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1.
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
2.
Clín. investig. arterioscler. (Ed. impr.) ; 31(5): 241-243, sept.-oct. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-184168

RESUMO

Se trata de un paciente con hipercolesterolemia familiar heterocigota y antecedentes de infarto agudo de miocardio, que es remitido a la unidad de lípidos de nuestro centro para ajuste del tratamiento hipocolesterolemiante. Dado que no alcanza los objetivos terapéuticos con tratamiento oral, comienza tratamiento con sesiones quincenales de aféresis de colesterol LDL, que mantiene durante 8 años. Con la introducción y disponibilidad de los inhibidores de la PCSK9, se presenta una nueva opción de tratamiento para este paciente


It is a patient with heterozygous familial hypercholesterolemia and a personal history of acute myocardial infarction, which is referred to our lipid unit for hypocholesterolemic treatment adjustment. Since he does not reach therapeutic goals with oral medication, he starts a treatment with fortnightly sessions of LDL-apheresis, which he keeps for 8 years. With the introduction and availability of PCSK9 inhibitors, a new treatment option is possible for this patient


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pró-Proteína Convertase 9/antagonistas & inibidores , Hiperlipoproteinemia Tipo II/diagnóstico , Infarto do Miocárdio/complicações , Anticorpos Monoclonais/farmacologia , LDL-Colesterol/antagonistas & inibidores , Anticolesterolemiantes , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/genética , Pró-Proteína Convertase 9/administração & dosagem , Pró-Proteína Convertase 9/metabolismo , Lipoproteínas LDL/efeitos dos fármacos
3.
Lancet ; 394(10207): 1415-1424, 2019 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-31500849

RESUMO

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden.


Assuntos
Precondicionamento Isquêmico Miocárdico/métodos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Idoso , Terapia Combinada , Morte Súbita Cardíaca/prevenção & controle , Feminino , Insuficiência Cardíaca/etiologia , Hospitalização , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento , Reino Unido
4.
Klin Lab Diagn ; 64(8): 463-468, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479600

RESUMO

To study the relationship between the blood concentration of superoxide dismutase in at the end of the hospital period of acute coronary syndrome without ST-segment elevation (nonST-ACS) and the development of adverse events in the long-term follow-up period. 415 patients with nonST-ACS are included in the local register study. The follow-up period was 60 months. The blood concentration of superoxide dismutase (SOD) determined in 200 patients on the 10-13th day of hospitalization in addition to clinical procedures. Within five years after discharge in 178 (47 %) patients reported the development of adverse events. Patients with poor outcome were older, had a history of myocardial infarction (PICS), stenoses of extracranial arteries more than 30% and decreased left ventricular ejection fraction (LVEF). There were significant differences in the concentration of SOD10-13 day, which was lower in the patients with development of adverse cardiovascular events (p = 0.0003). Multivariate analysis identified the factors that are most strongly associated with the development of the adverse events during a 5-year follow-up period in patients with nonST-ACS: SOD blood concentration ≤ 175,4 ng / ml (OR-3,85; р=0,0008), myocardial infarction in anamnesis (OR-3,26; р=0,006), LVEF ≤ 52% (OR-2,8; р=0,035). The incidence of adverse cardiovascular events during five years follow-up in patients with nonST-ACS was 47 % of cases. Adverse factors associated with the development of an unfavorable outcome in the long-term period follow are: SOD blood concentration ≤ 175,4 ng / ml, myocardial infarction in anamnesis, LVEF ≤ 52%.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Superóxido Dismutase/sangue , Síndrome Coronariana Aguda/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Tempo , Função Ventricular Esquerda
5.
Int Heart J ; 60(5): 1184-1188, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484860

RESUMO

We report the case of a 79-year-old man with acute myocardial infarction caused by left main trunk lesion, who experienced cardiogenic shock during percutaneous coronary intervention (PCI). To reverse the cardiogenic shock, we initiated veno-arterial extra corporeal membrane oxygenation (VA-ECMO) without an intra-aortic balloon pump (IABP) due to the severe tortuosity of the left external iliac artery. Although PCI was successful, arterial pressure monitoring revealed that the pulse pressure was too low to recover from the cardiogenic shock of decreased cardiac contraction function (the left ventricular ejection fraction was 30%). Thus, we decided to use IABP from the brachial artery to improve the hemodynamics. Immediately after the deployment of a 6-Fr IABP system (Takumi) from the left brachial artery, the pulse pressure was restored and finally VA-ECMO was withdrawn from the patient without complications. Although using IABP in combination with VA-ECMO is a reasonable strategy for cardiogenic shock, the effectiveness of this combination remains controversial. In this case, IABP added to VA-ECMO clearly achieved an improvement of pulse pressure and vital signs. Based on this result, monitoring of the pulse waveform is an effective tool to determine whether the concomitant use of IABP with VA-ECMO is indicated. Moreover, when it is difficult to insert IABP from the femoral arteries, the use of a 6-Fr IABP system (Takumi) approaching from the brachial artery should be considered.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico/métodos , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/terapia , Idoso , Pressão Sanguínea/fisiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Terapia Combinada , Serviço Hospitalar de Emergência , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Medição de Risco , Choque Cardiogênico/etiologia , Resultado do Tratamento
6.
Pol Merkur Lekarski ; 47(278): 45-51, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473751

RESUMO

Both glutathione peroxidase and deiodinases are selenoproteins requiring selenium. Oxidative stress accompanying acute myocardial infarction (MI) may lead to activation of peroxidase and relative selenium deficiency. That may impair conversion of tetraiodothyronine (T4) to triiodothyronine (T3). AIM: The aim of the study was the evaluation of the prevalence of low T3 syndrome in MI, in relation to selenium deficiency. MATERIALS AND METHODS: The study group consisted of 59 consecutive patients hospitalized due to STEMI or NSTEMI, treated with primary percutaneous coronary intervention. Exclusion criteria: thyroid dysfunction, severe systemic disease, treatment with amiodarone, steroids or propranolol. Group A consisted of 7 patients with low fT3 concentration, Group B consisted of remaining 52 patients with normal fT3 levels. RESULTS: The prevalence of low T3 syndrome was 11.9%. The prevalence of selenium deficiency was 71.2%. Patients with low T3 syndrome had higher heart rate at admission and more often needed intravenous diuretics or inotropic agents. Low fT3 group presented higher levels of NT-proBNP, hsCRP, WBC, admission CKMB levels. There was a nonsignificant trend towards lower selenium levels in A group. We demonstrated correlations between fT3 and hsTnT, CKMB, NT-proBNP, hsCRP, MAPSE but we did not find correlation between fT3 and selenium or LVEF. CONCLUSIONS: Selenium deficiency was found in majority of MI patients, while low T3 was identified in 11.9% of patients. fT3 levels correlate with markers of infarction severity and inflammatory markers. Se deficiency alone does not explain the reason of low fT3 concentration.


Assuntos
Síndromes do Eutireóideo Doente , Hipotireoidismo , Infarto do Miocárdio , Selênio , Síndromes do Eutireóideo Doente/complicações , Humanos , Hipotireoidismo/complicações , Infarto do Miocárdio/complicações , Selênio/deficiência , Tiroxina , Tri-Iodotironina
7.
Vasc Health Risk Manag ; 15: 221-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31410012

RESUMO

Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure. Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack. Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p<0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=-0.283, p<0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p=0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure. Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction.


Assuntos
Proteína C-Reativa/análise , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/sangue , Adulto , Idoso , Biomarcadores/sangue , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Arábia Saudita , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
9.
Int Heart J ; 60(4): 998-1002, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257334

RESUMO

Ventricular pseudoaneurysm (PSA) is a rare, yet life-threatening complication of myocardial infarction, cardiac surgery, and transcatheter valve replacement. Although conventional surgery is the preferred treatment strategy, transcatheter closure has emerged as an effective alternative in selected candidates. In this report, we describe successful transcatheter closure of two unique cases of ventricular pseudoaneurysm (PSA): first, a complex post-myocardial infarction left ventricular PSA (LVPSA) with multi-communications, and second, a case of post-traumatic right ventricular PSA (RVPSA) following blunt chest injury caused by domestic violence.


Assuntos
Falso Aneurisma/cirurgia , Cateterismo Cardíaco/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Infarto do Miocárdio/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Violência Doméstica , Ecocardiografia , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
11.
BMC Neurol ; 19(1): 152, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277605

RESUMO

BACKGROUND: Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. CASE PRESENTATION: A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. CONCLUSIONS: As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.


Assuntos
Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Administração Intravenosa , Idoso , Fibrilação Atrial/complicações , Doença da Artéria Coronariana/complicações , Imagem de Difusão por Ressonância Magnética , Eletrocardiografia , Procedimentos Endovasculares , Feminino , Fibrinolíticos/uso terapêutico , Coração , Humanos , Infarto da Artéria Cerebral Média/terapia , Trombectomia , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
12.
Clin Interv Aging ; 14: 1199-1206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308643

RESUMO

Objective: Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI. Methods: In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). Results: A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409-31.968; score 2, RR: 14.063, 95% CI: 3.018-65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068-70.126; score 2, RR: 10.549, 95% CI: 1.317-84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451-18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678-0.802), and the AUC of the PI was 0.703 (95% CI 0.634-0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602-0.753), and the AUC of the PI was 0.667 (95% CI 0.577-0.757). Conclusion: The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.


Assuntos
Inflamação/complicações , Inflamação/mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Idoso , Área Sob a Curva , Biomarcadores/sangue , Feminino , Humanos , Inflamação/sangue , Masculino , Análise Multivariada , Infarto do Miocárdio/sangue , Avaliação Nutricional , Prognóstico , Curva ROC , Estudos Retrospectivos
13.
Angiology ; 70(9): 860-866, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31170823

RESUMO

New-onset atrial fibrillation (NOAF) has been associated with poor outcome in patients with acute coronary syndromes (ACSs). The objective of this study was to investigate the relationship between the development of NOAF and severity of coronary artery disease using the SYNTAX score (SS) and SYNTAX score II (SSII) in patients with non-ST-segment elevation ACS (NSTE-ACS) who were treated with percutaneous coronary intervention (PCI). A total of 662 patients with NSTE-ACS were consecutively enrolled. The incidence of NOAF was 11.4% among the patients with NSTE-ACS. Mean age was significantly higher in NOAF group (P = .011). White blood cell count, peak troponin I, high sensitivity C-reactive protein, uric acid, left atrial volume index, and ratio between early mitral inflow velocity and mitral annular early diastolic velocity were significantly higher in NOAF group (respectively, P = .024, P = .017, P = .002, P = .009, P = .025, P < .001, and P < .001). The hemoglobin, ejection fraction, and post PCI thrombolysis in myocardial infarction grade <3 were significantly lower in NOAF group (P = 001, P = .010, P = .038). The SS and SSII were significantly higher in NOAF group (all P < .001). According to the results of multivariate logistic regression analysis, the SSII was correlated with NOAF (P < .001) in the study groups. We demonstrated that high SSII is significantly associated with NOAF.


Assuntos
Síndrome Coronariana Aguda/etiologia , Fibrilação Atrial/etiologia , Doença da Artéria Coronariana/etiologia , Infarto do Miocárdio/etiologia , Síndrome Coronariana Aguda/complicações , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/terapia , Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Contagem de Leucócitos/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/métodos
14.
Medicine (Baltimore) ; 98(24): e16005, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192944

RESUMO

BACKGROUND: The aim of this research is to further evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with chronic renal insufficiency (CRI) by meta-analysis, to provide scientific and effective medical evidence for PCI in patients with AMI complicated with CRI, and to support the clinical application of PCI. METHODS: Electronic databases will be searched, including PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data. Patients with AMI complicated by renal insufficiency treated with PCI will be included. The retrieval time is from inception to January 2019. The inclusion and exclusion criteria are formulated to search only the relevant literature. Endnote software management for literature will be adopted. The literature will be independently screened by 2 researchers. Excel 2016 will be applied to extract literature data with the "Research Information Registration Form." The final selected literature will be assessed for bias risk. Stata 12.0 software will be used for the meta-analysis. RESULTS: The systematic evaluation and meta-analysis will be carried out strictly in accordance with the requirements of the Cochrane System Evaluator Manual 5.3 on meta-analyses, which will provide a high-quality evaluation of the clinical efficacy and safety of PCI in patients with AMI and CRI. ETHICS AND DISSEMINATION: This study belongs to the category of systematic reviews, not clinical trials. Therefore, it does not require ethical approval. The results of this study will be published in influential international academic journals related to this topic. CONCLUSION: PCI is an effective and safe treatment for patients with AMI and CRI. This study will provide a definite evidence-based medical conclusion and provide a scientific basis for the clinical treatment of patients with AMI and CRI. PROSPERO REGISTRATION NUMBER: CRD42019131367.


Assuntos
Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Insuficiência Renal Crônica/etiologia , Feminino , Humanos , Masculino , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Projetos de Pesquisa , Resultado do Tratamento
15.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 217-226, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002227

RESUMO

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce. Objective: To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon. Methods: Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014. Results: A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 - 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 - 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 - 39.54, p = 0.001) were predictors of mortality after CABG. Conclusion: A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias , Brasil/epidemiologia , Hospitais Públicos , Revascularização Miocárdica/mortalidade , Comorbidade , Fatores Sexuais , Análise Estatística , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Síndrome Coronariana Aguda/complicações , Estudo Observacional , Infecção/complicações , Angina Instável/complicações , Infarto do Miocárdio , Infarto do Miocárdio/complicações
16.
Prog Cardiovasc Dis ; 62(3): 265-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075277

RESUMO

Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.


Assuntos
Doença das Coronárias/complicações , Morte Súbita Cardíaca/etiologia , Infarto do Miocárdio/complicações , Adulto , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Humanos , Lactente , Fatores de Risco , Tomografia Computadorizada por Raios X
17.
Mymensingh Med J ; 28(2): 474-478, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086170

RESUMO

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ruptura Cardíaca Pós-Infarto/etiologia , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/cirurgia , Humanos , Intervenção Coronária Percutânea , Próteses e Implantes , Dispositivo para Oclusão Septal , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/etiologia
18.
Ter Arkh ; 91(1): 114-128, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31090382

RESUMO

The review presents the results of a number of experimental and clinical studies proving the prospects of using L-carnitine in the clinic of internal diseases. Due to the antioxidant and antihypoxant properties, the additional use of L-carnitine in addition to the main etiopathogenetic therapy is prescribed by cardiologists, nephrologists, neurologists, gerontologists. Experimental studies we conducted earlier showed no effect of L-carnitine on the activity of the P450 CYP 3A4 system, which reduces the likelihood of drug-drug interaction at the level of metabolism of drugs metabolized by P450 3A4. When using L-carnitine as part of complex pharmacotherapy, the drug has an increased safety profile in comorbid patients taking L-carnitine. Keywords: L-carnitine, P450 CYP 3А4, chronic heart failure, myocardial infarction, chronic renal failure, inter-drug interaction, antioxidant, antihypoxant.


Assuntos
Antioxidantes/farmacologia , Carnitina/farmacologia , Citocromo P-450 CYP3A/metabolismo , Cardiopatias/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Coração/efeitos dos fármacos , Falência Renal Crônica/metabolismo , Infarto do Miocárdio/complicações , Antioxidantes/metabolismo , Carnitina/metabolismo , Carnitina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/metabolismo , Humanos , Medicina Interna , Rim/efeitos dos fármacos , Rim/metabolismo , Masculino , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/metabolismo
19.
Braz J Cardiovasc Surg ; 34(5): 550-559, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31112018

RESUMO

INTRODUCTION: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. OBJECTIVES: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. OBJECTIVES: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. RESULTS: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. CONCLUSION: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.


Assuntos
Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/etiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto , Distribuição por Idade , Brasil/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Distribuição por Sexo
20.
J Coll Physicians Surg Pak ; 29(5): 469-473, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036121

RESUMO

Myocardial infarction/ischemia can be an underlying etiology and a major causative risk factor of cardiovascular hiccups. The objective of this systematic review was to review the literature regarding clinical features and treatments of hiccups of cardiac ischemia origin. PRISMA guidelines were followed. In elderly patients with hiccups of uncertain causes, electrocardiography is necessary to ensure the cardiogenic etiology. Both symptomatic and etiologic treatments can be effective in terminating hiccups. Of the therapeutic regimens, gabapentin is a second-line agent alternative to baclofen in treating hiccups. It is especially helpful in patients undergoing stroke rehabilitation or palliative care when chlorpromazine is prohibited due to its adverse effects. Inferior myocardial infarction is the most common cause of hiccups in this patient setting. In addition to anti-myocardial ischemia agents and percutaneous coronary intervention, coronary artery bypass grafting could be an alternative to hiccups in such patients.


Assuntos
Baclofeno/uso terapêutico , Agonistas dos Receptores de GABA-B/uso terapêutico , Gabapentina/uso terapêutico , Soluço/tratamento farmacológico , Soluço/fisiopatologia , Infarto do Miocárdio/complicações , Isquemia Miocárdica/complicações , Eletrocardiografia , Soluço/diagnóstico , Soluço/etiologia , Humanos , Resultado do Tratamento
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