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1.
Medicina (B Aires) ; 79(4): 251-256, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487243

RESUMO

Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.


Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angioplastia Coronária com Balão/mortalidade , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Resultado do Tratamento
2.
Medicina (B.Aires) ; 79(4): 251-256, ago. 2019. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1040517

RESUMO

Se evaluaron las características clínicas, demoras, resultados y morbimortalidad de 1142 pacientes tratados con angioplastia primaria (AP) dentro de las 36 horas del infarto, incluidos en el registro ARGEN-IAM-ST, de carácter prospectivo, transversal, multicéntrico y de alcance nacional. Edades: 61.2 ± 12 años, 88% varones, 20% diabéticos y 58% hipertensos; 77.6% en Killip y Kimball I y 6.2% en shock cardiogénico. El tiempo desde el inicio del dolor hasta el ingreso fue de 153 (75-316) minutos, y puerta-balón de 91 (60-150) minutos. Los casos derivados (17%) tuvieron mayor demora de ingreso, 200 minutos (195-420; p = 0.0001) y mayor tiempo puerta-balón, 113 minutos (55-207); p = 0.099. En 47.6% de los casos la AP se hizo en arteria descendente anterior, en 36.4% a coronaria derecha, en 14.8% a circunfleja y en 1.2% al tronco de coronaria izquierda; en 95% con stent (29% farmacológico). El 95% fue exitoso. El 1.3% presentó angina post-infarto (APIAM), 1.3% re-infarto, 8.8% shock y 3.2% sangrado. Se asociaron a mayor mortalidad edad > 64 años (OR 6.2 (IC 95%: 3.2-12), p < 0.001), diabetes (OR 2.5, IC 95% 1.6-3.9, p < 0.001), re-infarto o APIAM (OR 3.3, IC 95% 1.3-8.3, p = 0.011) y shock (OR 29.2 (15.6-54.8), p < 0.001). La mortalidad hospitalaria del infarto agudo de miocardio con elevación del segmento ST tratado con AP fue de 7.6%. La derivación se asoció a demora de tratamiento. El shock cardiogénico y la isquemia post-infarto se asociaron a alta mortalidad. No hubo variables del procedimiento asociadas a mortalidad.


Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.

3.
Rev. argent. cardiol ; 83(5): 406-411, oct. 2015. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-957653

RESUMO

Introducción: El registro sobre Síndromes Coronarios Agudos en Argentina (SCAR) analizó la evolución intrahospitalaria del infarto de miocardio en nuestro país en pacientes que contaban con diferentes coberturas del sistema de salud, lo cual ha llevado al presente subanálisis derivado del registro SCAR. Objetivo: Determinar la influencia de la cobertura médica en el pronóstico intrahospitalario del infarto de miocardio. Material y métodos: El registro SCAR fue un estudio transversal, prospectivo y multicéntrico, que incluyó 476 pacientes con diagnóstico de infarto agudo de miocardio con supradesnivel del segmento ST (IAMST). La cobertura médica se diferenció en prepaga, obra social, PAMI y sin cobertura (solo estatal). Resultados: El 80% de los IAMST recibieron reperfusión, el 75% por angioplastia transluminal coronaria primaria (ATCP). La ATCP fue más frecuente en quienes tenían prepaga [OR 5,5 (2,5-12,4); p < 0,001] y los pacientes con PAMI [OR 0,47 (0,24-087); p = 0,02] o sin cobertura recibieron menos ATCP [OR 0,34 (0,2-0,6); p < 0,001]. El 13% fueron derivados a otro centro, más frecuentemente si tenían PAMI (p = 0,002). El tiempo hasta la ATCP fue mayor en pacientes con PAMI [240 (88-370) min; p = 0,0005] y menor si tenían prepaga [80 (42-120) min; p < 0,001]. La mortalidad intrahospitalaria del IAMST fue del 8%, 2,8% con prepaga, 4,3% con cobertura estatal, 6,88% con obra social y 25% con PAMI (ANOVA < 0,001). Tener prepaga se asoció con una mortalidad menor [OR 0,27 (0,08-0,91); p = 0,035] y tener PAMI se asoció con una mortalidad mayor, aun ajustado por sexo, edad y comorbilidades [OR 2,40 (1,1-5,8); p = 0,05]. Conclusión: El tratamiento y la mortalidad del IAMST fueron diferentes según la cobertura médica.


Background: The Acute Coronary Syndromes in Argentina (SCAR) registry analyzed in-hospital myocardial infarction out-come in patients with different medical coverage provided by the healthcare system; this has led to the present subanalysis derived from the SCAR registry. Objective: The aim of this study was to determine the influence of medical coverage on myocardial infarction in-hospital prognosis. Methods: The SCAR registry was a cross-sectional, prospective, multicenter study including 476 patients with ST-segment elevation acute myocardial infarction (STEMI). Medical coverage was classified in prepaid health insurance, social security insurance, PAMI and without medical coverage (except public coverage). Results: Eighty percent of STEMI patients received reperfusion therapy, 75% by primary transluminal coronary angioplasty (PTCA). PTCA was more frequent in those with prepaid health insurance [OR 5.5 (2.5-12.4); p<0.001] and less frequent in PAMI patients [OR 0.47 (0.24-0.87), p=0.02] or in those without any medical coverage [OR=0.34 (0.2-0.6), p<0.001]. Thirteen percent of patients were transferred to another hospital, more frequently if they were PAMI patients (p=0.002). Time to PTCA was longer in patients with PAMI [240 (88-370) min, p=0.0005] and shorter in patients with prepaid health insurance [80 (42-120) min, p<0.001]. Overall in-hospital STEMI mortality was 8%, 2.8% in patients with prepaid health insurance, 4.3% in patients with public medical coverage, 6.88% in patients with social security insurance and 25% in patients covered by PAMI (ANOVA <0.001). Mortality was significantly lower in patients with prepaid health insurance [OR=0.27 (0.08-0.91), p=0.035] and higher in patients with PAMI, even after adjusting by sex, age and comorbidities [OR 2.40 (1.1-5.8), p=0.05]. Conclusion: STEMI treatment and mortality were different according to the type of medical coverage.

4.
Rev. argent. cardiol ; 82(6): 500-505, dic. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-750558

RESUMO

Introducción: Se conoce que la leucocitosis y la hiperglucemia se correlacionan a corto plazo con peor pronóstico en pacientes con síndrome coronario agudo, pero su novel relación, denominada índice leucoglucémico (ILG), se ha evaluado escasamente. Objetivos: Analizar el valor pronóstico del ILG en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y su valor agregado a los puntajes de riesgo clásicos. Material y métodos: Se analizaron los pacientes con diagnóstico de IAMCEST del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). El punto final analizado fue la muerte o Killip Kimball 3-4 (KK 3-4) en el período hospitalario. Se analizó el ILG tanto como variable continua como en cuartiles según los valores de los percentiles 25, 50 y 75. Resultados: Se analizaron 405 de 476 pacientes con diagnóstico final de IAMCEST. La presencia del punto final fue significativamente creciente por cuartiles de ILG: 0%, 7,60%, 9,30% y 30,60% (p < 0,0001). El área bajo la curva ROC del ILG para el punto final combinado fue de 0,77 [(IC 95% 0,71-0,88); p = 0,0001]; el mejor valor de corte pronóstico fue de 1.000. La presencia de muerte o KK 3-4 fue del 0% y del 13% en los IAMCEST con ILG menor o mayor de 1.000, respectivamente. En un modelo de regresión logística multivariado, el ILG se asoció independientemente con muerte o KK 3-4. El área bajo la curva ROC del puntaje TIMI para IAMCEST fue de 0,58. El agregado del ILG incrementó su capacidad discriminatoria a 0,66 (p = 0,001). Conclusiones: El ILG demostró que es un predictor independiente de mala evolución en el IAMCEST (muerte o KK 3-4), con valor aditivo al puntaje TIMI.


Background: Leukocytosis and hyperglycemia correlate with worse short-term prognosis in patients with acute coronary syndrome, but their new relationship, called leuko-glycemic index (LGI), has been scarcely evaluated. Objectives: The aim of this study was to analyze the prognostic value of LGI in patients with ST-segment-elevation acute myocardial infarction (STEMI) and its added value to classical risk scores. Methods: Patients diagnosed with STEMI from the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry were analyzed. The final endpoint was death or in-hospital Killip-Kimball 3-4 (KK 3-4). The LGI was analyzed as a continu-ous variable and in quartiles according to 25, 50 and 75 percentile values. Results: The study evaluated 405 out of 476 patients with final STEMI diagnosis. Presence of the primary endpoint significantly increased per LGI quartile: 0%, 7.60%, 9.30% and 30.60% (p < 0.0001). The LGI area under the ROC curve for the composite endpoint was 0.77 [(95% CI 0.71-0.88); p = 0.0001]; the best prognostic cut-off value was 1000. Presence of death or KK 3-4 was 0% and 13% in STEMI patients with LGI below or above 1000, respectively In a multivariate logistic regression model, LGI was independently associated with death or KK 3-4. The area under the ROC curve of the TIMI risk score for STEMI was 0.58. The addition of LGI increased its discriminatory capacity to 0.66 (p = 0.001). Conclusions: The LGI was an independent predictor of adverse outcome in STEMI patients (death or KK 3-4), adding prognostic value to the TIMI risk score.

5.
Rev. argent. cardiol ; 82(5): 373-380, oct. 2014. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-734526

RESUMO

Introducción: Las mediciones de calidad ayudan a cuantificar la distancia entre la atención en salud que se brinda y la que se debería brindar. Existen mediciones específicas sobre la calidad de la atención del infarto de miocardio que permiten uniformar los datos de calidad que toda institución debería medir para autoevaluarse y compararse con otras. Objetivo: Analizar los datos de calidad de la atención del infarto en nuestro país utilizando los datos del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Material y métodos: Se analizaron los datos de calidad de atención del infarto de miocardio de los pacientes de la base de datos del Registro Multicéntrico SCAR utilizando definiciones del documento "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction". Resultados: Se analizaron 751 casos de infarto de miocardio con datos completos sobre indicadores de calidad. El uso de aspirina, betabloqueantes, estatinas y antagonistas de la angiotensina fue cercano al 90%. La excepción fue el uso de clopidogrel, que fue del 72,5% en quienes no recibieron reperfusión mecánica. Se relevó la función ventricular durante la internación en el 90,2% de los casos. Recibieron alguna estrategia de reperfusión el 90,1% de los infartos con elevación del segmento ST y menos de 12 horas de evolución. El tiempo puerta-balón fue < 90 minutos en el 50,8% de los casos, mientras que el tiempo puerta-aguja fue < 30 minutos en el 40,5%. Conclusiones: Globalmente se observaron valores altos de cumplimiento en los tratamientos farmacológicos y de reperfusión, excepto en el uso de clopidogrel sin revascularización mecánica. Se observó un cumplimiento bajo en los tiempos apropiados de los tratamientos de reperfusión.


Introduction: Quality assessments help to quantify the gap between healthcare provision and what should be awarded. There are specific measurements on quality of medical care for myocardial infarction which standardize the quality information that every institution should determine for self-assessment and for comparison with others. Objective: The aim of this study was to analyze quality of care for myocardial infarction data in our country using the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry. Methods: Quality of care data for myocardial infarction was analyzed in patients included in the database of the SCAR Multicenter Registry using definitions of the "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction" document. Results: The study analyzed 751 myocardial infarction cases with complete data on quality indicators. Aspirin, betablockers, statins and angiotensin antagonists were used in nearly 90% of patients. The exception was clopidogrel which was used in 72.5% of patients not receiving mechanical reperfusion. Ventricular function was assessed during hospitalization in 90.2% of cases. A reperfusion strategy was used in 90.1% of ST-segment-elevation infarctions and less than 12-hour evolution. Door-to-balloon time was < 90 minutes in 50.8% of cases, while door-to-needle time was < 40.5%. Conclusions: Overall, there was high compliance to pharmacological and reperfusion treatments except in the use of clopidogrel without mechanical revascularization, and low compliance to the appropriate times of reperfusion therapy.

6.
Rev. argent. cardiol ; 82(5): 373-380, oct. 2014. graf, tab
Artigo em Espanhol | BINACIS | ID: bin-131316

RESUMO

Introducción: Las mediciones de calidad ayudan a cuantificar la distancia entre la atención en salud que se brinda y la que se debería brindar. Existen mediciones específicas sobre la calidad de la atención del infarto de miocardio que permiten uniformar los datos de calidad que toda institución debería medir para autoevaluarse y compararse con otras. Objetivo: Analizar los datos de calidad de la atención del infarto en nuestro país utilizando los datos del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Material y métodos: Se analizaron los datos de calidad de atención del infarto de miocardio de los pacientes de la base de datos del Registro Multicéntrico SCAR utilizando definiciones del documento "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction". Resultados: Se analizaron 751 casos de infarto de miocardio con datos completos sobre indicadores de calidad. El uso de aspirina, betabloqueantes, estatinas y antagonistas de la angiotensina fue cercano al 90%. La excepción fue el uso de clopidogrel, que fue del 72,5% en quienes no recibieron reperfusión mecánica. Se relevó la función ventricular durante la internación en el 90,2% de los casos. Recibieron alguna estrategia de reperfusión el 90,1% de los infartos con elevación del segmento ST y menos de 12 horas de evolución. El tiempo puerta-balón fue < 90 minutos en el 50,8% de los casos, mientras que el tiempo puerta-aguja fue < 30 minutos en el 40,5%. Conclusiones: Globalmente se observaron valores altos de cumplimiento en los tratamientos farmacológicos y de reperfusión, excepto en el uso de clopidogrel sin revascularización mecánica. Se observó un cumplimiento bajo en los tiempos apropiados de los tratamientos de reperfusión.(AU)


Introduction: Quality assessments help to quantify the gap between healthcare provision and what should be awarded. There are specific measurements on quality of medical care for myocardial infarction which standardize the quality information that every institution should determine for self-assessment and for comparison with others. Objective: The aim of this study was to analyze quality of care for myocardial infarction data in our country using the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry. Methods: Quality of care data for myocardial infarction was analyzed in patients included in the database of the SCAR Multicenter Registry using definitions of the "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction" document. Results: The study analyzed 751 myocardial infarction cases with complete data on quality indicators. Aspirin, betablockers, statins and angiotensin antagonists were used in nearly 90% of patients. The exception was clopidogrel which was used in 72.5% of patients not receiving mechanical reperfusion. Ventricular function was assessed during hospitalization in 90.2% of cases. A reperfusion strategy was used in 90.1% of ST-segment-elevation infarctions and less than 12-hour evolution. Door-to-balloon time was < 90 minutes in 50.8% of cases, while door-to-needle time was < 40.5%. Conclusions: Overall, there was high compliance to pharmacological and reperfusion treatments except in the use of clopidogrel without mechanical revascularization, and low compliance to the appropriate times of reperfusion therapy.(AU)

7.
Medicina (B Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25188663

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology's Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists' median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Humanos , Medição de Risco
8.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-734394

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Humanos , Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Medição de Risco
9.
Rev. argent. cardiol ; 82(4): 275-284, ago. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-734511

RESUMO

Introducción Los registros de síndromes coronarios agudos realizados por la Sociedad Argentina de Cardiología aportan información actualizada y comparativa sobre su evolución, cuyo análisis permite conocer la tasa de mortalidad, diferentes patrones de tratamiento regionales y evaluar la relación entre los resultados y variables demográficas, características clínicas y terapéutica aplicada en la “vida real”. Objetivos Analizar las características clínicas, terapéuticas y evolutivas del infarto agudo de miocardio con supradesnivel del segmento ST (IAMST) del registro multicéntrico realizado por la Sociedad Argentina de Cardiología durante 2011. Material y métodos Se analizaron pacientes con diagnóstico de IAMST incluidos en el registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Se compararon datos de centros que participaron en los registros de 2005 y de 2011. Resultados Se incluyeron 476 pacientes. Una cuarta parte fueron mujeres, la edad media fue de 61 ± 12,3 años, el 70% recibió tratamiento de reperfusión: 20% (n = 92) con trombolíticos y 50% (n = 238) con angioplastia primaria. La mortalidad hospitalaria de los IAMST fue del 8%. Fueron predictores independientes de muerte la edad mayor de 70 años (OR 2, IC 95% 1,2-3,3; p = 0,003), no haber recibido tratamiento de reperfusión (OR 1,72, IC 95% 1,1-2,0; p = 0,01) y el shock cardiogénico (OR 37, IC 95% 12-117; p < 0,0001). Comparando los mismos centros, en 2011 se redujo en un 30% el número de casos que no recibieron tratamiento de reperfusión, con un incremento del uso de la angioplastia primaria [OR 3,7 (IC 95% 1,6-4; p < 0,001)]. Se detectó también una reducción de la mortalidad hospitalaria [OR 0,40 (IC 95% 0,23-0,83; p = 0,01)]. Conclusiones El 70% de los pacientes con IAMST del SCAR recibió tratamiento de reperfusión, mientras que la mortalidad fue del 8%. Respecto de 2005 se observó, entre otros hallazgos, un incremento de la angioplastia primaria y una disminución de la mortalidad hospitalaria.


Introduction Acute coronary syndrome registries made by the Argentine Society of Cardiology provide current and comparative information on their evolution, whose analysis allows to know mortality rate and different regional treatment patterns, and to evaluate the relationship between outcomes and demographic variables, clinical characteristics and therapy applied in “real life”. Objectives To analyze the clinical, therapeutic and outcome characteristics of ST segment elevation acute myocardial infarction (STEMI) included in a multicenter registry conducted by the Argentine Society of Cardiology in 2011. Methods Patients diagnosed with STEMI included in the multicenter SCAR (Acute Coronary Syndromes in Argentina) registry were analyzed. Data from centers that participated in the 2005 and 2011 registries were compared. Results The study included 476 patients. Twenty-five percent of patients were women, mean age was 61 ± 12.3 years, and 70% received reperfusion therapy: 20% (n = 92) with thrombolytics and 50% (n = 238) with primary angioplasty. In-hospital mortality rate due to STEMI was 8%. Independent predictors of death were age over 70 years (OR 2, 95% CI 1.2-3.3, p = 0.003), not having received reperfusion therapy (OR 1.72, 95% CI 1.1-2.0, p = 0.01) and cardiogenic shock (OR 37, 95% CI 12-117, p < 0.0001). Comparison of the same centers showed that in 2011 the number of cases that did not receive reperfusion therapy was reduced by 30%, with increased use of primary angioplasty [OR 3.7 (95% CI 1.6-4, p < 0.001)]. A reduction of in-hospital mortality [OR 0.40 (95% CI 0.23-0.83, p = 0.01)] was also identified. Conclusions Seventy percent of patients with STEMI included in the SCAR registry received reperfusion therapy, while mortality rate was 8%. Compared with 2005, an increase of primary angioplasty and decreased in-hospital mortality was found, among other findings.

10.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | BINACIS | ID: bin-131433

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.(AU)


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.(AU)

11.
Rev. argent. cardiol ; 82(4): 275-284, ago. 2014. tab
Artigo em Espanhol | BINACIS | ID: bin-131331

RESUMO

Introducción Los registros de síndromes coronarios agudos realizados por la Sociedad Argentina de Cardiología aportan información actualizada y comparativa sobre su evolución, cuyo análisis permite conocer la tasa de mortalidad, diferentes patrones de tratamiento regionales y evaluar la relación entre los resultados y variables demográficas, características clínicas y terapéutica aplicada en la ôvida realö. Objetivos Analizar las características clínicas, terapéuticas y evolutivas del infarto agudo de miocardio con supradesnivel del segmento ST (IAMST) del registro multicéntrico realizado por la Sociedad Argentina de Cardiología durante 2011. Material y métodos Se analizaron pacientes con diagnóstico de IAMST incluidos en el registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Se compararon datos de centros que participaron en los registros de 2005 y de 2011. Resultados Se incluyeron 476 pacientes. Una cuarta parte fueron mujeres, la edad media fue de 61 ± 12,3 años, el 70% recibió tratamiento de reperfusión: 20% (n = 92) con trombolíticos y 50% (n = 238) con angioplastia primaria. La mortalidad hospitalaria de los IAMST fue del 8%. Fueron predictores independientes de muerte la edad mayor de 70 años (OR 2, IC 95% 1,2-3,3; p = 0,003), no haber recibido tratamiento de reperfusión (OR 1,72, IC 95% 1,1-2,0; p = 0,01) y el shock cardiogénico (OR 37, IC 95% 12-117; p < 0,0001). Comparando los mismos centros, en 2011 se redujo en un 30% el número de casos que no recibieron tratamiento de reperfusión, con un incremento del uso de la angioplastia primaria [OR 3,7 (IC 95% 1,6-4; p < 0,001)]. Se detectó también una reducción de la mortalidad hospitalaria [OR 0,40 (IC 95% 0,23-0,83; p = 0,01)]. Conclusiones El 70% de los pacientes con IAMST del SCAR recibió tratamiento de reperfusión, mientras que la mortalidad fue del 8%. Respecto de 2005 se observó, entre otros hallazgos, un incremento de la angioplastia primaria y una disminución de la mortalidad hospitalaria.(AU)


Introduction Acute coronary syndrome registries made by the Argentine Society of Cardiology provide current and comparative information on their evolution, whose analysis allows to know mortality rate and different regional treatment patterns, and to evaluate the relationship between outcomes and demographic variables, clinical characteristics and therapy applied in ôreal lifeö. Objectives To analyze the clinical, therapeutic and outcome characteristics of ST segment elevation acute myocardial infarction (STEMI) included in a multicenter registry conducted by the Argentine Society of Cardiology in 2011. Methods Patients diagnosed with STEMI included in the multicenter SCAR (Acute Coronary Syndromes in Argentina) registry were analyzed. Data from centers that participated in the 2005 and 2011 registries were compared. Results The study included 476 patients. Twenty-five percent of patients were women, mean age was 61 ± 12.3 years, and 70% received reperfusion therapy: 20% (n = 92) with thrombolytics and 50% (n = 238) with primary angioplasty. In-hospital mortality rate due to STEMI was 8%. Independent predictors of death were age over 70 years (OR 2, 95% CI 1.2-3.3, p = 0.003), not having received reperfusion therapy (OR 1.72, 95% CI 1.1-2.0, p = 0.01) and cardiogenic shock (OR 37, 95% CI 12-117, p < 0.0001). Comparison of the same centers showed that in 2011 the number of cases that did not receive reperfusion therapy was reduced by 30%, with increased use of primary angioplasty [OR 3.7 (95% CI 1.6-4, p < 0.001)]. A reduction of in-hospital mortality [OR 0.40 (95% CI 0.23-0.83, p = 0.01)] was also identified. Conclusions Seventy percent of patients with STEMI included in the SCAR registry received reperfusion therapy, while mortality rate was 8%. Compared with 2005, an increase of primary angioplasty and decreased in-hospital mortality was found, among other findings.(AU)

12.
Medicina (B.Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | BINACIS | ID: bin-133491

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiologys Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.

13.
Artigo em Espanhol | MEDLINE | ID: mdl-24650652

RESUMO

Vitamin D (VitD) deficiency is associated with increased morbidity and mortality. We evaluated the association of VitD deficiency (<50 mmol/l) and cardiovascular risk factors in a healthy population, from July-November 2012, in a private center at Buenos Aires province. 333 people were included, aged 41.6±12.4 years (58.6% men), 49.2% practiced no physical activity, 56.8% were overweight (70.3% man vs 37.7% women, p<0.001), 12.5% with systolic blood pressure (SBP) >140 mmHg and 6% diastolic blood pressure (DBP) >90 mmHg. VitD deficiency was observed in 29.1% (31.3% man vs 26.1% women, p=0.3), more frequent with obesity (OR 1.85, IC95:1.05-3.25, p=0.02), HDL-cholesterol (HDL-C)<50 mg/dl (OR 1.71, IC95:1.06-2.76, p=0.02) and triglycerides>150 mg/dl (OR 1.77, IC95:1.02-3.06, p=0.03). A trend towards VitD deficiency and SBP>140 mmHg (OR 1.88, IC95:0.93-3.77, p=0.07) or DBP>90 mmHg (OR 1.39, IC95:0.5-3.65, p=0.5) was observed. Lineal correlation between VitD and HDL-C (p<0.001) or triglycerides (p<0.001) was observed. Multiple logistic regression showed that VitD deficiency association with low HDL-C was independent of age, female sex, obesity and physical activity. Association of VitD deficiency with hypetriglyceridemia was independent of age, female sex and obesity. This study shows an association between VitD deficiency and cardiovascular risk factors like obesity, low HDL <50 mg/dl and hypertriglyceridemia. A trend toward higher SBP was also observed. Experimental studies are granted in order to establish a cause-effect relationship.


Assuntos
Doenças Cardiovasculares/complicações , Deficiência de Vitamina D/complicações , Adulto , Fatores Etários , Pressão Sanguínea/fisiologia , HDL-Colesterol/sangue , Feminino , Humanos , Hipertrigliceridemia/sangue , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Obesidade/sangue , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
14.
Artigo em Espanhol | BINACIS | ID: bin-132689

RESUMO

Vitamin D (VitD) deficiency is associated with increased morbidity and mortality. We evaluated the association of VitD deficiency (<50 mmol/l) and cardiovascular risk factors in a healthy population, from July-November 2012, in a private center at Buenos Aires province. 333 people were included, aged 41.6±12.4 years (58.6


men), 49.2


practiced no physical activity, 56.8


were overweight (70.3


man vs 37.7


women, p<0.001), 12.5


with systolic blood pressure (SBP) >140 mmHg and 6


diastolic blood pressure (DBP) >90 mmHg. VitD deficiency was observed in 29.1


(31.3


man vs 26.1


women, p=0.3), more frequent with obesity (OR 1.85, IC95:1.05-3.25, p=0.02), HDL-cholesterol (HDL-C)<50 mg/dl (OR 1.71, IC95:1.06-2.76, p=0.02) and triglycerides>150 mg/dl (OR 1.77, IC95:1.02-3.06, p=0.03). A trend towards VitD deficiency and SBP>140 mmHg (OR 1.88, IC95:0.93-3.77, p=0.07) or DBP>90 mmHg (OR 1.39, IC95:0.5-3.65, p=0.5) was observed. Lineal correlation between VitD and HDL-C (p<0.001) or triglycerides (p<0.001) was observed. Multiple logistic regression showed that VitD deficiency association with low HDL-C was independent of age, female sex, obesity and physical activity. Association of VitD deficiency with hypetriglyceridemia was independent of age, female sex and obesity. This study shows an association between VitD deficiency and cardiovascular risk factors like obesity, low HDL <50 mg/dl and hypertriglyceridemia. A trend toward higher SBP was also observed. Experimental studies are granted in order to establish a cause-effect relationship.


Assuntos
Doenças Cardiovasculares/complicações , Deficiência de Vitamina D/complicações , Adulto , Fatores Etários , Pressão Sanguínea/fisiologia , HDL-Colesterol/sangue , Feminino , Humanos , Hipertrigliceridemia/sangue , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Obesidade/sangue , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
15.
Medicina (B Aires) ; 72(2): 135-42, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-22522857

RESUMO

Hyperglycemia with or without pre-existing diabetes mellitus, occurs frequently in the setting of acute coronary syndrome. Previous studies have demonstrated that hyperglycemia is highly prevalent and is associated with an increased risk of hospital complications and death. The underlying pathophysiology related an adverse clinical outcome to hyperglycemia is unclear, and it is uncertain whether increased serum glucose is simply a marker of adverse outcomes or their cause. Detrimental effects of hyperglycemia on the cardiovascular system are multiple. Glycemia control with insulin would prevent adverse outcomes. Numerous glucose-control protocols have been developed and tested proving to be safe and effective. In an initiative from the Emergency Council of the Argentine Society of Cardiology, local experts analyzed the management of hyperglycemia in acute coronary syndrome. The main objective of the prevent statement is to summarize the current state of knowledge on glycemic control, and to offer general recommendations regarding glucose management in the coronary care unit.


Assuntos
Síndrome Coronariana Aguda/etiologia , Diabetes Mellitus/fisiopatologia , Hiperglicemia/complicações , Glicemia/análise , Protocolos Clínicos , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia , Insulina/uso terapêutico
16.
Medicina (B.Aires) ; 72(2): 135-142, abr. 2012. tab
Artigo em Espanhol | BINACIS | ID: bin-129586

RESUMO

La hiperglucemia con o sin diabetes preexistente es un hallazgo frecuente en pacientes que cursan un síndrome coronario agudo. Estudios previos han demostrado que la hiperglucemia es altamente prevalente y se asocia a un mayor riesgo de muerte y complicaciones hospitalarias. Los mecanismos fisiopatológicos mediante los cuales la hiperglucemia provoca resultados adversos no son claros, y se desconoce si es un marcador de eventos o su causa. Los efectos perjudiciales de la hiperglucemia en el sistema cardiovascular son múltiples, y el control de los niveles de glucosa con insulina parece mejorar el pronóstico en estos pacientes. Se han desarrollado numerosos protocolos para el control de glucemia que demostraron ser seguros y efectivos. En una iniciativa originada en el Consejo de Emergencias de la Sociedad Argentina de Cardiología, se convocó a expertos de nuestro medio con el propósito de debatir estrategias para el control de la glucemia en pacientes que cursan un síndrome coronario agudo. Este documento refleja lo discutido en este evento académico con la intención de resumir los principales aspectos del control de la glucemia y ofrecer recomendaciones generales de tratamiento en la Unidad Coronaria.(AU)


Hyperglycemia with or without pre-existing diabetes mellitus, occurs frequently in the setting of acute coronary syndrome. Previous studies have demonstrated that hyperglycemia is highly prevalent and is associated with an increased risk of hospital complications and death. The underlying pathophysiology related an adverse clinical outcome to hyperglycemia is unclear, and it is uncertain whether increased serum glucose is simply a marker of adverse outcomes or their cause. Detrimental effects of hyperglycemia on the cardiovascular system are multiple. Glycemia control with insulin would prevent adverse outcomes. Numerous glucose-control protocols have been developed and tested proving to be safe and effective. In an initiative from the Emergency Council of the Argentine Society of Cardiology, local experts analyzed the management of hyperglycemia in acute coronary syndrome. The main objective of the prevent statement is to summarize the current state of knowledge on glycemic control, and to offer general recommendations regarding glucose management in the coronary care unit.(AU)

17.
Medicina (B.Aires) ; 72(2): 135-142, abr. 2012. tab
Artigo em Espanhol | LILACS | ID: lil-639667

RESUMO

La hiperglucemia con o sin diabetes preexistente es un hallazgo frecuente en pacientes que cursan un síndrome coronario agudo. Estudios previos han demostrado que la hiperglucemia es altamente prevalente y se asocia a un mayor riesgo de muerte y complicaciones hospitalarias. Los mecanismos fisiopatológicos mediante los cuales la hiperglucemia provoca resultados adversos no son claros, y se desconoce si es un marcador de eventos o su causa. Los efectos perjudiciales de la hiperglucemia en el sistema cardiovascular son múltiples, y el control de los niveles de glucosa con insulina parece mejorar el pronóstico en estos pacientes. Se han desarrollado numerosos protocolos para el control de glucemia que demostraron ser seguros y efectivos. En una iniciativa originada en el Consejo de Emergencias de la Sociedad Argentina de Cardiología, se convocó a expertos de nuestro medio con el propósito de debatir estrategias para el control de la glucemia en pacientes que cursan un síndrome coronario agudo. Este documento refleja lo discutido en este evento académico con la intención de resumir los principales aspectos del control de la glucemia y ofrecer recomendaciones generales de tratamiento en la Unidad Coronaria.


Hyperglycemia with or without pre-existing diabetes mellitus, occurs frequently in the setting of acute coronary syndrome. Previous studies have demonstrated that hyperglycemia is highly prevalent and is associated with an increased risk of hospital complications and death. The underlying pathophysiology related an adverse clinical outcome to hyperglycemia is unclear, and it is uncertain whether increased serum glucose is simply a marker of adverse outcomes or their cause. Detrimental effects of hyperglycemia on the cardiovascular system are multiple. Glycemia control with insulin would prevent adverse outcomes. Numerous glucose-control protocols have been developed and tested proving to be safe and effective. In an initiative from the Emergency Council of the Argentine Society of Cardiology, local experts analyzed the management of hyperglycemia in acute coronary syndrome. The main objective of the prevent statement is to summarize the current state of knowledge on glycemic control, and to offer general recommendations regarding glucose management in the coronary care unit.


Assuntos
Humanos , Síndrome Coronariana Aguda/etiologia , Diabetes Mellitus/fisiopatologia , Hiperglicemia/complicações , Glicemia/análise , Protocolos Clínicos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia , Insulina/uso terapêutico
18.
Rev. argent. cardiol ; 80(2): 114-120, abr. 2012. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-657549

RESUMO

Introducción El 30% de los pacientes presentan antiagregación plaquetaria inadecuada con 100 mg/día de aspirina (AAS) luego de la cirugía de revascularización miocárdica (CRM), que podría deberse a una acción inhibitoria menor de esta dosificación de AAS a la mayor activación plaquetaria y al aumento del recambio plaquetario que ocurren en el posoperatorio. Objetivos Evaluar la relación entre el recuento plaquetario y el menor efecto antiagregante y determinar si dosis fragmentadas de AAS mejoran la antiagregación. Material y métodos Luego de la CRM con bypass cardiopulmonar (2,95 puentes en promedio), se aleatorizaron prospectivamente 50 pacientes a tres grupos: 18 pacientes (G100) a 100 mg/día, 14 (G300) a 300 mg/día y 18 (G100×3) a 100 mg 3 veces por día de AAS. En el preoperatorio todos recibieron 100 mg/día. La reactividad plaquetaria se midió mediante agregación en sangre entera con ácido araquidónico antes de la cirugía (T0), al primero (T1), tercero (T2) y séptimo días (T3) y al mes (T4) pos-CRM. Resultados En el preoperatorio todos los pacientes tenían valores óptimos de antiagregación (0 W). En el posoperatorio, los pacientes del G100×3 tuvieron mejores niveles de antiagregación (p < 0,05). Ningún paciente del G100×3 tuvo valores ≥ 6 W, correspondientes a los de personas sanas sin AAS, a diferencia de 5 pacientes (28%) del G100 y 4 pacientes (29%) del G300. Se observó una asociación estadísticamente significativa entre la antiagregación plaquetaria y el recambio del número de plaquetas (R2 = 0,57; p = 0,001). Un recambio diario > 20% se relacionó con valores de agregación plaquetaria ≥ 6 W con un OR = 2,1 (IC 1,8-4,21; p = 0,0028). Conclusiones En los pacientes sometidos a CRM, la menor respuesta antiagregante a la AAS se correlacionó con el recambio aumentado de plaquetas. El tratamiento podría fragmentarse con dosis bajas de AAS para obtener mejor antiagregación.


Thirty percent of patients do not achieve an adequate antiplatelet effect despite therapy with aspirin (ASA) 100 mg/d after coronary artery bypass-graft surgery (CABGS), probably due to reduced inhibitory effect of ASA, increased platelet activation and increased platelet turnover secondary to the surgical procedure. Objectives To evaluate the relation between platelet count and lower antiplatelet effect and to determine if antiaggregation improves by dividing the dose of ASA. Material and Methods A total of 50 patients undergoing CABGS (with an average of 2.95 grafts per surgery) were randomly assigned to three groups depending on the dose of ASA indicated: G100 (100 mg/d, n=18 patients), G300 (300 mg/d, n=14) and G100×3 (100 mg TID, n=18). All the patients received 100 mg/d before surgery. Platelet reactivity was assessed by whole blood impedance using arachidonic acid before surgery (T0), 24 h (T1), 72 h (T2), 7 days (T3), and one month post-CABG (T4). Results Before surgery, all patients had optimal values of antiaggregation (0 W). During the postoperative period, antiaggregation values were better in patients from G100×3 (p <0.05). No patients in G100×3 had values ≥6 W, which correspond to those of healthy subjects who do not receive ASA. This value was observed in 5 patients (28%) from G100 and 4 patients (29%) from G300. The association between antiaggregation and platelet turnover was statistically significant (R2=0.57; p=0.001). A daily turnover >20% was related with values of platelet aggregation ≥6 W; OR=2.1 (CI 1.8-4.21; p=0.0028). Conclusions In patients undergoing CABGS, the lowest antiplatelet effect of ASA was associated with the highest platelet turnover. A better antiaggregation might be achieved by dividing therapy in low dose of ASA.

19.
Rev. argent. cardiol ; 80(2): 114-120, abr. 2012. ilus, graf, tab
Artigo em Espanhol | BINACIS | ID: bin-129289

RESUMO

Introducción El 30% de los pacientes presentan antiagregación plaquetaria inadecuada con 100 mg/día de aspirina (AAS) luego de la cirugía de revascularización miocárdica (CRM), que podría deberse a una acción inhibitoria menor de esta dosificación de AAS a la mayor activación plaquetaria y al aumento del recambio plaquetario que ocurren en el posoperatorio. Objetivos Evaluar la relación entre el recuento plaquetario y el menor efecto antiagregante y determinar si dosis fragmentadas de AAS mejoran la antiagregación. Material y métodos Luego de la CRM con bypass cardiopulmonar (2,95 puentes en promedio), se aleatorizaron prospectivamente 50 pacientes a tres grupos: 18 pacientes (G100) a 100 mg/día, 14 (G300) a 300 mg/día y 18 (G100Î3) a 100 mg 3 veces por día de AAS. En el preoperatorio todos recibieron 100 mg/día. La reactividad plaquetaria se midió mediante agregación en sangre entera con ácido araquidónico antes de la cirugía (T0), al primero (T1), tercero (T2) y séptimo días (T3) y al mes (T4) pos-CRM. Resultados En el preoperatorio todos los pacientes tenían valores óptimos de antiagregación (0 W). En el posoperatorio, los pacientes del G100Î3 tuvieron mejores niveles de antiagregación (p < 0,05). Ningún paciente del G100Î3 tuvo valores ≥ 6 W, correspondientes a los de personas sanas sin AAS, a diferencia de 5 pacientes (28%) del G100 y 4 pacientes (29%) del G300. Se observó una asociación estadísticamente significativa entre la antiagregación plaquetaria y el recambio del número de plaquetas (R2 = 0,57; p = 0,001). Un recambio diario > 20% se relacionó con valores de agregación plaquetaria ≥ 6 W con un OR = 2,1 (IC 1,8-4,21; p = 0,0028). Conclusiones En los pacientes sometidos a CRM, la menor respuesta antiagregante a la AAS se correlacionó con el recambio aumentado de plaquetas. El tratamiento podría fragmentarse con dosis bajas de AAS para obtener mejor antiagregación.(AU)


Thirty percent of patients do not achieve an adequate antiplatelet effect despite therapy with aspirin (ASA) 100 mg/d after coronary artery bypass-graft surgery (CABGS), probably due to reduced inhibitory effect of ASA, increased platelet activation and increased platelet turnover secondary to the surgical procedure. Objectives To evaluate the relation between platelet count and lower antiplatelet effect and to determine if antiaggregation improves by dividing the dose of ASA. Material and Methods A total of 50 patients undergoing CABGS (with an average of 2.95 grafts per surgery) were randomly assigned to three groups depending on the dose of ASA indicated: G100 (100 mg/d, n=18 patients), G300 (300 mg/d, n=14) and G100Î3 (100 mg TID, n=18). All the patients received 100 mg/d before surgery. Platelet reactivity was assessed by whole blood impedance using arachidonic acid before surgery (T0), 24 h (T1), 72 h (T2), 7 days (T3), and one month post-CABG (T4). Results Before surgery, all patients had optimal values of antiaggregation (0 W). During the postoperative period, antiaggregation values were better in patients from G100Î3 (p <0.05). No patients in G100Î3 had values ≥6 W, which correspond to those of healthy subjects who do not receive ASA. This value was observed in 5 patients (28%) from G100 and 4 patients (29%) from G300. The association between antiaggregation and platelet turnover was statistically significant (R2=0.57; p=0.001). A daily turnover >20% was related with values of platelet aggregation ≥6 W; OR=2.1 (CI 1.8-4.21; p=0.0028). Conclusions In patients undergoing CABGS, the lowest antiplatelet effect of ASA was associated with the highest platelet turnover. A better antiaggregation might be achieved by dividing therapy in low dose of ASA.(AU)

20.
Medicina (B.Aires) ; 72(2): 135-142, abr. 2012. tab
Artigo em Espanhol | BINACIS | ID: bin-127762

RESUMO

La hiperglucemia con o sin diabetes preexistente es un hallazgo frecuente en pacientes que cursan un síndrome coronario agudo. Estudios previos han demostrado que la hiperglucemia es altamente prevalente y se asocia a un mayor riesgo de muerte y complicaciones hospitalarias. Los mecanismos fisiopatológicos mediante los cuales la hiperglucemia provoca resultados adversos no son claros, y se desconoce si es un marcador de eventos o su causa. Los efectos perjudiciales de la hiperglucemia en el sistema cardiovascular son múltiples, y el control de los niveles de glucosa con insulina parece mejorar el pronóstico en estos pacientes. Se han desarrollado numerosos protocolos para el control de glucemia que demostraron ser seguros y efectivos. En una iniciativa originada en el Consejo de Emergencias de la Sociedad Argentina de Cardiología, se convocó a expertos de nuestro medio con el propósito de debatir estrategias para el control de la glucemia en pacientes que cursan un síndrome coronario agudo. Este documento refleja lo discutido en este evento académico con la intención de resumir los principales aspectos del control de la glucemia y ofrecer recomendaciones generales de tratamiento en la Unidad Coronaria.(AU)


Hyperglycemia with or without pre-existing diabetes mellitus, occurs frequently in the setting of acute coronary syndrome. Previous studies have demonstrated that hyperglycemia is highly prevalent and is associated with an increased risk of hospital complications and death. The underlying pathophysiology related an adverse clinical outcome to hyperglycemia is unclear, and it is uncertain whether increased serum glucose is simply a marker of adverse outcomes or their cause. Detrimental effects of hyperglycemia on the cardiovascular system are multiple. Glycemia control with insulin would prevent adverse outcomes. Numerous glucose-control protocols have been developed and tested proving to be safe and effective. In an initiative from the Emergency Council of the Argentine Society of Cardiology, local experts analyzed the management of hyperglycemia in acute coronary syndrome. The main objective of the prevent statement is to summarize the current state of knowledge on glycemic control, and to offer general recommendations regarding glucose management in the coronary care unit.(AU)

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