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1.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34083389

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly. OBJECTIVES: The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country. METHOD: Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions. RESULTS: A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175). CONCLUSION: There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , COVID-19/complicações , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Angina Instável/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/normas , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2/isolamento & purificação , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
2.
Emergencias ; 33(3): 181-186, 2021 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33978331

RESUMO

BACKGROUND: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS: A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.


Assuntos
Fatores Etários , Serviços Médicos de Emergência , Comportamento de Busca de Ajuda , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Feminino , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/estatística & dados numéricos , Paris/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
3.
Emerg Med J ; 38(6): 446-449, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33832923

RESUMO

BACKGROUND: In response to the COVID-19 pandemic, a national lockdown was introduced on 23 March 2020. In the following weeks, emergency departments in the UK reported a reduction in attendances. We aimed to explore the incidence of emergency calls across North East England, as well as the number of out-of-hospital cardiac arrest (OHCA) deaths. METHODS: Data were collected for all patients who contacted North East Ambulance Service between 4 March 2019-2 June 2019 and 2 March 2020-31 May 2020 suffering stroke, ST elevation myocardial infarction, allergy, asthma, chronic obstructive pulmonary disease, falls, intoxication, seizure, sepsis, acute coronary syndrome and OHCA. RESULTS: There were a reduction in incidence of calls, excluding OHCA, resulting in ambulance activation during the pandemic compared with same period in 2019, 16 743 versus 19 639, respectively (-14.74%). The decline in calls was partially reversed by the end of May 2020. Incidence of OHCA at the time of the national lockdown had increased by 13.79% with a peak increase of 73.56% in the second week in April 2020. OHCA deaths peaked in the first 2 weeks in April 2020, 95.65% and 90.07%, respectively, but by the end May 2020, incidence of OHCA and OHCA deaths had returned to prelockdown levels. CONCLUSION: Incidence of emergency calls were reduced during the pandemic compared with 2019. There was a rise in incidence of OHCA and OHCA deaths during the same period; however, these changes appear transient. Further research is required to understand patient behaviour towards seeking help during the pandemic and the long-term consequences of not doing so.


Assuntos
Ambulâncias/estatística & dados numéricos , COVID-19/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Estudos Transversais , Despacho de Emergência Médica/estatística & dados numéricos , Humanos , Incidência , Parada Cardíaca Extra-Hospitalar/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Reino Unido/epidemiologia
4.
Open Heart ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33811137

RESUMO

OBJECTIVE: We aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms. METHODS: We conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. Samples were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method. RESULTS: We enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%); p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8-46 vs 27 days, IQR: 7-44; p=0.378). CONCLUSION: We found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.


Assuntos
COVID-19/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Doenças não Diagnosticadas , Adulto , Idoso , Bangladesh/epidemiologia , COVID-19/diagnóstico , COVID-19/mortalidade , Progressão da Doença , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo
5.
Rev Cardiovasc Med ; 22(1): 247-256, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33792269

RESUMO

ST-segment elevation myocardial infarction (STEMI) is a common cardiovascular emergency for which timely reperfusion therapies are needed to minimize myocardial necrosis. The aim of this study was to investigate the impact of the COVID-19 pandemic and reorganization of chest pain centers (CPC) on the practice of primary percutaneous coronary intervention (PPCI) and prognosis of STEMI patients. This single-center retrospective survey included all patients with STEMI admitted to our CPC from January 22, 2020 to April 30, 2020 (during COVID-19 pandemic in Wuhan), compared with those admitted during the analogous period in 2019, in respect of important time points of PPCI and clinical outcomes of STEMI patients. In the present article, we observed a descending trend in STEMI hospitalization and a longer time from symptom onset to first medical contact during the COVID-19 pandemic as compared to the control period (4.35 h versus 2.58 h). With a median delay of 17 minutes in the door to balloon time (D2B), the proportion of in-hospital cardiogenic shock was significantly higher in the COVID-19 era group (47.6% versus 19.5%), and major adverse cardiac events (MACE) tend to increase in the 6-month follow-up period (14.3% versus 2.4%). Although the reorganization of CPC may prolong the D2B time, immediate revascularization of the infarct-related artery could be offered to most patients within 90 minutes upon arrival. PPCI remained the preferred treatment for patients with STEMI during COVID-19 pandemic in the context of timely implementation and appropriate protective measures.


Assuntos
COVID-19 , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , China/epidemiologia , Atenção à Saúde , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Pandemias , Intervenção Coronária Percutânea/efeitos adversos , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
6.
J Am Coll Cardiol ; 77(16): 1994-2003, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33888249

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). OBJECTIVES: The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. METHODS: A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. RESULTS: As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). CONCLUSIONS: COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.


Assuntos
COVID-19/epidemiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Estudos Prospectivos , Recidiva , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
7.
Med J Aust ; 214(7): 310-317, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33792058

RESUMO

OBJECTIVE: To determine whether the availability of invasive coronary angiography at the hospital of presentation influences catheterisation rates for patients with acute coronary syndrome (ACS), and whether presenting to a catheterisation-capable hospital is associated with better outcomes for patients with ACS. DESIGN, SETTING: Retrospective cohort study; analysis of Cooperative National Registry of Acute Coronary Events (CONCORDANCE) data. SETTING, PARTICIPANTS: Adults admitted with ACS to 43 Australian hospitals (including 31 catheterisation-capable hospitals), February 2009 - October 2018. MAIN OUTCOME MEASURES: Major adverse cardiovascular events (myocardial infarction, stroke, congestive heart failure, cardiogenic shock, cardiovascular death) and all-cause deaths in hospital and by six and 12- or 24-month follow-up. RESULTS: The proportion of women among the 5637 patients who presented to catheterisation-capable hospitals was smaller than for the 2608 patients who presented to hospitals without catheterisation facilities (28% v 33%); the proportion of patients diagnosed with ST elevation myocardial infarction was larger (32% v 20%). The proportions of patients who underwent catheterisation (81% v 70%) or percutaneous coronary intervention (49% v 35%) were larger for those who presented to catheterisation-capable hospitals. The baseline characteristics of patients who underwent catheterisation were similar for both presentation hospital categories, as were rates of major adverse cardiovascular events and all-cause death in hospital and by 6- and 12- or 24-month follow-up. CONCLUSIONS: Although a larger proportion of patients who presented to catheterisation-capable hospitals underwent catheterisation, patients with similar characteristics were selected for the procedure, independent of the hospital of presentation. Major outcomes for patients were also similar, suggesting equitable management of patients with ACS across Australia.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Cateterismo Cardíaco/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Cateterismo Cardíaco/métodos , Angiografia Coronária/métodos , Morte , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , 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/fisiopatologia , Choque Cardiogênico/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
9.
J Pak Med Assoc ; 71(2(A)): 484-488, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33819233

RESUMO

OBJECTIVE: To evaluate the angiographic profile and outcome of primary percutaneous coronary intervention in female patients with acute myocardial infarction. METHODS: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from July 1, 2017, to March 31, 2018, and comprised of female patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention and got enrolled in the National Cardiovascular Data Registry. Follow-up calls were made 1 year post-intervention and outcomes were noted. Data were analysed using SPSS 21. RESULTS: Of the 522 female patients with a mean age of 57.41±11.14 years, 334(64%) were hypertensive, 202(38.7%) diabetic, 16(3.1%) had a family history of coronary artery disease, and 9(1.7%) were smokers. Single-vessel disease was observed in 183(35.1%) patients, and three-vessel disease in 144(27.6%). Post-procedure thrombolysis in myocardial infarction flow (0-II) was observed in 29(5.6%) patients, bleeding in 2(0.4%), and in-hospital mortality was in 22(4.2%). Telephonic follow-up was successfully conducted in 436(87.5%) of the discharged patients, and, of them 15(3.4%) had expired and recurrence was reported by 10(2.3%) patients and 8(80%) of them underwent re-intervention. CONCLUSIONS: More than half the female patients had multi-vessel disease and bifurcation lesion was observed in more than three-fourth of the sample.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Angiografia Coronária , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Resultado do Tratamento
10.
J Cardiothorac Surg ; 16(1): 106, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888133

RESUMO

BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR. CASE PRESENTATION: We present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table. CONCLUSIONS: The occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.


Assuntos
COVID-19/epidemiologia , Ruptura Cardíaca/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Comorbidade , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Eletrocardiografia , Ruptura Cardíaca/diagnóstico , Ventrículos do Coração , Humanos , Masculino , Pandemias , Radiografia Torácica , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
11.
Int J Cardiol ; 332: 235-237, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33766626

RESUMO

BACKGROUND: Investigations demonstrated a decrease of admissions for myocardial infarction (MI) during the CoronaVirus Disease-19 (COVID-19) outbreak. No study has evaluated the time required to reverse this downward curve of MI admissions. METHODS: This is a retrospective analysis on patients (N = 2415) admitted to the Emergency Departments for acute MI in nine Italian centers. Primary endpoint was the incidence rates (IRs) of MI admissions in the post-lockdown COVID-19 period (case-period: from May 4 to July 12, 2020) vs. the following control periods: January 1-February 19, 2020 (pre-lockdown period); February 20-May 3, 2020 (intra-lockdown period); May 4-July 12, 2019 (inter-year non-COVID-19 period). RESULTS: IR of admissions for MI in the post-lockdown period was higher than the intra-lockdown period (IR ratio, IRR: 1.60, 95% CI 1.42-1.81; p = 0.0001), was lower than the pre-lockdown period (IRR: 0.86, 0.77-0.96; p = 0.009) and similar to the inter-year non-COVID-19 period (IRR: 0.96, 0.87-1.07; p = 0.47). Within the case period, the increase in MI admissions was more pronounced in earlier vs later weeks (IRR 1.19, 95% CI 1.02-1.38, p = 0.024) and, compared to the inter-year control period, was significant for non ST-segment elevation MI (IRR: 1.25, 95% CI 1.08-1.46, p = 0.004), but was not observed for ST-segment elevation MI (STEMI), where hospitalizations were reduced (IRR 0.76, 95% CI 0.65-0.88, p = 0.0001). CONCLUSIONS: Our study first indicates an increase in the number of admissions for MI after the removal of the national lockdown for COVID-19 in Italy. This increase was prevalent in the first weeks following the lockdown removal, but was under-represented in STEMI patients.


Assuntos
COVID-19 , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Controle de Doenças Transmissíveis , Surtos de Doenças , Hospitalização , Humanos , Itália/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , 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/cirurgia
12.
Kardiologiia ; 61(2): 40-46, 2021 Mar 06.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734047

RESUMO

Aim      To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1-2=0.001; p1-3<0.001; p2-3=0.520). The incidence of major cardiac complications ("adverse cardiac events", MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1-2=0.020; p1-3<0.001; p2-3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1-2=0.539; p1-3=0.001; p2-3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion      The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the "door-to-balloon" time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , 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/cirurgia , Resultado do Tratamento
13.
Echocardiography ; 38(3): 469-472, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33599346

RESUMO

The Covid-19 pandemia has many other undesirable consequences apart of virus infection. Less people is hospitalized due to acute coronary syndrome and the delay to seek medical attention has increased. Patients with ST segment elevation myocardial infarction arrive at the hospital too late to be timely treated and we have recently seen mechanical complications that were more frequent in the past decades before the use of reperfusion strategies. In this report we describe the presentation, evolution and detailed imaging evaluation of two patients with unusual presentations of cardiac rupture: left ventricular pseudoaneurysm and left ventricular intramyocardial dissecting hematoma.


Assuntos
COVID-19/epidemiologia , Ecocardiografia/métodos , Ruptura Cardíaca Pós-Infarto/etiologia , Ventrículos do Coração/diagnóstico por imagem , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Comorbidade , Feminino , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
14.
Am J Emerg Med ; 43: 134-141, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33561622

RESUMO

BACKGROUND: One of the modifiable risk factors for ST elevation myocardial infarction is prehospital delay. The purpose of our study was to look at the effect of contamination contamination obsession on prehospital delay compared with other measurements during the Covid-19 pandemic. METHOD: A total of 139 patients with acute STEMI admitted to our heart center from 20 March 2020 to 20 June 2020 were included in this study. If the time interval between the estimated onset of symptoms and admission to the emergency room was >120 min, it was considered as a prehospital delay. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and Padua Inventory-Washington State University Revision (PI-WSUR) test were used to assess Contamination-Obbsessive compulsive disorder (C-OCD). RESULT: The same period STEMI count compared to the previous year decreased 25%. The duration of symptoms onset to hospital admission was longer in the first month compared to second and third months (180 (120-360), 120 (60-180), and 105 (60-180), respectively; P = 0.012). Multivariable logistic regression (model-2) was used to examine the association between 7 candidate predictors (age, gender, diabetes mellitus (DM), hypertension, smoking, pain-onset time, and coronary artery disease (CAD) history), PI-WSUR C-OCD, and admission month with prehospital delay. Among variables, PI-WSUR C-OCD and admission month were independently associated with prehospital delay (OR 5.36 (2.11-13.61) (P = 0.01); 0.26 (0.09-0.87) p < 0.001] respectively]. CONCLUSION: Our study confirmed that contamination obsession was associated with prehospital delay of STEMI patients, however anxiety and depression level was not associated during the pandemic.


Assuntos
COVID-19/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Serviço Hospitalar de Emergência , Comportamento Obsessivo , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Tempo para o Tratamento , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo
15.
Am J Emerg Med ; 43: 50-53, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33516070

RESUMO

BACKGROUND: Acute coronary syndrome is a disease with high prevalence and high mortality. Exposure to heat or cold increases the risks of myocardial infarction significantly. Gender-specific effects of this have not yet been examined. Our goal was to determine whether extreme weather conditions, which become more and more frequent, are gender-specific risk factors for myocardial infarction, in order to help provide faster diagnosis and revascularization therapy for patients. METHODS: We analysed the incidence of ST-elevation myocardial infarction (STEMI) in a large urban area over a 65-months period in a cohort study. A day was the unit of analysis. Incidence rate ratios (IRR) with Poisson regression models were calculated. All patients with STEMI on Saturdays and Sundays were included. Gender, high or low perceived temperatures (PT), a function of temperature, wind speed and humidity, and meteorological cold and heat warnings by the Austrian Central Institute for Meteorology and Geodynamics (ZAMG) were considered as risk factors. RESULTS: During the 562 days of the study period, a total of 1109 patients with STEMI (803; 72% men, mean age 61;14 years) were included. The gender difference between men and women was much more pronounced on cold (0 °C) days (85% of patients male; 1.8 per day) than on hot (20 °C) days (71% male; 1.4 per day) or days without extreme temperatures (72% male; 1.4 per day). We found significant interaction between gender and cold days (IRR of the interaction term 2.3 (95% CI 1.2-4.6), p = 0.02). No gender-specific effect was observed on warm days (IRR for interaction 0.9 (95% CI 0.6-1.3), p = 0.3). CONCLUSION: Low perceived temperature pronouncedly increases the already elevated risk for STEMI in males. Whether this effect is based on gender alone, or on one of the cardiovascular risk factors which are more common in men, is up to further study.


Assuntos
Tempo Frio Extremo , Clima Quente Extremo , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Estudos de Coortes , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo
18.
Int J Clin Pract ; 75(5): e14005, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33400345

RESUMO

OBJECTIVE: Delayed revascularisation in patients with ST-segment elevation myocardial infarction (STEMI) is associated with poor prognosis. The aim of this study is to investigate how the timeline in STEMI treatment was affected during the Covid-19 outbreak. METHOD: Consecutive 165 STEMI patients were enrolled in the study during the Covid-19 pandemic period (Pandemic period) and the prepandemic period (Control period). The time period until patients' leaving their current position after the onset of pain (home delay), the time from the onset of pain to the first medical contact (FMC delay), door-to-balloon time, procedure time and hospitalisation time were recorded. RESULTS: A total of 165 patients, 82 in the Pandemic period and 83 in the Control period, were included in the study. When compared with the control period, home delay [30 (5-6912) minutes vs 165 (10-360) minutes, P < .001] and FMC delay [61 (20-6932) minutes vs 190 (15-3660) minutes, P < .001] were significantly prolonged during the pandemic period. In addition, non-IRA PCI rate (8.8% vs 19.3% P = .043) and hospitalisation time [71 (15-170) vs 74.2 (37-329) hours, P = .045] were decreased. CONCLUSION: During the Covid-19 pandemic period, prolonged prehospital time parameters were observed in STEMI patients. Therefore, additional measures may be required to prevent unfavourable delays in STEMI patients during the outbreak.


Assuntos
COVID-19 , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Pandemias , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
19.
Am J Cardiol ; 145: 18-24, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33454349

RESUMO

Discrepancies in medical care are well known to adversely affect patients with opioid abuse disorders (OUD), including management and outcomes of acute myocardial infarction (AMI) in patients with OUD. We used the National Inpatient Sample was queried from January 2006 to September 2015 to identify all patients ≥18 years admitted with a primary diagnosis of AMI (weighted N = 13,030; unweighted N = 2,670) and concomitant OUD. Patients using other nonopiate illicit drugs were excluded. Propensity matching (1:1) yielded 2,253 well-matched pairs in which intergroup comparison of invasive revascularization strategies and cardiac outcomes were performed. The prevalence of OUD patients with AMI over the last decade has doubled, from 163 (2006) to 326 cases (2015) per 100,000 admissions for AMI. The OUD group underwent less cardiac catheterization (63.2% vs 72.2%; p <0.001), percutaneous coronary intervention (37.0% vs 48.5%; p <0.001) and drug-eluting stent placement (32.3% vs 19.5%; p <0.001) compared with non-OUD. No differences in in-hospital mortality/cardiogenic shock were noted. Among subgroup of ST-elevation myocardial infarction patients (26.2% of overall cohort), the OUD patients were less likely to receive percutaneous coronary intervention (67.9% vs 75.5%; p = 0.002), drug-eluting stent (31.4% vs 47.9%; p <0.001) with a significantly higher mortality (7.4% vs 4.3%), and cardiogenic shock (11.7% vs 7.9%). No differences in the frequency of coronary bypass grafting were noted in AMI or its subgroups. In conclusion, OUD patients presenting with AMI receive less invasive treatment compared with those without OUD. OUD patients presenting with ST-elevation myocardial infarction have worse in-hospital outcomes with increased mortality and cardiogenic shock.


Assuntos
Mortalidade Hospitalar , Revascularização Miocárdica/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Choque Cardiogênico/epidemiologia , Injúria Renal Aguda/epidemiologia , Idoso , Cateterismo Cardíaco/estatística & dados numéricos , Comorbidade , Ponte de Artéria Coronária/estatística & dados numéricos , Stents Farmacológicos/estatística & dados numéricos , Feminino , Hospitalização/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Avaliação de Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/estatística & dados numéricos , Prevalência , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estados Unidos/epidemiologia
20.
J Cardiovasc Med (Hagerstown) ; 22(5): 344-349, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399345

RESUMO

BACKGROUND: Public health emergencies such as the COVID-19 outbreak may impact on the incidence rate of ST-elevation myocardial infarction (STEMI) in severely affected areas. However, this phenomenon demands attention also in areas where media and patients were focused on the COVID-19 pandemic, but the healthcare system was not overwhelmed by the huge number of COVID-19 patients. METHODS AND RESULTS: In this observational study, we compared the incidence rate of all consecutive STEMI patients admitted at the University Hospital of Trieste, Italy, during March and April 2020 with the same 2 months of the previous 5 years (2015-2019). Patient characteristics were compared between 2020 and 2019.The incidence rate of STEMI admission in March-April 2020 was lower than those in March-April 2015-2019, 36 vs. 56 cases per 100 000 inhabitants/year [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.42-0.96, P = 0.045]. Considering that the incidence rates were constant in the past years (P = 0.24), the turnaround in 2020 is most likely due to the COVID-19 outbreak. Interestingly, this reduction was a dynamic phenomenon with a U-shaped curve during the 2-month period. System-of-care times were similar between 2020 and 2019; however in 2020, patients presented more frequently signs of heart failure compared to 2019 (Killip class ≥2 in 68% vs. 29%, P = 0.003). CONCLUSION: During the COVID-19 outbreak, we observed a marked reduction in the STEMI incidence rate. This U-shaped phenomenon demands attention because a potential cause for the decrease in STEMI incidence may include the avoidance of medical care. Public campaigns aiming to increase awareness of ischemic symptoms may be needed during community outbreak.


Assuntos
COVID-19/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Controle de Doenças Transmissíveis , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/estatística & dados numéricos
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