Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 161.683
Filtrar
1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 99-103, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914576

RESUMO

To explore the epidemiological characteristics, trends and relevant factors of pre-hospital mortality due to acute myocardial infarction (AMI) from 1999 to 2016 in Tianjin city, based on mortality surveillance information and household registration population information. Standardized mortality rates were calculated using the year 2000 world standard population. From 1999 to 2016, the research result showed that the pre-hospital crude mortality rates of AMI were 39.47/100 000 to 90.64/100 000 and the standardized mortality rates were 30.92/100 000 to 53.90/100 000. The proportion of pre-hospital AMI deaths was 73.96%-81.92% (t=1.09, P>0.05) within the same period. Aged, female, rural residents, unmarried, divorced, widowed, low education level, and outdoor workers have a relative higher proportion of pre-hospital AMI mortality.


Assuntos
Infarto do Miocárdio/mortalidade , Idoso , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Mortalidade/tendências , Fatores Socioeconômicos
2.
Angiology ; 71(1): 17-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31129986

RESUMO

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/prevenção & controle , África do Norte/epidemiologia , Idade de Início , Idoso , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade Prematura , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Prevalência , Prevenção Primária , Prognóstico , Projetos de Pesquisa , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
3.
Angiology ; 71(1): 27-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31533437

RESUMO

We assessed the cardiovascular safety of long-term direct-acting oral anticoagulant (DOAC) treatment. A search of the medical literature was performed from inception until May 31, 2019. Inclusion criteria were (1) randomized trial that assessed the clinical efficacy and/or safety of 1 or more DOAC, (2) control group including oral anticoagulation and/or antiplatelet and/or placebo treatment, and (3) the incidence of acute coronary syndrome during follow-up was reported. Fixed-effect and random-effects models were applied. The analyzed outcomes were myocardial infarction (MI), major bleeding, and mortality. Twenty-eight randomized clinical trials (196 761 patients) were included. Rivaroxaban was associated with a 21% reduction in the relative risk of MI when compared to placebo (relative risk [RR]: 0.79 [95% credible interval, CrI: 0.65-0.94]) and a 31% reduction (RR: 0.70 [95% CrI: 0.53-0.89]) when compared to dabigatran. Apixaban resulted in 24% (RR: 0.76 [95% CrI: 0.58-0.99]) and vitamin K antagonists anticoagulation resulted in 19% (RR: 0.81 [95% CrI: 0.65-0.98]) risk reduction compared to dabigatran. The computed probability of being the first best choice of treatment was 61.8% for rivaroxaban. Cardiovascular safety shows considerable heterogeneity among oral anticoagulants. Treatment with rivaroxaban is associated with reduced rate of MI.


Assuntos
Anticoagulantes/administração & dosagem , Infarto do Miocárdio/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Esquema de Medicação , Hemorragia/induzido quimicamente , Humanos , Infarto do Miocárdio/mortalidade , Meta-Análise em Rede , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Zhongguo Zhong Yao Za Zhi ; 44(18): 3869-3875, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31872717

RESUMO

Mahuang Fuzi Xixin Decoction recorded in Treatise on Febrile Diseases by Zhang Zhongjing in the Han Dynasty have been widely used in treating Yang deficiency and exogenous wind-cold syndrome by traditional Chinese medicine physicians for thousands of years. The indications of Mahuang Fuzi Xixin Decoction include bradyarrhythmia,sinus bradycardia,sick sinus node syndrome,senile exogenous,asthmatic cold,rhinitis,bronchial asthma,optic neuritis,optic atrophy,sudden blindness,sudden onset of cough,laryngeal obstruction,migraine,joint pain,low back pain,insomnia,shock,heart failure,renal failure,accompanied by fever or nosocomial infection,and hyperpyrexia after tracheotomy; dark complexion,chills,cold limbs,listlessness,fatigue,insomnia,lack of thirst,liking hot drinks,slightly swollen limbs or whole body,pale fat tongue,greasy fur,and deep pulse. Mahuang Fuzi Xixin Decoction is a potential drug for Shaoyin disease complicated with fever and pain. Tracheal intubation is an artificial ephedrine syndrome. It is necessary to distinguish Yin and Yang syndrome in treating hyperpyrexia after tracheotomy. However,it belongs to Yin syndrome,which could be treated by Mahuang Fuzi Xixin Decoction. Mahuang Fuzi Xixin Decoction is effective in the treatment of sick sinus syndrome,second degree atrioventricular block and third degree atrioventricular block. It can significantly alleviate symptoms,improve heart rate,and heart rhythm in a short period of time. However,after one year of drug withdrawal,the diseases may recur,indicating that Mahuang Fuzi Xixin Decoction may not improve the long-term prognosis of slow arrhythmia. Mahuang Fuzi Xixin Decoction is often used for fever or nosocomial infection in critical care medicine. In the treatment of critical care medicine complicated with high fever,Mahuang Fuzi Xixin Decoction is often taken continuously by stomach tube.


Assuntos
Infecção Hospitalar/tratamento farmacológico , Neuropatias Diabéticas/complicações , Medicamentos de Ervas Chinesas/farmacologia , Febre/tratamento farmacológico , Infarto do Miocárdio/complicações , Dor Pós-Operatória/tratamento farmacológico , Traqueotomia/efeitos adversos , Cuidados Críticos , Diabetes Mellitus , Humanos , Medicina Tradicional Chinesa , Fitoterapia , Síndrome
5.
ABCS health sci ; 44(3): 213-216, 20 dez 2019.
Artigo em Inglês, Português | LILACS | ID: biblio-1047758

RESUMO

INTRODUÇÃO: Este estudo relata possíveis fatores para a recorrência de infarto agudo do miocárdio de um paciente atendido em unidade coronariana sob a perspectiva familiar. RELATO DE CASO: Trata-se de um estudo descritivo, com abordagem qualitativa, do tipo relato de caso. Os dados foram coletados através de uma entrevista piloto semiestruturada, realizada com um familiar de uma paciente que se encontrava internada na unidade coronariana com recorrência de Infarto Agudo do Miocárdio (IAM). O familiar relatou que a intensa atividade física realizada pela paciente, o consumo excessivo de álcool e a não adesão ao tratamento medicamentoso contribuíram para o segundo quadro de IAM. A familiar mencionou que as orientações recebidas durante a alta foram somente em torno dos medicamentos prescritos, destacando a ausência de orientações acerca das alterações no estilo de vida, em especial à equipe de enfermagem. CONCLUSÃO: O presente relato revelou que as orientações durante a alta não estão sendo efetivas na prevenção da recorrência de IAM e ressalta a necessidade de repensar o papel dos profissionais de enfermagem em relação às orientações prestadas, como forma de facilitar a adesão do paciente ao tratamento medicamentoso e às mudanças no estilo de vida.


INTRODUCTION: This study reports the possible factors for the recurrence of acute myocardial infarction of a patient attended in the coronary care unit in the perspective of relatives. CASE REPORT: This is a descriptive study, with qualitative approach, of the case report type. The data were collected through a semi-structured pilot interview, conducted with a member of the patient family, who was hospitalized in the coronary care unit with the recurrence of Acute Myocardial Infarction (AMI). The relative reported that the intense physical activity performed by the patient, the excessive consumption of alcohol and non-adherence to drug therapy, have contributed to the second event of AMI. The same mentioned that the guidance received during the high, were only around for medicines prescribed, highlighting the absence of guidance about the changes in life style and the realization of the same by health care professionals, in particular nursing staff. CONCLUSION: The present report revealed that the guidelines during the high are not being effective in the prevention of the recurrence of AMI, and highlights the need to rethink the role of professional nursing in relation to the guidelines provided, as a way of facilitating the patient's adherence to medication treatment and changes in lifestyle.


Assuntos
Humanos , Feminino , Idoso , Relatos de Casos , Família , Prevenção de Doenças , Relações Familiares , Cooperação e Adesão ao Tratamento , Promoção da Saúde , Infarto do Miocárdio
6.
MMWR Morb Mortal Wkly Rep ; 68(5): 101-106, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-31851653

RESUMO

Heart disease is the leading cause of death in the United States (1). Heart attacks (also known as myocardial infarctions) occur when a portion of the heart muscle does not receive adequate blood flow, and they are major contributors to heart disease, with an estimated 750,000 occurring annually (2). Early intervention is critical for preventing mortality in the event of a heart attack (3). Identification of heart attack signs and symptoms by victims or bystanders, and taking immediate action by calling emergency services (9-1-1), are crucial to ensure timely receipt of emergency care and thereby improve the chance for survival (4). A recent report using National Health Interview Survey (NHIS) data from 2014 found that 47.2% of U.S. adults could state all five common heart attack symptoms (jaw, neck, or back discomfort; weakness or lightheadedness; chest discomfort; arm or shoulder discomfort; and shortness of breath) and knew to call 9-1-1 if someone had a heart attack (5). To assess changes in awareness and response to an apparent heart attack, CDC analyzed data from NHIS to report awareness of heart attack symptoms and calling 9-1-1 among U.S. adults in 2008, 2014, and 2017. The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/prevenção & controle , Adolescente , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
7.
Kyobu Geka ; 72(13): 1061-1065, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879380

RESUMO

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit (a viscous diisocyanate prepolymer). A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass (CPB) was discontinued under intraaortic balloon pumping (IABP) support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.


Assuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca , Infarto do Miocárdio , Idoso , Ponte Cardiopulmonar , Feminino , Ventrículos do Coração , Humanos
8.
Wiad Lek ; 72(11 cz 1): 2094-2098, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860853

RESUMO

OBJECTIVE: Introduction: Modern strategies of STEMI/NSTEMI management, that include revascularization by coronary stenting, bypass grafting, nowadays are used in 30-40% of urgent patients of such category. The prevalent part of patients is treated by administration of the optimal drug therapy. The aim of the research was to study the influence of trimetazidine and levocarnitine on the clinical course of STEMI/NSTEMI. PATIENTS AND METHODS: Materials and methods: 100 patients with STEMI/NSTEMI were included into the research. Depending on the therapy scheme, patients were divided into three groups and the control one. Determination of the key parameters was performed initially after hospitalization and at the day of patient discharge. RESULTS: Results: Promising results were shown while slowing the myocardial fibrosing. Limiting of the infarcted and `stunned` myocardium area resulted in ejection fraction increase, increase of the myocardial reserve, measured by echocardiographic indexes. CONCLUSION: Conclusions: Decreasing of myocardial fibrosing can be potentiated by the pharmacological postconditioning as well as limiting of the necrotic myocardium area and increase of viable myocardium area. Pharmacological postconditioning is effective and save, that can be proved by the absence of any serious complications.


Assuntos
Infarto do Miocárdio , Fibrose , Humanos , Resultado do Tratamento , Trimetazidina
9.
Kardiologiia ; 59(11): 14-20, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849295

RESUMO

AIM: The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event. MATERIALS AND METHODS: Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index. RESULTS: At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome. CONCLUSION: ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.


Assuntos
Síndrome Coronariana Aguda , Fibrilação Atrial , Infarto do Miocárdio , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/terapia , Idoso , Humanos , Inibidores da Agregação de Plaquetas , Testes de Função Plaquetária , Sistema de Registros , Fatores de Risco , Resultado do Tratamento
10.
Kardiologiia ; 59(12): 92-96, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849316

RESUMO

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease of unknown etiology characterized by a wide range of clinical manifestations with damage to various organs and systems of the body. There are bad prognostic factors for SLE: damage to the heart, kidney, central nervous system, the development of hematological crises and secondary antiphospholipid syndrome. A number of authors consider systemic lupus erythematosus a "new" risk factor for atherosclerosis. The overall risk of myocardial infarction (MI) in patients with SLE is 10 times higher than in the general population. The article presents clinical case report of the development of myocardial infarction in a woman with SLE, receiving therapy for secondary antiphospholipid syndrome.


Assuntos
Síndrome Antifosfolipídica , Aterosclerose , Lúpus Eritematoso Sistêmico , Infarto do Miocárdio , Feminino , Humanos , Fatores de Risco
11.
Rev. Hosp. El Cruce ; (25): 44-48, Dic 2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1047126

RESUMO

El score de riesgo KAsH fue diseñado como alternativa para predecir mortalidad intrahospitalaria en pacientes con IAMCEST en una población europea, y cuenta con variables sencillas que se pueden obtener en la cabecera de los pacientes. OBJETIVO:Validar el score KAsH en nuestro medio y compararlo con otros scores. METODOLOGÍA: La validación se realizó en una base de datos hospitalaria del conurbano bonaerense que cuenta con un registro consecutivo y en forma prospectiva de pacientes con IAMCEST desde mayo de 2009 a julio de 2018 (n=977). Se descartaron los casos con información incompleta. Para cada paciente se calculó un puntaje según la fórmula KAsH y se agruparon en 4 categorías. La discriminación del modelo se evaluó con curva ROC y se calculó el área bajo la curva (AUC) con su respectivo intervalo de confianza. El score KAsH se comparó con los modelos GRACE, TIMI y ProACS mediante el test de DeLong. RESULTADOS: Se incluyeron 884 casos con información completa. La mortalidad intrahospitalaria fue 5.2% y por subgrupos fue la siguiente: 1=0.91%, 2=5.1%, 3=18.8%, 4=53.3%. El AUC fue de 0.86 (IC 95% 0,80-0.93). El análisis de comparaciones múltiples de AUC evaluado con el test de DeLong no evidenció diferencias estadísticamente significativas (p=0.18). CONCLUSIONES: El score KAsH presentó buena discriminación y calibración para pronóstico de mortalidad intrahospitalaria en nuestro medio. Dado que requiere pocas variables de sencilla adquisición, la aplicación del score KAsH puede constituir una alternativa atractiva a los scores tradicionales.


The KAsH risk score was designed as an alternative to predict in-hospital mortality in patients with IAMCEST in a European population, and has variables that can be obtained at the bedside. OBJECTIVE: To validate the KAsH score in our environment and compare it with other scores. METHODS: The validation was carried out in a hospital database of the Buenos Aires suburbs that has a consecutive and prospective registry of patients with IAMCEST from May 2009 to July 2018 (n = 977). Cases with incomplete information were ruled out. For each patient, a score was calculated according to the KAsH formula and grouped into 4 categories. The discrimination of the model was evaluated with the ROC curve and the area under the curve (AUC) was calculated with its respective confidence interval. The KAsH score was compared with the GRACE, TIMI and ProACS models using the DeLong test. RESULTS: 884 cases with complete information were included. In-hospital mortality was 5.2% and by subgroups it was as follows: 1 = 0.91%, 2 = 5.1%, 3 = 18.8%, 4 = 53.3%. The AUC was 0.86 (95% CI 0.80-0.93). The analysis of multiple comparisons of AUC evaluated with the DeLong test showed no statistically significant differences (p = 0.18). CONCLUSIONS: The KAsH score presented good discrimination and calibration for in-hospital mortality prognosis in our environment. Since it requires few variables of simple acquisition, the application of the KAsH score can be an attractive alternative to traditional scores.


Assuntos
Prognóstico , Mortalidade , Estudos de Validação , Infarto do Miocárdio
15.
Kardiologiia ; 59(10S): 41-51, 2019 Dec 23.
Artigo em Russo | MEDLINE | ID: mdl-31876461

RESUMO

According to the literature, 40-60% of patients with acute myocardial infarction (AMI) have obstructive multivessel coronary artery disease (CA) and 8.8% of patients have non-obstructive CA lesions. And it is around these two groups of patients that there are active discussions and disputes regarding the choice of optimal treatment tactics and further prognosis. The aim of the study was to study clinical and laboratory features of development and course of primary AMI in patients with multi-and single-vessel obstructive lesion of the CA compared with patients with non-obstructive CA lesions. Methods. The study has included patients hospitalized "through the ambulance channel" in the Department of cardiac intensive care of municipal clinical hospital named after S. S. Yudin Moscow with a diagnosis "primary acute myocardial infarction", ACS with and without ST segment elevation, unstable angina in 2015-2016. The diagnosis of acute myocardial infarction (AMI) was established at the hospital stage according to the criteria of the "Third universal definition of myocardial infarction" in 2012. The study included 1240 patients who underwent coronary angiography (CAG) no later than 12 hours from the time of admission. The first group (comparison group) consisted of patients with AMI and the first detected multivessel obstructive atherosclerotic lesion of CA (664 patients), the second (interest group) consisted of patients with AMI and non-obstructive atherosclerotic lesion of CA (96 patients) meeting the MINOCA criteria. The third group consisted of patients with single-vessel obstructive lesion and complete acute occlusion of the CA (272 patients). Patients with hemodynamically significant lesions of the left CA trunk were not included in the study. The clinical and laboratory features of the course of acute primary myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis were studied. The generally accepted statistical processing methods were used. A year after discharge from the hospital, 727 patients (468 patients from the 1st group, 78 from the 2nd group, 181 from the 3rd group) were interviewed by means of a structured telephone survey about the course of the disease (collection of medical history). The median follow-up was 12 months. (interquartile range 11-13 months). The endpoints were: re-hospitalization for any reason, re-coronary event, death. The received answers are entered into questionnaires and statistically processed. Results and conclusions. In patients with AMI and non-obstructive atherosclerotic CA lesion, pain behind the sternum is observed one and a half times less often (54.2%) than in patients with obstructive CA lesion (MOAPCA 86.1%, OAPCA 89.7%) and the cardiac co duction system is almost three times more likely to be affected ( 30% versus 8.4% and 12%). Only 12.5% of patients in this group had an abnormal Q wave (Q - myocardial infarction) on the ECG, therefore, a smaller volume of myocardial damage and a lower level of troponin than in patients of groups 1 and 3. During the first year after the development of AMI, patients with obstructive coronary atherosclerosis did not experience repeated coronary events, there were no indications for conducting CAG, PCI or CABG, in contrast to patients with obstructive lesion of CA. For multivascular obstruction (group 1), PCI was performed in 9.6% of patients and 3.8% of CABG. PCI was performed in group 3 with obstructive single-vessel lesion of CA in 7.7% of patients. In patients with AMI and obstructive single-vessel atherosclerotic lesion of CA (group 3), two and a half times less often (9.1%) myocardial reperfusion injury is observed, while in patients with multivascular obstructive CA defeat, this syndrome was observed in 21.3%.


Assuntos
Aterosclerose/complicações , Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Humanos , Moscou , Infarto do Miocárdio/complicações
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(6): 1103-1107, 2019 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-31848512

RESUMO

OBJECTIVE: To observe the clinical prognosis and surgical treatment results in patients with postinfarction ventricular septal rupture, and to discuss the risk factors, methods & timing of treatment. METHODS: From January 2006 to February 2019, 23 patients with postinfarction ventricular septal rupture were admitted to the department of cardiac surgery, Peking University People's Hospital, including 12 males (52.2%) and 11 females (47.8%), aged (64.26 ±11.09) years. Among them, 18 cases underwent operation, and 5 cases did not receive surgical treatment. The clinical data and follow-up data were summarized retrospectively. RESULTS: Among the patients treated with operation, the average time from perforation to operation was (19.39 ±13.67) d, including 6 cases (33.3%) of perforation within 1 week, 6 cases (33.3%) within 2 to 4 weeks and 6 cases (33.3%) more than 4 weeks. Emergency surgery was performed in 11 cases (61.1%) because of hemodynamic instability, and selective operation in 7 cases (38.9%). Direct enlarged patch was used in 13 cases (72.2%), and some infarct exclusion techniques were used in 5 patients (27.8%). In 18 cases, coronary artery bypass grafting was performed in 12 cases (66.7%). Of all the surgical patients, 7 (38.9%) died during hospitalization. Compared with the survival patients, the perioperative death patients had earlier perforation [(1.83±0.75) d vs. (5.22 ±4.66) d, P=0.019] and higher emergency operation rate (100% vs. 36.4%, P=0.009) and lower simultaneous bypass grafting rate (28.6% vs. 90.1%, P=0.008). The median follow-up time was 2 years (3 months to 10 years). 2 patients died of heart failure in 2 months after operation, and 9 cases (50.0%) survived for a long time. Of the 5 patients who had not been treated, 2 died while waiting for operation, and 3 patients who refused surgery died within 1 week after discharge. CONCLUSION: Surgery is an effective treatment for patients with acute myocardial infarction complicated with ventricular septum perforation. The best time for operation should be determined by real-time evaluation and monitoring, combined with the situation of patients. Concomitant coronary artery bypass grafting may be beneficial to these patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Infarto do Miocárdio , Ruptura do Septo Ventricular , Idoso , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Pan Afr Med J ; 33: 275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692844

RESUMO

The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.


Assuntos
Dor no Peito/diagnóstico , Infarto do Miocárdio/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos
20.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-31668726

RESUMO

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Criança , Estudos de Coortes , Pesquisa Comparativa da Efetividade/métodos , Bases de Dados Factuais , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Medicina Baseada em Evidências/métodos , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA