Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.799
Filtrar
1.
J Int Med Res ; 48(10): 300060520966151, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33108941

RESUMO

OBJECTIVE: No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era. METHODS: Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period. RESULTS: In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic. CONCLUSION: Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Fibrinolíticos/uso terapêutico , Pandemias , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Idoso , Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Feminino , Fibrinólise , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Proteínas Recombinantes/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents , Análise de Sobrevida , Resultado do Tratamento
2.
Sci Rep ; 10(1): 15284, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943714

RESUMO

Acute myocardial ischaemia and reperfusion (I-R) are major causes of ventricular arrhythmias in patients with a history of coronary artery disease. Ursodeoxycholic acid (UDCA) has previously been shown to be antiarrhythmic in fetal hearts. This study was performed to investigate if UDCA protects against ischaemia-induced and reperfusion-induced arrhythmias in the adult myocardium, and compares the effect of acute (perfusion only) versus prolonged (2 weeks pre-treatment plus perfusion) UDCA administration. Langendorff-perfused adult Sprague-Dawley rat hearts were subjected to acute regional ischaemia by ligation of the left anterior descending artery (10 min), followed by reperfusion (2 min), and arrhythmia incidence quantified. Prolonged UDCA administration reduced the incidence of acute ischaemia-induced arrhythmias (p = 0.028), with a reduction in number of ventricular ectopic beats during the ischaemic phase compared with acute treatment (10 ± 3 vs 58 ± 15, p = 0.036). No antiarrhythmic effect was observed in the acute UDCA administration group. Neither acute nor prolonged UDCA treatment altered the incidence of reperfusion arrhythmias. The antiarrhythmic effect of UDCA may be partially mediated by an increase in cardiac wavelength, due to the attenuation of conduction velocity slowing (p = 0.03), and the preservation of Connexin43 phosphorylation during acute ischaemia (p = 0.0027). The potential antiarrhythmic effects of prolonged UDCA administration merit further investigation.


Assuntos
Arritmias Cardíacas/tratamento farmacológico , Coração/efeitos dos fármacos , Isquemia Miocárdica/complicações , Ácido Ursodesoxicólico/administração & dosagem , Animais , Antiarrítmicos/administração & dosagem , Vasos Coronários/efeitos dos fármacos , Masculino , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/complicações , Miocárdio/patologia , Perfusão/métodos , Ratos , Ratos Sprague-Dawley
3.
Life Sci ; 257: 118004, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621918

RESUMO

BACKGROUND: Patients undergoing cardiopulmonary bypass (CPB) often develop acute kidney injury (AKI) caused by myocardial ischemia reperfusion (MI/R), and this renal injury can be resolved notably by dexmedetomidine. Endoplasmic reticulum (ER) stress was reported to get involved in organ injury including AKI. OBJECTIVES: The current study aimed to address the correlation between MI/R induced AKI with ER stress and to assess the effects of dexmedetomidine pretreatment on AKI protection. METHOD: Patients selected for heart valve replacement surgery were randomly assigned to NS group (pre-anesthesia with 0.9% NaCl) and DEX group (pre-anesthesia with dexmedetomidine). Rat MI/R model was induced by occluding coronary artery for 30 min followed by 48-hour reperfusion. Rats were randomized into Sham (0.9% NaCl), I/R (MI/R + 0.9% NaCl) and I/R + DEX (MI/R + dexmedetomidine). Organ function and ER stress condition were evaluated by blood chemistry, pathology, and molecular test. RESULTS: Clinical data indicated dexmedetomidine pretreatment attenuated AKI and oxidative stress as well as postischemic myocardial injury in patients. Accordingly animal results suggested dexmedetomidine reduced cellular injury and improved postischemic myocardial and renal function. Dexmedetomidine also reduced myocardial and renal cells apoptosis and down-regulated ER stress. CONCLUSIONS: These results suggested that dexmedetomidine pretreatment attenuates MI/R injury-induced AKI by relieving the ER stress.


Assuntos
Dexmedetomidina/farmacologia , Isquemia Miocárdica/tratamento farmacológico , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/prevenção & controle , Idoso , Animais , Apoptose/efeitos dos fármacos , China , Dexmedetomidina/metabolismo , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Estresse do Retículo Endoplasmático/fisiologia , Feminino , Humanos , Isquemia/metabolismo , Rim/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Estudos Prospectivos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/metabolismo , Transdução de Sinais/efeitos dos fármacos
4.
Arch Cardiol Mex ; 90(Supl): 62-66, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-595541

RESUMO

Reperfusion therapy is a measure of care in patients with ST-elevation myocardial infarction (STEMI), which should be performed once we have the diagnosis. Percutaneous coronary intervention is considered the gold standard, however in patients with SARS-CoV-2 infection, the reperfusion strategy is more focused on fibrinolytic therapy due to the shorter time required to perform and less exposure. This pandemic represents a contact problem in health personnel, since cases are increasing worldwide, so it is important to know the measures that must be followed to avoid coronavirus disease (COVID-19).


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Reperfusão Miocárdica/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Síndrome Coronariana Aguda/terapia , Infecções por Coronavirus/epidemiologia , Humanos , Intervenção Coronária Percutânea/métodos , Pneumonia Viral/epidemiologia , Terapia Trombolítica/métodos
5.
Arch Cardiol Mex ; 90(Supl): 62-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523136

RESUMO

Reperfusion therapy is a measure of care in patients with ST-elevation myocardial infarction (STEMI), which should be performed once we have the diagnosis. Percutaneous coronary intervention is considered the gold standard, however in patients with SARS-CoV-2 infection, the reperfusion strategy is more focused on fibrinolytic therapy due to the shorter time required to perform and less exposure. This pandemic represents a contact problem in health personnel, since cases are increasing worldwide, so it is important to know the measures that must be followed to avoid coronavirus disease (COVID-19).


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Reperfusão Miocárdica/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Síndrome Coronariana Aguda/terapia , Infecções por Coronavirus/epidemiologia , Humanos , Intervenção Coronária Percutânea/métodos , Pneumonia Viral/epidemiologia , Terapia Trombolítica/métodos
6.
Circ Heart Fail ; 13(1): e005893, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31959013

RESUMO

BACKGROUND: Despite advances in reperfusion times, patients presenting with acute myocardial infarction carry an unacceptably high rate of mortality and morbidity. Mechanical unloading of the left ventricle (LV) has been suggested to reduce infarct size after acute myocardial infarction. Although prior studies have investigated LV unloading during ischemia with a delay in reperfusion, little is known about the optimal timing for LV unloading in the setting of acute myocardial infarction. METHODS: Studies were conducted in 17 adult Yorkshire swine weighing 67±5 kg. A coronary balloon was inflated in the mid left anterior descending for 60 minutes to induce a myocardial infarction. The coronary balloon was then deflated for 120 minutes (reperfusion). The animals were stratified into 3 groups: group 1 (control, reperfusion with no LV unloading, n=5), group 2 (LV unloading during ischemia with delayed reperfusion, n=6), and group 3 (simultaneous LV unloading and reperfusion, n=6). Staining the hearts with Evans blue and 2,3,5-triphenyltetrazolium chloride was used to identify the area at risk and the infarct area respectively. Infarct percent size was defined as the area of infarcted myocardium divided by the area at risk. RESULTS: Of the 3 groups, group 3 demonstrated significantly smaller infarct percent size compared with controls (54.7±20.3% versus 22.2±13.4%; P=0.03). Comparison between group 1 and group 2 did not reveal significant difference (54.7±20.3% versus 43.3±24.6%; P=0.19). CONCLUSIONS: In our large animal experimental model, simultaneous reperfusion and mechanical LV unloading yielded the smallest infarct size compared with no LV unloading or LV unloading with delayed reperfusion. In the context of prior studies showing benefit to unloading before reperfusion, these findings raise questions about how this strategy may be translated to humans.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miocárdio/patologia , Animais , Circulação Coronária/fisiologia , Modelos Animais de Doenças , Feminino , Ventrículos do Coração/fisiopatologia , Hemodinâmica/fisiologia , Reperfusão Miocárdica/métodos , Suínos
7.
J Pak Med Assoc ; 69(9): 1313-1319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511717

RESUMO

OBJECTIVE: To determine the frequency of no reperfusion therapy, its reasons, hospital management and intermediate-term outcome s of ST- elevation my ocardial in farction patients . METHODS: The retrospective ambi-directional observational study was conducted at Tabba Heart Institute, Karachi, and comprised record of ST-elevation myocardial infarction patients without immediate reperfusion therapy with symptom onset time of 12 hours who presented between January 2013 and December 2017. Prospective follow-up of all patients was performed till June 2018. Coronary angiography, non-invasive stress tests, medications and late revascularisation were explored. Predictors of hospital mortality and major adverse cardiovascular events at follow-up were analysed. Data was analysed using SPSS 19. RESULTS: Of the 1977 records evaluated, 218(11%) patients of mean age 60.3±12.4 years did not receive immediate reperfusion therapy. Coronary angiography was done in 163(74.7%) patients of whom 45(27.6%) were taken for immediate procedure. Besides, 26 (11.9%) patients died during hospital stay. Predictors of hospital mortality were no revascularisation (odds ratio: 24.1, 95% confidence interval: 1.3-500), cardiogenic shock (odds ratio: 65, 95% confidence interval: 5.7-745) and tachycardia (odds ratio: 17, 95% confidence interval: 1.2-254.5) at presentation. Predictor of major adverse cardiovascular events was guideline-directed medical therapy (hazard ratio 2.6, 95% confidence interval: 1.16-6.2) at discharge, while revascularisation was not a significant predictor (p>0.05). Conclusion: A huge number of salvageable ST-elevation myocardial infarction patients failed to receive reperfusion therapy. There is a huge potential of improvement in ST-elevation myocardial infarction care in terms of increasing community awareness, prompt reperfusion therapy and usage of optimal medical therapy.


Assuntos
Mortalidade Hospitalar , Reperfusão Miocárdica/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/estatística & dados numéricos , Idoso , Institutos de Cardiologia , Angiografia Coronária , Ponte de Artéria Coronária/estatística & dados numéricos , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Paquistão/epidemiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Choque Cardiogênico/epidemiologia , Taquicardia/epidemiologia
8.
Med Sci Monit ; 25: 4149-4158, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31160548

RESUMO

BACKGROUND The aim of this study was to determine the role of AMP-activated protein kinase (AMPK) in myocardial insulin resistance after myocardial ischemia-reperfusion during cardiopulmonary bypass surgery in dogs. MATERIAL AND METHODS Twenty-four mongrel dogs were randomly assigned to 4 groups. The control group did not undergo aortic cross-clamping; the model group underwent 60 mins of aortic cross-clamping with 150 ml cardioplegic solution. The treatment group, the inhibition group respectively with 0.11mg/kg AICAR (AMPK agonist) in 150 ml cardioplegic solution and 0.11mg/kg Compound C (AMPK inhibitor) in 150 ml cardioplegic solution. The blood flow was determined and left ventricular myocardial tissue were taken at pre-bypass, 15, 60, and 90 min after aorta declamping, respectively. Expression of AMPK mRNA, p-AMPK and GLUT-4 proteins was determined by RT-PCR, IHC and WB. RESULTS Compared with the control group, receiving 60 min ischemia at 15 min after reperfusion, Myocardial Glucose Extraction Ratio were significantly decreased in the other 3 groups, it was significantly decreased from 20.0% to 1.2% at 60 min of reperfusion, and recovered to 6.1% after 90 min reperfusion in model group, while recovered to 4.1%, 12.0% after 90 min reperfusion respectively exposed to Compound C and AICAR. The expressions of p-AMPK, GLUT-4 protein and AMPK mRNA in myocardium were decreased in different experiment groups, but these changes occurred to a lesser extent in the treatment group. CONCLUSIONS The inability of GLUT-4 expression induced by the decreases in p-AMPK protein expression that may be one of the reasons for myocardial insulin resistance.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Resistência à Insulina/fisiologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Aminoimidazol Carboxamida/análogos & derivados , Aminoimidazol Carboxamida/farmacologia , Animais , Soluções Cardioplégicas , Ponte Cardiopulmonar/métodos , Ponte Cardiopulmonar/veterinária , China , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/cirurgia , Cães , Feminino , Glucose/metabolismo , Transportador de Glucose Tipo 4/metabolismo , Ventrículos do Coração/fisiopatologia , Isquemia/metabolismo , Masculino , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Miocárdio/metabolismo , Fosforilação , Pirazóis/farmacologia , Pirimidinas/farmacologia , Ribonucleotídeos/farmacologia
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002219

RESUMO

The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência , Infarto do Miocárdio
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, may.-june. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1005940

RESUMO

Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model , with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio
11.
Med Sci Monit ; 25: 3100-3107, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31028241

RESUMO

BACKGROUND The aim of this study was to investigate the effects of sevoflurane (SEV) on myocardial ischemia/reperfusion (I/R) injury in rats and its mechanism. MATERIAL AND METHODS Sixty male Sprague-Dawley rats were randomly divided into 3 groups: Sham group (n=20), I/R group (n=20) and I/R+SEV group (n=20). The I/R model was established by ligating and recanalizing the left anterior descending coronary artery (LAD). Triphenyl tetrazolium chloride (TTC) test and echocardiography (ECG) were used for analysis. Hematoxylin and eosin (H&E) staining was applied to detect the morphological changes. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was conducted to detect the apoptosis levels. The expression level of superoxide dismutase 2 (SOD2) was measured. Finally, the effect of SEV on the protein kinase B (Akt)/hypoxia-inducible factor 1-alpha (HIF-1alpha)/vascular endothelial growth factor (VEGF) signaling pathway was detected via western blotting. RESULTS SEV could significantly improve I/R-induced cardiac insufficiency, inhibit cardiac infarction, and as well as reduce the infarction area from 53.21±2.11% to 32.33±3.49% (P<0.05). Compared with rats in I/R group, the cardiac myofilament was better in alignment, degradation and necrosis were milder, and cell edema was notably reduced in the I/R+SEV group. Thus, SEV could significantly reverse the decreased expression of SOD2 caused by I/R and reduce oxidative stress in the heart (P<0.05). According to the western blotting results, SEV was capable of obviously activating the expressions of phosphorylated-Akt (p-Akt), HIF-1alpha, and VEGF. CONCLUSIONS SEV can significantly improve myocardial injury caused by I/R in rats, and its mechanism might be related to the activation of the Akt/HIF-1alpha/VEGF signaling pathway.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Proteínas Proto-Oncogênicas c-akt/metabolismo , Sevoflurano/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Apoptose/efeitos dos fármacos , Masculino , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
12.
J Clin Nurs ; 28(17-18): 3233-3241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31017336

RESUMO

AIMS AND OBJECTIVES: To establish and report cross-sectional data of reperfusion times for emergency primary percutaneous coronary interventions (PPCI) and to examine factors associated with times to reperfusion. BACKGROUND: Rapid coronary reperfusion can salvage myocardial tissue, preserve left ventricular function and reduce mortality. PPCI is the gold standard of management. Researchers have reported on international median reperfusion times, but this is the first Irish study to do so. METHODS: This observational, prospective, cross-sectional study included patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and admitted for emergency PPCI. Descriptive and inferential statistics were used. The study was ethically approved. We adopted the STROBE guidelines. RESULTS: All patients (N = 133) who met the inclusion criteria were included initially. Of these, 105 (79%) were diagnosed with STEMI and received emergency PPCI. The majority of STEMIs were diagnosed by paramedics and most (67%) were reperfused within 120 min, with a median time of 96 min. The results suggested that younger patients achieved timelier PPCI and source of referral was also significant in that more of those transferred directly to the coronary catheterisation laboratory achieved reperfusion within 120 min, compared with those who presented to the emergency department. CONCLUSION: A timely reperfusion service is achieved for the majority. Attention is needed in respect of the ageing and those admitted directly to the emergency departments with STEMI. RELEVANCE TO CLINICAL PRACTICE: Further international research is recommended to compare current reperfusion times against guidelines and to identify areas for improvement. Clinicians should be mindful of the importance of rapid reperfusion and the implications of its delay for patients with STEMI. Those presenting to emergency departments with chest pain should be prioritised.


Assuntos
Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
13.
Rev. chil. cardiol ; 38(1): 46-53, abr. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1003637

RESUMO

Resumen En Chile, se han logrado avances importantes en el manejo del Infarto Agudo de Miocardio (IAM) con elevación del segmento ST (IAMCEST). Debido a la mejoría en el diagnóstico precoz y tratamiento, particularmente, con el incremento de la Angioplastía Primaria (APP), hoy están dadas las condiciones para seguir progresando por la vía de la combinación de estrategias de reperfusión y la creación de Redes de Manejo del IAM. El siguiente artículo revisa la evidencia que justifica impulsar dicho avance y se esbozan posibles caminos para lograrlo.


Abstract In Chile, important advances have been made in the management of Acute Myocardial Infarction (MI) with ST segment elevation (STEMI). Due to the progress in early diagnosis and treatment, particularly with the increase in Primary Angioplasty (Primary PCI), nowadays there are conditions to improve early management through the combination of reperfusion strategies and the implementation of MI reperfusion networks. The present article reviews the evidence justifying the promotion of this strategy and outlines possible actions to achieve it.


Assuntos
Humanos , Reperfusão Miocárdica/métodos , Terapia Trombolítica/métodos , Angioplastia/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Chile , Procedimentos Endovasculares , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
14.
Rev. esp. cardiol. (Ed. impr.) ; 72(4): 317-323, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187897

RESUMO

Introducción y objetivos: En el infarto agudo de miocardio con elevación del segmento ST, el ADN libre circulante podría originarse de los leucocitos activados en la lesión coronaria. El objetivo fue investigar la relación entre el ADN libre y la reperfusión coronaria. Métodos: Se incluyó a 116 pacientes, tratados con angioplastia primaria y tromboaspiración. Se cuantificó el ADN libre coronario (durante la aspiración) y periférico (al final del procedimiento), así como la troponina T ultrasensible y la mieloperoxidasa. El objetivo primario fue la no resolución del segmento ST (RST) (≥ 70%) y el secundario la ausencia de flujo Thrombolysis In Myocardial Infarction 3 (TIMI 3) final. Resultados: Se obtuvo RST en 51 (44%) pacientes y flujo TIMI 3 en 97 (84%). Los pacientes sin RST y flujo TIMI 3 tuvieron un menor gradiente ADN libre periférico-coronario (p = 0,02 y p = 0,04, respectivamente). Un gradiente pequeño de ADN libre (< 1,82 ng/ml) se asoció a una mayor frecuencia de no RST (65 frente al 30%; p = 0,001) y de falta de flujo TIMI 3 (21 frente al 3%; p = 0,05. Tras el ajuste multivariable, un gradiente de ADN libre pequeño fue predictivo de no RST (OR = 4,50; IC95%, 1,60-12,62; p = 0,004), en tanto que hubo una tendencia no significativa para el flujo TIMI 3 (p = 0,14). El ADN libre no se correlacionó con la troponina o la mieloperoxidasa. Conclusiones: Un gradiente pequeño de ADN libre periférico-coronario, como expresión de una alta carga de ADN libre coronario, se asocia con no RST en el infarto agudo de miocardio. El ADN libre coronario podría reflejar la activación de los neutrófilos. La potencial contribución de este fenómeno al fracaso de la tromboaspiración requiere nuevos estudios


Introduction and objectives: Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. Methods: We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). Results: ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (21% vs 3%; P = .05). After multivariable adjustment, the small cfDNA gradient was predictive of no STR (OR, 4.50; 95%CI, 1.60-12.62; P = .004), while there was a nonsignificant trend for final TIMI 3 flow (P = .14). Cell-free DNA levels did not correlate with troponin T or myeloperoxidase. Conclusions: A small peripheral-coronary cfDNA gradient, as an expression of high coronary cfDNA burden, is associated with no STR in acute myocardial infarction. Intracoronary cfDNA might reflect neutrophil activation. Whether this phenomenon contributes to thrombus aspiration failure requires further study


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/métodos , Ácidos Nucleicos Livres/análise , Angioplastia/métodos , Reperfusão Miocárdica/métodos , Trombectomia/métodos , Troponina/análise , Peroxidase/análise , Estudos Prospectivos
15.
Resuscitation ; 135: 176-182, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30639790

RESUMO

BACKGROUND: We investigated the association of health insurance status with post-resuscitation care and neurological recovery in out-of-hospital cardiac arrest (OHCA) and whether the effects changed with age or gender. METHODS: Adult OHCAs with presumed cardiac etiology who had sustained ROSC from 2013 to 2016 were enrolled from the nationwide OHCA registry of Korea. Insurance status was categorized into 2 groups: National Health Insurance (NHI) and Medical Aid (MA). The endpoints were post-resuscitation coronary reperfusion therapy (CRT), targeted temperature management (TTM), and good neurological recovery (cerebral performance category of 1 or 2). Multivariable logistic regression models and interaction analyses (insurance × age and insurance × gender) were conducted for adjusted odds ratios (aORs) and 95% confidence intervals (CI). RESULTS: Of a total of 19,865 eligible OHCA patients, 18,119 (91.2%) were covered by NHI and 1746 (8.8%) by MA. The MA group was less likely to receive post-resuscitation CRT and TTM (aOR (95% CI): 0.75 (0.59-0.96) for CRT; 0.71 (0.57-0.89) for TTM) and had worse neurological outcomes (0.71 (0.57-0.89)) compared with the NHI group. In the interaction analyses, MA was associated with less CRT and good neurological recovery in the 45-64 year old group (0.54 (0.37-0.77) for CRT; 0.70 (0.51-0.95) for neurological outcome) and in the male group (0.69 (0.52-0.91) for CRT; 0.77 (0.61-0.97) for TTM; 0.70 (0.53-0.92)) for neurological outcome). CONCLUSIONS: There were disparities in post-resuscitation care and substantial neurological recovery by health insurance status, and the disparities were prominent in middle-aged adults and males. Increasing health insurance coverage for post-resuscitation care should be considered.


Assuntos
Assistência ao Convalescente , Reanimação Cardiopulmonar , Seguro Saúde/estatística & dados numéricos , Doenças do Sistema Nervoso , Parada Cardíaca Extra-Hospitalar/reabilitação , Recuperação de Função Fisiológica , Adulto , Assistência ao Convalescente/economia , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Idoso , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Hipotermia Induzida/métodos , Hipotermia Induzida/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Reperfusão Miocárdica/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Alta do Paciente , República da Coreia
16.
Hellenic J Cardiol ; 60(4): 211-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30639352

RESUMO

The management of ST-segment elevation myocardial infarction (STEMI) has evolved significantly over the last decades. STEMI treatment includes reperfusion therapy, ideally by primary percutaneous coronary intervention (pPCI), modern antithrombotic therapy and secondary prevention measures. Even though many areas in the management of STEMI are well studied and analyzed in the guidelines, there are still challenges and unanswered questions on how to improve outcomes. This review aims to offer an insight in areas that need to be explored.


Assuntos
Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/métodos , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Ciclosporina/farmacologia , Ciclosporina/uso terapêutico , Feminino , Humanos , Hipotermia , Masculino , Pessoa de Meia-Idade , Mitocôndrias Cardíacas/efeitos dos fármacos , Glicoproteínas da Membrana de Plaquetas/antagonistas & inibidores , Guias de Prática Clínica como Assunto , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Prevenção Secundária/métodos , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/uso terapêutico
17.
Int J Cardiol ; 280: 80-83, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661844

RESUMO

AIM: Ventricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. Tpeak-Tend interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether Tpeak-Tend before PCI in STEMI is associated with reperfusion VF. METHODS: STEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ±â€¯13 years, 80% male) were compared with 374 consecutive patients without reperfusion arrhythmias (No-rVF group; age 67 ±â€¯12 years; 68% male). Digital ECGs were automatically processed and Tpeak-Tend interval computed on a per-lead basis. The global Tpeak-Tend was calculated between the earliest Tpeak and the latest Tend in any lead, and tested for association with reperfusion VF using logistic regression analysis. RESULTS: The leftward shift of Tpeak toward QRS complex in ischemic leads resulted in Tpeak-Tend prolongation. Global Tpeak-Tend in rVF group was higher than in No-rVF group (142 ±â€¯24 vs 130 ±â€¯27 ms; p = 0.007). Global Tpeak-Tend ≥ 131 ms predicted reperfusion VF (OR = 3.41; 95% CI 1.66-7.04; p = 0.001) and remained a significant predictor of reperfusion VF in multivariable analysis. CONCLUSION: Tpeak-Tend interval before PCI in STEMI was an independent predictor of reperfusion VF. Our findings warrants further research aimed at prospective validation of Tpeak-Tend as a marker of periprocedural arrhythmic risk.


Assuntos
Frequência Cardíaca/fisiologia , Reperfusão Miocárdica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/cirurgia , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Suécia/epidemiologia , Fibrilação Ventricular/epidemiologia
18.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(1 (Supl)): 94-96, jan.-mar. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1015189

RESUMO

O eletrocardiograma (ECG) é fundamental na avaliação dos pacientes com síndrome coronariana aguda (SCA), pois possibilita a identificação precoce dos pacientes com sinais de oclusão coronariana (infarto agudo do miocárdio com supradesnivelamento do segmento ST - IAMCSSST), que se beneficiam com estratégias de reperfusão miocárdica de emergência. Os casos de SCA sem supradesnivelamento de segmento ST pressupõem ausência de oclusão coronariana, e o ECG pode mostrar sinais de isquemia como inversão simétrica de ondas T, infradesnivelamento de segmento ST, ou mesmo ser normal em até 15% dos casos. No entanto, recentemente foi descrito um padrão eletrocardiográfico raro, conhecido como padrão "De Winter", relacionado à oclusão coronariana aguda da artéria descendente anterior (ADA) em seu terço proximal, na ausência de supradesnivelamento de segmento ST. Este é o relato de um paciente jovem, do sexo masculino, com quadro clínico anginoso típico, menos de uma hora depois de angioplastia eletiva da ADA, que apresentou padrão "De Winter" no ECG e teve confirmada trombose aguda de stent. O reconhecimento desse padrão eletrocardiográfico incomum é fundamental para garantir terapia de reperfusão coronariana emergencial em casos de síndrome coronariana aguda


he electrocardiogram (ECG) is a crucial tool in the evaluation of patients with acute coronary syndrome (ACS), since it allows the early identification of patients with signs of coronary occlusion (ST-elevation myocardial infarction ­ STEMI), who benefit from emergency myocardial reperfusion strategies. On the other hand, cases of non-ST-elevation ACS presumably have no coronary occlusion, and the ECG may show signs of ischemia such as symmetrical T-wave inversion, ST-segment depression, or even be normal in up to 15% of cases. However, a rare ECG pattern, known as the "De Winter" pattern, related to an acute occlusion of the Left Anterior Descending (LAD) coronary artery in its proximal third segment, has been recently described without ST-segment elevation. This is a case report of a young male patient with typical chest pain symptoms less than one hour after an elective LAD angioplasty, who presented with "De Winter" pattern on the ECG and had confirmed acute stent thrombosis. The recognition of this unusual electrocardiographic pattern is essential to guarantee emergency coronary reperfusion therapy in cases of acute coronary syndrome


Assuntos
Humanos , Masculino , Adulto , Eletrocardiografia/métodos , Síndrome Coronariana Aguda , Oclusão Coronária , Trombose , Reperfusão Miocárdica/métodos , Stents , Angioplastia/métodos , Infarto do Miocárdio
19.
Biomed Pharmacother ; 109: 1346-1350, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30551385

RESUMO

Interleukin 8 (IL-8) is an important pro-inflammatory cytokine that recruits neutrophil to the areas of inflammation and has been implicated in myocardial ischemia reperfusion injury (MIRI). This study aimed to apply IL-8 targeted myocardial contrast echocardiography (MCE) to evaluate MIRI in rabbits. MCE imaging with IL-8 targeted microbubbles (MBIL-8) and control microbubbles (MBc) was performed in 40 Japanese white rabbits after brief proximal left anterior descending (LAD) partial occlusion for 30 min and subsequent reperfusion for 30 min, 60 min, 120 min and 180 min. Electrocardiogram and regional wall motion were assessed during occlusion and reperfusion. MCE demonstrated that IL-8 level rapidly increased in reperfused myocardial tissue and reached the peak after 120 min of reperfusion and lasted to 180 min of reperfusion. ELISA showed that the tendency of MCE data to change with reperfusion time was the same as that of IL-8 content. Taken together, these results suggest that targeted MCE with IL-8 antibody provides a new approach to noninvasive evaluation of MIRI using ultrasound imaging techniques.


Assuntos
Interleucina-8/metabolismo , Isquemia Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Miocárdio/metabolismo , Animais , Meios de Contraste/metabolismo , Ecocardiografia/métodos , Masculino , Microbolhas , Infarto do Miocárdio/metabolismo , Reperfusão Miocárdica/métodos , Coelhos
20.
Arq Bras Cardiol ; 112(1): 20-29, 2019 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30570061

RESUMO

BACKGROUND: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. OBJECTIVE: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. METHODS: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. RESULTS: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. CONCLUSION: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.


Assuntos
Fibrinolíticos/uso terapêutico , Reperfusão Miocárdica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Tenecteplase/uso terapêutico , Terapia Trombolítica/métodos , Adulto , Idoso , Angiografia Coronária/métodos , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Estudos Prospectivos , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Estatísticas não Paramétricas , Tenecteplase/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA