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2.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 403-408, out.-dez. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-970502

RESUMO

Objetivo: As doenças cardiovasculares são responsáveis pela principal causa de óbitos na população adulta mundial, sendo a síndrome coronariana aguda (SCA) a mais prevalente entre elas. Resultados: Sabemos que hoje, do ponto de vista epidemiológico, a coronariopatia aguda sem supradesnivelamento de ST tornou-se a forma mais frequente de apresentação clínica da SCA, aproximadamente, em 62% dos casos. Nos últimos anos, houve importantes avanços em relação à terapêutica antiplaquetária e anticoagu-lante capazes de reduzir a mortalidade associada à doença coronariana. Além disso, a estratificação invasiva precoce teve papel fundamental nesse incremento de prognóstico. Conclusão:Dessa forma, atualmente, a escolha terapêutica e de estratificação devem ser avaliadas individual


Cardiovascular diseases are the main cause of death in the adult population worldwide, with acute coronary syndrome (ACS) being the most prevalent. We know that, presently, from an epidemiological point of view, non-ST elevation ACS is the most frequent form of clinical presentation of ACS, in about 62% of cases. Recently, important advances regarding antiplatelet and anticoagulant therapy exist, capable of reducing mortality associated with coronary heart disease. Moreover, early invasive stratification has played a key role in the improvement in prognosis. Thus, the choice of therapy and stratification should be evaluated individually and can modify short- and long-term outcome


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tratamento Farmacológico/métodos , Angina Instável/terapia , Infarto do Miocárdio/diagnóstico , Prognóstico , Heparina/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Aspirina/uso terapêutico , Fatores de Risco , Isquemia Miocárdica/complicações , Diabetes Mellitus , Eletrocardiografia/métodos , Síndrome Coronariana Aguda , Hemorragia , Anticoagulantes/uso terapêutico
3.
J Am Heart Assoc ; 7(14)2018 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-29980522

RESUMO

BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; P<0.001), and more patients were transferred to the referral center (44.7%-76.3%; P=0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy. CONCLUSIONS: Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.


Assuntos
Mortalidade/tendências , Transferência de Pacientes/tendências , Programas Médicos Regionais , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/uso terapêutico , Brasil , Cardiologia , Serviços Médicos de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação de Plaquetas/uso terapêutico , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Sistema de Registros , Telemedicina , Centros de Atenção Terciária
4.
J Am Heart Assoc ; 6(9)2017 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-28912210

RESUMO

BACKGROUND: Greater understanding of differences between men and women with coronary heart disease is needed. METHODS AND RESULTS: In this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatments, and outcomes of men versus women with stable coronary heart disease and explored the association of sex with psychosocial characteristics and cardiovascular risk. Cox proportional hazards models were used to assess the relationship between sex and outcomes. Interactions among sex, psychosocial factors, and the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2% felt often or always stressed at home (versus 9.8% of men), and 19.2% felt often or always sad or depressed (versus 10.1% of men; all P<0.0001). The median duration of follow-up was 3.7 years (25th-75th percentiles: 3.5-3.8 years). Use of evidence-based medications for coronary heart disease at baseline and 24 months was similar between sexes, as were event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction (P=0.03) such that the lower risk in women varied by depressive symptom frequency, whereby women who were more depressed had a risk similar to men. CONCLUSIONS: Female sex was independently associated with better long-term clinical outcomes, although this was modified by frequency of depressive symptoms. This suggests that emotional state may be an important target for improving outcomes in patients with coronary heart disease, specifically in women. CLINICAL TRIAL REGISTRATION: STABILITY ClinicalTrials.gov number (NCT00799903).


Assuntos
Benzaldeídos/administração & dosagem , Doença da Artéria Coronariana/epidemiologia , Oximas/administração & dosagem , Placa Aterosclerótica/epidemiologia , Psicometria/métodos , Medição de Risco , Idoso , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/psicologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/tratamento farmacológico , Placa Aterosclerótica/psicologia , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
5.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(3): f:186-l:194, jul.-set. 2017. tab, graf, ilus
Artigo em Português | LILACS | ID: biblio-875256

RESUMO

O uso de anticoagulantes tem papel essencial na prevenção de eventos tromboembólicos em pacientes com fibrilação atrial (FA). Entretanto, esse tratamento pode ter consequências graves, como eventos hemorrágicos. Por este motivo, é importante classificar os pacientes quanto ao risco de acidente vascular cerebral (AVC) e embolia sistêmica e identificar aqueles para os quais a terapia anticoagulante está indicada para prevenção desses eventos, assim como evitar o uso desse tratamento em pacientes de baixo risco. Os escores de risco de eventos tromboembólicos para pacientes com FA mais utilizados na prática clínica são CHADS2 e o CHA2DS2VASc, que apresentam um valor de estatística C entre 0,6 e 0,7, o que representa performance razoável. Para predizer o risco de eventos hemorrágicos, estão disponíveis os escores HEMORR2HAGES, HAS-BLED, ATRIA e ORBIT, com estatística C em torno de 0,6, ou seja, capacidade preditora modesta. Os escores usados para pacientes com FA são razoáveis na predição de risco de eventos isquêmicos e hemorrágicos, no entanto seu papel quanto à capacidade de guiar o tratamento é limitado. Os registros de prática clínica têm demonstrado que os pacientes com maior risco de AVC são os que recebem anticoagulante com menos frequência, o que configura um "paradoxo" de tratamento. Novos escores, que incluem fatores clínicos e biomarcadores e que já têm validação externa, deverão ajudar a comunidade médica nas decisões terapêuticas, fornecendo informações úteis adicionais para se atingir o maior benefício líquido: máxima redução de eventos isquêmicos à custa do menor risco de sangramento ao promover a anticoagulação em pacientes com FA


Anticoagulation therapy plays an essential role in preventing thromboembolic events in patients with atrial fibrillation (AF). However, this treatment can have severe consequences, such as hemorrhagic events. For this reason, it is important to classify patients according to their risk of stroke and systemic embolism, and to identify those patients for whom anticoagulation therapy is indicated, in order to prevent these events and avoid the use of this treatment in low-risk patients. The risks scores of thromboembolic events for patients with AF that are most used in clinical practice are CHADS2 and CHA2DS2VASc, which present C-statistics values of between 0.6 to 0.7, representing reasonable performance. To predict the risk of hemorrhagic events, the HEMORR2HAGES, HAS-BLED, ATRIA and ORBIT scores are available, with C-statistics of around 0.6, i.e. modest predicting capacity. The scores used for patients with AF are reasonable in predicting the risk of ischemic and bleeding events, but their role in terms of their capacity to guide the treatment is limited. Registries of clinical practice have shown that patients at higher risk for stroke are those that received anticoagulants with less frequency, leading to what is known as a treatment "paradox". New scores, which include clinical factors and biomarkers and have external validation, should help the medical community in the therapeutic decision-making process, providing useful additional information in order to achieve better net benefit: maximum reduction of isquemic events, with a lower risk of bleeding, while promoting anticoagulation in patients with AF


Assuntos
Humanos , Masculino , Feminino , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Hemorragia/complicações , Fatores de Risco , Tromboembolia/complicações , Tromboembolia/terapia , Fatores Etários , Anticoagulantes/efeitos adversos , Biomarcadores , Hipertensão/complicações , Pacientes , Curva ROC , Fatores Sexuais , Acidente Vascular Cerebral/complicações
6.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.545-569.
Monografia em Português | LILACS | ID: biblio-971555
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