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1.
BMJ ; 367: l5367, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31594780

RESUMO

OBJECTIVE: To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). DESIGN: Matched cohort study. SETTING: Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 225 925), Spain (n=5 488 397), and UK (n=12 695 046). PARTICIPANTS: 120 795 adults with a recorded diagnosis of NAFLD or NASH and no other liver diseases, matched at time of NAFLD diagnosis (index date) by age, sex, practice site, and visit, recorded at six months before or after the date of diagnosis, with up to 100 patients without NAFLD or NASH in the same database. MAIN OUTCOME MEASURES: Primary outcome was incident fatal or non-fatal AMI and ischaemic or unspecified stroke. Hazard ratios were estimated using Cox models and pooled across databases by random effect meta-analyses. RESULTS: 120 795 patients with recorded NAFLD or NASH diagnoses were identified with mean follow-up 2.1-5.5 years. After adjustment for age and smoking the pooled hazard ratio for AMI was 1.17 (95% confidence interval 1.05 to 1.30; 1035 events in participants with NAFLD or NASH, 67 823 in matched controls). In a group with more complete data on risk factors (86 098 NAFLD and 4 664 988 matched controls), the hazard ratio for AMI after adjustment for systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, and hypertension was 1.01 (0.91 to 1.12; 747 events in participants with NAFLD or NASH, 37 462 in matched controls). After adjustment for age and smoking status the pooled hazard ratio for stroke was 1.18 (1.11 to 1.24; 2187 events in participants with NAFLD or NASH, 134 001 in matched controls). In the group with more complete data on risk factors, the hazard ratio for stroke was 1.04 (0.99 to 1.09; 1666 events in participants with NAFLD, 83 882 in matched controls) after further adjustment for type 2 diabetes, systolic blood pressure, total cholesterol level, statin use, and hypertension. CONCLUSIONS: The diagnosis of NAFLD in current routine care of 17.7 million patient appears not to be associated with AMI or stroke risk after adjustment for established cardiovascular risk factors. Cardiovascular risk assessment in adults with a diagnosis of NAFLD is important but should be done in the same way as for the general population.


Assuntos
Hipertensão/epidemiologia , Fígado/patologia , Infarto do Miocárdio/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Países Baixos/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Espanha/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
2.
Medicine (Baltimore) ; 98(39): e17195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574826

RESUMO

The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into 4 groups: ECG-/Echo- (negative ECG and Echo), ECG+/Echo- (positive ECG and negative Echo), ECG-/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.MACEs were similar between ECG-/Echo- and ECG+/Echo- groups. Compared with ECG+/Echo- group, ECG-/Echo+ group had more MACEs (adjusted hazard ratio [HR] adjusted by clinical risk factors [95% confidence interval {CI}], 3.57 [1.75-7.29], P < .001). Compared with ECG+/Echo+ group, ECG-/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs (HR, 0.49 [0.29-0.81], P = .006).Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared with exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Dor no Peito/complicações , Angiografia Coronária , Doença da Artéria Coronariana/etiologia , Exercício/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X
3.
Eur J Epidemiol ; 34(10): 967-977, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31512117

RESUMO

Asthma, a chronic inflammatory airway disease, shares several common pathophysiological mechanisms with acute myocardial infarction (AMI). Our aim was to assess the prospective associations between asthma, levels of asthma control and risk of AMI. We followed 57,104 adults without previous history of AMI at baseline from Nord-Trøndelag health study (HUNT) in Norway. Self-reported asthma was categorised as active asthma (i.e., using asthma medication) and non-active asthma (i.e., not using asthma medication). Levels of asthma control were defined as controlled, partly controlled, and uncontrolled based on the Global Initiative for Asthma guidelines. AMI was ascertained by linking HUNT data with hospital records. A total of 2868 AMI events (5.0%) occurred during a mean (SD) follow-up of 17.2 (5.4) years. Adults with active asthma had an estimated 29% higher risk of developing AMI [adjusted hazard ratio (HR) 1.29, 95% CI 1.08-1.54] compared with adults without asthma. There was a significant dose-response association between asthma control and AMI risk, with highest risk in adults with uncontrolled asthma (adjusted HR 1.73, 95% CI 1.13-2.66) compared to adults with controlled asthma (p for trend < 0.05). The associations were not explained by smoking status, physical activity and C-reactive protein levels. Our study suggests that active asthma and poor asthma control are associated with moderately increased risk of AMI. Further studies are needed to evaluate causal relationship and the underlying mechanisms and to clarify the role of asthma medications in the risk of AMI.


Assuntos
Asma/epidemiologia , Infarto do Miocárdio/epidemiologia , Adulto , Idoso , Asma/fisiopatologia , Asma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Noruega/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
Einstein (Sao Paulo) ; 17(4): eAO4632, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31433007

RESUMO

OBJECTIVE: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. METHODS: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. RESULTS: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). CONCLUSION: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.


Assuntos
Atividade Motora/fisiologia , Força Muscular/fisiologia , Infarto do Miocárdio/etiologia , Obesidade/complicações , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Sarcopenia/fisiopatologia
5.
Yonsei Med J ; 60(9): 824-831, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433580

RESUMO

PURPOSE: We evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation drug-eluting stent (DES) implantation. MATERIALS AND METHODS: A total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data. RESULTS: All 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank). CONCLUSION: Although CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.


Assuntos
Aneurisma Coronário/epidemiologia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Idoso , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/terapia , Angiografia Coronária , Reestenose Coronária/terapia , Vasos Coronários , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Prognóstico , Sistema de Registros , Trombose/complicações , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(33): e16657, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415359

RESUMO

RATIONALE: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic stem cell disease. Patients with PNH often experience a high incidence (14%-40%) of thrombotic events, which are mainly venous and rarely arterial thrombotic events. Because it is very rare, delay in diagnosis is common in patients with PNH, imposing a remarkable impact on patient's management and prognosis. PATIENT CONCERNS: We presented a 33-year-old female case with no medical history of any systemic illnesses who complained of approximately 1-month progressively worsening constant heartburn, and was also hospitalized twice due to acute myocardial infarction (AMI). DIAGNOSES: In our case, AMI occurred twice, whereas there were no cardiovascular risk factors and abnormalities based on the angiography of the coronary artery. Flow cytometry analysis showed that 25% of CD55 and CD59 were lost on the surface of neutrophils, and 30% of CD55 and CD59 were lost on the surface of the blood cells. Thus, our diagnosis of this patient was AMI secondary to PNH. INTERVENTIONS AND OUTCOMES: For the first myocardial infarction, local hospitals used thrombolytic therapy to alleviate symptoms. After the patient's second myocardial infarction was treated in our hospital, we adopted coronary interventional therapy. Considering the patient's situation, eculizumab was given for treatment. The patient was gradually restored to achieve stability, and the follow-up observation showed that there was no arterial thrombosis. LESSONS: This case report aimed to provide a reliable reference for the rare cause of AMI. In addition, PNH should be highly taken into consideration in young patients who have a rare cause of AMI.


Assuntos
Hemoglobinúria Paroxística/complicações , Infarto do Miocárdio/etiologia , Doença Aguda , Adulto , China , Feminino , Humanos , Infarto do Miocárdio/urina , Recidiva
7.
Br J Anaesth ; 123(4): 421-429, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256916

RESUMO

BACKGROUND: The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and the Revised Cardiac Risk Index (RCRI) were derived using currently outdated methods of diagnosing perioperative myocardial infarctions. We tested the external validity of these tools in a setting of a systematic perioperative cardiac biomarker measurement. METHODS: Analysis of routinely collected data nested in the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study. A consecutive sample of patients ≥45 yr old undergoing in-hospital noncardiac surgery in a single tertiary care centre was enrolled. The predictive performance of the models was tested in terms of the occurrence of major cardiac complications defined as a composite of a nonfatal myocardial infarction, a nonfatal cardiac arrest, or a cardiac death within 30 days after surgery. The plasma concentration of high-sensitivity troponin T was measured before surgery, 6-12 h after operation, and on the first, second, and third days after surgery. Myocardial infarction was diagnosed according to the Third Universal Definition. RESULTS: The median age was 65 (59-72) yr, and 704/870 (80.9%) subjects were male. The primary outcome occurred in 76/870 (8.7%; 95% confidence interval [CI], 6.9-10.8%) patients. The c-statistic was 0.64 (95% CI, 0.57-0.70) for the NSQIP MICA and 0.60 (95% CI, 0.54-0.65) for the RCRI. Predicted risks were systematically underestimated in calibration belts (P<0.001). The RCRI and the NSQIP MICA showed no clinical utility before recalibration. CONCLUSIONS: The NSQIP and RCRI models had limited predictive performance in this at-risk population. The recently updated version of the RCRI was more reliable than the original index.


Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Cardiopatias/epidemiologia , Complicações Intraoperatórias/terapia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/terapia , Medição de Risco/normas , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Estudos de Coortes , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Melhoria de Qualidade , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
8.
Nat Commun ; 10(1): 3027, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289275

RESUMO

Fibrosis accompanying wound healing can drive the failure of many different organs. Activated fibroblasts are the principal determinants of post-injury pathological fibrosis along with physiological repair, making them a difficult therapeutic target. Although activated fibroblasts are phenotypically heterogeneous, they are not recognized as distinct functional entities. Using mice that express GFP under the FSP1 or αSMA promoter, we characterized two non-overlapping fibroblast subtypes from mouse hearts after myocardial infarction. Here, we report the identification of FSP1-GFP+ cells as a non-pericyte, non-hematopoietic fibroblast subpopulation with a predominant pro-angiogenic role, characterized by in vitro phenotypic/cellular/ultrastructural studies and in vivo granulation tissue formation assays combined with transcriptomics and proteomics. This work identifies a fibroblast subtype that is functionally distinct from the pro-fibrotic αSMA-expressing myofibroblast subtype. Our study has the potential to shift our focus towards viewing fibroblasts as molecularly and functionally heterogeneous and provides a paradigm to approach treatment for organ fibrosis.


Assuntos
Fibroblastos/metabolismo , Infarto do Miocárdio/patologia , Miocárdio/patologia , Neovascularização Fisiológica/fisiologia , Cicatrização/fisiologia , Actinas/genética , Actinas/metabolismo , Animais , Transplante de Medula Óssea , Proteínas de Ligação ao Cálcio/metabolismo , Diferenciação Celular , Modelos Animais de Doenças , Fibroblastos/patologia , Fibrose/etiologia , Fibrose/patologia , Proteínas de Fluorescência Verde/genética , Células Endoteliais da Veia Umbilical Humana , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/citologia , Proteína A4 de Ligação a Cálcio da Família S100/genética , Proteína A4 de Ligação a Cálcio da Família S100/metabolismo , Quimeras de Transplante
9.
Angiology ; 70(10): 908-915, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31256614

RESUMO

The optimal treatment strategy for coronary chronic total occlusion (CTO) has not been well established. The benefit of percutaneous coronary intervention (PCI) was inferred mainly from observational studies comparing successful versus failed PCI without a control group receiving optimal medical therapy (OMT). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing PCI using drug-eluting stent (DES) versus OMT alone in patients with CTO. Eight studies were identified: 3 RCTs and 5 observational studies. Among a total of 4784 included patients, 2461 patients underwent PCI and 2323 patients received OMT. There was a significant association between PCI and lower cardiac mortality (odds ratio = 0.62; 95% confidence interval 0.42-0.93; P = .02). There was no significant difference between PCI and OMT regarding major adverse cardiac events, recurrent myocardial infarction (MI), repeat revascularization, or stroke. In the RCT subset (1399 patients), there was no significant difference between PCI and OMT regarding clinical outcomes. Compared with OMT alone, PCI with DES for CTO was associated with lower cardiac mortality, mainly driven by observational studies, without significant difference in recurrent MI or repeated revascularization. Further RCTs are needed to investigate the role of PCI for management of patients with CTO.


Assuntos
Oclusão Coronária/terapia , Stents Farmacológicos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Oclusão Coronária/mortalidade , Stents Farmacológicos/efeitos adversos , Humanos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
10.
N Engl J Med ; 381(3): 243-251, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314968

RESUMO

BACKGROUND: The relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes remains unclear and has been complicated by recently revised guidelines with two different thresholds (≥140/90 mm Hg and ≥130/80 mm Hg) for treating hypertension. METHODS: Using data from 1.3 million adults in a general outpatient population, we performed a multivariable Cox survival analysis to determine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years. The analysis controlled for demographic characteristics and coexisting conditions. RESULTS: The burdens of systolic and diastolic hypertension each independently predicted adverse outcomes. In survival models, a continuous burden of systolic hypertension (≥140 mm Hg; hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI], 1.17 to 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07) independently predicted the composite outcome. Similar results were observed with the lower threshold of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. A J-curve relation between diastolic blood pressure and outcomes was seen that was explained at least in part by age and other covariates and by a higher effect of systolic hypertension among persons in the lowest quartile of diastolic blood pressure. CONCLUSIONS: Although systolic blood-pressure elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg). (Funded by the Kaiser Permanente Northern California Community Benefit Program.).


Assuntos
Pressão Sanguínea , Hipertensão/complicações , Infarto do Miocárdio/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Isquemia Encefálica/etiologia , Diástole , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Análise de Sobrevida , Sístole
11.
Expert Rev Cardiovasc Ther ; 17(7): 497-510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232618

RESUMO

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Doenças Vasculares/congênito , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Recidiva , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
12.
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
13.
Int J Mol Sci ; 20(11)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167392

RESUMO

Spaceflight alters many processes of the human body including cardiac function and cardiac progenitor cell behavior. The mechanism behind these changes remains largely unknown; however, simulated microgravity devices are making it easier for researchers to study the effects of microgravity. To study the changes that take place in cardiac progenitor cells in microgravity environments, adult cardiac progenitor cells were cultured aboard the International Space Station (ISS) as well as on a clinostat and examined for changes in Hippo signaling, a pathway known to regulate cardiac development. Cells cultured under microgravity conditions, spaceflight-induced or simulated, displayed upregulation of downstream genes involved in the Hippo pathway such as YAP1 and SOD2. YAP1 is known to play a role in cardiac regeneration which led us to investigate YAP1 expression in a sheep model of cardiovascular repair. Additionally, to mimic the effects of microgravity, drug treatment was used to induce Hippo related genes as well as a regulator of the Hippo pathway, miRNA-302a. These studies provide insight into the changes that occur in space and how the effects of these changes relate to cardiac regeneration studies.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Expressão Gênica , Mioblastos Cardíacos/metabolismo , Fosfoproteínas/genética , Voo Espacial , Simulação de Ausência de Peso , Ausência de Peso , Animais , Biomarcadores , Diferenciação Celular/genética , Humanos , Proteínas com Homeodomínio LIM/metabolismo , MicroRNAs/genética , Mioblastos Cardíacos/citologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Proteínas Serina-Treonina Quinases/metabolismo , Ovinos , Transdução de Sinais , Transplante de Células-Tronco , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismo , Fatores de Transcrição/metabolismo
14.
Biomed Res Int ; 2019: 6585040, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179331

RESUMO

Adherence to antiplatelet therapy is critical to successful treatment of cardiovascular conditions. However, little has been known about this issue in the context of constrained resources such as in Vietnam. The objective of this study was to examine the adherence to antiplatelet therapy among patients receiving acute myocardial infarction interventions and its associated factors. In a cross-sectional survey design, 175 adult patients revisiting Vietnam National Heart Institute diagnosed with acute myocardial infarction were approached for data collection from October 2014 to June 2015. Adherence to antiplatelet therapy was assessed by asking patients whether they took taking antiplatelet regularly as per medication (do not miss any dose at the specified time) for any type of antiplatelet (aspirin, clopidogrel, ticlopidine...) during the last month before the participants came back to take re-examinations. The results indicated that the adherence to antiplatelet therapy among patients was quite high at 1 month; it begins to decline by 6 months, 12 months, and more than 12 months (less than 1 month was 90.29%; from 1 to 6 months 88.0%, from 6 to 12 months 75.43%, and after 12 months only 46.29% of patients). Multivariable logistic regression was utilized to detect factors associated with the adherence to antiplatelet therapy. It showed that patients with average income per month of $300 or more (OR=2.92, 95% CI=1.24-6.89), distance to the hospital of less than 50km (OR=2.48, 95% CI: 1.12-5.52), taking medicine under doctor's instructions (OR=3.65; 95% CI=1.13-11.70), and timely re-examination (OR=3.99, 95% CI=1.08-14.73) were more likely to follow the therapy. In general, the study suggested that to increase the likelihood of adherence to antiplatelet therapy it is important to establish a continuous care system after discharging from hospital.


Assuntos
Adesão à Medicação/psicologia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Adulto , Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Estudos Transversais , Feminino , Coração , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Alta do Paciente , Análise de Regressão , Inquéritos e Questionários , Ticlopidina/uso terapêutico , Vietnã
15.
Medicine (Baltimore) ; 98(22): e15634, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145279

RESUMO

To analyze the short-term effects of air pollution on the hospitalization rates of individuals with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), stroke, and myocardial infarction (MI) after adjusting for confounding factors including weather, day of the week, holidays, and long-term trends in Jinan, China.Hospitalization information was extracted based on data from the primary class 3-A hospitals in Jinan from 2013 to 2015. The concentrations of PM2.5, PM10, SO2, NO2, and O3 were obtained from Jinan Environment Monitoring Center. The relative risk and 95% confidence intervals of AECOPD, stroke, and MI were estimated using generalized additive models with quasi-Poisson distribution in the mgcv package, using R software, version 1.0.136.The incremental increased concentrations of particulate pollutants including PM2.5 and PM10 were significantly associated with increased risk of hospitalization of AECOPD, stroke, and MI, and the adverse influences of PM2.5 on these diseases were generally stronger than that of PM10. The incremental increased concentrations of gaseous pollutants including SO2, NO2, and O3 were significantly associated with increased risk of hospitalization of stroke and MI in this population.Air pollution has significant adverse effects on hospitalization rates of individuals with AECOPD, stroke, and MI in Jinan, China.


Assuntos
Poluição do Ar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Doença Aguda , Adulto , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , China/epidemiologia , Progressão da Doença , Monitoramento Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/etiologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
16.
Medicine (Baltimore) ; 98(22): e15797, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145306

RESUMO

OBJECTIVE: This study evaluated the clinical value of drug-coated balloons for patients with small-vessel coronary artery disease (SVD). METHODS: A computerized literature search was performed using the databases to conduct a meta-analysis and evaluate the clinical value of drug-coated balloons among patients with SVD. RESULTS: This review enrolling 1545 patients receiving drug-coated balloons and 1010 patients receiving stents (including drug-eluting stents and bare-metal stents). The meta-analysis results showed that the incidence of major adverse cardiovascular events among patients with SVD did not significantly differ between the drug-coated balloon group and the stent group within 1 postoperative year (odds ratio = 0.81, P = .5). A subgroup analysis showed that the incidence of myocardial infarction among the drug-coated balloon group was significantly lower than that among the stent group (odds ratio = 0.58, P = .04). Nevertheless, the late lumen loss of the drug-coated balloon group was significantly lower than that of the stent group (mean difference = 0.31, P = .01). CONCLUSIONS: Drug-coated balloons can be used to effectively reduce the incidence of myocardial infarction in patients with SVD within 1 year and decrease the extent of late lumen loss without increasing the incidence of major adverse cardiovascular events.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fármacos Cardiovasculares/administração & dosagem , Estudos de Casos e Controles , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Feminino , Humanos , Incidência , Masculino , Infarto do Miocárdio/etiologia , Razão de Chances , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
17.
World Neurosurg ; 122: e512-e515, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31060199

RESUMO

BACKGROUND: Postoperative ileus is not uncommon after spinal surgery. Although previous research has focused on the frequency of ileus formation, little has been done to investigate the clinical sequelae after development. We investigated the effect of postoperative ileus on patients' length of stay and rates of deep vein thrombosis (DVT) formation, myocardial infarction (MI), aspiration pneumonia, sepsis, and death. METHODS: The Healthcare Cost and Utilization Project National Inpatient Sample was queried to identify adult patients who underwent any spinal fusion procedure. Patient characteristics and outcomes for discharges involving spinal fusion surgery were compared between patients with and without postoperative ileus. The Rao-Scott χ2 test of association was used for categorical variables, and a t test for equality of means was used for continuous variables. Among discharges with postoperative ileus, a multivariate linear regression model was used to assess how fusion approach and fusion length were associated with length of hospital stay, controlling for sex, age, and race. RESULTS: A total of 250,221 patients were included. The mean length of stay was 3.75 days for patients without postoperative ileus and 9.40 days for patients with postoperative ileus. Patients with postoperative ileus are more likely to have DVT (4.1% vs. 20.8%, P < 0.001), MI (2.5% vs. 7.1%, P < 0.001), aspiration pneumonia (6.6% vs. 34.3%, P < 0.001), sepsis (5.7% vs. 35.7%, P < 0.001), and death (2.6% vs. 11.4%, P < 0.001). CONCLUSIONS: This study demonstrates that patients with postoperative ileus are significantly more likely to have DVT, experience MI, acquire aspiration pneumonia, develop sepsis, and die.


Assuntos
Íleus/etiologia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Íleus/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Sepse/etiologia , Sepse/mortalidade , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Fusão Vertebral/mortalidade , Resultado do Tratamento , Estados Unidos/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/mortalidade , Adulto Jovem
18.
Georgian Med News ; (288): 66-69, 2019 Mar.
Artigo em Russo | MEDLINE | ID: mdl-31101778

RESUMO

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases often coexist and are the predictors of severe outcomes. The purpose of literature review is analytical analysis of complex, multifactorial links between myocardial infarction and COPD. The nature and underlying mechanisms of link between the diseases are presented. It was concluded that endothelial dysfunction, chronic systemic inflammation and the system of coagulation and anticoagulation are common pathogenic mechanisms providing development of myocardial infarction in the patients with COPD.


Assuntos
Infarto do Miocárdio , Doença Pulmonar Obstrutiva Crônica , Humanos , Inflamação , Infarto do Miocárdio/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Fatores de Risco
19.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040148

RESUMO

A 28-year-old man diagnosed with diabetes mellitus and systemic hypertension presented with a medical history of sudden onset retrosternal discomfort followed by loss of consciousness and generalised tonic clonic seizures. Examination revealed obesity, polysyndactyly and retinal pigment dystrophy. He was diagnosed to have acute myocardial infarction and left posterior watershed infarct. He was also diagnosed to have Bardet-Biedl syndrome based on clinical features. He was managed symptomatically and is currently doing well on regular follow-up in the outpatient clinic.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome de Bardet-Biedl/fisiopatologia , Imagem por Ressonância Magnética , Infarto do Miocárdio/fisiopatologia , Obesidade/complicações , Adulto , Síndrome de Bardet-Biedl/complicações , Síndrome de Bardet-Biedl/diagnóstico por imagem , Síndrome de Bardet-Biedl/tratamento farmacológico , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Neuroimagem , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(19): e15621, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083259

RESUMO

RATIONAL: Plaque rapid progression prior to acute myocardial infarction is not a common phenomenon, and its mechanism remains unknown. Intracoronary imaging may help to assess the plaque characteristics and progression. PATIENT CONCERN: A 37-year-old male patient suffered an acute myocardial infarction (AMI) 1 month after the diagnosis of a mildly stenosed coronary artery. Intracoronary imaging was done to seek the underlying causes and guide further treatment. DIAGNOSIS: Two coronary angiograms in 1 month showed plaque rapid progressing prior to the AMI. Intracoronary optical coherence tomography (OCT) post-AMI showed plaque erosion and heavy burden of thrombus. INTERVENTION: The patient was advised to defer stent deployment. The patient was then given intensified antithrombotic therapy. Three weeks later, OCT imaging revealed sufficient lumen area and the intact endothelium without remaining thrombus. Fractional flow reverse (FFR) showed no functional ischemia. Dual-antiplatelet therapy without stenting was recommended for 12 months. OUTCOMES: The 6-month follow-up showed good recovery and normal cardiac function. LESSONS: First, for patients with mild coronary stenosis and typical angina symptoms, further intracoronary assessment should be performed. Second, OCT can not only help to determine the plaque characteristics but can also help to develop patient-tailored strategies for AMI patients.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/terapia , Adulto , Estenose Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Progressão da Doença , Humanos , Masculino , Infarto do Miocárdio/etiologia , Placa Aterosclerótica/complicações
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