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1.
Artigo em Inglês | MEDLINE | ID: mdl-30485894

RESUMO

BACKGROUND: Periprocedural myocardial injury after coronary artery bypass grafting (CABG) may affect the patient's prognosis and may be due to a different set of factors beyond the atherosclerotic plaque instability. Considering the challenges in the diagnosis of myocardial injury after CABG, the aim of this study was to determine the association between postoperative early elevation of high-sensitivity troponin T (hsTnT) and all-cause 30-day mortality after CABG. METHODS: We enrolled 600 consecutive patients who underwent CABG. The hsTnT value was measured immediately before surgery and in the morning of the first postoperative day. RESULTS: The baseline hsTnT was 13 ng/L (7-26 ng/L) and 273 patients (45.7%) had baseline hsTnT above the 99th percentile/upper reference limit (URL) (14 ng/L). The median for hsTnT at first postoperative day was 235 ng/L (152-425 ng/L). We calculated the postoperative hsTnT ratio to URL for each patient, representing the number of times exceeding the URL (hsTnT value divided by 14 ng/L). The multivariate analysis by Cox proportional hazard model revealed that age (years) (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.07-1.20; p < 0.001) and postoperative hsTnT ratio to URL (per 10-fold increase) (HR = 1.06, 95% CI: 1.04-1.08; p < 0.001) were independent predictors of all-cause 30-day mortality after CABG. CONCLUSION: In our series, age and higher postoperative hsTnT levels were independent and reliable predictors of all-cause 30-day mortality after CABG.

2.
Am Heart J ; 184: 88-96, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27892891

RESUMO

Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30days. RESULTS: The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P=.46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P=.74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P=.50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P=.26), and stroke (0.9% vs 0%, P=.25). CONCLUSION: In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naïve patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naïve patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population.


Assuntos
Atorvastatina/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/prevenção & controle , Assistência Perioperatória/métodos , Modelos de Riscos Proporcionais , Medição de Risco , Troponina/sangue
3.
Arq Bras Cardiol ; 105(2 Suppl 1): 1-105, 2015 Aug.
Artigo em Português | MEDLINE | ID: mdl-26375058
4.
Rev Bras Cir Cardiovasc ; 29(3): 299-307, 2014 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25372901

RESUMO

INTRODUCTION: Preoperatively elevated serum creatinine (SCr) is considered an independent risk factor for morbidity and mortality after cardiac surgery. The aim of this study was to apply the Kidney Disease Improving Global Outcomes classification for acute kidney injury in a population of patients with preoperatively elevated serum creatinine who underwent cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) and to evaluate the acute worsening of renal function as a predictor of 30-day mortality. METHODS: This was a single-center retrospective study that included patients from the Postoperative Cardiac Surgery Intensive Care Unit of the Hospital de Base, São José do Rio Preto Medical School. Demographics, type of surgery, laboratory data and pre, peri and postoperative data were obtained from a prospectively collected database. From January 2003 to June 2013, 2,878 patients underwent cardiac surgery, either coronary artery bypass grafting or cardiac valve surgery, at the Hospital de Base of São José do Rio Preto Medical School. Out of those, 918 showed elevated preoperative serum creatinine, with SCr > 1.30 mg/dL for men and > 1.00 mg/dL for women. Five hundred and forty nine patients (60%) undergoing coronary artery bypass grafting and 369 patients (40%) undergoing cardiac valve surgery. A Multivariate Cox Proportional Hazard Model (stepwise) was used to assess the relationship between AKI and mortality at 30 days. RESULTS: Out of the 918 patients studied, 391 (43%) had postoperative AKI: 318 (35%) had Kidney Disease Improving Global Outcomes stage 1, 27 (2.9%) had Kidney Disease Improving Global Outcomes stage 2, and 46 (5.0%) had Kidney Disease Improving Global Outcomes stage 3. Patients in every stage of acute kidney injury showed progressive increase in EuroSCORE values, 30-day mortality rates, cardiopulmonary bypass duration, and intensive care length of stay. Among patients classified as Kidney Disease Improving Global Outcomes stage 3, 76% required dialysis with a 30-day mortality of 66%. The Cox proportional hazards model showed that the hazard ratio for 30-day mortality was 4.8 for Kidney Disease Improving Global Outcomes stage 1 patients, 13.5 for Kidney Disease Improving Global Outcomes stage 2 patients, and 20.8 for Kidney Disease Improving Global Outcomes stage 3 patients (P<0.001 for all). Subgroup analyses (coronary artery bypass grafting and cardiac valve surgery) had similar results. CONCLUSION: In this population, acute kidney injury based on the Kidney Disease Improving Global Outcomes criteria was a powerful predictor of 30-day mortality in patients with elevated preoperative serum creatinine who underwent cardiac surgery (coronary artery bypass grafting or cardiac valve surgery).


Assuntos
Lesão Renal Aguda/sangue , Lesão Renal Aguda/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Creatinina/sangue , Lesão Renal Aguda/etiologia , Idoso , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Feminino , Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
5.
Rev. bras. cir. cardiovasc ; 29(3): 299-307, Jul-Sep/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-727158

RESUMO

Introduction: Preoperatively elevated serum creatinine (SCr) is considered an independent risk factor for morbidity and mortality after cardiac surgery. The aim of this study was to apply the Kidney Disease Improving Global Outcomes classification for acute kidney injury in a population of patients with preoperatively elevated serum creatinine who underwent cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) and to evaluate the acute worsening of renal function as a predictor of 30-day mortality. Methods: This was a single-center retrospective study that included patients from the Postoperative Cardiac Surgery Intensive Care Unit of the Hospital de Base, São José do Rio Preto Medical School. Demographics, type of surgery, laboratory data and pre, peri and postoperative data were obtained from a prospectively collected database. From January 2003 to June 2013, 2,878 patients underwent cardiac surgery, either coronary artery bypass grafting or cardiac valve surgery, at the Hospital de Base of São José do Rio Preto Medical School. Out of those, 918 showed elevated preoperative serum creatinine, with SCr > 1.30 mg/dL for men and > 1.00 mg/dL for women. Five hundred and forty nine patients (60%) undergoing coronary artery bypass grafting and 369 patients (40%) undergoing cardiac valve surgery. A Multivariate Cox Proportional Hazard Model (stepwise) was used to assess the relationship between AKI and mortality at 30 days. Results: Out of the 918 patients studied, 391 (43%) had postoperative AKI: 318 (35%) had Kidney Disease Improving Global Outcomes stage 1, 27 (2.9%) had Kidney Disease Improving Global Outcomes stage 2, and 46 (5.0%) had Kidney Disease Improving Global Outcomes stage 3. Patients in every stage of acute kidney injury showed progressive increase in EuroSCORE values, 30-day mortality ratescardiopulmonary bypass duration, and intensive care length of stay. Among patients classified ...


Introdução: Creatinina sérica (CSr) elevada no período pré-operatório é considerada um fator de risco independente para morbidade e mortalidade em cirurgia cardíaca. Avaliar o impacto da lesão renal aguda pelos critérios Kidney Disease Improving Global Outcomes como preditor de mortalidade em 30 dias em pacientes submetidos à revascularização miocárdica ou cirurgia valvar com creatinina sérica pré-operatória elevada. Métodos: Este foi um estudo retrospectivo de centro único que incluiu pacientes da Unidade de Cuidados Intensivos em Pós-operatório de Cirurgia Cardíaca do Hospital de Base, Faculdade de Medicina de São José do Rio Preto. Dados demográficos, tipos de cirurgia, dados laboratoriais e informações pré, peri e pós-operatórias foram obtidos a partir de uma coleta prospectiva de banco de dados. Foram considerados 2878 pacientes consecutivamente submetidos à revascularização miocárdica ou cirurgia valvar no período de janeiro de 2003 a junho de 2013. Destes, 918 indivíduos apresentavam creatinina sérica alterada no pré-operatório (CrS > 1.30 mg/dL para homens e > 1.00 mg/dL para mulheres), compreendendo 549 pacientes (60%) submetidos à revascularização miocárdica e 369 pacientes (40%) submetidos à cirurgia valvar. O modelo de riscos proporcionais de Cox foi utilizado para avaliar a relação entre lesão renal aguda e mortalidade em 30 dias. Resultados: Nesta casuística, 391 pacientes (43%) apresentaram lesão renal aguda no pós-operatório, sendo 318 (35%) Kidney Disease Improving Global Outcomes estágio 1, 27 (2,9%) Kidney Disease Improving Global Outcomes estágio 2 e 46 (5,0%) Kidney Disease Improving Global Outcomes estágio 3. EuroSCORE, mortalidade em 30 ...


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão Renal Aguda/sangue , Lesão Renal Aguda/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Creatinina/sangue , Lesão Renal Aguda/etiologia , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Mortalidade Hospitalar , Valvas Cardíacas/cirurgia , Tempo de Internação , Modelos de Riscos Proporcionais , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
6.
Rev Bras Cir Cardiovasc ; 28(1): 29-35, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23739930

RESUMO

OBJECTIVE: We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality. METHODS: We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP), Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis), evaluating perioperative clinical outcomes and 30-day all cause mortality. RESULTS: In our series, 64 patients (8%) underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%), greater need for dialysis (9%) and higher 30-day mortality (17%) compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively). In a Cox regression analysis, age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), re-exploration for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) were identified as independent predictors for death. Although the manifestation of infective endocarditis influenced on mortality in univariate analysis, multivariate Cox regression analysis did not confirm such variable as an independent predictor of death. CONCLUSION: Age and perioperative complications stand out as predictors of hospital mortality in Brazilian population. Cardiac valve surgery in the presence of active infective endocarditis was not confirmed itself as an independent predictor of 30-day mortality.


Assuntos
Endocardite/mortalidade , Endocardite/cirurgia , Mortalidade Hospitalar , Adulto , Fatores Etários , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Perioperatório/efeitos adversos , Período Perioperatório/mortalidade , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
7.
Rev. bras. cir. cardiovasc ; 28(1): 29-35, jan.-mar. 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-675870

RESUMO

OBJECTIVE: We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality. METHODS: We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP), Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis), evaluating perioperative clinical outcomes and 30-day all cause mortality. RESULTS: In our series, 64 patients (8%) underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%), greater need for dialysis (9%) and higher 30-day mortality (17%) compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively). In a Cox regression analysis, age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), re-exploration for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) were identified as independent predictors for death. Although the manifestation of infective endocarditis influenced on mortality in univariate analysis, multivariate Cox regression analysis did not confirm such variable as an independent predictor of death. CONCLUSION: Age and perioperative complications stand out as predictors of hospital mortality in Brazilian population. Cardiac valve surgery in the presence of active infective endocarditis was not confirmed itself as an independent predictor of 30-day mortality.


OBJETIVO: Avaliamos pacientes submetidos à cirurgia valvar em vigência de endocardite infecciosa na tentativa de identificar preditores independentes de mortalidade intrahospitalar em 30 dias. MÉTODOS: Foram avaliados 837 pacientes consecutivamente submetidos à cirurgia valvar, no período de janeiro de 2003 a maio de 2010, em um hospital terciário de São José do Rio Preto, SP, Brasil. O Grupo de Estudo compreendeu indivíduos submetidos à intervenção em vigência de endocardite infecciosa e foi comparado ao Grupo Controle, considerando complicações clínicas perioperatórias e óbito por todas as causas em 30 dias. RESULTADOS: Em nossa casuística, 64 (8%) pacientes foram submetidos à cirurgia valvar em vigência de endocardite infecciosa, sendo 37,5% deles com indicação de intervenção cirúrgica em múltiplas valvas. O Grupo de Estudo apresentou maior permanência em Unidade de Terapia Intensiva (16%), necessidade de diálise (9%) e maior mortalidade em 30 dias (17%) comparado ao Grupo Controle (7%, P=0,020; 2%, P=0,002 e 9%, P=0,038; respectivamente). A análise de regressão de Cox confirmou idade (P=0,007), lesão renal aguda (P=0,004), diálise (P=0,026), reoperação (P=0,026), reintervenção por sangramento (P=0,013), reintubação orotraqueal (P<0,001) e lesão neurológica tipo I (P<0,001) como preditores independentes para óbito. Embora a manifestação de endocardite infecciosa influencie na mortalidade na análise univariada, a regressão de Cox não confirmou tal variável como preditor independente de óbito em nossa casuística. CONCLUSÃO: Idade e complicações perioperatórias destacam-se como preditores de mortalidade hospitalar em população brasileira. Cirurgia valvar em vigência de infecção ativa não se confirma como preditor independente de óbito nesta casuística.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Endocardite/mortalidade , Endocardite/cirurgia , Mortalidade Hospitalar , Fatores Etários , Brasil/epidemiologia , Métodos Epidemiológicos , Tempo de Internação , Período Perioperatório/efeitos adversos , Período Perioperatório/mortalidade , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
9.
In. Timerman, Ari; Bertolami, Marcelo; Ferreira, João Fernando Monteiro. Manual de Cardiologia. São Paulo, Atheneu, 2012. p.1-5, tab.
Monografia em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-26882
10.
Rev Bras Cir Cardiovasc ; 26(2): 213-21, 2011 Apr-Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21894411

RESUMO

OBJECTIVE: To compare mechanical ventilation weaning based on a protocol using the spontaneous breathing trial against mechanical ventilation weaning without a standardized protocol in heart patients. METHODS: Prospective, open, randomized study. In 2006, 36 patients undergoing mechanical ventilation for over 24 hours were randomized into two groups: control group - eighteen patients whose mechanical ventilation weaning was performed according to the different procedures adopted by the multidisciplinary team; and experimental group - eighteen patients weaned according to previously established protocol. RESULTS: Control group patients started the weaning process sooner than experimental group patients (74.7 ± 14.7 hours vs. 185.7 ± 22.9 hours, P=0.0004). However, after the experimental group patients were ready for weaning, the extubation was carried out more rapidly than in the control group (149.1 ± 3.6 min vs. 4179.1 ± 927.8 min, P < 0.0001) with significantly lower reintubation rates (16.7% vs. 66.7%, P = 0.005). CONCLUSION: The use of a specific protocol based on the spontaneous breathing trial for mechanical ventilation weaning in heart patients had better outcomes than weaning carried out without a standardized protocol, with shorter weaning times and lower reintubation rates.


Assuntos
Unidades de Cuidados Coronarianos , Desmame do Respirador/métodos , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
11.
Rev. bras. cir. cardiovasc ; 26(2): 213-221, abr.-jun. 2011. tab
Artigo em Português | LILACS | ID: lil-597741

RESUMO

OBJETIVO: Comparar o desmame da ventilação mecânica realizado segundo a aplicação de protocolo baseado no teste de respiração espontânea e o mesmo procedimento realizado sem padronização, em pacientes cardiopatas. MÉTODOS: Estudo prospectivo, aberto e randomizado. Em 2006, 36 pacientes em ventilação mecânica há mais de 24 horas foram randomizados em dois grupos: grupo controle: 18 pacientes foram submetidos ao desmame da ventilação mecânica de acordo com os procedimentos adotados pela equipe multiprofissional e grupo experimental: 18 pacientes foram submetidos ao desmame de acordo com protocolo previamente estabelecido. RESULTADOS: Os pacientes do grupo controle iniciaram o desmame precocemente em relação ao grupo experimental (74,7 ± 14,7 horas vs. 185,7 ± 22,9 horas; P=0,0004), Porém, após os pacientes do grupo experimental estarem aptos ao desmame, este foi realizado em um tempo mais curto em relação ao grupo controle (149,1 ± 3,6 min vs. 4179,1 ± 927,8 min; P < 0,0001) com taxas de reintubação significativamente menores (16,7 por cento vs. 66,7 por cento; P = 0,005). CONCLUSÃO: O uso de um protocolo específico, baseado no Teste de Respiração Espontânea para desmame de ventilação mecânica, em pacientes cardiopatas, teve resultados melhores do que o desmame realizado sem um protocolo padronizado, com menor tempo de desmame e menores taxas de reintubação.


OBJECTIVE: To compare mechanical ventilation weaning based on a protocol using the spontaneous breathing trial against mechanical ventilation weaning without a standardized protocol in heart patients. METHODS: Prospective, open, randomized study. In 2006, 36 patients undergoing mechanical ventilation for over 24 hours were randomized into two groups: control group - eighteen patients whose mechanical ventilation weaning was performed according to the different procedures adopted by the multidisciplinary team; and experimental group - eighteen patients weaned according to previously established protocol. RESULTS: Control group patients started the weaning process sooner than experimental group patients (74.7 ± 14.7 hours vs. 185.7 ± 22.9 hours, P=0.0004). However, after the experimental group patients were ready for weaning, the extubation was carried out more rapidly than in the control group (149.1 ± 3.6 min vs. 4179.1 ± 927.8 min, P < 0.0001) with significantly lower reintubation rates (16.7 percent vs. 66.7 percent, P = 0.005). CONCLUSION: The use of a specific protocol based on the spontaneous breathing trial for mechanical ventilation weaning in heart patients had better outcomes than weaning carried out without a standardized protocol, with shorter weaning times and lower reintubation rates.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unidades de Cuidados Coronarianos , Desmame do Respirador/métodos , Protocolos Clínicos , Estudos Prospectivos , Fatores de Tempo
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 20(3): 383-396, jul.-set. 2010. ilus, tab
Artigo em Português | LILACS | ID: lil-574286

RESUMO

Os antiplaquetários representam importante estratégia de tratamento para pacientes com síndromes coronárias agudas.Em decorrência do importante papel da aspirina e das robustas evidências de benefício na doença isquêmica do coração, seu emprego passou a abranger praticamente todas as modalidades de tratamento clínico, procedimentos percutâneos invasivos e intervenções cirúrgicas relacionadas à doença arterial coronária. Porém, apesar dos benefícios decorrentes do uso de aspirina, pacientes com síndrome coronáriana aguda ainda apresentam risco considerável de eventos cardiovasculares indesejáveis a curto prazo, como morte, reinfarto e acidente vascular cerebral. Derivados tienopiridínicos como ticlopidina e clopidogrel agregaram benefícios ao tratamento desses pacientes, agindo de maneira sinérgica à aspirina. Com perfil mais seguro e menos efeitos adversos comparativamente à ticlopidina, o clopidogrel foi testado em estudos clínicos controlados, randopmizados conduzidos internacionalmente, envolvendo grande número de pacientes com síndromes coronárias agudas com indiscutível demonstração de benefícios em ampla gama de situações clínicas. Características farmacológicas...


Antiplatelet agents represent an important treatment strategy for patients with acute coronary syndromes. Due to the important role of aspirin and robust evidence of benefit in ischemic heart disease, its use was expanded to include virtually all forms of medical treatment, invasive percutaneous procedures and surgical interventions related to coronary artery disease. But despite the benefits of aspirin, patients with acute coronary syndromes still present considerable risk of short and long-term adverse cardiovascular events, such as death, reinfarction and stroke. Thienopyridine derivatives like ticlopidine and clopidogrel have added benefits to the treatment of these patients acting in synergism with aspirin. With a safer profile and less adverse effects as compared to ticlopidine, clopidogrel has been tested in controlled, randomized, international clinical trials involving a large number of patients with acute coronary syndromes clearly showing to be beneficial in a wide range of clinical situations. Pharmacological characteristics of clopidogrel as time of onset, need of metabolization for a therapeutic effect and irreversible platelet receptors blockade still limit its use, as well as the possibility of gene polymorphism of cytochrome P450, drug interactions and resistance to its effect and to aspirin. This review briefly addresses the main scientific studies evaluating the effects of these drugs in acute coronary syndromes with emphasis on new knowledge about aspirin and clopidogrel, drug interaction, use of genetic and platelet adhesiveness tests and the impact of recent scientific studies in the daily practice.


Assuntos
Humanos , Aspirina/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Ticlopidina/administração & dosagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico
13.
Arq Bras Cardiol ; 92(6): 405-11, 422-8, 439-45, 2009 Jun.
Artigo em Inglês, Mul | MEDLINE | ID: mdl-19629306

RESUMO

BACKGROUND: Several infectious agents have been investigated since the association between atherosclerosis and infection was demonstrated; however, the results of these studies are contradictory. OBJECTIVE: To test the association between serum titers of anti-Chlamydia and anti-Mycoplasma antibodies in different forms of acute coronary syndromes (ACS). METHODS: One hundred and twenty-six patients were divided in 4 groups: ACS with ST-segment elevation (32 patients), ACS without ST-segment elevation (30 patients), chronic coronary artery disease (30 patients) and blood donors without known coronary disease (34 patients--control group). In the two first groups, serum samples were collected at hospital admission (first 24 hours of hospitalization) and after a 6-month follow-up. In the other two groups, only a basal sample was collected. Anti-Chlamydia and anti-Mycoplasma antibodies were measured by indirect immunofluorescence in all samples. RESULTS: Significant differences were observed between the basal sample and the one measured after a 6-month follow-up in patients with myocardial infarction with ST-segment elevation for Chlamydia (650+/-115.7 versus 307+/-47.5, p=0.0001) as well as Mycoplasma (36.5+/-5.0 versus 21.5+/-3.5, p=0.0004). The groups with ACS had higher anti-Chlamydia and anti-Mycoplasma serum antibody levels in the basal measurement, when compared to the patients with chronic coronary disease and the control group, but the differences were not statistically significant. CONCLUSION: The present study showed an association between the serum titers of anti-Chlamydia and anti-Mycoplasma antibodies in the acute phase of patients with unstable angina or myocardial infarction.


Assuntos
Síndrome Coronariana Aguda/microbiologia , Anticorpos Antibacterianos/sangue , Chlamydophila pneumoniae/imunologia , Mycoplasma pneumoniae/imunologia , Idoso , Doença Crônica , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Arq. bras. cardiol ; 92(6): 439-445, jun. 2009. graf, tab
Artigo em Inglês, Espanhol, Português | LILACS | ID: lil-519964

RESUMO

FUNDAMENTO: Vários agentes infecciosos foram investigados desde que se demonstrou a associação entre infecção e aterosclerose, porém os resultados desses estudos são conflitantes. OBJETIVO: Testar a associação entre títulos séricos de anticorpos anti-Chlamydia e anti-Mycoplasma em diferentes formas de síndromes coronarianas agudas (SCA). MÉTODOS: Cento e vinte e seis pacientes foram divididos em quatro grupos: SCA com elevação do segmento ST (32 pacientes), SCA sem elevação do segmento ST (30 pacientes), doença arterial coronariana crônica (30 pacientes) e doadores de sangue sem doença coronariana conhecida (34 pacientes - grupo-controle). Nos primeiros dois grupos, amostras de soro foram coletadas na admissão (primeiras 24 horas de hospitalização) e após 6 meses de seguimento. Nos outros dois grupos, colheu-se apenas uma amostra basal. Em todas as amostras, anticorpos IgG anti-Chlamydia e anti-Mycoplasma foram dosados por imunofluorescência indireta. RESULTADOS: Diferenças significativas foram observadas entre a medida basal e após 6 meses de seguimento nos pacientes com infarto do miocárdio com elevação do segmento ST, tanto para Chlamydia (650±115,7 vs. 307±47,5, p = 0,0001) quanto para Mycoplasma (36,5±5,0 vs. 21,5±3,5, p = 0,0004). Os grupos com SCA tiveram níveis séricos de anticorpos anti-Chlamydia e anti-Mycoplasma mais altos na dosagem basal, em relação aos pacientes com doença arterial coronariana crônica e grupo-controle, mas as diferenças obtidas não tiveram significância estatística. CONCLUSÃO: O presente estudo mostrou associação entre os títulos de anticorpos anti-Chlamydia e anti-Mycoplasma na fase aguda dos pacientes com angina instável ou infarto do miocárdio.


BACKGROUND: Several infectious agents have been investigated since the association between atherosclerosis and infection was demonstrated; however, the results of these studies are contradictory. OBJECTIVE: To test the association between serum titers of anti-Chlamydia and anti-Mycoplasma antibodies in different forms of acute coronary syndromes (ACS). METHODS: One hundred and twenty-six patients were divided in 4 groups: ACS with ST- segment elevation (32 patients), ACS without ST-segment elevation (30 patients), chronic coronary artery disease (30 patients) and blood donors without known coronary disease (34 patients - control group). In the two first groups, serum samples were collected at hospital admission (first 24 hours of hospitalization) and after a 6-month follow-up. In the other two groups, only a basal sample was collected. Anti-Chlamydia and anti-Mycoplasma antibodies were measured by indirect immunofluorescence in all samples. RESULTS: Significant differences were observed between the basal sample and the one measured after a 6-month follow-up in patients with myocardial infarction with ST-segment elevation for Chlamydia (650±115.7 versus 307±47.5, p=0.0001) as well as Mycoplasma (36.5±5.0 versus 21.5±3.5, p=0.0004). The groups with ACS had higher anti-Chlamydia and anti-Mycoplasma serum antibody levels in the basal measurement, when compared to the patients with chronic coronary disease and the control group, but the differences were not statistically significant. CONCLUSION: The present study showed an association between the serum titers of anti-Chlamydia and anti-Mycoplasma antibodies in the acute phase of patients with unstable angina or myocardial infarction.


FUNDAMENTO: Se han investigado diversos agentes infecciosos desde que se evidenció la asociación entre infección y aterosclerosis, sin embargo esos estudios ofrecen resultados conflictivos. OBJETIVO: Probar la asociación entre títulos séricos de anticuerpos anti-Chlamydia y anti-Mycoplasma en diferentes formas de síndromes coronarios agudos (SCA). MÉTODOS: Se dividieron a 126 pacientes en 4 grupos: SCA con elevación del segmento ST (32 pacientes), SCA sin elevación del segmento ST (30 pacientes), enfermedad arterial coronaria crónica (30 pacientes) y donadores de sangre sin enfermedad coronaria conocida (34 pacientes - grupo-control). En los primeros dos grupos, muestras de suero se colectaron al ingreso (primeras 24 horas de hospitalización) y tras 6 meses de seguimiento. En los otros dos grupos, se colectó solamente una muestra basal. En todas las muestras, se dosificaron anticuerpos IgG anti-Chlamydia y anti-Mycoplasma por inmunofluorescencia indirecta. RESULTADOS: Se observaron diferencias significativas entre la medida basal y tras 6 meses de seguimiento en los pacientes con infarto de miocardio con elevación del segmento ST, tanto para Chlamydia (650±115,7 vs 307±47,5, p = 0,0001) como para Mycoplasma (36,5±5,0 vs 21,5±3,5, p = 0,0004). Los grupos con SCA tuvieron niveles séricos de anticuerpos anti-Chlamydia y anti-Mycoplasma más altos en la dosificación basal, con relación a los pacientes con enfermedad arterial coronaria crónica y grupo-control, sin embargo las diferencias obtenidas no tuvieron significancia estadística. CONCLUSIÓN: El presente estudio reveló asociación entre los títulos de anticuerpos anti-Chlamydia y anti-Mycoplasma en la fase aguda de los pacientes con angina inestable o infarto de miocardio.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/microbiologia , Anticorpos Antibacterianos/sangue , Chlamydophila pneumoniae/imunologia , Mycoplasma pneumoniae/imunologia , Doença Crônica , Métodos Epidemiológicos
15.
Rev. bras. cir. cardiovasc ; 23(4): 488-493, out.-dez. 2008. graf, tab
Artigo em Inglês, Português | LILACS | ID: lil-506031

RESUMO

OBJETIVO: É comum a obtenção de acesso venoso femoral em pacientes submetidos a cirurgia cardíaca em associação ou como alternativa ao acesso superior (veia jugular interna ou veia subclávia). O objetivo deste estudo foi comparar as medidas de pressão venosa central (PVC) em dois sítios diferentes (superior vs. femoral). MÉTODOS: Estudo prospectivo e aberto com 60 pacientes submetidos a cirurgia cardíaca no período de julho a novembro de 2006. Foram obtidas três medidas de cada paciente em cada sítio (admissão, 6 e 12 horas após a cirurgia) em duas inclinações diferentes da cabeceira do leito (zero e 30 graus), totalizando 720 medidas. RESULTADOS: Cinqüenta e cinco por cento dos pacientes foram submetidos a revascularização do miocárdio, 38 por cento a cirurgia valvar e 7 por cento a outras cirurgias. A média de PVC ± desvio padrão (DP) medida no acesso superior foi de 13,0 ± 5,5 mmHg (zero grau) e 13,3 ± 6,1 mmHg (30 graus), enquanto que as medidas no acesso inferior foram 11,1 ± 4,9 mmHg (zero grau) e 13,7 ± 4,6 mmHg (30 graus). A correlação linear (r) entre as medidas nos dois sítios foi de 0,66 (zero grau) e 0,53 (30 graus), ambas com p < 0,0001. CONCLUSÃO: A PVC pode ser medida com acurácia no acesso venoso femoral no pós-operatório imediato de cirurgia cardíaca, com melhor correlação linear obtida com as medidas feitas com a cabeceira do leito posicionada em zero grau.


OBJECTIVE: It is common to obtain femoral venous approach in patients undergoing combined heart surgery or as an alternative to superior approach (internal jugular vein or subclavian vein). The aim of this study was to compare the measures of central venous pressure (CVP) at two different sites (superior versus femoral). METHODS: We prospectively and openly allocated 60 patients who underwent heart surgery between July from November 2006. Three measures were obtained from each patient at each site (admission, 6 and 12 hours after surgery) in two different inclinations of the headboard (zero and 30 degrees) totaling 720 measures. RESULTS: Fifty five percent of patients who underwent coronary artery bypass grafting, 38 percent heart valve surgery and 7 percent other surgeries. The mean of CVP ± standard deviation (SD) measured in superior approach was 13.0 ± 5.5 mmHg (zero degree) and 13.3 ± 6.1 mmHg (30 degrees) while the measures in inferior approach were 11.1 ± 4.9 mmHg (zero degree) and 13.7 ± 4.6 mmHg (30 degrees). The linear correlation (r) between the measures in both sites was 0.66 (zero degree) and 0.53 (30 degrees), both with p value<0.0001. CONCLUSION: The CVP can be measured with accuracy in the femoral venous approach in the immediate postoperative period of heart surgery with better linear correlation obtained with the measures made with the headboard positioned at zero degree.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Cateterismo Venoso Central/métodos , Pressão Venosa Central/fisiologia , Veia Femoral/fisiologia , Veias Jugulares/fisiologia , Veia Subclávia/fisiologia , Leitos , Métodos Epidemiológicos , Período Pós-Operatório , Postura , Cuidados Pré-Operatórios , Fatores de Tempo
16.
Rev Bras Cir Cardiovasc ; 23(1): 129-31, 2008 Jan-Mar.
Artigo em Português | MEDLINE | ID: mdl-18719841

RESUMO

Syphilis is an infectious disease occurring through a series of frequently overlapping stages. It can impair the cardiovascular and neurological system. In 30% of the non treated patients, syphilis develops its tertiary form. We report a case of a 46-year-old male patient admitted due to edema pulmonary and acute coronary syndrome with left bundle branch block, submitted to fibrinolytic therapy successfully. Coronary angiography showed a 90% ostial lesion of left main coronary artery and occlusion of the right coronary artery ostium. VDRL was titrated to 1/128. The patient was undergone to CABG and was discharged after treatment with crystalline penicillin.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Sífilis Cardiovascular/diagnóstico , Bloqueio de Ramo/terapia , Doença da Artéria Coronariana/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/terapia , Sífilis Cardiovascular/terapia
17.
Rev. bras. cir. cardiovasc ; 23(1): 129-131, jan.-mar. 2008. ilus
Artigo em Inglês, Português | LILACS | ID: lil-489715

RESUMO

A sífilis é uma doença infecciosa que se desenvolve em estágios e pode acometer o sistema cardiovascular e neurológico. Em 30 por cento dos pacientes não tratados, a sífilis desenvolve sua forma terciária. Relatamos o caso de um homem de 46 anos, admitido por edema pulmonar agudo por cardiopatia isquêmica com bloqueio completo do ramo esquerdo, submetido a terapia fibrinolítica com sucesso. Angiografia coronária mostrou lesão ostial de 90 por cento na artéria coronária esquerda e oclusão do óstio da artéria coronária direita. Os títulos de VDRL foram de 1/128. O paciente foi submetido a revascularização do miocárdio e recebeu alta após tratamento antibiótico com penicilina cristalina.


Syphilis is an infectious disease occurring through a series of frequently overlapping stages. It can impair the cardiovascular and neurological system. In 30 percent of the non treated patients, syphilis develops your tertiary form. We report a case of a 46-year-old male patient admitted due to edema pulmonary and acute coronary syndrome with left bundle branch block, submitted to fibrinolytic therapy successfully. Coronary angiography showed a 90 percent ostial lesion of left main coronary artery and occlusion of the right coronary artery ostium. VDRL was titrated to 1/128. The patient was undergone to CABG and was discharged after treatment with crystalline penicillin.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/diagnóstico , Sífilis Cardiovascular/diagnóstico , Bloqueio de Ramo/terapia , Doença da Artéria Coronariana/terapia , Edema Pulmonar/terapia , Sífilis Cardiovascular/terapia
18.
Rev Bras Cir Cardiovasc ; 23(4): 488-93, 2008 Oct-Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19229419

RESUMO

OBJECTIVE: It is common to obtain femoral venous approach in patients undergoing combined heart surgery or as an alternative to superior approach (internal jugular vein or subclavian vein). The aim of this study was to compare the measures of central venous pressure (CVP) at two different sites (superior versus femoral). METHODS: We prospectively and openly allocated 60 patients who underwent heart surgery between July from November 2006. Three measures were obtained from each patient at each site (admission, 6 and 12 hours after surgery) in two different inclinations of the headboard (zero and 30 degrees) totaling 720 measures. RESULTS: Fifty five percent of patients who underwent coronary artery bypass grafting, 38% heart valve surgery and 7% other surgeries. The mean of CVP +/- standard deviation (SD) measured in superior approach was 13.0 +/- 5.5 mmHg (zero degree) and 13.3 +/- 6.1 mmHg (30 degrees) while the measures in inferior approach were 11.1 +/- 4.9 mmHg (zero degree) and 13.7 +/- 4.6 mmHg (30 degrees). The linear correlation (r) between the measures in both sites was 0.66 (zero degree) and 0.53 (30 degrees), both with p value<0.0001. CONCLUSION: The CVP can be measured with accuracy in the femoral venous approach in the immediate postoperative period of heart surgery with better linear correlation obtained with the measures made with the headboard positioned at zero degree.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cateterismo Venoso Central/métodos , Pressão Venosa Central/fisiologia , Veia Femoral/fisiologia , Veias Jugulares/fisiologia , Veia Subclávia/fisiologia , Leitos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Postura , Cuidados Pré-Operatórios , Fatores de Tempo
19.
In. Serrano Jr, Carlos V; Timeramn, Ari; Stefanini, Edson; Serrano Jr, Carlos V. Faculdade de Medicina da Universidade de São Paulo. BrasilTimeramn, Ari. Instituto Dante Pazzanese de Cardiologia. BrasilStefanini, Edson. Faculdade de Medicina da Universidade de São Paulo. Brasil. Tratado de Cardiologia SOCESP. São Paulo, Manole, 2 ed; 2009. p.92-97.
Monografia em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-8592

RESUMO

Provavelmente não exista estratégia perfeita, capaz de atingir plenamente o objetivo de praticar a medicina que idealizamos na rotina assistencial diária. Podemos considerar que já existem meios até recentemente não conhecidos para tentar incorporar conhecimentos sólidos de pesquisa clínica à real prática médica, mas há ainda um grande campo a explorar quanto a isso. De qualquer fora, o que percebemos atualmente, é uma crescente preocupação em proporcionar o melhor tratamento disponível aos pacientes portadores de síndromes cardiológicas, em larga escala e de forma efetiva, porque somente por meio de aplicação real do conhecimento adquirido seremos capazes de observar um impacto positivo em desfechos considerados clinicamente relevantes em nossas instituições e em nosso país como um todo.(AU)


Assuntos
Medicina Baseada em Evidências , Padrões de Prática Médica , Guias de Prática Clínica como Assunto
20.
Arq Bras Cardiol ; 87(1): 28-36, 2006 Jul.
Artigo em Português | MEDLINE | ID: mdl-16906267

RESUMO

OBJECTIVE: To evaluate the length of time required for atherosclerotic plaque stabilization in acute coronary syndromes (ACS), using inflammatory markers. METHODS: In this prospective study, C-reactive protein (CRP), fibrinogen, factor VIIIc, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels were measured on admission, at discharge, and three and six months post-discharge in 40 patients with non-ST-segment elevation ACS (NSTE-ACS) and 40 healthy subjects. RESULTS: C-reactive protein levels were significantly higher on admission and at discharge, but not at three and six months post-discharge, compared with the control group. Fibrinogen levels remained unchanged, except at six months, when they were significantly lower than in the control group. Factor VIII-c did not differ from that of the control group on admission, but it was significantly higher at discharge, with no differences at three and six months. Interleukin-6 levels were significantly higher than in the control group in all time points. However, they declined significantly between discharge and three months. In no time point was TNF-alpha significantly different from that of the control group. Only IL-6 correlated significantly and independently with future cardiovascular events. CONCLUSION: With respect to CRP and factor VIIIc, plaque stabilization is suggested in up to three months; IL-6 analysis suggests stabilization as from the third month, although it remained higher than that of the control group for up to six months. Only IL-6 showed prognostic value for further events within a year.


Assuntos
Angina Instável/sangue , Aterosclerose/sangue , Proteína C-Reativa/análise , Infarto do Miocárdio/sangue , Distribuição por Idade , Angina Instável/fisiopatologia , Aterosclerose/fisiopatologia , Aterosclerose/terapia , Biomarcadores/sangue , Estudos de Casos e Controles , Fator VIII/análise , Feminino , Hospitalização , Humanos , Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Estudos Prospectivos , Distribuição por Sexo , Fator de Necrose Tumoral alfa/sangue
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