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1.
Lancet ; 394(10206): 1335-1343, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31492505

RESUMO

BACKGROUND: We aimed to assess the safety of edoxaban in combination with P2Y12 inhibition in patients with atrial fibrillation who had percutaneous coronary intervention (PCI). METHODS: ENTRUST-AF PCI was a randomised, multicentre, open-label, non-inferiority phase 3b trial with masked outcome evaluation, done at 186 sites in 18 countries. Patients had atrial fibrillation requiring oral anticoagulation, were aged at least 18 years, and had a successful PCI for stable coronary artery disease or acute coronary syndrome. Participants were randomly assigned (1:1) from 4 h to 5 days after PCI using concealed, stratified, and blocked web-based central randomisation to either edoxaban (60 mg once daily) plus a P2Y12 inhibitor for 12 months or a vitamin K antagonist (VKA) in combination with a P2Y12 inhibitor and aspirin (100 mg once daily, for 1-12 months). The edoxaban dose was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, bodyweight ≤60 kg, or concomitant use of specified potent P-glycoprotein inhibitors) were present. The primary endpoint was a composite of major or clinically relevant non-major (CRNM) bleeding within 12 months. The primary analysis was done in the intention-to-treat population and safety was assessed in all patients who received at least one dose of their assigned study drug. This trial is registered with ClinicalTrials.gov, NCT02866175, is closed to new participants, and follow-up is completed. FINDINGS: From Feb 24, 2017, through May 7, 2018, 1506 patients were enrolled and randomly assigned to the edoxaban regimen (n=751) or VKA regimen (n=755). Median time from PCI to randomisation was 45·1 h (IQR 22·2-76·2). Major or CRNM bleeding events occurred in 128 (17%) of 751 patients (annualised event rate 20·7%) with the edoxaban regimen and 152 (20%) of 755 patients (annualised event rate 25·6%) patients with the VKA regimen; hazard ratio 0·83 (95% CI 0·65-1·05; p=0·0010 for non-inferiority, margin hazard ratio 1·20; p=0·1154 for superiority). INTERPRETATION: In patients with atrial fibrillation who had PCI, the edoxaban-based regimen was non-inferior for bleeding compared with the VKA-based regimen, without significant differences in ischaemic events. FUNDING: Daiichi Sankyo.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Fibrinolíticos/uso terapêutico , Intervenção Coronária Percutânea , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Vitamina K/antagonistas & inibidores , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/cirurgia , Idoso , Fibrilação Atrial/complicações , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
2.
Klin Lab Diagn ; 64(8): 463-468, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479600

RESUMO

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


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Superóxido Dismutase/sangue , Síndrome Coronariana Aguda/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Tempo , Função Ventricular Esquerda
3.
Rev Med Liege ; 74(7-8): 375-377, 2019 07.
Artigo em Francês | MEDLINE | ID: mdl-31373448

RESUMO

We report a case of left ventricular pseudo-aneurysm and we take the opportunity to briefly review the literature concerning etiologies, diagnosis and management of this pathology, emphasizing some differences with the true aneurysm.


Assuntos
Síndrome Coronariana Aguda , Falso Aneurisma , Aneurisma Cardíaco , Síndrome Coronariana Aguda/complicações , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Ventrículos do Coração , Humanos
4.
Zhonghua Yi Xue Za Zhi ; 99(23): 1782-1786, 2019 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-31207687

RESUMO

Objective: To investigate the effect of obstructive sleep apnea (OSA) on cardiac structure and function in patients with acute coronary syndrome (ACS). Methods: A total of 767 patients with ACS consecutively hospitalized at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017 were enrolled in this study. There were 637 males and 130 females. Patients who met the inclusion criteria according to the sleep apnea hypopnea index (AHI) were examined with portable sleep respiration monitoring. Patients were divided into moderate or severe OSA group (AHI≥15,n=389) and non or mild OSA group (AHI<15, n=78). The general information and echocar diographic results were analyzed. The data fitted normal distribution were compared between the groups with independent sample t test. Results: The body mass index [(27.8±3.6) vs (25.8±3.4) kg/m(2), t=-7.854, P<0.01], neck circumference [(41.1±4.2) vs (39.3±3.2) cm, t=-6.717, P<0.01] and waist-to-hip ratio (0.99±0.54 vs 0.97±0.53, t=-4.735, P<0.01) at admission were significantly higher in moderate or severe OSA group than those in non or mild OSA group. The left ventricular end-diastolic diameter, inter-ventricular septum thickness, left atrial diameter,right atrial diameter were all significantly higher, and the E/A peak ratio was remarkably lower in the moderate or severe OSA group (t=-2.130, 0.278, -3.045, -2.241, 2.260, all P<0.05). Conclusion: Moderate or severe OSA may aggravate cardiac remodeling and diastolic function in ACS patients.


Assuntos
Síndrome Coronariana Aguda , Apneia Obstrutiva do Sono , Síndrome Coronariana Aguda/complicações , Diástole , Feminino , Ventrículos do Coração , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/complicações
5.
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
6.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 217-226, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002227

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias , Brasil/epidemiologia , Hospitais Públicos , Revascularização Miocárdica/mortalidade , Comorbidade , Fatores Sexuais , Análise Estatística , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Síndrome Coronariana Aguda/complicações , Estudo Observacional , Infecção/complicações , Angina Instável/complicações , Infarto do Miocárdio , Infarto do Miocárdio/complicações
7.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 217-226, may.-june. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1005925

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias , Brasil/epidemiologia , Hospitais Públicos , Revascularização Miocárdica/mortalidade , Comorbidade , Fatores Sexuais , Análise Estatística , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Síndrome Coronariana Aguda/complicações , Estudo Observacional , Infecção/complicações , Angina Instável/complicações , Infarto do Miocárdio/complicações
8.
Chem Pharm Bull (Tokyo) ; 67(5): 419-425, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061366

RESUMO

Patients with type 2 diabetes (T2DM) and hyperlipidemia are with high risk of myocardial infarction (MI) or coronary death events. The combined use of ezetimibe and atorvastatin could improve treatment efficacy and safety. To explore the efficacy and safety of ezetimibe in combination with atorvastatin for the treatment of patients with T2DM and acute coronary syndrome (ACS). This was a non-randomized cohort study of 95 consecutive, treatment-naïve patients with T2DM and ACS treated at the Quanzhou First Hospital of Fujian Province between February 2014 and March 2016. According to the treatment strategy they selected, the patients were categorized into the atorvastatin (n = 46) and atorvastatin + ezetimibe (n = 49) groups. The patients were followed up at 2 weeks and 12 months. The primary endpoints included the incidence of adverse cardiovascular events and changed in blood lipids and high-sensitivity C-reactive protein (hs-CRP). At 12 months, serum total cholesterol (TC), triglycerides, and low-density lipoprotein cholesterol (LDL-C) levels were significantly lower, and high-density lipoprotein cholesterol (HDL-C) levels were significantly higher in the atorvastatin + ezetimibe (EZ) group than in the atorvastatin group (all p < 0.05). The LDL-C control rate at 12 months was significantly higher in the atorvastatin + EZ group compared with the atorvastatin group (p = 0.006). Seven patients in the atorvastatin group were re-hospitalized for angina pectoris, while only one patient in the atorvastatin + EZ group was re-hospitalized for angina pectoris (p = 0.02). The efficacy of atorvastatin + EZ in treating T2DM patients accompanied with ACS was significantly higher than using atorvastatin alone. This combined strategy has good safety profile, and could be recommended for clinical application.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Anticolesterolemiantes/uso terapêutico , Atorvastatina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Ezetimiba/uso terapêutico , Síndrome Coronariana Aguda/sangue , Anticolesterolemiantes/efeitos adversos , Atorvastatina/efeitos adversos , Proteína C-Reativa/análise , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Quimioterapia Combinada , Ezetimiba/efeitos adversos , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Miocárdio/enzimologia
9.
Angiology ; 70(9): 838-843, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30987433

RESUMO

Thromboembolic events are a common complication in Takotsubo syndrome (TTS). However, their long-term incidence compared with acute coronary syndrome (ACS) is lacking. In-hospital and long-term incidence of thromboembolic events of 138 consecutive patients with TTS were compared with 138 sex- and age-matched patients with ACS. Predictors of events were analyzed. The incidence of thromboembolic events in TTS was 2-fold higher than ACS (21% vs 9%; P < .01) over a mean follow-up of 5 years. Although the left ventricular ejection fraction (LVEF) at event was significantly lower in TTS compared with ACS (38% [9%] vs 54% [11%]; P < .01), the follow-up LVEF was comparable. Patients with TTS suffering from thromboembolic events were more often treated with anticoagulation compared with ACS (44.8% vs 8.3%, P = .03). However, more patients presenting with ACS (100% vs 48.3%; P < .01) were discharged on aspirin. Only elevated C-reactive protein was a predictor of thromboembolic events using multivariate analysis (hazard ratio 1.1, 95% confidence interval, 1.0-1.2; P < .01). In conclusion, the risk of thromboembolic events in TTS was significantly higher than the risk of thromboembolic events in ACS over a mean follow-up of 5 years.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Tromboembolia/epidemiologia , Função Ventricular Esquerda/fisiologia , Síndrome Coronariana Aguda/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Risco , Volume Sistólico/fisiologia , Cardiomiopatia de Takotsubo/complicações
10.
Br J Hosp Med (Lond) ; 80(4): 204-210, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951425

RESUMO

Cardiogenic shock remains a major problem affecting a large proportion of patients with acute coronary syndromes, with a persistent high mortality rate. Although mechanical reperfusion with percutaneous coronary intervention has improved outcomes following acute coronary syndromes, there is limited evidence supporting the other current treatments used to manage patients with cardiogenic shock (intra-aortic balloon pumps, percutaneous left ventricular assist devices and extracorporeal membrane oxygenation). This article looks at these options, assessing current evidence and recent advances. It also discusses areas that still require research to ensure there is improvement in these high-risk patients, such as coordinated regionalised approaches to cardiogenic shock management with multidisciplinary care provided in designated tertiary shock centres.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiotônicos/uso terapêutico , Oxigenação por Membrana Extracorpórea/métodos , Coração Auxiliar , Balão Intra-Aórtico/métodos , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/terapia , Vasoconstritores/uso terapêutico , Síndrome Coronariana Aguda/complicações , Cateterismo de Swan-Ganz , Gerenciamento Clínico , Hidratação , Humanos , Choque Cardiogênico/etiologia
11.
Int Heart J ; 60(3): 569-576, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019178

RESUMO

Blood glucose variability is considered to be one of the risk factors for coronary heart disease, and there is growing evidence that blood glucose fluctuation is closely related to the characteristics of plaques. The aim of the study was to investigate the influence of blood glucose variability on the vulnerability of culprit plaques in elderly non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients.Coronary angiography and VH-IVUS were applied to evaluate the components of culprit plaque in NSTE-ACS patients. CGMS monitoring was performed for 72 hours and blood glucose variability was assessed by glycemic excursions (MAGE), absolute means of daily differences (MODD), postprandial glycemic excursions (PPGE), and the largest amplitude of glycemic excursions (LAGE). An oxidative stress indicator (urinary 8-iso-PGF2α) was also tested.Eighty two elderly NSTE-ACS patients were enrolled in this study. Higher glucose variability was associated with the increased culprit plaque instability. MODD was positively correlated with urinary 8-iso-PGF2α. PPGE and urinary 8-iso-PGF2α were independent risk factors for percent fibrous and necrotic volume in culprit plaques (PPGE: ß = -0.340, P = 0.024; urinary 8-iso-PGF2α: ß = -0.294, P = 0.013).Blood glucose variability is positively related to oxidative stress. With an increase in blood glucose variability, the instability of criminal plaques in elderly NSTE-ACS patients increased.


Assuntos
Síndrome Coronariana Aguda/sangue , Glicemia/análise , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Placa Aterosclerótica/diagnóstico por imagem , Síndrome Coronariana Aguda/complicações , Idoso , Angiografia Coronária , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Estresse Oxidativo , Placa Aterosclerótica/sangue , Placa Aterosclerótica/etiologia , Período Pós-Prandial
12.
Medicine (Baltimore) ; 98(8): e14669, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813214

RESUMO

BACKGROUND: Several studies have shown that patients with type 2 diabetes mellitus (T2DM) have worse clinical outcomes in comparison to patients without diabetes mellitus (DM) following Percutaneous Coronary Intervention (PCI). However, the adverse clinical outcomes were not similarly reported in all the studies. Therefore, in order to standardize this issue, a meta-analysis including 139,774 patients was carried out to compare the in-hospital, short-term (<1 year) and long-term (≥1 year) adverse clinical outcomes in patients with and without T2DM following PCI. METHODS: Electronic databases including MEDLINE, EMBASE, and the Cochrane Library were searched for Randomized Controlled Trials (RCTs) and observational studies. The adverse clinical outcomes which were analyzed included mortality, myocardial infarction (MI), major adverse cardiac events (MACEs), stroke, bleeding, target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis. Risk Ratios (RR) with 95% confidence intervals (CI) were used to express the pooled effect on discontinuous variables and the analysis was carried out by RevMan 5.3 software. RESULTS: A total number of 139,774 participants were assessed. Results of this analysis showed that in-hospital mortality and MACEs were significantly higher in patients with T2DM (RR 2.57; 95% CI: 1.95-3.38; P = .00001) and (RR: 1.38; 95% CI: 1.10-1.73; P = .005) respectively. In addition, majority of the short and long-term adverse clinical outcomes were also significantly higher in the DM group as compared to the non-DM group. Stent thrombosis was significantly higher in the DM compared to the non-DM group during the short term follow-up period (RR 1.59; 95% CI: 1.16-2.18;P = .004). However, long-term stent thrombosis was similarly manifested. CONCLUSION: According to this meta-analysis including a total number of 139,774 patients, following PCI, those patients with T2DM suffered more in-hospital, short as well as long-term adverse outcomes as reported by most of the Randomized Controlled Trials and Observational studies, compared to those patients without diabetes mellitus.


Assuntos
Síndrome Coronariana Aguda , Diabetes Mellitus Tipo 2/complicações , Efeitos Adversos de Longa Duração , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/cirurgia , Mortalidade Hospitalar , Humanos , Efeitos Adversos de Longa Duração/classificação , Efeitos Adversos de Longa Duração/mortalidade , Razão de Chances , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/mortalidade , Stents/efeitos adversos
13.
N Engl J Med ; 380(16): 1509-1524, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30883055

RESUMO

BACKGROUND: Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS: In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS: Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS: In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both. (Funded by Bristol-Myers Squibb and Pfizer; AUGUSTUS ClinicalTrials.gov number, NCT02415400.).


Assuntos
Síndrome Coronariana Aguda/complicações , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Intervenção Coronária Percutânea , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Vitamina K/antagonistas & inibidores , Síndrome Coronariana Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Fibrilação Atrial/complicações , Método Duplo-Cego , Quimioterapia Combinada , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Pirazóis/efeitos adversos , Piridonas/efeitos adversos
15.
Diabetes Care ; 42(4): 674-681, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30728222

RESUMO

OBJECTIVE: Acute glucose fluctuations are associated with hypoglycemia and are emerging risk factors for cardiovascular outcomes. However, the relationship between glycemic variability (GV) and the occurrence of midterm major cardiovascular events (MACE) in patients with diabetes remains unclear. This study investigated the prognostic value of GV in patients with diabetes and acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS: This study included consecutive patients with diabetes and ACS between January 2015 and November 2016. GV was assessed using SD during initial hospitalization. MACE, including new-onset myocardial infarction, acute heart failure, and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analyzed with respect to baseline characteristics and cardiac status. RESULTS: A total of 327 patients with diabetes and ACS were enrolled. MACE occurred in 89 patients (27.2%) during a mean follow-up of 16.9 months. During follow-up, 24 patients (7.3%) died of cardiac causes, 35 (10.7%) had new-onset myocardial infarction, and 30 (9.2%) were hospitalized for acute heart failure. Multivariable logistic regression analysis showed that GV >2.70 mmol/L, a Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score >34, and reduced left ventricular ejection fraction of <40% were independent predictors of MACE, with odds ratios (ORs) of 2.21 (95% CI 1.64-2.98; P < 0.001), 1.88 (1.26-2.82; P = 0.002), and 1.71 (1.14-2.54; P = 0.009), respectively, whereas a Global Registry of Acute Coronary Events (GRACE) risk score >140 was not (OR 1.07 [0.77-1.49]; P = 0.69). CONCLUSIONS: A GV cutoff value of >2.70 mmol/L was the strongest independent predictive factor for midterm MACE in patients with diabetes and ACS.


Assuntos
Síndrome Coronariana Aguda/complicações , Glicemia/análise , Doenças Cardiovasculares/etiologia , Complicações do Diabetes , Diabetes Mellitus , Hospitalização , Humanos , Intervenção Coronária Percutânea , Prognóstico , Sistema de Registros , Fatores de Risco
16.
J Thromb Thrombolysis ; 47(3): 427-435, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30739305

RESUMO

To investigate the safety and efficacy of an early platelet function testing (PFT)-guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVS). Early DAPT de-escalation is a new non-inferior alternative to 12-months DAPT in patients with biomarker positive ACS treated with stent implantation. In this post-hoc analysis of the TROPICAL-ACS trial, which randomized 2610 ACS patients to a PFT-guided DAPT de-escalation (switch from prasugrel to clopidogrel) or to control group (uniform prasugrel), we compared clinical outcomes of patients (n = 151) who received a BVS during the index PCI. The frequency of the primary endpoint (cardiovascular death, myocardial infarction, stroke or BARC ≥ 2 bleeding) was 8.8% (n = 6) in the de-escalation group vs. 12.0% (n = 10) in the control group (HR 0.72, 95% CI 0.26-1.98, p = 0.52) at 12 months. One early definite stent thrombosis (ST) occurred in the control group (day 19) and 1 possible ST (sudden cardiovascular death) in the de-escalation group (day 86), both despite prasugrel treatment and in a background of high on-treatment platelet reactivity assessed at day 14 after randomization (ADP-induced platelet aggregation values of 108 U and 59 U, respectively). A PFT-guided DAPT de-escalation strategy could potentially be a safe and effective strategy in ACS patients with BVS implantation but the level of platelet inhibition may be of particular importance. This hypothesis-generating post-hoc analysis requires verification in larger studies with upcoming BVS platforms.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Implante de Prótese Vascular/métodos , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Implantes Absorvíveis , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Clopidogrel/administração & dosagem , Substituição de Medicamentos/métodos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Testes de Função Plaquetária , Cloridrato de Prasugrel/administração & dosagem , Trombose/etiologia , Tecidos Suporte , Adulto Jovem
17.
Lipids Health Dis ; 18(1): 22, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670045

RESUMO

PURPOSE: This study was designed to explore the value of monitoring miR-92a in T2DM patients with coronary heart disease (CHD). MATERIALS AND METHODS: 40 ACS patients with prior history of CHD and diabetes while the onset time of diabetes preceded that of CHD by more than 2 years were enrolled as the DACS group(diabetic ACS group). 40 ACS subjects who had had a definite diagnosis of CHD for more than 2 years with no history of T2DM were recuited as the CACS group(chronic CHD with ACS group). All enrolled subjects from DACS and CACS group came from an emergency basis and diagnosed with ACS by coronary angiography. Another 68 age- and sex-matched volunteers with chronic stable CHD without diabetes history were assigned as the control group (CHD group). We examined the serum levels of miR-92a and analyzed their correlations with blood pressure, glucose level, and lipid level. RESULTS: The levels of miR-92a were significantly elevated in the DACS group compared with those of the CACS and CHD groups. Multivariate analysis showed that miR-92a, systolic blood pressure (SBP), and glycosylated hemoglobin (HbA1c) were significantly related to ACS events in patients with T2DM. Forward stepwise binary logistic regression analysis identified miR-92a as an independent predictive factor for ACS events in the patients with T2DM. CONCLUSION: An elevated circulating miR-92a level was associated with an increased risk of ACS in CHD patients with T2DM. Thus the level of miR-92a, especially combined with elevated SBP and HbA1c, may be helpful in the detection of ACS in patients with T2DM.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/genética , MicroRNA Circulante/sangue , Doença das Coronárias/sangue , Doença das Coronárias/genética , Diabetes Mellitus Tipo 2/complicações , MicroRNAs/sangue , Síndrome Coronariana Aguda/complicações , Adulto , Doença das Coronárias/complicações , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Análise de Regressão
18.
Herz ; 44(1): 16-21, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30627740

RESUMO

The current guidelines of the European Society of Cardiology have up-dated and confirmed the role of a primary percutaneous coronary intervention (PCI) as the preferred reperfusion therapy in patients with acute coronary syndrome and ST-elevation. The establishment of regional network structures for implementation of this reperfusion strategy is recommended and described. Primary PCI should preferably be carried out via the transradial route and should include the implantation of modern drug-eluting stents. In most cases of coronary multivessel disease, primary PCI should be limited to the treatment of the infarcted artery. Routine mechanical thrombus aspiration during primary PCI is no longer recommended. Recommendations for a specific anti-thrombotic and secondary prophylactic medication after primary PCI are highlighted.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do Tratamento
19.
BMC Med Inform Decis Mak ; 19(1): 5, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626381

RESUMO

BACKGROUND: Main adverse cardiac events (MACE) are essentially composite endpoints for assessing safety and efficacy of treatment processes of acute coronary syndrome (ACS) patients. Timely prediction of MACE is highly valuable for improving the effects of ACS treatments. Most existing tools are specific to predict MACE by mainly using static patient features and neglecting dynamic treatment information during learning. METHODS: We address this challenge by developing a deep learning-based approach to utilize a large volume of heterogeneous electronic health record (EHR) for predicting MACE after ACS. Specifically, we obtain the deep representation of dynamic treatment features from EHR data, using the bidirectional recurrent neural network. And then, the extracted latent representation of treatment features can be utilized to predict whether a patient occurs MACE in his or her hospitalization. RESULTS: We validate the effectiveness of our approach on a clinical dataset containing 2930 ACS patient samples with 232 static feature types and 2194 dynamic feature types. The performance of our best model for predicting MACE after ACS remains robust and reaches 0.713 and 0.764 in terms of AUC and Accuracy, respectively, and has over 11.9% (1.2%) and 1.9% (7.5%) performance gain of AUC (Accuracy) in comparison with both logistic regression and a boosted resampling model presented in our previous work, respectively. The results are statistically significant. CONCLUSIONS: We hypothesize that our proposed model adapted to leverage dynamic treatment information in EHR data appears to boost the performance of MACE prediction for ACS, and can readily meet the demand clinical prediction of other diseases, from a large volume of EHR in an open-ended fashion.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Registros Eletrônicos de Saúde , Hospitalização , Modelos Teóricos , Redes Neurais (Computação) , Síndrome Coronariana Aguda/terapia , Idoso , Aprendizado Profundo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
20.
Med Glas (Zenica) ; 16(1): 28-34, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30680982

RESUMO

Aim To assess triglyceride - to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS - RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDLC ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction.


Assuntos
Síndrome Coronariana Aguda/sangue , Lipoproteínas HDL/sangue , Insuficiência Renal/sangue , Triglicerídeos/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Proteína C-Reativa/análise , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ureia/sangue
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