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2.
Cardiovasc Diabetol ; 18(1): 68, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159858

RESUMO

BACKGROUND: Hyperglycemia has detrimental effect on ischemic myocardium, but the impact of acute hyperglycemia on the myocardium in asymptomatic diabetic patients has not been fully elucidated. Thus, this follow-up study was aimed to investigate the effects and reversibility of acute hyperglycemia on regional contractile function of left ventricle (LV) in diabetic patients without cardiovascular disease. METHODS: The two-dimensional speckle tracking echocardiography (2D-STE), including multilayer strain analysis, was used for evaluation of global and regional LV function in asymptomatic, normotensive patients with uncomplicated diabetes, with acute hyperglycemia ( ≥ 11.1 mmol/l) (Group A, n = 67), or with optimal metabolic control (fasting plasma glucose < 7 mmol/l and HbA1c < 7%) (Group B, n = 20), while 20 healthy individuals served as controls (Group C). In group A, after 72 h of i.v. continuous insulin treatment (at the time euglycemia was achieved) (second examination) and after 3 months following acute hyperglycemia (third examination) 2D-STE was repeated. RESULTS: Global longitudinal strain (GLS) (- 19.6 ± 0.4%) in Group A was significantly lower in comparison to both groups B (- 21.3 ± 0.4%; p < 0.05) and C (- 21.9 ± 0.4%; p < 0.01) at baseline, while we could not detect the differences between groups B and C. Peak systolic longitudinal endocardial (Endo), mid-myocardial (Mid) and epicardial (Epi) layer strain were significantly lower in group A at baseline compared to both groups B and C. Deterioration in peak systolic circumferential strain was observed at basal LV level, in all three layers (Endo, Mid and Epi) and in mid-cavity LV level in Epi layer in group A in comparison to group C. Moreover, in group A, after euglycemia was achieved (at second and third examination) GLS, as well as peak longitudinal and circumferential strain remain the same. CONCLUSION: Acute hyperglycemia in asymptomatic diabetic patients has significant negative effects on systolic LV myocardial mechanics primarily by reducing GLS and multilayer peak systolic longitudinal and circumferential strain which was not reversible after three months of good glycemic control.

3.
Heart ; 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31129612

RESUMO

OBJECTIVES: The influence of the bleeding site on long-term survival after the primary percutaneous coronary intervention (PCI) is poorly understood. This study sought to investigate the relationship between in-hospital access site versus non-access site bleeding and very late mortality in unselected patients treated with primary PCI. METHODS: Data of the 2715 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI, enrolled in a prospective registry of a high volume tertiary centre, were analysed. Bleeding events were assessed according to the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 4-year mortality. RESULTS: The BARC type ≥2 bleeding occurred in 171 patients (6.3%). Access site bleeding occurred in 3.8%, and non-access site bleeding in 2.5% of patients. Four-year mortality was significantly higher for patients with bleeding (BARC type ≥2) than in patients without bleeding (BARC type 0+1), (36.3% vs 16.2%, p<0.001). Patients with non-access site bleeding had higher 4 year mortality (50.7% vs 26.5%, p=0.001). After multivariable adjustment, BARC type ≥2 bleeding was the independent predictor of 4 year mortality (HR 2.01; 95% CI 1.49 to 2.71, p<0.001). Patients with a non-access site bleeding were at 2-fold higher risk of very late mortality than patients with an access site bleeding (HR 2.62; 1.78 to 3.86, p<0.001 vs HR 1.57; 1.03 to 2.38, p=0.034). CONCLUSIONS: Both access and non-access site BARC type ≥2 bleeding is independently associated with a high risk of 4-year mortality after primary PCI. Patients with non-access site bleeding were at higher risk of late mortality than patients with access site bleeding.

4.
Eur J Heart Fail ; 21(5): 553-576, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30989768

RESUMO

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

5.
Eur J Prev Cardiol ; : 2047487318807767, 2018 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-30335505

RESUMO

Background We assessed the prevalence of newly diagnosed prediabetes and type-2 diabetes mellitus (T2DM), and their impact on long-term mortality in patients hospitalized for worsening heart failure with reduced ejection fraction (HFrEF). Methods We included patients hospitalized with HFrEF and New York Heart Association (NYHA) functional class II-III. Baseline two-hour oral glucose tolerance test was used to classify patients as normoglycaemic or having newly diagnosed prediabetes or T2DM. Outcomes included post-discharge all-cause and cardiovascular mortality during the median follow-up of 2.1 years. Results At baseline, out of 150 patients (mean-age 57 ± 12 years; 88% male), prediabetes was diagnosed in 65 (43%) patients, and T2DM in 29 (19%) patients. These patients were older and more often with NYHA class III symptoms, but distribution of comorbidities was similar to normoglycaemic patients. Taking normoglycaemic patients as a reference, adjusted risk of all-cause mortality was significantly increased both in patients with prediabetes (hazard ratio, 2.6; 95% confidence interval (CI), 1.1-6.3; p = 0.040) and in patients with T2DM (hazard ratio, 5.3; 95% CI, 1.7-15.3; p = 0.023). Likewise, both prediabetes (hazard ratio, 2.9; 95% CI, 1.1-7.9; p = 0.041) and T2DM (hazard ratio, 9.7; 95% CI 2.9-36.7; p = 0.018) independently increased the risk of cardiovascular mortality compared with normoglycaemic individuals. There was no interaction between either prediabetes or T2DM and heart failure aetiology or gender on study outcomes (all interaction p-values > 0.05). Conclusions Newly diagnosed prediabetes and T2DM are highly prevalent in patients hospitalized for worsening HFrEF and NYHA functional class II-III. Importantly, they impose independently increased long-term risk of higher all-cause and cardiovascular mortality.

6.
Anatol J Cardiol ; 20(4): 256, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30297592
7.
Curr Pharm Des ; 24(25): 2960-2966, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29992878

RESUMO

BACKGROUND: The Heart Failure with Preserved Ejection Fraction (HFpEF) is defined as the preserved left ventricular ejection fraction (LVEF) with the signs of heart failure, elevated natriuretic peptides, and either the evidence of the structural heart disease or diastolic dysfunction. The importance of this form of heart failure was increased after studies where the mortality rates and readmission to the hospital were founded similar as in patients with HF and reduced EF (HFrEF). Coronary microvascular ischemia, cardiomyocyte injury and stiffness could be important factors in the pathophysiology of HFpEF. METHODS: The goal of this work is to analyse the relationship of HFpEF and coronary microcirculation in previous studies. RESULTS: The useful diagnostic marker of coronary microcirculation in HFpEF may be the parameters measured by transthoracic echocardiography (TTE), the coronary flow reserve (CFR), as well as fractional flow reserve (FFR) and quantitative myocardial contrast echocardiography (MCE). Cardiac magnetic resonance (CMR) imaging represents the diagnostic gold standard in HFpEF. Coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD) is poorly understood and may be more prevalent amongst women than men. Troponin level may be important in risk stratification of HEpEF patients. CONCLUSION: There are no precise answers with respect to the pathophysiological mechanism, nor are there any precise practical clinical assessment of and diagnostic method for coronary microvascular dysfunction and diastolic dysfunction. In accordance with that, there is no well-established treatment for HFpEF.

8.
Endocrine ; 62(1): 136-143, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29959689

RESUMO

OBJECTIVE: Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status. DESIGN: Retrospective cross-sectional study. PATIENTS AND MEASUREMENTS: One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20-49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations. RESULTS: FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20-49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score). CONCLUSION: Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.

9.
Anatol J Cardiol ; 20(1): 21-28, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29952358

RESUMO

OBJECTIVE: The aim of this study was to investigate and compare the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI). METHODS: We included 2436 patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients presenting with cardiogenic shock and those on hemodyalisis were excluded. According to the left ventricular ejection fraction (EF), patients were divided in three groups: preserved left ventricular systolic function - EF >50%, moderately impaired - EF=40%-50% and severely impaired left ventricular systolic function-EF <40%. RD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 at admission. The follow-up period was 6 years. RESULTS: Preserved, moderately impaired and severely impaired systolic function were found in 741 (30.5%), 1367 (56.1%) and 328 (13.4%) patients, respectively. RD was present in 105 (14.2%) patients with preserved systolic function, 247 (18.1%) patients with moderately impaired, and 120 (36.5%) patients with severely impaired systolic function.Regardless of the presence of RD, 6-year mortality rates in patients with preserved, moderately impaired, and severely impaired systolic function were 2.7%, 5.2% and 31.1% respectively. Within each LVEF group, patients with RD had a worse outcome, both in the short- and long-term. In the Mulivariate Cox Analysis, RD remained an independent predictor of 6-year mortality in patients with moderately (HR 2.52, 95% CI 1.54-3.78) and severely impaired systolic function (HR 2.84, 95% CI 1.68-5.34), but not in patients with preserved left ventricular systolic function (HR 0.59, 95% CI 0.14-1.41). CONCLUSION: Although patients with RD had higher 6-year mortallity following STEMI regardless of LVEF, RD at admission remained a strong independent predictor for 6-year mortality only in patients with moderately and severely impaired left ventricular systolic function.

10.
JAMA Intern Med ; 178(5): 632-639, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29630703

RESUMO

Importance: Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI). Objective: To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk. Design, Setting, and Participants: From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). Exposures: Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI. Main Outcomes and Measures: Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models. Results: There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTW adjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively). Conclusions and Relevance: Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.

12.
Int J Cardiol ; 217 Suppl: S27-31, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27395070

RESUMO

BACKGROUND: There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age (≤65years). METHODS: From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality. RESULTS: The study population was constituted by 2876 patients younger than 65years and 2294 patients older. Women were older than men in both the young (56.2±6.6 vs. 54.1±7.4) and old (74.9±6.4 vs. 73.6±6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients. CONCLUSIONS: In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Intervenção Coronária Percutânea/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Caracteres Sexuais , Inquéritos e Questionários , Resultado do Tratamento
13.
Hellenic J Cardiol ; 57(2): 109-15, 2016 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27445026

RESUMO

BACKGROUND/AIM: Renal function potentially has different prognostic impact in men and women with acute myocardial infarction. The aim of this study was to evaluate the prognostic impact of chronic kidney disease (CKD) on five-year all-cause mortality in men and women with left ventricular systolic dysfunction (LVSD) following ST elevation myocardial infarction (STEMI). METHOD: We included 348 consecutive STEMI patients who were treated with primary percutaneous coronary intervention (pPCI) and had a left ventricular ejection fraction < 40%. CKD was defined as baseline creatinine clearance (CrCl) < 60 ml/min. Patients with cardiogenic shock at admission were excluded. RESULTS: Among analyzed patients, 104 patients (29.8%) were women, and 244 patients (70.1%) were men. Compared with male patients, female patients were older. Females were more likely to have previous angina and hypertension. CKD was more common in women compared with men (54.8% vs. 22.5%, p<0.001). Female gender and older age were independent predictors of CKD. No significant difference in five-year all-cause mortality was between men and women (27.8% vs. 23.3%, p=0.370). In a Cox regression model (adjustments were made for age, Killip class at admission, post-procedural flow TIMI<3, left main stenosis and women with diabetes), CKD remained an independent predictor of five-year all-cause mortality in men (HR 2.2; 95% CI 1.22-3.3, p=0.007). CONCLUSIONS: Although pre-terminal CKD was more frequently noted in women, it was an independent predictor of five-year mortality exclusively in men. Different prognostic significance of CKD between sexes indicates that renal function must be considered in the prognosis of men and women following acute myocardial infarction.


Assuntos
Insuficiência Renal Crônica/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Disfunção Ventricular Esquerda/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Prognóstico , Insuficiência Renal Crônica/complicações , Caracteres Sexuais , Taxa de Sobrevida
14.
Clin Lab ; 62(3): 317-25, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27156319

RESUMO

BACKGROUND: RISK-PCI score is a novel score for risk stratification of patients with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). The aim of this study was to evaluate the role of B-type natriuretic peptide (BNP) and the RISK-PCI score for early risk assessment in patients with STEMI treated by pPCI. METHODS: In 120 patients with STEMI treated by pPCI, BNP was measured on admission before pPCI. The primary end point was 30-day mortality. RESULTS: The ROC curve analysis revealed that the most powerful predictive factors of 30-day mortality were the plasma level of BNP ≥ 206.6 pg/mL with the sensitivity of 75% and specificity of 87.5% and the RISK-PCI score ≥ 5.25 with the sensitivity of 75% and specificity of 85.7%. Thirty-day mortality was 6.7%. After multivariate adjustment, admission BNP (≥ 206.6 pg/mL) (OR 2.952, 95% CI 1.072 - 8.133, p = 0.036) and the RISK-PCI score (≥ 5.25) (OR 2.284, 95% CI 1.140-4.578, p = 0.020) were independent predictors of 30-day mortality. The area under the ROC curve using the RISK-PCI score and BNP to detect mortality was 0.828 (p = 0.002) and 0.903 (p < 0.001), respectively. Addition of BNP to RISK-PCI score increased the area under the ROC to 0.949 (p < 0.001), but this increase measured by the c-statistic was not significant (p = 0.107). Furthermore, the significant improvement in risk reclassification (p < 0.001) and the integrated discrimination index (p = 0.042) were observed with the addition of BNP to RISK-PCI score for 30-day mortality. CONCLUSIONS: BNP on admission and the RISK-PCI score were the independent predictors of 30-day mortality in patients with the STEMI treated by pPCI. BNP in combination with the RISK-PCI score showed the way to more accurate risk assessment in patients with STEMI treated by pPCI.


Assuntos
Infarto do Miocárdio/mortalidade , Peptídeo Natriurético Encefálico/sangue , Intervenção Coronária Percutânea , Medição de Risco , Adulto , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Curva ROC
15.
Cardiovasc Drugs Ther ; 30(2): 151-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26843365

RESUMO

AIMS: The objective of the present substudy was to examine whether aspirin poor/high responsiveness (APR/AHR) is associated with increased rates of major adverse cardiovascular events (MACE) and serious bleeding after primary percutaneous coronary intervention (PPCI). METHODS: We analyzed 961 consecutive ST-elevation acute myocardial infarction patients who underwent PPCI between February 2008 and June 2011. Multiplate analyser (Dynabite, Munich, Germany) was used for the assessment of platelet reactivity. APR/AHR were defined as the upper/lower quintiles of ASPI values, determined 24 h after aspirin loading. APR patients were tailored using 300 mg maintenance dose for 30 days. The co-primary end points at 30 days were: MACE (death, non-fatal infarction, ischemia-driven target vessel revascularization and ischemic stroke) and serious bleeding according to the BARC classification. RESULTS: One hundred and 90 patients were classified as APR, and 193 patients as AHR. At admission, compared with aspirin sensitive patients (ASP), patients with APR had more frequently diabetes, anterior infarction and heart failure, while AHR patients had reduced values of creatine kinase, leukocytes, heart rate and systolic blood pressure. Compared with ASP, the rates of 30-day primary end points did not differ neither in APR group including tailored patients (MACE, adjusted OR 1.02, 95%CI 0.47-2.17; serious bleeding, adjusted OR 1.92, 95%CI 0.79-4.63), nor in patients with AHR (MACE, adjusted OR 1.58, 95%CI 0.71-5.51; serious bleeding, adjusted OR 0.69, 95%CI 0.22-2.12). CONCLUSIONS: The majority of APR patients were suitable for tailoring. Neither APR including tailored patients nor AHR were associated with adverse 30-day efficacy or safety clinical outcomes.


Assuntos
Aspirina/efeitos adversos , Aspirina/uso terapêutico , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Idoso , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Creatina Quinase/metabolismo , Feminino , Frequência Cardíaca/efeitos dos fármacos , Hemorragia/induzido quimicamente , Hemorragia/metabolismo , Humanos , Leucócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/metabolismo , Intervenção Coronária Percutânea/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
16.
Vojnosanit Pregl ; 72(8): 702-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26495696

RESUMO

BACKGROUND/AIM: The coincidence of left ventricular systolic dysfunction (LVSD) and renal dysfunction (RD) is a strong independent predictor of adverse events in the short-term and mid-term follow-ups of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The aim of this study was primarily to assess the prognostic impact of the LVSD-RD combination on the 5-year all-cause mortality in patients with STEMI treated with pPCI, as well as to assess the prognostic impact of the LVSD-RD combination on the occurrence of major adverse cardiovascular events (MACEs: cardiovascular death, reinfarction, stroke and target vessel revas- cularization) in these patients. METHODS: We analyzed 951 patients divided into 4 groups according to the presence of LVSD (ejection fraction < 40%) and/or baseline RD (creatinine clearance < 60 mL/min): group I (no LVSD, no RD); group II (LVSD, no RD); group III (RD, no LVSD); group IV (LVSD+RD). RESULTS: The 5-year mortality rates were 2.3%, 17.6%, 11.7% and 38.3%, while the 5-year MACE rates were 8.8%, 28.4%, 18.3% and 44.4% in the groups I, II, III and IV, respectively (p < 0.001). The highest percentage of lethal outcomes and MACE was registered in the first year of follow-up in all the groups. The 1-year landmark analysis confirmed that the patients with LVSD-RD combination had the highest percentage of lethal outcomes in the period of 1 to 5 years (p = 0.028). There was a strong trend toward the significance in the occurrence of MACE among the analyzed groups in the period of 1 to 5 years (p = 0.085). In the Cox regression model the LVSD-RD combination was a strong independent predictor of 5-year mortality and the occurrence of MACE: mortality hazard ratio (HR) 4.5 (95%CI 1.9-10.8); MACE HR 2.5 (95% CI 1.4-4.5). CONCLUSION: The strong negative independent prognostic impact of the LVSD-RD combination persisted in the long-term follow-up of the patients with STEMI treated with pPCI.


Assuntos
Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Insuficiência Renal/complicações , Disfunção Ventricular Esquerda/complicações , Idoso , Angioplastia Coronária com Balão , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Taxa de Sobrevida , Sístole/fisiologia , Resultado do Tratamento
17.
Eur Heart J Acute Cardiovasc Care ; 3(1): 56-66, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24562804

RESUMO

BACKGROUND: Studies with platelet glycoprotein IIb/IIIa receptor inhibitors (GPIs) showed conflicting results in primary percutaneous coronary intervention (PPCI) patients who were pretreated with 600 mg clopidogrel. We sought to investigate the short- and long-term efficacy and safety of the periprocedural administration of tirofiban in a largest Serbian PPCI centre. METHODS: We analysed 2995 consecutive PPCI patients enrolled in the Clinical Center of Serbia STEMI Register, between February 2007 and March 2012. All patients were pretreated with 600 mg clopidogrel and 300 mg aspirin. Major adverse cardiovascular events, comprising all-cause death, nonfatal infarction, nonfatal stroke, and ischaemia-driven target vessel revascularization, was the primary efficacy end point. TIMI major bleeding was the key safety end point. RESULTS: Analyses drawn from the propensity-matched sample showed improved primary efficacy end point in the tirofiban group at 30-day (OR 0.72, 95% CI 0.53-0.97) and at 1-year (OR 0.74, 95% CI 0.57-0.96) follow up. Moreover, tirofiban group had a significantly lower 30-day all-cause mortality (secondary end point; OR 0.63, 95% CI 0.40-0.90), compared with patients who were not administered tirofiban. At 1 year, a trend towards a lower all-cause mortality was observed in the tirofiban group (OR 0.74, 95% CI 0.53-1.04). No differences were found with respect to the TIMI major bleeding during the follow-up period. CONCLUSIONS: Tirofiban administered with PPCI, following 600 mg clopidogrel pretreatment, improved primary efficacy outcome at 30 days and at 1 year follow up without an increase in major bleeding.


Assuntos
Eletrocardiografia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Cuidados Pré-Operatórios/métodos , Sistema de Registros , Ticlopidina/análogos & derivados , Tirosina/análogos & derivados , Idoso , Clopidogrel , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Sérvia/epidemiologia , Taxa de Sobrevida/tendências , Ticlopidina/administração & dosagem , Tirofibana , Resultado do Tratamento , Tirosina/administração & dosagem
18.
Circ J ; 77(7): 1719-27, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23603843

RESUMO

BACKGROUND: Bleeding is a potentially catastrophic complication after primary percutaneous coronary intervention (PPCI). It occurs most frequently within the first 30 days following the intervention. The aim of this study was to generate a simple and accurate risk model for the prediction of bleeding after PPCI. METHODS AND RESULTS: The training set included 2,096 patients enrolled in the RISK-PCI trial. The model was validated using a database of 961 patients enrolled in the ART-PCI trial. Bleeding was defined as type ≥3a bleeding according to the Bleeding Academic Research Consortium definition. Multivariate logistic regression was used to evaluate the predictors of outcome. A sum of weighted points for specific predictors was calculated to determine the final score. The model included 5 independent predictors of 30-day bleeding: gender (female); history of peptic ulcer; creatinine clearance at admission (<60 ml/min); hemoglobin at presentation (<125 g/dl); and Killip class >1 heart failure at admission. The model showed good discrimination and calibration for the prediction of bleeding in the derivation set (C-statistic, 0.79; goodness of fit, P=0.12) and in the validation set (C-statistic, 0.76; goodness of fit, P=0.37). Patients were classified into 3 risk classes and the observed incidence of 30-day bleeding of 1.0%, 3.5% and 10.7% corresponded to the low-, intermediate- and high-risk classes, respectively. CONCLUSIONS: A simple risk model was developed that has a reasonably good capacity for the prediction of 30-day bleeding after PPCI.


Assuntos
Algoritmos , Modelos Cardiovasculares , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Valor Preditivo dos Testes , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
19.
J Interv Cardiol ; 26(3): 221-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23373620

RESUMO

OBJECTIVES: The present trial aims at examining whether antiplatelet regimen modification, guided by assessment of the on-treatment platelet reactivity, might result with clinical benefit in moderate to high-risk patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: High platelet reactivity has been associated with an increased rate of ischemic events after PCI. Recent large trials did not show a clinical benefit of platelet reactivity-guided therapy modification in acute coronary syndrome patients treated by PCI. METHODS: PLATFORM is an investigator-initiated, prospective, randomized, parallel-group, controlled clinical trial. Approximately 632 STEMI patients with intermediate to high-risk (RISK-PCI score >3) clinical features undergoing PPCI will be randomly allocated to treatment modification or standard therapy. Low responders to aspirin will receive 200 mg aspirin for 30 days. Low responders to clopidogrel will receive 180 mg ticagrelor for 1 year. The primary end-point is the time to the first composite major adverse cardiovascular events (MACE) including death, nonfatal infarction, stroke, or immediate target vessel revascularization. Key safety end-point is the rate of TIMI major bleeding unrelated to coronary artery bypass graft surgery. Our secondary end-points are individual components of MACE, definite stent thrombosis, total bleeding, and the need for blood transfusions. Patients will be followed-up at 30 days and at 1 year after PPCI. CONCLUSION: PLATFORM will determine whether the platelet reactivity-guided use of ticagrelor in combination with 200 mg aspirin, compared with standard antiplatelet regimen, improves clinical outcome in moderate to high-risk STEMI patients undergoing PPCI. CLINICAL TRIAL REGISTRATION: U.S. National Institutes of Health (NIH) at www.clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT01739556, and Current Controlled Trials at www.controlledtrials.com. International Standard Randomized Controlled Trial Number ISRCTN83081599.


Assuntos
Adenosina/análogos & derivados , Aspirina/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Ticlopidina/análogos & derivados , Adenosina/efeitos adversos , Adenosina/uso terapêutico , Aspirina/efeitos adversos , Clopidogrel , Quimioterapia Combinada , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Prospectivos , Ticagrelor , Ticlopidina/efeitos adversos , Ticlopidina/uso terapêutico , Resultado do Tratamento
20.
Int J Cardiol ; 162(3): 220-7, 2013 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-21663982

RESUMO

BACKGROUND: Identification of patients at risk for major adverse cardiovascular events (MACE) might help selecting candidates for aggressive treatment or early discharge after primary percutaneous coronary intervention (pPCI). METHODS: The RISK-PCI is an observational trial of 2096 consecutive patients who underwent pPCI between 2006 and 2009, randomly allocated to derivation and validation sets with a set ratio of 80% to 20%. Thirty-day MACE comprising death, nonfatal reinfarction and stroke was the primary end point. Multivariable logistic regression was used to determine the independent predictors of outcome. A sum of weighted points for specific predictors was calculated to define the final score. RESULTS: The RISK-PCI score comprised 12 independent predictors of 30-day MACE, with a graded 125-fold increase in the primary end point with increasing risk score from ≤ 1 to ≥ 15. The model showed good discrimination and calibration for the prediction of 30-day MACE (c-statistic 0.83, goodness-of-fit p = 0.72) and 30-day death (c-statistic 0.87, goodness-of-fit p = 0.56). Bootstrapping with 1000 resample confirmed the stability of the model's performance. Patients were classified into risk classes, with the observed incidence of 30-day MACE of 1.9, 5.9, 13.3 and 39.4% in the low, intermediate, high and very high-risk classes, respectively. An 18-fold graded increase in the primary end point was observed between patients in a low risk class and those in a very high risk class. CONCLUSION: We derived a novel risk model to predict 30-day MACE after pPCI, which might help clinician decide the most appropriate treatment in accordance with the patient's risk profile.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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