarcadores/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Fatores de Tempo
2.
Arq Bras Cardiol ; 106(3): 218-25, 2016 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26840056

RESUMO

BACKGROUND: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. OBJECTIVE: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. RESULTS: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. CONCLUSIONS: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Peptídeo Natriurético Encefálico/sangue , Admissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Angina Instável/sangue , Angina Instável/diagnóstico , Angina Instável/mortalidade , Biomarcadores/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Fatores de Tempo
3.
Arq Bras Cardiol ; 105(2 Suppl 1): 1-105, 2015 Aug.
Artigo em Português | MEDLINE | ID: mdl-26375058
4.
Rev. bras. cardiol. (Impr.) ; 24(4): 241-250, jul.-ago. 2011. tab, graf
Artigo em Português | LILACS | ID: lil-605502

RESUMO

Fundamentos: Um grande número de estudos tem confirmado que o treinamento físico é um dos métodos mais eficazes para melhorar a capacidade funcional e o bem-estar dos pacientes cardiopatas. Objetivo: Avaliar os benefícios clínicos e funcionais do Programa de Reabilitação Cardíaca em pacientes encaminhados ao Centro de Cardiologia do Exercício do Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro. Métodos: Foi realizado um estudo retrospectivo tipo coorte, comparativo antes e depois da participação no Programa de Reabilitação Cardíaca numa amostra de 88 indivíduos (60 homens e 28 mulheres) com idade entre37 anos e 81 anos. A maioria dos pacientes era portadora de doença coronariana estável. As principais variáveis analisadas dos testes ergométricos foram a duração doexercício, consumo de oxigênio do pico de exercício (VO2pico), o equivalente metabólico (MET), o déficit aeróbico funcional (FAI), o duplo-produto no pico do exercício(DP pico), a redução da frequência cardíaca no primeiro minuto da recuperação, a presença de isquemia, a classe funcional segundo a NYHA e a aptidão cardiorrespiratória (APCR) segundo a American Heart Association. Resultados: Houve melhora significativa da maioria das variáveis analisadas tais como da capacidade funcional,da duração do exercício, do VO2 pico, da quantidade deMET obtidos, do FAI, e da APCR (p<0,0001). Não foram observadas diferenças significativas em relação ao duplo produto(p=0,1359). Conclusão: O Programa de Reabilitação Cardíaca utilizado neste estudo proporcionou significativa melhora dos parâmetros fisiológicos, hemodinâmicos, funcionais e autonômicos dos pacientes e, consequentemente, no desempenho cardiovascular e metabólico no exercício.


Background: A great number of studies have confirmed that physical training is one of the most effective methods of improving functional capacity and well-being in patients with heart disease.Objective: To evaluate the clinical and functional benefits of the Cardiac Rehabilitation Program in patients referred to the Cardiac Exercise Center at the Aloysio de Castro State Institute of Cardiology in Rio de Janeiro, Brazil.Methods: A retrospective comparative cohort study was conducted of a sample of 88 individuals (60 men and 28 women) between 37 and 81 years old. Most of the patients had stable coronary artery disease. The main parameters analyzed for the treadmill tests wereexercise duration, peak oxygen consumption (peak VO2), metabolic equivalent (MET), functional aerobicimpairment (FAI), peak exercise double product (peak DP), reduction in heart rate for the first minute of recovery, presence of ischemia, NYHA functional class and American Heart Association cardiorespiratory fitness. Results: There was significant improvement in mostof the parameters analyzed, such as functional capacity, exercise duration, peak VO2, MET achieved, FAI and cardiorespiratory fitness (p<0.0001). There was no significant difference for the double product (p=0.1359). Conclusion: The Cardiac Rehabilitation Program used in this study provided significant improvements in the physiological, hemodynamic, functional and autonomic parameters of the patients and consequently their cardiovascular and metabolic exerciseperformance.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença das Coronárias/reabilitação , Exercício , Resultado do Tratamento , Teste de Esforço/métodos , Teste de Esforço , Eletrocardiografia/métodos , Eletrocardiografia , Frequência Cardíaca , Fatores de Risco
5.
Coron Artery Dis ; 20(2): 143-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19293713

RESUMO

BACKGROUND: The prognostic importance of early measurement of B-type natriuretic peptide (BNP) in patients with acute chest pain while the diagnosis is still uncertain is unknown. We determined the prognostic value of BNP in these patients immediately after presenting to the emergency department. METHODS: Seven hundred and twenty-three consecutive individuals with suspicious ischemic acute chest pain and no ST-segment elevation were prospectively evaluated using a systematic diagnostic strategy and followed for 1 year. Acute coronary syndrome was diagnosed in 326 patients during their hospital stay. RESULTS: In the follow-up, 15 (2.1%) patients of the whole cohort died of cardiac cause at 1 month and 51 (7.1%) at 1 year. Patients who died had significantly higher admission BNP levels than survivors and this correlation proved linear according to quartile levels. Patients with BNP greater than 101 pg/ml had 13 times higher rate of 1-month mortality (P<0.0001) and 5.3 times higher rate of 1-year mortality (P<0.0001) than patients with BNP of 101 pg/ml or less. Multiple logistic regression analysis disclosed BNP as a strong independent predictor of 1-month and 1-year mortality adding significant prognostic information over traditional risk markers. CONCLUSION: Admission BNP is an independent and powerful marker of early and late cardiac mortality in patients with acute chest pain without ST-segment elevation. These results suggest that BNP should be measured upon arrival at the emergency department for risk stratification in all these patients.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angina Pectoris/etiologia , Serviço Hospitalar de Emergência , Peptídeo Natriurético Encefálico/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/sangue , Angina Pectoris/mortalidade , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco , Fatores de Tempo , Regulação para Cima
6.
Arq Bras Cardiol ; 87(3): 275-80, 2006 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-17057926

RESUMO

OBJECTIVE: To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG). METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS) (age = 64.9 +/- 14.3, men = 55%, diabetic = 18%, normal ECG = 84%). Serial CRP, creatine kinase MB mass (CKMB-mass) and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP) by the upper limit of normal (ULN) of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]). RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI), and their s-CRP values were 1.31 +/- 2.90 (median = 0.47) compared to 0.79 +/- 1.39 (0.30) in no-AMI patients (p = 0.031). The s-CRP > 1.0 showed 30% sensitivity and 80% specificity, plus negative and positive predictive values of 6.1% and 96.7%, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction). In the first quartile of the s-CRP (< 0.10), three events were recorded, while in the fourth quartile (> 0.93) 15 events (p = 0.003) occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively) were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP) were predictive of in-hospital adverse cardiac events.


Assuntos
Proteína C-Reativa/análise , Dor no Peito/diagnóstico , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio/diagnóstico , Troponina I/sangue , Biomarcadores/sangue , Dor no Peito/sangue , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
7.
Arq. bras. cardiol ; 87(3): 275-280, set. 2006. graf, tab
Artigo em Português, Inglês | LILACS | ID: lil-436187

RESUMO

OBJETIVO: Testar os valores diagnóstico e prognóstico imediatos da proteína C-reativa (PCR) nos pacientes admitidos na sala de emergência (SE) com dor torácica (DT) e sem elevação do segmento ST no eletrocardiograma (ECG). MÉTODOS: De janeiro de 2002 a dezembro de 2003, 980 pacientes consecutivos foram atendidos com DT suspeita de síndrome coronariana aguda na SE (idade = 64,9 ± 14,3 anos, homens = 55 por cento, diabéticos = 18 por cento, ECG normal = 84 por cento). Dosou-se a PCR na admissão, a creatinofosfoquinase MB fração massa (CKMB) e a troponina I seriadas, além de se registrar ECG seriados. As medidas da PCR foram padronizadas (PCR-p) pelo valor do limite superior da normalidade (LSN) do teste utilizado (3,0 mg/L para a PCR de alta sensibilidade-PCR-AS e 0,1 mg/dl para PCR titulada-PCR-t). RESULTADOS: Foi diagnosticado infarto agudo do miocárdio (IAM) em 125 pacientes, e seus valores para a PCR-p foram 1,31 ± 2,90 (mediana = 0,47) versus 0,79 ± 1,39 (0,30) nos sem IAM (p = 0,031). A PCR-p > 1,0 apresentou sensibilidade de 30 por cento, especificidade de 80,4 por cento, valores preditivos positivo e negativo de 6,1 por cento e de 96,7 por cento, para o diagnóstico de IAM. Houve quarenta eventos cardíacos intra-hospitalares (óbitos = dezesseis, revascularizações de urgência = 22, IAM = dois). No 1° quartil da PCR-p (< 0,10) registraram-se três eventos, enquanto no 4° quartil (> 0,93) ocorreram quinze eventos (p = 0,003). Na regressão logística foram preditores independentes para eventos cardíacos a insuficiência ventricular esquerda, o sexo masculino e a PCR-p > 0,32, com razão de chances de 7,6, 2,8 e 2,2, respectivamente. CONCLUSÃO: Nos pacientes atendidos com DT na SE, a PCR-p: 1) Não foi um bom marcador de IAM, apesar de um valor normal praticamente afastar esse diagnóstico; 2) Um valor superior a um terço do seu limite superior da normalidade (LSN) (>1 mg/L da PCR-AS ou >0,33 mg/dl da PCR-t) foi preditor de eventos cardíacos adversos intra-hospitalares.


OBJECTIVE: To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG). METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS) (age = 64.9 ± 14.3, men = 55 percent, diabetic = 18 percent, normal ECG = 84 percent). Serial CRP, creatine kinase MB mass (CKMB-mass) and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP) by the upper limit of normal (ULN) of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]). RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI), and their s-CRP values were 1.31 ± 2.90 (median = 0.47) compared to 0.79 ± 1.39 (0.30) in no-AMI patients (p = 0.031). The s-CRP > 1.0 showed 30 percent sensitivity and 80 percent specificity, plus negative and positive predictive values of 6.1 percent and 96.7 percent, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction). In the first quartile of the s-CRP (< 0.10), three events were recorded, while in the fourth quartile (> 0.93) 15 events (p = 0.003) occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively) were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP) were predictive of in-hospital adverse cardiac events.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Proteína C-Reativa/análogos & derivados , Dor no Peito/diagnóstico , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio/diagnóstico , Troponina I/sangue , Biomarcadores/sangue , Dor no Peito/sangue , Eletrocardiografia , Serviço Hospitalar de Emergência , Infarto do Miocárdio/sangue , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
8.
Rev. SOCERJ ; 19(1): 87-91, jan.-fev. 2006. ilus
Artigo em Português | LILACS | ID: lil-436603

RESUMO

O angiossarcoma primário do coração é um tumor maligno raro, derivado do mesênquima, com predileção pelo átrio direito. Acomete mais homens, com idade média de 40 anos. Na maioria dos casos já tornando pior o prognóstico. As modalidades terapêuticas atualmente têm pouco sucesso, apenas prolongando a sobrevida em alguns meses, mesmo nos casos em que se consegue ressecção cirúrgica ampla ou transplante cardíaco. Relata-se o caso de uma paciente negra, de 53 anos, que apresentou súbito quadro de dor torácica direita e síncope e, posteriormente, evoluiu com dispnéia e síndrome da veia cava superior. A investigação pelos métodos de imagem demonstrou um tumor cardíaco no átrio direito sugestivo de sarcoma, sendo considerado de difícil abordagem cirúrgica. Em poucas semanas a paciente evoluiu para insuficiência pré-renal, congestão pulmonar e óbito após 4 meses do início dos sintomas


Assuntos
Humanos , Feminino , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/mortalidade , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade
9.
Eur Heart J ; 26(3): 234-40, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15618053

RESUMO

AIMS: This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation. METHODS AND RESULTS: A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cut-off value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P<0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model. CONCLUSION: BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.


Assuntos
Dor no Peito/etiologia , Isquemia Miocárdica/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Idoso , Angina Instável/sangue , Angina Instável/diagnóstico , Biomarcadores/sangue , Feminino , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Troponina I/sangue
10.
Arq. bras. cardiol ; 83(supl.4): 1-86, set. 2004. ilus, tab
Artigo em Português | LILACS | ID: lil-389546
11.
Rev. SOCERJ ; 17(2): 83-87, abr.-jun. 2004.
Artigo em Português | LILACS | ID: lil-400613

RESUMO

As diretrizes atuais sobre o tratamento das dislipidemias para a prevenção primária e a secundária da doença arterial coronariana estipulam patamares variáveis de valor sérico de LDL colesterol, de acordo com o risco de doença, para a utilização de terapêutica farmacológica. Assim, pacientes sem evidência de doença arteriosclerótica, com até um fator de risco e LDL>ou igual a 190mg/dl, devem iniciar o uso de hipolipemiante. Para aqueles com dois ou mais fatores de risco, e risco de doença menor que 10 por cento em 10 anos, o tratamento deve ser iniciado se LDL maior ou igual a 160mg/dl, enquanto aqueles com risco de doença entre 10 por cento e 20 por cento em 10 anos recebem tratamento se LDL maior ou igual a 130mg/dl. Pacientes com risco de doença maior que 20 por cento em 10 anos, pacientes com diabetes, pacientes com doença arterioesclerótica e pacientes com doença coronariana recebem tratamento se LDL maior ou igual a 130mg/dl. Os níveis séricos de LDL a serem alcançados nestes 3 grupos de pacientes com o tratamento são menores que 160mg/dl, menores que 130mg/dl e menores que 100mg/dl, respectivamente. O estudo HPS demonstrou que, em pacientes com doença arteriosclerótica conhecida, mesmo quando o nível de LDL estiver menor que 100mg/dl, o uso de sinvastatina produz benefício na redução de eventos, sugerindo irrelevância de valor sérico do LDL na tomada de decisão do uso de estatina na prevenção secundária. O estudo ASCOTT-LLA demonstrou importante redução de eventos cardiovasculares com o uso de atorvastatina na prevenção primária de indivíduos de baixo risco e LDL menor ou igual a 130mg/dl, sugerindo uma mudança no...


Assuntos
Humanos , Doença das Coronárias/prevenção & controle , Hiperlipidemias , Hipercolesterolemia/sangue , Hipercolesterolemia/terapia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Seguimentos , Guias como Assunto , Fatores de Tempo
12.
Rev. SOCERJ ; 17(2): 140-147, abr.-jun. 2004. ilus, graf
Artigo em Português | LILACS | ID: lil-400618

RESUMO

Objetivos: verificar o quantitativo de Unidades de Dor Torácica no Brasil e identificar as suas características de operacionalidade. Métodos: análise de questionário enviado em 2002 a todas as Unidades de Dor Torácica do Brasil conhecidas e rastreadas pelos pesquisadores, contendo perguntas sobre diversas características dos hospitais/clínicas onde estão instaladas e sobre o funcionamento de suas respectivas salas de emergência. Resultados: foram contatadas 47 Unidades de Dor Torácica; destas, 42 estavam em funcionamento e responderam ao questionário. A maior parte delas está localizada na região sul-sudeste e 37 em instituições privadas. Angioplastia e cirurgia cardíaca são realizadas na grande maioria destes centros e 1/3 deles realizam angioplastia primária. Nas unidades que administram fibrinolítico, o tempo porta-agulha mediano é de 30 minutos. A maioria das unidades realiza um teste de estresse pré-alta nos pacientes com dor torácica sem síndrome coronariana aguda. Muitas instituições informaram não conseguir pagamento dos atendimentos realizados na Unidade de Dor Torácica por parte das diversas fontes pagadoras. Conclusões: desde 1996, o crescimento das Unidades de Dor Torácica no Brasil tem sido constante, apesar de o quantitativo ainda ser pequeno. O atendimento médico prestado por estas unidades parece ser mais rápido e de melhor qualidade e eficiência que o padrão assistencial médio nacional, e por isso deve ser um modelo a ser buscado pelos gestores de saúde e fontes pagadoras.


Assuntos
Dor no Peito/fisiopatologia , Dor no Peito/prevenção & controle , Tórax/anormalidades , Dor/prevenção & controle
13.
Crit Pathw Cardiol ; 3(1): 1-7, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18340129

RESUMO

Management of chest pain patients in the emergency department has been a dilemma because of difficulty in identifying those who can be immediately discharged and those who need to be hospitalized. We assessed the efficacy of a probability stratification model and a systematic diagnostic strategy in 1003 consecutive chest pain patients prospectively evaluated and stratified for acute coronary syndromes according to chest pain characteristics and admission electrocardiogram. Patients with no suspicion of acute coronary syndromes (n = 224) were immediately discharged, whereas those with very-high probability (n =119) were admitted to the coronary care unit. Remaining patients were evaluated in a Chest Pain Unit and investigated during a 9-hour period (intermediate-probability, n = 433) (route 2) and a 6-hour period (low-probability, n = 277) (route 3). Sensitivity and negative predictive value of chest pain type for the diagnosis of acute myocardial infarction (94% and 97%, respectively) was much better than the admission electrocardiogram (49% and 86%, respectively) and admission creatine kinase-MB (46% and 86%, respectively). Serial creatine kinase-MB determinations ruled out acute myocardial infarction by the third-hour postadmission in all route 3 patients but only at the ninth-hour in route 2 patients. For patients with no ST-segment elevation, chest pain type was the strongest independent predictor of acute coronary syndromes. It is concluded that chest pain type is the best single diagnostic tool to rule in/out acute coronary syndromes on admission to the emergency department. Patients with suspicious chest pain must have serum creatine kinase-MB measurements up to 9 hours postadmission to rule out acute myocardial infarction.

14.
Crit Pathw Cardiol ; 3(2): 72-8, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18340143

RESUMO

Identifying acute coronary syndrome is a difficult task in the emergency department because symptoms may be atypical and the electrocardiogram has low sensitivity. In this prospective cohort study done in a tertiary community emergency hospital, we developed and tested a neural diagnostic tree in 566 consecutive patients with chest pain and no ST-segment elevation for the diagnosis of acute coronary syndrome. Multivariate regression and recursive partitioning analysis allowed the construction of decision rules and of a neural tree for the diagnosis of acute myocardial infarction and acute coronary syndrome. Predictive variables of acute coronary syndrome were: age > or =60 years (odds ratio [OR] = 2.3; P = 0.0016), previous history of coronary artery disease (OR = 2.9; P = 0.0008), diabetes (OR = 2.8; P = 0.0240), definite/probable angina-type chest pain (OR = 17.3; P = 0.0000) and ischemic electrocardiogram (ECG) changes on admission (OR = 3.5; P = 0.0002). The receiver operating characteristic curve of possible diagnostic decision rules of the regression model disclosed a C-index of 0.904 (95% confidence interval = 0.878 to 0.930) for acute coronary syndrome and 0.803 (95% confidence interval 0.757 to 0.849) for acute myocardial infarction. For both disorders, sensitivities of the neural tree were 99% and 93%, respectively, and negative predictive values were both 98%. Negative likelihood ratios were 0.02 and 0.1, respectively. It is concluded that this simple and easy-to-use neural diagnostic tree was very accurate in the identification of non-ST segment elevation chest pain patients without acute coronary syndrome. Patients identified as low probability of disease could receive immediate stress testing and be discharged if the test is negative.

15.
Arq Bras Cardiol ; 81(2): 174-81, 166-73, 2003 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-14502386

RESUMO

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7 12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.


Assuntos
Dor no Peito/fisiopatologia , Serviço Hospitalar de Emergência , Teste de Esforço , Idoso , Análise de Variância , Estudos de Coortes , Teste de Esforço/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Segurança , Resultado do Tratamento
16.
Arq. bras. cardiol ; 81(2): 166-181, ago. 2003. ilus, tab
Artigo em Português, Inglês | LILACS | ID: lil-345307

RESUMO

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64 percent) patients were eligible for exercise testing, but only 268 (40 percent) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70 percent) were males. Twenty-eight (10 percent) patients had a previous history of coronary artery disease, 244 (91 percent) had a normal or unspecific electrocardiogram, and 150 (56 percent) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13 percent) were positive, 191 (71 percent) were negative, and 43 (16 percent) were inconclusive. In the group of patients with a positive exercise test, 21 (62 percent) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dor no Peito , Serviço Hospitalar de Emergência , Teste de Esforço , Estudos de Coortes , Segurança de Equipamentos , Estudos de Viabilidade , Estudos Prospectivos , Resultado do Tratamento
17.
Arq Bras Cardiol ; 79(2): 196-209, 2002 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-12219197

RESUMO

It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED) in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS). This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI), and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.


Assuntos
Dor no Peito/diagnóstico , Serviços Médicos de Emergência , Algoritmos , Angina Pectoris/complicações , Angina Pectoris/diagnóstico , Angina Pectoris/economia , Brasil , Dor no Peito/economia , Dor no Peito/etiologia , Custos e Análise de Custo , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia
19.
Arq. bras. cardiol ; 79(2): 196-209, Aug. 2002. ilus, mapas, tab, graf
Artigo em Português, Inglês | LILACS | ID: lil-317896

RESUMO

It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED) in the United States 1,2, which corresponds to 5 to 10 percent of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS). This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI), and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management


Assuntos
Humanos , Dor no Peito , Serviços Médicos de Emergência , Angina Pectoris , Brasil , Dor no Peito , Custos e Análise de Custo , Infarto do Miocárdio
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