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1.
Pol Merkur Lekarski ; 49(291): 171-175, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34218233

RESUMO

Dyslipidemia has been widely acknowledged as one of the major predisposing factors for the development and progression of atherosclerosis. While advanced atherosclerosis confirmed to influence the prognosis of patients with acute coronary syndrome (ACS), it has not yet been established, whether this impact is gender-dependent. AIM: The aim of study was to investigate possible gender-related effect of dyslipidemia and generalized atherosclerosis on the long-term outcomes in patients with ACS. MATERIALS AND METHODS: A total of 247 patients (88 women and 159 men) with ACS were included. Sample was divided into two groups, according to gender. Patients' lipid and comorbidity profiles were assessed. Cumulative major adverse coronary events (MACE) were estimated throughout 3-year follow-up period. RESULTS: Women were older and had more comorbidities. Cumulative 3-year MACE rates were higher in women than in men (33% vs. 23%, p=0.06). In the multivariable Cox regression analysis abnormal lipid profiles were more significantly associated with higher MACE in females (HR=1.5, 95% CI [1-2,28], p<0.00001), compared with males (HR=1.0, 95% CI [0.5-2.08], p=0.4), as well as prior MI: (HR=3.8, 95% CI [1.4- 10.5], p<0.00001) vs. (HR=1.9, 95% [0.8-4.2], p=0.009) and concomitant peripheral artery disease (PAD): (HR=5.2, 95% CI [1.5-18.2], p<0.00001) vs. (HR=2.2, 95% CI [0.73-6.6], p=0.02) respectively. CONCLUSIONS: In our study dyslipidemia, concomitant PAD and history of MI were independent predictors of higher MACE more significantly in females with ACS than in males. Thus, it can be assumed that female patients require an increased medical attention with strict serum lipid control.


Assuntos
Síndrome Coronariana Aguda , Aterosclerose , Feminino , Humanos , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Caracteres Sexuais , Fatores Sexuais
2.
BMC Infect Dis ; 21(1): 657, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233630

RESUMO

BACKGROUND: HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. METHODS: We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. RESULTS: Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3-4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd's ratio (OR) (95% CI): 3.12 (1.2-8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2-8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. CONCLUSIONS: We found an HIV-prevalence of 3.4% (95% CI 2.3-4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Infecções por HIV/epidemiologia , Síndrome Coronariana Aguda/terapia , Adulto , Idoso , Comorbidade , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
3.
BMJ Case Rep ; 14(7)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233865

RESUMO

Ticagrelor is a part of dual antiplatelet therapy (DAPT) which has proven benefits in patients with acute coronary syndrome especially in those undergoing percutaneous coronary intervention (PCI). However, like most other drugs, it can lead to undesired and adverse effects such as dyspnoea, easy bruising and gastrointestinal bleeding. We present a case of 70-year-old woman who developed diarrhoea following initiation of DAPT comprising of aspirin and ticagrelor following PCI. After excluding more common causes, it was attributed to ticagrelor administration and completely resolved after it was replaced with another oral antiplatelet agent. On follow-up, the patient reported complete resolution of symptoms.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/tratamento farmacológico , Idoso , Diarreia/induzido quimicamente , Feminino , Hemorragia , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Ticagrelor/efeitos adversos
4.
J Coll Physicians Surg Pak ; 30(7): 841-845, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271788

RESUMO

In patients with acute coronary syndrome (ACS), the predicted short-term result of ischemic modified albumin (IMA) is still not recognised now. The above have been searched in PubMed, Embase, Medline, Cochrane Library databases, and Wanfang databases from the beginning to June 2020. The study explored that patients with positive of IMA had differences in short-term results compared to negative of IMA. Odds ratios for each study was compiled and conducted for heterogeneity assessment, quality review, publication bias. A total of 684 patients (405 positive patients; 279 negative patients) were included in four studies. Comprehensive analysis found that compared with the negative of IMA in patients with ACS, the positive of IMA in patients with ACS had a high incidence of major cardiovascular adverse events (MACE) (HR 1.85; p=0.03), but there was no significant difference in the occurrence of cardiac death (HR 4.40; p = 0.16).  It was concluded that the positive of IMA in patients with ACS is associated with an increased incidence of MACE, but there was no statistically significant difference in incidence of cardiac death. Due to the limited data coming from different research groups in different countries, the diagnostic criteria for the IMA cut-off may be different. Future large randomised controlled trials will be certainly needed to confirm these findings. Key Words: Acute coronary syndrome, Ischemia-modified albumin, Meta-analysis, MACE, Cardiac death.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Biomarcadores , Humanos , Prognóstico , Albumina Sérica , Albumina Sérica Humana
5.
Medicina (Kaunas) ; 57(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200527

RESUMO

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infecções por HIV , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(5): 710-715, 2021 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-34134958

RESUMO

OBJECTIVE: To investigate serum levels of von Willebrand factor lytic protease (ADAMTS13) and thrombospondin-1 (TSP1) in patients with different types of acute coronary syndrome (ACS) and their correlation with the patients' clinical prognosis. OBJECTIVE: According to their disease history, results of angiography and clinical biochemical tests, a total of 405 patients undergoing coronary angiography, were divided into unstable angina (UAP) group (n=215), acute myocardial infarction (AMI) group (n=96), and angiographically normal group (n=94). Serum ADAMTS13 and TSP1 levels were detected in all the patients, who were followed up for 15 months to evaluate the occurrence of long-term major cardiac adverse events (MACE). OBJECTIVE: Serum ADAMTS13 level was significantly lower and TSP1 level was significantly higher in AMI group and UAP group than in the normal group (P < 0.001). Serum ADAMTS13 and TSP1 levels were negative correlated in ACS patients (R=-0.577, P < 0.001). The patients experiencing MACE had significantly different serum TSP1 level from those without MACE (P < 0.05). Cox proportion regression model analysis showed that TSP1 was a risk factor affecting the occurrence of MACE in ACS patients; Kaplan-Meier survival analysis showed that the patients with high levels of TSP1 had a higher incidence of longterm MACE than those with low TSP1 levels. OBJECTIVE: A lowered serum ADAMTS13 level and an elevated TSP1 level can support the diagnosis of ACS. An elevated TSP1 level may serve as an indicator for predicting the risk of MACE in patients with ACS.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Proteína ADAMTS13 , Angina Instável , Humanos , Prognóstico , Trombospondina 1
8.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1255622

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly. OBJECTIVES: The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country. METHOD: Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions. RESULTS: A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175). CONCLUSION: There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , COVID-19/complicações , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Angina Instável/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/normas , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2/isolamento & purificação , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
9.
Clin Chim Acta ; 520: 78-86, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34090879

RESUMO

The prevalence and incidence of diabetes mellitus (DM) are increasing worldwide bringing with it a significantly higher rate of complications. Various mechanisms such as carbonyl stress, polyol pathway, oxidative stress, hexosamine pathways, diacylglycerol/protein kinase-C activation, etc., are responsible for the pathogenesis of DM and its complications. Persistent hyperglycaemia and inhibition of metabolising and detoxifying enzymes lead to the excessive synthesis of carbonyl compounds such as methylglyoxal, glyoxal, and 3-deoxyglucosone, resulting in carbonyl stress. The substrates, metabolizing and detoxifying enzymes of carbonyl compounds are discussed. The mechanistic roles of carbonyl compounds and advanced glycation end products (AGEs) in atherosclerosis, insulin resistance, thrombogenicity, and endothelial dysfunction in animal and cell culture model of DM and patients with DM are summarised. Because of the essential role of carbonyl stress, therapeutics are aimed at scavenging, metabolizing, detoxifying, and inhibiting carbonyl compounds or AGEs so that their harmful effects are minimized. Clinically used drugs, plants extracts and miscellaneous chemical with antiglycation properties are used in an animal model of DM to alleviates the impact of carbonyl compounds. Extensive clinical trials with derivatisation of available antiglycation agents to increase the bioavailability and decrease side effects are warranted further.


Assuntos
Síndrome Coronariana Aguda , Diabetes Mellitus , Animais , Diabetes Mellitus/tratamento farmacológico , Produtos Finais de Glicação Avançada/metabolismo , Humanos , Estresse Oxidativo , Aldeído Pirúvico
10.
BMJ Open ; 11(6): e042406, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172542

RESUMO

OBJECTIVES: To identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men. DESIGN: Cross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS. SETTING: Nine OHS-PC in the Netherlands. PARTICIPANTS: 993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016. PRIMARY OUTCOME MEASURE: Diagnosis of ACS retrieved from the patient's medical record in general practice, including hospital specialists' discharge letters. RESULTS: Among 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%). CONCLUSION: Our results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses. TRIAL REGISTRATION NUMBER: NTR7331.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores Sexuais , Telefone , Triagem
15.
Zhonghua Nei Ke Za Zhi ; 60(6): 544-551, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34058811

RESUMO

Objective: To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein Ⅱb/Ⅲa inhibitor (GPI). Methods: The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization. Results: A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI (OR=0.881, 95%CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group (OR=1.401, 95%CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group (OR=0.919, 95%CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group (OR=1.559, 95%CI 1.130-2.150; P=0.007). Conclusion: In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/tratamento farmacológico , China , Clopidogrel/efeitos adversos , Glicoproteínas , Humanos , Ticagrelor/efeitos adversos
16.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34083389

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly. OBJECTIVES: The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country. METHOD: Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions. RESULTS: A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175). CONCLUSION: There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , COVID-19/complicações , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Angina Instável/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/normas , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2/isolamento & purificação , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 573-577, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112295

RESUMO

OBJECTIVE: To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio (HCRP/ALB) for the death in patients with acute coronary syndrome (ACS). METHODS: The clinical data of patients with ACS [including unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI)] admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed. The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated. Patients were divided into death group and survival group according to the hospital outcome. The differences of baseline data and biochemical indexes between the two groups were compared. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of each variable to death. Logistic regression was used to analyze the risk factors of death. RESULTS: Among the 1 722 ACS patients, 74 died in hospital. Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia. Among them, patients in death group had higher heart rate (HR), HCRP, B-type natriuretic peptide (BNP), HCRP/ALB [HR (bpm): 89±19 vs. 73±15, HCRP (mg/L): 23.24 (9.79, 33.69) vs. 3.57 (1.03, 14.26), BNP (ng/L): 424.0 (164.3, 1 596.1) vs. 79.0 (31.0, 211.4), HCRP/ALB: 0.700 (0.289, 1.017) vs. 0.089 (0.026, 0.368), all P < 0.01], while ALB was lower (g/L: 35.37±5.16 vs. 39.97±6.43, P < 0.01). ROC curve analysis showed that area under ROC curve and 95% confidence interval [AUC (95%CI)] of BNP, HCRP and HCRP/ALB for predicting death were 0.781 (0.717-0.845), 0.790 (0.724-0.856) and 0.803 (0.738-0.869), respectively. The Youden index of HCRP/ALB was 0.559, and the corresponding HCRP/ALB was 0.246. The patients were divided into low HCRP/ALB group (HCRP/ALB ≤ 0.246, 1 163 cases) and high HCRP/ALB group (HCRP/ALB > 0.246, 559 cases). Except for gender, previous smoking, hypertension and diabetes rates, the other baseline data were statistically different between the two groups. Patients in the high HCRP/ALB group had a higher mortality (10.4% vs. 1.4%, P < 0.01), higher rates of implanted intra-aortic balloon pump (IABP, 12.7% vs. 2.7%, P < 0.01), higher BNP, HCRP, HCRP/ALB [BNP (ng/L): 253.0 (82.8, 749.0) vs. 60.0 (26.0, 145.2), HCRP (mg/L): 25.42±17.47 vs. 2.62±2.43, HCRP/ALB: 0.700±0.435 vs. 0.066±0.062, all P < 0.01], while lower ALB (g/L: 36.89±4.30 vs. 41.17±6.83, P < 0.01). Logistic regression analysis showed that higher HR [odds ratio (OR) = 1.037, 95%CI was 1.020-1.055, P = 0.000] and higher HCRP/ALB (OR = 3.835, 95%CI was 1.612-9.125, P = 0.002) were independent risk factors for the death in ACS patients, while higher ALB could reduce the mortality in ACS patients (OR = 0.884, 95%CI was 0.818-0.957, P = 0.002). CONCLUSIONS: The higher the HCRP/ALB, the higher the risk of death in patients with ACS. When HCRP/ALB is greater than 0.246, the patient has a higher mortality. Therefore, HCRP/ALB in patients with ACS can be used as an effective predictor for death risk.


Assuntos
Síndrome Coronariana Aguda , Proteína C-Reativa , Albumina Sérica , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Proteína C-Reativa/análise , Humanos , Prognóstico , Curva ROC , Estudos Retrospectivos
19.
Ann Palliat Med ; 10(5): 5763-5766, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34107713

RESUMO

BACKGROUND: Acute coronary syndrome (ACS), which usually results from the buildup of fatty deposits (plaques) in and on the walls of coronary arteries, remains a major cause of morbidity and mortality worldwide. In the present systematic review, we aim to evaluate the efficacy and safety of adding traditional Chinese medicine (TCM) to standard western medicine to treat patients with ACS. METHODS: A systematic search was carried out in the China National Knowledge Infrastructure (CNKI; Chinese), the Chinese Biomedical Literature Disk Database CBMdisc (Chinese), Wanfang Data (Chinese), PubMed, Embase, and Web of Science for relevant papers up to January 20, 2021. All published randomized controlled trials related to the integration of TCM and Western medicine for ACS will be included. The primary outcome is the effective rate and cardiovascular function index (left ventricular ejection fraction, early peak flow velocity, and thrombolysis in myocardial infarction). The secondary outcome is blood lipid level (total cholesterol, triacylglycerol, low/high density lipoprotein) and the incidence of adverse cardiovascular events. Study selection, data collection, and quality evaluation will be conducted by 2 reviewers independently. Comprehensive meta-analyses together with sensitivity and subgroup analyses will be performed with Stata 15.0 software (StataCorp). DISCUSSION: The results will provide a high-quality guidance for the current clinical treatment of ACS, and the patients more options to relieve their symptoms. The findings from this study may provide updated evidence concerning the efficacy and safety of TCM for patients with ACS. TRIAL REGISTRATION: This protocol has been registered in the INPLASY platform (https://inplasy.com/), and the registration number is INPLASY202140145.


Assuntos
Síndrome Coronariana Aguda , Medicamentos de Ervas Chinesas , Síndrome Coronariana Aguda/tratamento farmacológico , China , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Medicina Tradicional Chinesa , Metanálise como Assunto , Volume Sistólico , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Função Ventricular Esquerda
20.
Arq Bras Cardiol ; 116(6): 1039-1045, 2021 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34133584

RESUMO

BACKGROUND: According to traditional diagnosis thinking, very elderly individuals are more predisposed to develop atypical symptoms in acute coronary syndromes. OBJECTIVE: To test the hypothesis that very elderly individuals are more predisposed to atypical chest pain manifestations due to obstructive coronary artery disease (CAD). METHODS: The Registry of Thoracic Pain includes patients admitted with acute chest pain. Firstly, the typicality index of this clinical manifestation was constructed: the sum of 12 symptom characteristics (8 typical and 4 atypical symptoms). In the subgroup of patients with coronary etiology, the typicality index was compared between octogenarian and non-octogenarian individuals. Statistical significance was defined by p<0.05. RESULTS: 958 patients were included in the registry, and 486 (51%) had a supposedly coronary etiology. In this group, 59 (12%) octogenarians (age 84±3.5, 50% men) were compared to 427 patients aged <80 (60±12 years, 71% men). The typicality index in octogenarians was 3.42±1.92, which is similar to that of non-octogenarians (3.44±1.74; p=0.92 in univariate analysis and p=0.80 after adjustment for sex by analysis of variance - ANOVA). There was also no statistically significant difference when the sample was divided into median age (62 years; 3.41±1.77 vs. 3.49 ± 1.77; p=0.61). There was no statistically significant linear association between age and typicality index (r=- 0.05; p=0.24). Logistic regression analysis for prediction of CAD in the general sample of 958 patients showed no interaction of typicality index with numeric age (p=0.94), octogenarians (p=0.22) or age above median (p=0.74). CONCLUSION: In patients with acute chest pain of coronary etiology, advanced age does not influence the typical clinical presentation.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Idoso , Idoso de 80 Anos ou mais , Dor no Peito , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
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