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2.
PLoS One ; 14(2): e0207979, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794566

RESUMO

BACKGROUND: The FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI). METHODS: Data for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%). RESULTS: Among the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; p<0.001), with less IF (28.6% vs. 43.1%; p = 0.002) but more PPCI (37.8% vs. 3.9%; p<0.0001). However, in-hospital mortality in the two types of hospitals was similar (5.3% vs. 5.1%; p = 0.866). CONCLUSIONS: Data from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , Fibrinolíticos/uso terapêutico , Mortalidade Hospitalar , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Terapia Trombolítica/mortalidade , Terapia Trombolítica/estatística & dados numéricos , Resultado do Tratamento , Tunísia/epidemiologia
3.
Crit Pathw Cardiol ; 18(1): 23-31, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747762

RESUMO

BACKGROUND: Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. METHODS: This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60-75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493). RESULTS: Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death. CONCLUSION: Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Distribuição por Idade , Fatores Etários , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
4.
Orv Hetil ; 160(1): 20-25, 2019 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-30599777

RESUMO

INTRODUCTION AND AIM: The authors examined the pre-hospital delay of patients with ST-elevation myocardial infarction receiving percutaneous coronary revascularization. METHOD: In the Hungarian Myocardial Infarction Registry (HUMIR), between January 1, 2014 and March 31, 2016, 7146 patients were found who had all necessary time intervals available. In the database of the National Ambulance Service (OMSZ), 3288 patients were found who had the necessary time intervals. The following time intervals were investigated: the time from the beginning of the complaint to the rescue service notification (patient delay time = PDT), the time of the rescue service to arrive at the scene (R1), the on-site care time (R2) and the time from the scene until arriving to the centre (R3). The case of care at the centre, we investigated the time from the onset of symptoms until the balloon inflation (SBI). If the first hospital had no cardiac catheterization laboratory, we measured the transfer time to the cath centre. The methodological details related to the operation of the HUMIR had been described in our earlier communication. Rescue times (R1, R2, R3) were investigated on the basis of the paper-based records of the National Emergency Service. The patients were divided into two groups based on the fact that the first admission hospital is a centre with a heart catheter facility (C) or a non-invasive hospital (H). RESULTS: 2621 patients (79.7%) were admitted to a hospital with cath lab (C) and 667 patients with secondary transport. Patients with primary transport to C were younger, but for other data, the two groups did not differ. The median of PDT for patients in group C was 114, and 121 minutes for patients in group H. There was no significant difference between R1 and R2 time between the two groups. R3 time in group C was longer than for H patients. In the case of secondary transport, the median time was 98 minutes until the centre. The median time from the beginning of the complaint to the balloon inflation (total ischemic time) was 260 minutes in group C and 356 minutes in group H. CONCLUSION: Based on the analysis of the total ischemic time and the pre-hospital delay, it is clear that the care of myocardial infarction patients can be further improved by reducing the patient's decision time and increasing the proportion of primary transport. Rescue times (R1, R2, R3) met the expectations, however, further analysis of the M2 time should be considered. Orv Hetil. 2019; 160(1): 20-25.


Assuntos
Serviços Médicos de Emergência/normas , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/estatística & dados numéricos , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , Humanos , Hungria , Masculino , Infarto do Miocárdio/terapia , Admissão do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores de Tempo
5.
Int Heart J ; 59(5): 935-940, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30101849

RESUMO

Increasing evidence is available for the use of percutaneous coronary intervention (PCI) in selected patients with unprotected left main (LM) bifurcation coronary lesions. However, little data have been reported on recurrent in-stent restenosis (ISR) for LM bifurcation lesions. The aim of this study was to evaluate the efficacy of a drug-eluting balloon (DEB) for LM bifurcation ISR compared with that of a drug-eluting stent (DES).Between December 2011 and December 2015, 104 patients who underwent PCI for unprotected LM bifurcation ISR were enrolled. We separated the patients into 2 groups: (1) those underwent PCI with further DEB and (2) those underwent PCI with further DES. Clinical outcomes were analyzed.Patients' average age was 67.14 ± 7.65 years, and the percentage of male patients was 76.0%. A total of 75 patients were enrolled in the DEB group, and another 29 patients were enrolled in the DES group. Similar target lesion revascularization (TLR) rate and recurrent myocardial infarction (MI) rate were noted for both groups. A significantly higher cardiovascular mortality rate was found in the DES group (10.7% versus 0%, P = 0.020), and a higher all-cause mortality rate was noted in the DES group (21.4% versus 6.8%, P = 0.067).It is feasible to use DEB for LM bifurcation ISR. When comparing DEB with DES, similar TLR rates were found, but lower recurrent MI and lower cardiovascular death were noted for DEB treatment.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Doença da Artéria Coronariana/complicações , Reestenose Coronária/cirurgia , Vasos Coronários/patologia , Stents Farmacológicos/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/instrumentação , Idoso , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/patologia , Vasos Coronários/anatomia & histologia , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/prevenção & controle , Revascularização Miocárdica/instrumentação , Intervenção Coronária Percutânea/mortalidade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
6.
Orv Hetil ; 159(27): 1113-1120, 2018 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-29961371

RESUMO

INTRODUCTION: The significance of the total ischemic time (from the beginning of the complaint to the opening of the vessel) is an important factor for myocardial salvage. AIM: The aim of the study was to determine the prognostic significance of the TIT in patients with ST elevation myocardial infarction in Hungary. METHOD: From 1 January 2014 all patients with myocardial infarction were recorded by law in an on-line database of the Hungarian Myocardial Infarction Registry. Between 1 January 2014 and 31 March 2016, 27 157 patients with 28 408 myocardial infarction events were recorded. To investigate TIT, 7146 STEMI patients were selected who were treated with percutaneous coronary intervention (PCI) within 24 hours of the beginning of the complaint and all of its components were known. RESULTS: Average follow-up was 740 ± 346 days. The median time of the TIT is 260 minutes, within which the earliest prehospital time was found (median 205 minutes). The TIT influenced survival: if this time was less than 400 minutes, the 30-day and the 1-year deaths were 7.5% and 12.2%, respectively. In longer TIT, higher mortality rate was found (9.2% versus 19.7%, respectively). Multivariate analysis was performed for short (<30 days), medium (30-364 days) and long-term (≥365 days) survival. Diabetes mellitus is a short-term prognostic factor, abnormal creatinine, and severe coronary status have affected short and medium survival. PCI was significant in terms of medium and long-term survival. Previous myocardial infarction and TIT influenced the long-term survival significantly. CONCLUSIONS: In Hungary, TIT is too long, and its dominant part falls within the prehospital period. The TIT is an independent prognostic factor, so reducing this time can improve the long-term prognosis of patients with ST-elevation myocardial infarction. Orv Hetil. 2018; 159(27): 1113-1120.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Tempo
7.
J Am Geriatr Soc ; 66(7): 1325-1331, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29684242

RESUMO

OBJECTIVES: To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST-segment elevation myocardial infarction (STEM) managed within an integrated regional system of care. DESIGN: Ongoing, prospective, regional, hospital-based clinical registry. SETTING: Twenty-three public and private hospitals in the Northern Alps in France. PARTICIPANTS: Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77.2%) <75, 782 (16.2%) 75-84, 315 (6.5%) ≥85). MEASUREMENTS: Delivery of any reperfusion therapy (primary percutaneous coronary intervention (PCI), intravenous fibrinolysis), primary PCI, and timely reperfusion therapy and in-hospital outcomes. RESULTS: The percentages of patients receiving any reperfusion therapy were 92.9% for those younger than 75, 89.0% for those aged 75 to 84, and 78.7% for those aged 85 and older (P < .001). The percentages of patients undergoing primary PCI were 63.7%, 70.3%, 72.4% (P < .001); and the percentages of patients receiving timely delivery of reperfusion therapy were 44.6%, 36.8%, 29.9% (P < .001). In-hospital all-cause mortality was 3.4% for those younger than 75, 10.2% for those aged 75 to 84, and 19.8% for those aged 85 and older (P <.001). In multivariable analysis adjusting for baseline characteristics, timely delivery of reperfusion therapy was associated with lower in-hospital mortality (adjusted odds ratio=0.63, 95% confidence interval=0.46-0.85) with no significant heterogeneity between age groups (P-value for interaction = .45). CONCLUSION: Older adults meeting contemporary eligibility criteria for reperfusion therapy continue to receive delayed reperfusion therapy and experience higher mortality than their younger counterparts.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , França , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do Tratamento
8.
Rev. esp. cardiol. (Ed. impr.) ; 71(4): 243-249, abr. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-171751

RESUMO

Introducción y objetivos. Una red para la atención del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) activada por no cardiólogos reduce los retrasos en la atención, pero pueden aumentar los falsos positivos. El objetivo es evaluar la prevalencia, los predictores y el impacto de los diagnósticos falsos positivos dentro de la red catalana para la atención del IAMCEST (Codi Infart). Métodos. Se incluyó a los pacientes atendidos por el Codi Infart entre enero de 2010 y diciembre de 2011. Se consideró activación apropiada si se cumplían los criterios clínicos y electrocardiográficos de IAMCEST. Las activaciones apropiadas se clasificaron como falso positivo según 2 definiciones no excluyentes: a) «angiográfica» si no se identificó una arteria causal, y b) «clínica» si el diagnóstico al alta no era IAMCEST. Resultados. Se incluyó un total de 5.701 activaciones. La activación resultó apropiada en el 87,8% de las veces. Los falsos positivos angiográficos fueron el 14,6% y los clínicos, el 11,6%. El sexo femenino, el bloqueo de rama izquierda y el antecedente de infarto de miocardio se asociaron con el falso positivo. Utilizando la definición clínica, se observó una tasa de falsos positivos mayor en los hospitales sin sala de hemodinámica y los pacientes con complicaciones durante el primer contacto. La mortalidad hospitalaria y a los 30 días fue similar entre los falsos y los verdaderos positivos. Conclusiones. La evolución clínica es similar entre los pacientes con falsos positivos y aquellos con verdaderos positivos. La identificación de predictores de falsos positivos justifica una evaluación cuidadosa para optimizar el uso de las redes de IAMCEST (AU)


Introduction and objectives. ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical impact of false-positive activations within the Catalonian STEMI network (Codi Infart). Methods. From January 2010 through December 2011, all consecutive patients treated within the Codi Infart network were included. Code activations were classified as appropriate if they satisfied both electrocardiogram and clinical STEMI criteria. Appropriate activations were classified as false positives using 2 nonexclusive definitions: a) “angiographic” if a culprit coronary artery was not identified, and b) “clinical” if the discharge diagnosis was other than STEMI. Results. In total, 5701 activations were included. Appropriate activation was performed in 87.8% of the episodes. The rate of angiographic false positives was 14.6%, while the rate of clinical false positives was 11.6%. Irrespective of the definition, female sex, left bundle branch block, and previous myocardial infarction were independent predictors of false-positive STEMI diagnoses. Using the clinical definition, hospitals without percutaneous coronary intervention and patients with complications during the first medical contact also had a false-positive STEMI diagnoses rate higher than the mean. In-hospital and 30-day mortality rates were similar for false-positive and true-positive STEMI patients after adjustment for possible confounders. Conclusions. False-positive STEMI diagnoses were frequent. Outcomes were similar for patients with a true-positive or false-positive STEMI diagnosis treated within a STEMI network. The presence of any modifiable predictors of a false-positive STEMI diagnosis warrants careful assessment to optimize the use of STEMI networks (AU)


Assuntos
Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Angiografia Coronária/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Cateterismo Cardíaco/estatística & dados numéricos , Angioplastia Coronária com Balão/estatística & dados numéricos , Reações Falso-Positivas , Sensibilidade e Especificidade , Procedimentos Clínicos/organização & administração , Tratamento de Emergência/métodos
9.
J Interv Cardiol ; 31(4): 450-454, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29356080

RESUMO

OBJECTIVES: To evaluate the systematic chain of care for patients with acute ST-elevation myocardial infarction (STEMI) referred for primary angioplasty in a capital city in Midwestern Brazil. BACKGROUND: Acute myocardial infarction is recognized as an important cause of morbidity and mortality and as a public health problem worldwide. Early specialized care is crucial for a good prognosis. METHODS: All STEMI patients receiving care through the public health system at two tertiary care centers from March 2012 to June 2014 were retrospectively analyzed. Symptom onset-to-balloon time and door-to-balloon time were analyzed and compared with current guideline recommendations. RESULTS: A total of 835 patients were included. Median symptom onset-to-balloon time was 32 h. A total of 783 (94%) patients had had symptoms for more than 12 h and 507 (61%) for more than 24 h. Only 51 (6%) patients arrived within 12 h of symptom onset and were treated with primary angioplasty. Among these patients, median door-to-balloon time was 37 min, in accordance with guideline recommendations. CONCLUSION: Treatment of STEMI through the public health system in a capital city in Midwestern Brazil falls short of the recommended guidelines due to failure in the initial links of the chain of care. This potentially reversible failure has an important impact on patient outcomes and on health care burden.


Assuntos
Angioplastia Coronária com Balão , Necessidades e Demandas de Serviços de Saúde , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento , Idoso , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Reperfusão Miocárdica/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos
10.
Am J Epidemiol ; 187(5): 1064-1078, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28992207

RESUMO

This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Pesquisa Comparativa da Efetividade/métodos , Doença da Artéria Coronariana/cirurgia , Pontuação de Propensão , Idoso , Angioplastia Coronária com Balão/estatística & dados numéricos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Ponte de Artéria Coronária/estatística & dados numéricos , Stents Farmacológicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Intervenção Coronária Percutânea/estatística & dados numéricos , Resultado do Tratamento
11.
Gac Med Mex ; 153(Supl. 2): S13-S17, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-29099107

RESUMO

Objective: To evaluate the impact of the implementation of the Infarction Code strategy in patients with acute myocardial infarction diagnosis. Methods: Consecutive patients with ST-elevation acute myocardial infarction ≤12 hours of evolution, were included in the infarction code strategy, before (Group I) and after (Group II). Times of medical attention and major cardiovascular events during hospitalization were analyzed. Results: 1227 patients were included, 919 men (75%) and 308 women (25%) with an average age of 62 ± 11 years. Among Group I and Group II, percutaneous coronary intervention reperfusion therapy changed (16.6% to 42.6%), fibrinolytic therapy (39.3% to 25%), and patients who did not receive any form of reperfusion therapy (44% to 32.6%; p < 0.0001). Times of medical attention decreased significantly (door-to-needle time decreased from 92 to 72 minutes, p = 0.004; door-to-balloon time decreased from 140 to 92 minutes, p < 0.0001). Kidney failure (24.6% vs. 17.9%; p = 0.006), major complications (35.3% to 29.3%), and death (21% vs. 12%; odds ratio: 0.52; 95% confidence interval: 0.38-0.71; p = 0.004). also decreased. Conclusion: The Infarction Code strategy improved treatment, times of medical attention and decreased complications and death in these patients.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/classificação , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Insuficiência Renal/etiologia , Insuficiência Renal/prevenção & controle , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos
13.
Catheter Cardiovasc Interv ; 90(6): 881-887, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-28544146

RESUMO

BACKGROUND: No previous studies have evaluated the performance of the Synergy stent in a large real-life population. OBJECTIVES: To describe the initial real-life experience with a novel everolimus eluting platinum chromium stent with abluminal biodegradable polymer (SYNERGY) in unselected patients from a nationwide registry. METHODS: All implanted Synergy stents were compared with other new generation drug eluting stents (n-DES) with >1,000 implantations in Sweden between March 2013 and October 2015. Restenosis, definite stent thrombosis (ST), myocardial infarction (MI) and death rates were assessed using propensity score and Cox regression analyses. RESULTS: A total of 7,886 of Synergy stents and 64,429 other n-DES (BioMatrix, N = 1,953; Orsiro, N = 4,946; Promus Element Plus, N= 2,543; Promus Premier, N= 20,414; Xience Xpedition, N= 7,971, Resolute/Resolute Integrity, N = 19,021; Ultimaster, N = 1,156; Resolute Onyx, N = 6,425) were implanted in 42,357 procedures. Restenosis and stent thrombosis occurred in 642 and 314 cases, respectively, in the overall population at 1 year. The cumulative rate of restenosis (1.1% vs. 1.0%, adjusted HR: 1.24 95% CI: 0.88-1.75; P = 0.21) and ST (0.4% vs. 0.5%, adjusted HR: 0.97; 95% CI: 0.63-1.50; P = 0.17) up to 1 year was low in both the Synergy group and the other n-DES group. Death occurred in 5.2% versus 4.5% (adjusted HR: 1.14; 95% CI: 0.96-1.36; P = 0.11) and MI in 3.2% versus 3.5%, (adjusted HR: 1.11; 95% CI: 0.93-1.33; P = 0.24) up to 1 year. CONCLUSIONS: In a large real-life population the Synergy stent appears to be safe and effective with a low rate of restenosis and ST comparable with other n-DES. © 2017 Wiley Periodicals, Inc.


Assuntos
Implantes Absorvíveis , Angioplastia Coronária com Balão/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Everolimo/farmacologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Cromo , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Imunossupressores/farmacologia , Incidência , Masculino , Platina , Polímeros , Modelos de Riscos Proporcionais , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suécia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
14.
West J Emerg Med ; 18(3): 349-355, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28435484

RESUMO

INTRODUCTION: The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. METHODS: This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal-Wallis tests were used to examine differences in variables by mode of transportation. RESULTS: Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1-5.3), and 4.5 (3.0-7.5), respectively; door-to-balloon time in minutes, 70 (48-78), 81 (64-105), and 62 (46-77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group. CONCLUSION: Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Serviços Médicos de Emergência , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Adulto , Ambulâncias , Eletrocardiografia/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Transporte de Pacientes/métodos , Emirados Árabes Unidos/epidemiologia
15.
Cochrane Database Syst Rev ; 3: CD011114, 2017 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-28301692

RESUMO

BACKGROUND: Vitamin C is an essential micronutrient and powerful antioxidant. Observational studies have shown an inverse relationship between vitamin C intake and major cardiovascular events and cardiovascular disease (CVD) risk factors. Results from clinical trials are less consistent. OBJECTIVES: To determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of CVD. SEARCH METHODS: We searched the following electronic databases on 11 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid); Web of Science Core Collection (Thomson Reuters); Database of Abstracts of Reviews of Effects (DARE); Health Technology Assessment Database and Health Economics Evaluations Database in the Cochrane Library. We searched trial registers on 13 April 2016 and reference lists of reviews for further studies. We applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials of vitamin C supplementation as a single nutrient supplement lasting at least three months and involving healthy adults or adults at moderate and high risk of CVD were included. The comparison group was no intervention or placebo. The outcomes of interest were CVD clinical events and CVD risk factors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, abstracted the data and assessed the risk of bias. MAIN RESULTS: We included eight trials with 15,445 participants randomised. The largest trial with 14,641 participants provided data on our primary outcomes. Seven trials reported on CVD risk factors. Three of the eight trials were regarded at high risk of bias for either reporting or attrition bias, most of the 'Risk of bias' domains for the remaining trials were judged as unclear, with the exception of the largest trial where most domains were judged to be at low risk of bias.The composite endpoint, major CVD events was not different between the vitamin C and placebo group (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.89 to 1.10; 1 study; 14,641 participants; low-quality evidence) in the Physicians Health Study II over eight years of follow-up. Similar results were obtained for all-cause mortality HR 1.07, 95% CI 0.97 to 1.18; 1 study; 14,641 participants; very low-quality evidence, total myocardial infarction (MI) (fatal and non-fatal) HR 1.04 (95% CI 0.87 to 1.24); 1 study; 14,641 participants; low-quality evidence, total stroke (fatal and non-fatal) HR 0.89 (95% CI 0.74 to 1.07); 1 study; 14,641 participants; low-quality evidence, CVD mortality HR 1.02 (95% 0.85 to 1.22); 1 study; 14,641 participants; very low-quality evidence, self-reported coronary artery bypass grafting (CABG)/percutaneous transluminal coronary angioplasty (PTCA) HR 0.96 (95% CI 0.86 to 1.07); 1 study; 14,641 participants; low-quality evidence, self-reported angina HR 0.93 (95% CI 0.84 to 1.03); 1 study; 14,641 participants; low-quality evidence.The evidence for the majority of primary outcomes was downgraded (low quality) because of indirectness and imprecision. For all-cause mortality and CVD mortality, the evidence was very low because more factors affected the directness of the evidence and because of inconsistency.Four studies did not state sources of funding, two studies declared non-commercial funding and two studies declared both commercial and non-commercial funding. AUTHORS' CONCLUSIONS: Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle-aged and older male physicians from the USA. There is limited low- and very low-quality evidence currently on the effect of vitamin C supplementation and risk of CVD risk factors.


Assuntos
Ácido Ascórbico/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Suplementos Nutricionais , Prevenção Primária/métodos , Vitaminas/administração & dosagem , Angioplastia Coronária com Balão/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Ponte de Artéria Coronária/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Médicos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologia
17.
Med. intensiva (Madr., Ed. impr.) ; 41(2): 70-77, mar. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-161104

RESUMO

Objetivo: Evaluar el impacto del género sobre el pronóstico y el manejo en una red regional de atención al infarto agudo de miocardio con elevación del segmento ST. Diseño: Estudio observacional sobre una base de pacientes consecutivos recogida prospectivamente. Ámbito: Red catalana de atención al infarto agudo de miocardio con elevación del segmento ST. Pacientes: Pacientes atendidos entre enero de 2010 y diciembre de 2011. Intervenciones: Angioplastia primaria, fibrinólisis o manejo conservador. Variables de interés: Se compararon, según el género, intervalos de tiempo, proporción y tipo de reperfusión, mortalidad global y complicaciones intrahospitalarias y mortalidad global a 30 días y un año. Resultados: De 5.831 pacientes atendidos, 4.380 tenían diagnóstico de infarto agudo de miocardio con elevación del segmento ST, siendo 961 (21,9%) de ellos mujeres. Estas tenían mayor edad (69,8±13,4 frente a 60,6±12,8 años, p<0,001), mayor prevalencia de diabetes (27,1 frente a 18,1%, p<0,001), Killip>I (24,9 frente a 17,3%, p<0,001) y ausencia de reperfusión (8,8 frente a 5,2%, p<0,001) que los hombres. Además, las mujeres presentaban mayores retrasos en la atención (primer contacto médico-balón: 132 frente a 122min, p<0,001; inicio de síntomas-balón: 236 frente a 210min, p<0,001), más complicaciones intrahospitalarias (20,6 frente a 17,4%, p=0,031) y mortalidad intrahospitalaria, a 30 días y un año (4,8 frente a 2,6%, p=0,001; 9,1 frente a 4,5%, p<0,001; 14,0 frente a 8,3%, p<0,001). Sin embargo, tras el análisis multivariado no hubo diferencias en mortalidad a 30 días y un año. Conclusiones: A pesar del peor perfil de riesgo y el peor tratamiento recibido, las mujeres presentaron similares resultados a 30 días y un año que sus homólogos masculinos atendidos por una red de atención al infarto (AU)


Objective: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. Design: An observational study was made of consecutive patients entered in a prospective database. Scope: The Catalan acute ST-elevation myocardial infarction management network. Patients: Patients treated between January 2010 and December 2011. Interventions: Primary angioplasty, thrombolysis or conservative management. Variables of interest: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. Results: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. Conclusions: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network (AU)


Assuntos
Humanos , Infarto do Miocárdio/epidemiologia , Angioplastia Coronária com Balão/estatística & dados numéricos , Reperfusão Miocárdica/estatística & dados numéricos , Estudos Prospectivos , Gênero e Saúde , Distribuição por Sexo , Redes Comunitárias/organização & administração , Mortalidade Hospitalar/tendências
18.
Orv Hetil ; 158(3): 90-93, 2017 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-28110568

RESUMO

The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure. CONCLUSION: comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90-93.


Assuntos
Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Sistema de Registros/normas , Terapia Trombolítica/estatística & dados numéricos , Adulto , Idoso , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Hungria/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
19.
Artigo em Inglês | MEDLINE | ID: mdl-26714975

RESUMO

BACKGROUND: Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units. METHODS: A total of 1107 STEMI patients from the German chest pain unit registry were enrolled. Analyses comprised critical time intervals (symptoms to first medical contact (FMC), FMC to admission, symptoms to admission, symptoms to balloon, FMC to balloon, door to balloon times) and major adverse cardiac and cerebrovascular events at follow-up. RESULTS: 54.8% of patients were admitted off-hours. Symptoms to admission (2:28 (1:28-5:20 h) vs. 3:16 h (1:35-8:06 h), P<0.001), symptoms to FMC (1:15 h (0:33-3:00 h) vs. 2:00 h (0:40-6:46 h), P<0.001) and FMC to admission intervals (0:45 h (0:30-1:20 h) vs. 0:52 h (0:32-1:35 h), P=0.09) were shorter during off-hours. Percutaneous revascularisation rates were high and without difference between on and off-hours (95.5% vs. 96.8%, P=0.30). Door to balloon times were significantly less during on-hours (0:32 h (0:18-1:06 h) vs. 0:44 h (0:23-1:20 h), P<0.01) without negative impact on the proportion of patients with a door to balloon time of <60 min (72.6% vs. 68.4%, P=0.19), symptoms to balloon (3:49 h (2:12-10:46 h) vs. 3:30 h (2:04-7:41 h), P=0.08) or FMC to balloon times (1:26 h (0:56-2:22 h) vs. 1:30 h (1:03-2:29 h), P=0.14). Major adverse cardiac and cerebrovascular event rates did not differ significantly between on and off-hours (log-rank test P=0.36). CONCLUSIONS: The German chest pain unit network ensures rapid and structured preclinical and in-hospital care independent from the circadian variation of admission. Slower door to balloon times off-hours are compensated by faster symptoms to admission or symptoms to FMC intervals. Further efforts should focus on patient awareness programmes on-hours and STEMI alarming tracks off-hours.


Assuntos
Síndrome Coronariana Aguda/terapia , Plantão Médico/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angioplastia Coronária com Balão/métodos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Revascularização Miocárdica/estatística & dados numéricos , Tempo para o Tratamento
20.
Heart ; 103(2): 117-124, 2017 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-27411838

RESUMO

OBJECTIVE: Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service. METHODS: We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours. RESULTS: The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p<0.0001) with a HR of 1.95 (95% CI 1.54 to 2.47) for a CTB time of >180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients. CONCLUSION: CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays.


Assuntos
Angioplastia Coronária com Balão/normas , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/mortalidade , Angioplastia Coronária com Balão/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/organização & administração , Inglaterra/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Prevenção Secundária/organização & administração , Distribuição por Sexo , Medicina Estatal/organização & administração , Fatores de Tempo , País de Gales/epidemiologia
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