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1.
Trials ; 22(1): 582, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34470656

RESUMO

BACKGROUND: Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI). METHODS: DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data. DISCUSSION: It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.


Assuntos
Dieta , Infarto do Miocárdio , Adulto , Biomarcadores , Glicemia , LDL-Colesterol , Humanos , Estudos Multicêntricos como Assunto , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Rev Med Chil ; 149(3): 323-329, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479310

RESUMO

BACKGROUND: There is no recent information on the incidence of acute myocardial infarction (AMI) in Chile. AIM: To describe and evaluate the temporal incidence trend of AMI in Chile between 2008 and 2016. MATERIAL AND METHODS: A time series study. We included all AMI cases (ICD10 = I21) that were registered in Chile between 2008 and 2016 in the national hospital discharge and death databases. Rates were stratified according to sex and age group. We calculated crude and standardized rates (direct method). Time trends were evaluated using Prais-Winsten (PW) regression models. RESULTS: There were 132,784 cases of AMI. The mean age of cases was 67 ± 14 years, 67% were men. Crude and standardized rates were 84.4 and 73.1 cases per 100,000 inhabitants, respectively. Standardized incidence increased in total population and women, whose PW coefficients were 0.43 (0.01-0.82; p = 0.045) and 0.26 (0.005-0.47; p = 0.02), respectively. Regarding age, an upward trend was observed in the younger age groups, whose coefficients were 0.20 (0.08 - 0.31; p = 0.004) for cases < 45 years, 1.31 (0.81-1.81; p < 0.01) for cases between 45 and 54 years, and 2.68 (1.31 - 4.04; p = 0.002) for cases between 55 and 64 years. CONCLUSIONS: An increase in the number of cases with AMI was observed, especially in younger age groups. This estimation could be useful for planning and evaluating public policies.


Assuntos
Infarto do Miocárdio , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Alta do Paciente
3.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479878

RESUMO

A 64-year-old man with diabetes mellitus was diagnosed with a non-ST-segment elevation myocardial infarction and was treated with stent implantation. Four days later, he developed an electrical storm (ES) that persisted despite antiarrhythmic drugs and sedation. External defibrillation was performed more than 100 times over 2 hours. After ruling out the common causes of polymorphic ventricular tachycardia, an ES was considered because of brady-dependent R-on-T phenomenon, presumably precipitated by antiarrhythmic drugs. Temporary transvenous atrial overdrive pacing allowed complete suppression of premature ventricular complexes and ventricular fibrillation.


Assuntos
Infarto do Miocárdio , Preparações Farmacêuticas , Complexos Ventriculares Prematuros , Estimulação Cardíaca Artificial , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Fibrilação Ventricular/terapia
4.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479879

RESUMO

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare form of acute myocardial infarction and it is an even rarer cause of ventricular septal defect (VSD). We present a case of successful endovascular closure of post-MINOCA VSD with the use of an atrial septal defect (ASD) occluder. The patient improved from intra-aortic balloon pump dependent to New York Heart Association (NYHA) I in a matter of days. 18-month follow-up period is event free and symptom free.


Assuntos
Comunicação Interventricular , Infarto do Miocárdio , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Vasos Coronários , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Resultado do Tratamento
5.
Orv Hetil ; 162(36): 1438-1450, 2021 09 05.
Artigo em Húngaro | MEDLINE | ID: mdl-34482289

RESUMO

Összefoglaló. Elozmény: A szívinfarktus miatt kezelt betegek ellátásának regionális adataira és a betegek hosszú távú kórlefolyására vonatkozó hazai kutatás eddig nem történt. Célkituzés: A vizsgálat célja a Magyar Infarktus Regiszter pilotidoszakában rögzített betegeknél az ellátás és a 10 éves túlélés elemzése a magyarországi nagyrégiókban. Módszer: A Magyar Infarktus Regiszter (késobbi neve: Nemzeti Szívinfarktus Regiszter) 2010. január 1. és 2013. december 31. között a centrumok önkéntes részvételével 23 142 beteg adatait rögzítette, akik írásban hozzájárultak egészségügyi és klinikai adataik kezeléséhez. Az adatgyujtés a Kutatásetikai Bizottság engedélyével rendelkezett. A vizsgált populációban 12 104, ST-elevációval járó myocardialis infarctuson (STEMI) és 10 768, ST-elevációval nem járó myocardialis infarctuson (NSTEMI) átesett beteg szerepelt. A feldolgozott adatok 128 220 betegévre vonatkoznak, amelyeket nagyrégiók szerint (Nyugat-, Közép- és Kelet-Magyarország) hasonlítottunk össze. Eredmények: A STEMI-betegek 78,4%-ánál, az NSTEMI-betegek 51,6%-ánál történt katéteres érmegnyitás (PCI). NSTEMI esetén a Közép-Magyarország és Nyugat-Magyarország régiókban a beavatkozás gyakoribb volt, mint a Kelet-Magyarország régióban (p<0,01). Az utánkövetés során a PCI a Nyugat-Magyarország régióban, a revascularisatiós szívmutét (CABG) a Nyugat-Magyarország és a Kelet-Magyarország régióban szignifikánsan gyakoribb volt, mint a Közép-Magyarország régióban (p<0,01). A STEMI-betegek között a 10 év alatt a férfiak 49,2%-a, a nok 46,6%-a halt meg, az NSTEMI-csoportban 63%, illetve 57,6%. Az akut szakban elvégzett PCI mindkét betegcsoportban, nemben, az utánkövetés minden idopontjában és a vizsgált régiókban csökkentette a halálozást (p<0,01). A STEMI-betegek esetén a túlélés a régiók között nem különbözött (p = 0,72), míg az NSTEMI után a 10 éves túlélés a Nyugat-Magyarország régióban jobb volt (p<0,01). Következtetés: A magyarországi nagyrégiók között az infarktusos betegek ellátásában és prognózisában regionális különbségek vannak. Orv Hetil. 2021; 162(36): 1438-1450. HISTORY: Regional data on patients' care for myocardial infarction and the long-term follow up of patients have not yet been studied in Hungary. OBJECTIVE: The study aims to analyze the care and 10-year survival of patients recorded during the Hungarian Myocardial Infarction Registry's pilot period in large regions of Hungary. METHOD: Between Jan 1, 2010 and Dec 31, 2013, the Hungarian Myocardial Infarction Registry recorded data on 23 142 patients with voluntary participation. The Research Ethics Committee approved the program. The study included 12 104 patients with ST-elevation myocardial infarction (STEMI) and 10 768 patients with non-ST-elevation myocardial infarction (NSTEMI). The data processed refer to 128 220 patient years based on large regions (West, Central and East Hungary). RESULTS: Percutaneous coronary intervention occurred in 78.4% of STEMI patients and 51.6% of NSTEMI patients. In the NSTEMI group, percutaneous coronary interventions (PCIs) in the Central-Hungary and West-Hungary regions were significantly more common than in the East-Hungary region (p<0.01). During follow-up, PCI in the West-Hungary region, revascularization surgery in the West-Hungary and East-Hungary regions were significantly more common than in the Central-Hungary region (p<0.01). Among STEMI patients, 49.2% of men and 46.6% of women died within 10 years, while in the NSTEMI group 63% and 57.6%, respectively. PCI reduced mortality in both patient groups, sex, at all times of follow-up and in the regions studied (p<0.01). As for STEMI patients, survival was similar in all regions (p = 0.72), while after NSTEMI, 10-year survival in the West-Hungary region was better (p<0.01). CONCLUSION: There are regional differences in the care and prognosis of patients with myocardial infarction. Orv Hetil. 2021; 162(36): 1438-1450.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Humanos , Hungria , Masculino , Infarto do Miocárdio/terapia , Sistema de Registros
6.
Arq Bras Cardiol ; 117(2): 319-326, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495227

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) is the main cause of death in Brazil and the world. Approximately half of these deaths occur outside the hospital. OBJECTIVES: To analyze the distribution, temporal evolution, and sociodemographic characteristics (SDC) of in- and out-of-hospital deaths by AMI in Brazilian state capitals and their relationship with municipal development indicators (MDI). METHODS: This is an ecological study of the number of deaths due to AMI reported annually by the 27 Brazilian state capitals from 2007 to 2016; these were divided into 2 groups: in-hospital (H) and out-of-hospital (OH). We evaluated the temporal evolution of mortality rates in each group and differences in SDC. Negative binomial regression models were used to compare the temporal evolution of the number of deaths in each group with the following variables: residing in the South/Southeast regions (S/SE), municipal human development index (MHDI), Gini coefficient, and expected years of schooling (EYS). We considered p-values<0.05 as statisticallysignificant. RESULTS: The OH mortality rate increased with time for all state capitals. All studied SDC were different between groups (p<0.001). In the OH group, most deaths were of men and patients aged 80 years or older and not married. S/SE increased the incidence of OH deaths (incidence rate ratio [IRR]=2.84; 95% confidence interval [CI]=1.67-4.85), while higher EYS reduced it (IRR=0.86; 95% CI=0.77-0.97). In the H group, higher MHDI reduced the incidence of deaths (IRR=0.44; 95% CI=0.33-0.58), while higher EYS increased it (IRR=1.09; 95% CI=1.03-1.15). CONCLUSIONS: In- and out-of-hospital deaths due to AMI in Brazilian state capitals were influenced by MDI, presented sociodemographic differences and a progressive increase in out-of-hospital occurrences.


Assuntos
Infarto do Miocárdio , Brasil/epidemiologia , Proteínas do Olho , Hospitais , Humanos , Incidência , Masculino
8.
Zhongguo Zhen Jiu ; 41(9): 1023-8, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34491653

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on expression of interleukin (IL) -23/IL-17 axis and Toll-like receptor 4 (TLR4) in the infarcted tissue in rats with myocardial infarction (MI), and to explore the mechanism of EA on alleviating MI injury. METHODS: Forty male SD rats were randomly divided into a sham-operation group, a sham-operation plus EA group, a model group and an EA group, 10 rats in each group. The MI models were established by ligation of left anterior descending coronary artery in the model group and EA group, while only threading was performed in the sham-operation group and sham-operation plus EA group. The rats in the sham-operation plus EA group and EA group were treated with EA at "Neiguan" (PC 6), disperse-dense wave, 2 Hz/100 Hz, 2 mA, once a day, 20 min each time, for 3 days. After the intervention, the ejection fraction (EF) was measured by echocardiography to evaluate the cardiac function; the infarct area was measured by TTC staining; the HE staining was used to observe the morphological changes of myocardial tissue; the levels of IL-23 and IL-17 in infarcted tissue were detected by ELISA; the protein expression of TLR4 in infarcted tissue was detected by Western blot. RESULTS: Compared with the sham-operation group, the EF was decreased (P<0.01), the infarct area was increased (P<0.01), the myocardial fiber injury was obvious, accompanied by inflammatory cell infiltration, and the contents of IL-23, IL-17 and the expression of TLR4 in infarcted tissue were increased in the model group (P<0.01). Compared with the model group, the EF was increased (P<0.05), the infarct area was reduced (P<0.05), the myocardial fiber injury was significantly improved, the inflammatory cell infiltration was reduced, and the contents of IL-23, IL-17 and TLR4 expression in infarcted tissue were decreased in the EA group (P<0.05). CONCLUSION: EA may alleviate the excessive inflammatory response after MI by inhibiting the expression of IL-23/IL-17 axis in MI rats, and TLR4 may be involved during the process.


Assuntos
Eletroacupuntura , Infarto do Miocárdio , Animais , Interleucina-17/genética , Interleucina-23/genética , Masculino , Infarto do Miocárdio/genética , Infarto do Miocárdio/terapia , Ratos , Ratos Sprague-Dawley , Receptor 4 Toll-Like/genética
9.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493556

RESUMO

We report a case of a ventricular septal rupture (VSR) which occurred during coronary artery bypass grafting (CABG) operation. The procedure took place 5 days after ST-elevation myocardial infarction of the inferior wall. The VSR repair was not performed at the time of the CABG operation. The intention was to wait until scar formation occurs to facilitate the repair. The patient was supported with venoarterial extracorporeal membranous oxygenation (VA-ECMO) and additional intra-aortic balloon pump (IABP) on intensive care unit. Ten days after CABG the patient underwent a successful VSR repair and 5 days later was weaned from VA-ECMO. He was discharged from hospital 6 weeks after the initial CABG. This case report underlines the importance of VA-ECMO and a multidisciplinary approach with frequent examination of haemodynamic state in the treatment of patients with mechanical complications of myocardial infarction who are not suitable for immediate repair.


Assuntos
Oxigenação por Membrana Extracorpórea , Infarto do Miocárdio , Ruptura do Septo Ventricular , Ponte de Artéria Coronária , Humanos , Balão Intra-Aórtico , Masculino , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia
10.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433529

RESUMO

COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.


Assuntos
COVID-19 , Trombose Coronária , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Vasos Coronários , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
11.
Int J Mol Sci ; 22(16)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445662

RESUMO

Acute myocardial infarction (MI) is associated with an intense inflammatory response that is critical for cardiac repair but is also involved in the pathogenesis of adverse cardiac remodeling, i.e., the set of size, geometry, and structure changes that represent the structural substrate for the development of post-MI heart failure. Deciphering the pathophysiological mechanisms underlying cardiac repair after MI is, therefore, critical to favorably regulate cardiac wound repair and to prevent development of heart failure. Catecholamines and estrogen play an active role in regulating the inflammatory response in the infarcted area. For example, stress-induced catecholamines alter recruitment and trafficking of leukocytes to the heart. Additionally, estrogen affects rate of cardiac rupture during the acute phase of MI, as well as infarct size and survival in animal models of MI. In this review, we will summarize the role of ß-adrenergic receptors and estrogen in cardiac repair after infarction in preclinical studies.


Assuntos
Estrogênios/metabolismo , Insuficiência Cardíaca/prevenção & controle , Infarto do Miocárdio/complicações , Receptores Adrenérgicos beta/metabolismo , Remodelação Ventricular , Animais , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Humanos
12.
BMJ Open ; 11(8): e046824, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446485

RESUMO

OBJECTIVES: Few studies have explored whether the risk of myocardial infarction (MI) or stroke varies among patients with degenerative aortic valve disease (DAVD) with different severity of aortic regurgitation (AR) or not. Thus, a prospective study was conducted to elucidate the causal relationship between AR severity and risk of incident MI and stroke among patients with DAVD recruited from a general population in Northeast China. DESIGN: Prospective cohort study. SETTING: Community-based study carried out in rural areas of Northeast China. METHODS: There were 3675 patients with DAVD aged ≥45 years eligible for the prospective study. During a median follow-up time of 4.64 years, 99 participants lost to follow-up. Cox regression analyses were used to investigate the association between baseline AR severity and the risk of incident MI or stroke. RESULTS: In the final cohort of 3576 patients with DAVD, there were 3153 patients without AR (88.2%), 386 patients with mild AR (10.8%) and 37 patients with moderate or severe AR (1.0%). Multivariate analyses showed that, compared with participants without AR, those with moderate/severe AR were associated with 8.33 and 6.22-fold increased risk of MI and MI mortality, respectively. However, no significant associations between AR and the risk of stroke or stroke mortality were observed. CONCLUSIONS: As compared with no AR, moderate/severe AR but not mild AR was an independent predictor for the risk of MI and MI mortality. AR was not significantly associated with stroke or stroke mortality, irrespective of AR severity. Secondary prevention strategies should be taken to delay the progression of DAVD and thus reduce the incidence of MI.


Assuntos
Valvopatia Aórtica , Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Infarto do Miocárdio , Acidente Vascular Cerebral , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , China/epidemiologia , Estudos de Coortes , Ecocardiografia , Humanos , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
14.
Curr Cardiol Rep ; 23(10): 133, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410529

RESUMO

PURPOSE OF REVIEW: High mechanical index impulses from a diagnostic transducer are utilized in myocardial perfusion imaging, but can also be utilized therapeutically in three cardiovascular applications: (a) thrombus dissolution (sonothrombolysis), (b) improving microvascular flow in ischemic territories (sonoperfusion), and (c) targeted drug and nucleic acid delivery. The targeted therapeutic effect appears to be based on acoustic cavitation of the intravascular microbubbles which results in endothelial shear and pore formation, as well as mechanical destruction of thrombi. RECENT FINDINGS: Within the last 5 years, clinical trials have been performed in acute myocardial infarction demonstrating successful reductions in myocardial infarct size with sonothrombolysis added to current guideline-based treatment. In patients with severe peripheral arterial disease, brief improvements in calf microvascular blood flow have been observed for 1 h after 10 min of sonoperfusion therapy. Targeted ultrasound therapies are developing for prevention of microvascular obstruction in acute coronary syndromes and peripheral vascular disease.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Terapia por Ultrassom , Humanos , Microbolhas , Infarto do Miocárdio/terapia , Ultrassonografia
17.
BMJ Open ; 11(8): e050254, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404713

RESUMO

OBJECTIVES: To determine the relationship between depressive symptoms and progression of carotid intima-media thickness (cIMT) in a Beijing community-based population. DESIGN: Prospective cohort study between 2014 and 2018. SETTING: Dwellers without cardiovascular disease, hypertension or diabetes from a Beijing community. PARTICIPANTS: 3849 Chinese community-dwelling individuals who underwent baseline screening for depressive symptoms were invited to participate in the study in 2014 and follow-up visit in 2018. Among them, 2124 participants completed carotid ultrasound examination both at baseline and a follow-up visit. After further excluding patients with a history of stroke, myocardial infarction or lower extremity arterial stenosis and those with a diagnosis of hypertension or diabetes and ankle-brachial index ≤0.9 at baseline, 1011 eligible participants were finally included. PRIMARY OUTCOME MEASURE: The rate of mean cIMT change. RESULTS: Over a median follow-up period of 4.40 years, the overall rate of mean cIMT change was 2.23% (-5.64% to 9.51%). After adjustment for 13 covariates, there was an increase of 2.36% (ß=2.36, 95% CI: 0.37 to 4.36, p=0.020) for the rates of mean cIMT change in the depressive group compared with the control group. Furthermore, this association was modified by drinking status (ß=3.22, 95% CI: 1.25 to 5.19, P-interaction=0.006). CONCLUSION: Depressive symptoms were independently associated with progression of mean cIMT in a community-based cohort in Beijing, China. Furthermore, this relationship was modified by drinking status.


Assuntos
Espessura Intima-Media Carotídea , Infarto do Miocárdio , Pequim/epidemiologia , China/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Humanos , Estudos Prospectivos
18.
BMJ Open ; 11(8): e048356, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408048

RESUMO

BACKGROUND: The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED). METHODS: We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC). RESULTS: The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs. CONCLUSIONS: TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.


Assuntos
Infarto do Miocárdio , Troponina , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Triagem
19.
Molecules ; 26(16)2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34443591

RESUMO

The development and progression of heart failure (HF) due to myocardial infarction (MI) is a major concern even with current optimal therapy. Resveratrol is a plant polyphenol with cardioprotective properties. Sacubitril/valsartan is known to be beneficial in chronic HF patients. In this study, we investigated the comparative and combinatorial benefits of resveratrol with sacubitril/valsartan alongside an active comparator valsartan in MI-induced male Sprague Dawley rats. MI-induced and sham-operated animals received vehicle, resveratrol, sacubitril/valsartan, valsartan alone or sacubitril/valsartan + resveratrol for 8 weeks. Echocardiography was performed at the endpoint to assess cardiac structure and function. Cardiac oxidative stress, inflammation, fibrosis, brain natriuretic peptide (BNP), creatinine and neutrophil gelatinase associated lipocalin were measured. Treatment with resveratrol, sacubitril/valsartan, valsartan and sacubitril/valsartan + resveratrol significantly prevented left ventricular (LV) dilatation and improved LV ejection fraction in MI-induced rats. All treatments also significantly reduced myocardial tissue oxidative stress, inflammation and fibrosis, as well as BNP. Treatment with the combination of sacubitril/valsartan and resveratrol did not show additive effects. In conclusion, resveratrol, sacubitril/valsartan, and valsartan significantly prevented cardiac remodeling and dysfunction in MI-induced rats. The reduction in cardiac remodeling and dysfunction in MI-induced rats was mediated by a reduction in cardiac oxidative stress, inflammation and fibrosis.


Assuntos
Aminobutiratos/farmacologia , Compostos de Bifenilo/farmacologia , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Resveratrol/farmacologia , Valsartana/farmacologia , Remodelação Ventricular/efeitos dos fármacos , Animais , Combinação de Medicamentos , Interações Medicamentosas , Fibrose , Humanos , Masculino , Infarto do Miocárdio/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Função Ventricular Esquerda/efeitos dos fármacos
20.
Curr Cardiol Rep ; 23(10): 142, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410528

RESUMO

PURPOSE OF REVIEW: Pregnancy-associated myocardial infarction is a principal cause of cardiovascular disease with a steadily rising incidence of 4.98 AMI events/100,000 deliveries over the last four decades in the USA. It is also linked with significant maternal and fetal morbidity and mortality, with maternal case fatality rate ranging from 5.1 to 37%. The management of acute myocardial infarction can be challenging in pregnant patients since treatment modalities and medication use are limited by their safety during pregnancy. RECENT FINDINGS: Limited guidelines exist regarding the management of pregnancy-associated myocardial infarction. Routinely used medications in myocardial infarction including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and statin therapy are contraindicated during pregnancy. Aspirin use is considered safe in pregnant women, but dual antiplatelet therapy and therapeutic anticoagulation can be associated with increased risk of maternal and fetal complications, and should only be used after a comprehensive benefit-to-risk assessment. The standard approach to revascularization requires additional caution in pregnant women. Percutaneous coronary intervention is generally considered safe but can be associated with high failure rates and poor outcomes depending on the etiology. Fibrinolytic therapy may have significant sequelae in pregnant patients, and hemodynamic management during surgery is complex and adds risk during pregnancy. Understanding the risks and benefits of the different treatment modalities available and their utility depending on the underlying etiology, encompassed with a multidisciplinary team approach, is vital to improve outcomes and minimize maternal and fetal complications.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Humanos , Incidência , Infarto do Miocárdio/terapia , Gravidez
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