Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.330
Filtrar
1.
Angiol Sosud Khir ; 26(3): 179-184, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063766

RESUMO

Acute coronary syndrome has for a long time been giving no way of decreasing mortality related to ischaemic heart disease. The primary cause of acute coronary syndrome in the majority of cases is rupture of an unstable atherosclerotic plaque in the coronary artery followed by thrombosis thereof. The main missions of modern cardiology include: assessment of the risk of acute coronary syndrome, identification of predictors of adverse events, and working-out of measures aimed at prevention and optimal management of patients with ischaemic heart disease. This article deals with clinical and morphological factors associated with destabilization of coronary plaques, their rupture, and the development of an acute coronary event.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Humanos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico
2.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933907

RESUMO

A 51-year-old woman who presented in June 2010 with acute coronary syndrome (ACS) and anterior wall motion abnormality on the echocardiogram but was found to have an insignificant angiogram. Eight years later she presented again with ACS and evidence of worsening cardiac wall motion affecting a similar territory; however, the angiogram revealing spontaneous coronary artery dissection of the distal left anterior descending artery. Extravascular screening revealed evidence of multifocal fibromuscular dysplasia. We suggest offering vascular screening for fibromuscular dysplasia in young women who present with ACS and normal angiograms, after weighing in risks and benefits.


Assuntos
Síndrome Coronariana Aguda/complicações , Anomalias dos Vasos Coronários/complicações , Displasia Fibromuscular/complicações , Doenças Vasculares/congênito , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Doenças Vasculares/complicações
3.
Medicine (Baltimore) ; 99(30): e21312, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791719

RESUMO

Bleeding complications of acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes, and gastrointestinal bleeding (GIB) is the most common major bleeding event, especially in the early post-PCI period. Current guidelines recommend routinely conducting bleeding risk assessments. The existing tools are mainly used to evaluate the overall bleeding risk and guide the adjustment of antithrombotic strategies after 1 year. However, there are no specific tools for GIB risk assessment.Between January 2015 and June 2015, 4943 ACS patients underwent PCI were consecutively enrolled in the derivation cohort. GIB, cardiovascular, and cerebrovascular events were recorded within 1 year of follow-up. A validation cohort including 1000 patients who met the same inclusion and exclusion criteria was also established by propensity-score matching baseline characteristics. Multivariable cox proportional-hazards regression model was used to derive a risk-scoring system, and predictive variables were selected. A risk score nomogram based on the risk prediction model was created to estimate the 1-year risk of GIB.In this study, we found that the usage of clopidogrel (hazard ratio, HR: 2.52, 95% confidence intervals, CI: 1.573-4.021) and glycoprotein IIb/IIIa receptor inhibitors (HR: 1.863, 95% CI: 1.226-2.829), history of peptic ulcers (HR: 3.601, 95% CI: 1.226-2.829) or tumor (HR: 4.884, 95% CI: 1.226-2.829), and cardiac insufficiency (HR: 11.513, 95% CI: 7.282-18.202), renal insufficiency (HR: 2.010, 95% CI: 1.350-2.993), and prolonged activated partial thromboplastin time (HR: 4.639, 95% CI: 2.146-10.032) were independent risk factors for GIB 1 year after PCI. Based on these 7 factors, a nomogram and scoring system was established. The area under curve of risk score was 0.824 in the deviation cohort and 0.810 in the verification cohort. In both cohorts, the GIB score was significantly better than that of 3 classical bleeding scores (all P < .05).This score could well predict the risk of GIB within 1 year after PCI and could be used to guide antithrombotic strategies.


Assuntos
Síndrome Coronariana Aguda/complicações , Hemorragia Gastrointestinal/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Síndrome Coronariana Aguda/terapia , Idoso , Regras de Decisão Clínica , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/diagnóstico , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Úlcera Péptica/complicações , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Insuficiência Renal/complicações , Projetos de Pesquisa/normas , Medição de Risco
5.
Angiology ; 71(10): 886-893, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32757765

RESUMO

Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blockers (ARB) showed comparable survival results in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is lack of evidence of the comparative effectiveness in preserved LVEF patients after an acute coronary syndrome (ACS). The aim of this study was to evaluate whether the selection between ACEi and ARB in preserved LVEF after an ACS confers a prognostic benefit, based on real life results. We analyzed a cohort of 3006 contemporary patients with LVEF ≥40% after an ACS. A propensity score matching and Cox regression analysis were performed to assess the association between treatment and events (death, acute myocardial infarction [AMI], HF, and combined event) for a mean follow-up of 3.6 ± 2.1 years. We found no significant differences between ACEi/ARB for all-cause mortality (hazard ratio [HR] for ARB: 0.95, 95% CI: 0.70-1.29), AMI (HR for ARB: 1.34, 95% CI: 0.95-1.89), HF (HR for ARB: 1.11, 95% CI: 0.85-1.45), or combined end point (death, AMI and HF: HR for ARB: 1.14, 95% CI: 0.92-1.40). In conclusion, there are no prognostic differences between the use of ACEi and ARB in patients with LVEF ≥40% after ACS. Further prospective studies are needed to confirm our results.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca/epidemiologia , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Volume Sistólico/fisiologia , Taxa de Sobrevida
6.
N Z Med J ; 133(1519): 41-54, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32777794

RESUMO

BACKGROUND: Concomitant atrial fibrillation (AF) and acute coronary syndrome (ACS) present the difficult therapeutic dilemma of balancing bleeding, cardio-embolic and coronary thrombotic risks with appropriate combinations of antithrombotic medications. We aim to evaluate current New Zealand practice by identifying the incidence of AF in ACS; describe the population characteristics; and assess our antithrombotic management. METHODS: Consecutive patients ≥18y presenting with ACS who had coronary angiography (2017-2018) were identified from the All New Zealand ACS Quality Improvement (ANZACS-QI) registry. The cohort was divided into three groups: 1) patients with pre-existing AF; 2) new-onset AF; and 3) no AF. Antithrombotic regimens included dual antiplatelet therapy (DAPT), dual antithrombotic therapy (DAT-single antiplatelet plus an oral anticoagulant (OAC)) and triple antithrombotic therapy (TAT). RESULTS: There were 9,489 patients, 9.6% with pre-existing AF, 4.4% new AF and 86% without AF. Both AF groups were older (median 74 vs 71 vs 65y, p=0.001), had poorer renal function, were more likely to present with heart failure (16% vs 19% vs 8%, p=0.001) and have left ventricular ejection fraction <40% (22% vs 28% vs 13%, p<0.001). They received less percutaneous coronary intervention (PCI) (53% vs 59% vs 70%, p=0.001). In the cohort, 25 different combinations of antithrombotic agents were utilised. Ninety-six percent of patients with any AF had a CHA2DS2VASC stroke risk score of ≥2, of whom 48% did not receive OAC. Twenty-four percent received TAT and 19% DAT. OAC use increased slightly with increasing stroke risk but were independent of CRUSADE bleeding risk. Of patients with AF treated with PCI, 53% received DAPT, 11% DAT and 35% TAT. 51% of those at high stroke risk were discharged on DAPT only. In contrast, 19% at low stroke risk received TAT. CONCLUSION: In New Zealand, one in seven patients presenting with ACS have AF, a third being new-onset AF. Antithrombotic management is inconsistent, with underutilisation of anticoagulants, particularly the DAT regimen, and is inadequately informed by stroke and bleeding risk scores.


Assuntos
Síndrome Coronariana Aguda , Fibrilação Atrial , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
7.
Am Heart J ; 228: 1-7, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32739652

RESUMO

BACKGROUND: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the cornerstone for prevention ischemic events in patients with acute coronary syndromes (ACS) and undergoing percutaneous coronary intervention. However, the optimal antiplatelet strategy for ACS patients with both high bleeding and high ischemic risks is unclear. STUDY DESIGN: The OPT-BIRISK trial is a multicenter, double-blinded, placebo-controlled randomized study designed to test the superiority of extended antiplatelet therapy with clopidogrel monotherapy compared with aspirin and clopidogrel for reduction of bleeding events in ACS patients with both high bleeding and high ischemic risks ("bi-risk"). A total of 7,700 patients who completed 9- to 12-month dual antiplatelet therapy after new-generation drug-eluting stent implantation for the treatment of ACS will be randomized to receive clopidogrel monotherapy or aspirin plus clopidogrel for 9 months followed by aspirin monotherapy for 3 months. The primary end point is Bleeding Academic Research Consortium type 2, 3, or 5 bleedings at 9 months after randomization. The key secondary end point is major adverse cardiac and cerebral events at 9 months after randomization, defined as a composite of all-cause death, myocardial infarction, stroke, or coronary artery revascularization. CONCLUSIONS: OPT-BIRISK is the first large-scale randomized trial aimed to explore the optimal antiplatelet strategy for bi-risk ACS patients after percutaneous coronary intervention in current clinical practice. The results will add evidence regarding de-escalation antiplatelet therapy for patients at special risk.


Assuntos
Síndrome Coronariana Aguda , Aspirina , Clopidogrel , Hemorragia , Risco Ajustado/métodos , Acidente Vascular Cerebral , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/cirurgia , Adulto , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Método Duplo-Cego , Stents Farmacológicos/efeitos adversos , Terapia Antiplaquetária Dupla/efeitos adversos , Terapia Antiplaquetária Dupla/métodos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
8.
Angiology ; 71(9): 831-839, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32638621

RESUMO

Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells' inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 109/L, discharge hemoglobin <120 g/L, and discharge platelet count >250 × 109/L were defined as "high-risk CBC." Among 1076 patients with ACS discharged alive, 129 (12%) had a "high-risk CBC" and 947 (88%) had a "low-risk CBC." Patients with "high-risk CBC" were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to "low-risk CBC" patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient's risk and improve therapeutic management.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Taxa de Sobrevida , Fatores de Tempo
9.
Medicine (Baltimore) ; 99(29): e21272, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702916

RESUMO

There are limited data regarding the association between brain natriuretic peptide (BNP) levels obtained after weaning from extracorporeal membrane oxygenation (ECMO) and the outcomes of patients with acute coronary syndrome (ACS)-associated cardiogenic shock.We prospectively obtained data regarding patients (aged ≥ 19 years) with ACS-associated cardiogenic shock who received ECMO and were subsequently weaned off the treatment. BNP levels were collected at 5 time points: pre-ECMO implantation, post-ECMO implantation, pre-ECMO weaning, day 1 after ECMO weaning, and day 5 after ECMO weaning.Of 48 patients with ACS-related cardiogenic shock, 33 were included in this analysis. Mean patient age was 59.0 (50.0-66.5) years, and 5 patients (15.2%) were women. Eight patients had asystole/pulseless electrical activity before ECMO and 14 (42.4%) had 3-vessel disease on coronary angiography. During the 6-month follow up, 12 (36.4%) patients died. BNP levels after ECMO weaning were significantly different between 6-month survivors and non-survivors. Cox proportional hazards model revealed that BNP levels (tertiles) on days 1 and 5 after ECMO weaning were significantly associated with 6-month mortality (hazard ratio, 7.872; 95% confidence interval, 1.870-32.756; 8.658 and 1.904-39.365, respectively). According to the Kaplan-Meier curves, the first tertile had significantly longer survival compared to the third tertile for both days 1 and 5 after ECMO weaning.Post-ECMO weaning BNP levels (days 1 and 5) were significantly associated with increased 6-month mortality in patients with ACS complicated by refractory cardiogenic shock who were weaned off ECMO.


Assuntos
Oxigenação por Membrana Extracorpórea , Peptídeo Natriurético Encefálico/sangue , Choque Cardiogênico/mortalidade , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Choque Cardiogênico/sangue , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia
10.
Am J Cardiol ; 131: 115-119, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32723554

RESUMO

Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction. Despite these unprecedented times providers should not overlook acute coronary syndrome (ACS) guidelines, but may choose to modify the recommended approach in situations with confirmed or suspected COVID-19 disease. In this document, we suggest recommendations as to how to triage patients diagnosed with ACSs and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic.


Assuntos
Síndrome Coronariana Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Pneumonia Viral/complicações , Triagem/métodos , Síndrome Coronariana Aguda/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
12.
Angiology ; 71(10): 894-902, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32643400

RESUMO

The prevalence of coronary artery disease is increasing in young adults. We evaluated the outcomes of different types of acute coronary syndrome in 917 patients undergoing coronary angiography aged ≤45 years. Male sex, smoking, dyslipidemia were the most important risk factors. ST-elevation myocardial infarction (STEMI; 54.8%) predominated. The STEMI patients had higher risk of hospital mortality (3.6% vs 0.6%; P = .004) and major adverse cardiac and cerebrovascular events (MACCE; 13.8% vs 3.3%; P < .001, hazard ratio [HR], 4.65; 95% CI, 2.45-8.82). Presentation heart rate, blood pressure, heart failure, shock, arrhythmia, ejection fraction (EF), diabetes, contrast-induced nephropathy (CIN), and elevated troponin were associated with hospital mortality and MACCE. But only heart failure (HR, 5.816; 95% CI, 2.254-15.008) and CIN (HR, 6.241; 95% CI, 2.340-16.641) were independent risk factors for hospital MACCE. There was no difference in long-term mortality between the 2 groups, but non-STEMI patients had higher risk for MACCE after 3 years (14.4% vs 9.9%, P = .033). Although shock (HR, 0.814; 95% CI, 0.699-0.930), Killip class ≥2 (HR, 0.121; 95% CI, 0.071-0.170), CIN (HR, 0.323; 95% CI, 0.265-0.380), and EF (HR, 0.917; 95% CI, 0.854-0.984) were independent predictors of hospital death, only EF was the independent predictor of long-term mortality (HR, 0.897; 95% CI, 0.852-0.944).


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Adulto , Fatores Etários , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
14.
Angiology ; 71(9): 825-830, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32597198

RESUMO

Inflammation parameters can predict the severity of coronary artery disease and predict long-term mortality. However, there is no study in which these parameters were evaluated together. We compared the prognostic values of inflammation parameters in predicting long-term mortality in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Consecutive patients with NSTE-ACS (n = 170) were included in the study. Monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), total cholesterol/HDL-C ratio (TC/HDL-C), triglyceride /HDL-C ratio (TG/HDL-C), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index, and ischemia-modified albumin (IMA) were measured. Total antioxidant status and TOS variables were significant independent predictors of mortality. When 1.17 value is taken as a cutoff point of TAS values, the sensitivity (70.0%) and specificity (77.39%) values calculated for this value indicate that TAS variable has a predictive value on mortality. Monocyte/high-density lipoprotein cholesterol ratio, LMR, NLR, PLR, TC/HDL-C, TG/HDL-C, TOS, and IMA levels could not be used alone in the diagnosis, severity assessment, and predicting future mortality of NSTE-ACS. Only TAS levels had a predictive value on mortality.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Síndrome Coronariana Aguda/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Contagem de Células Sanguíneas , HDL-Colesterol/sangue , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Estresse Oxidativo , Valor Preditivo dos Testes , Prognóstico , Taxa de Sobrevida
15.
Medicine (Baltimore) ; 99(24): e20655, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541506

RESUMO

BACKGROUND: In this meta-analysis, we aimed to systematically compare the complications during hospitalization and at 30 days respectively, in intensive cardiac care unit (ICCU) for patients with ST elevation (STE) vs non-STE acute coronary syndrome (NSTE ACS). METHODS: Electronic search databases including http://www.ClinicalTrials.gov, EMBASE, Cochrane Central, Google Scholar, Web of Science, and MEDLINE were searched for publications comparing complications observed in STE ACS vs NSTE ACS patients admitted in ICCU, intensive care unit (ICU) or coronary care unit (CCU). This is a meta-analysis and risk ratios (RR) with 95% confidence intervals (CI) were used to illustrate the data following analysis by the RevMan 5.3 software. RESULTS: Six studies consisting of a total number of 25,604 participants (12,880 participants admitted due to STE ACS and 12,724 participants admitted due to NSTE ACS) were included. Our results showed that the total outcomes including severely abnormal electrocardiography (ECG) (RR: 1.48, 95% CI: 1.27-1.73; P = .00001) and mortality (RR: 1.83, 95% CI: 1.64-2.04; P = .00001) were significantly higher in patients with STE ACS. Re-infarction (RR: 0.86, 95% CI: 0.62-1.19; P = .37) and heart failure (RR: 1.04, 95% CI: 0.88-1.23; P = .62) were similarly manifested in those patients with ACS. However, the risk for recurrent angina was significantly higher with NSTE ACS (RR: 0.65, 95% CI: 0.46-0.92; P = .01). CONCLUSIONS: Patients with STE ACS were at a higher risk for in-hospital and 30 days mortality in this analysis. In hospital, severely abnormal ECG was also significantly higher in this category of patients compared to NSTE ACS. However, re-admission for heart failure and re-infarction was similar in both groups. Future studies should be able to confirm this hypothesis.


Assuntos
Síndrome Coronariana Aguda/complicações , Hospitalização , Projetos de Pesquisa , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Humanos , Unidades de Terapia Intensiva , Fatores de Tempo
16.
N Z Med J ; 133(1516): 58-71, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525862

RESUMO

AIMS: To describe the use of evidence-based heart failure therapies in patients with reduced left ventricular ejection fraction (LVEF) following acute coronary syndrome (ACS). METHODS: Patients with ACS and LVEF ≤40% were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry between June 2017 and May 2018. Data was obtained from retrospective review of clinical records. Dispensed medications were identified from pharmacy dispensing records and compared with target doses recommended in guidelines. RESULTS: Of 292 patients, 28% were seen in cardiology heart failure (HF) clinic, 54% seen in general cardiology clinic and 17% were not seen in cardiology clinic. At one year post-discharge, 52% and 39% were dispensed ≥50% target dose of angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB), and beta-blockers respectively. Seventy-one percent and 68% of patients were on maximally tolerated doses of ACEi/ARB and beta-blockers respectively. The highest rates of medication up-titration occurred in those seen in cardiology HF clinics. Seventy-four percent and 59% were dispensed ≥50% target dose of ACEi/ARB and beta-blocker respectively. Ninety-five percent and 89% were on maximally tolerated doses of ACEi/ARB and beta-blockers respectively. Thirteen percent were potentially eligible for primary prevention implantable cardiac defibrillator; however, only 24% of these eligible patients had one implanted by one year post-discharge. CONCLUSIONS: Evidence-based HF therapies were underutilised in this regional cohort of patients with reduced LVEF post-ACS. Strategies to improve use of these therapies should focus on increasing the number of patients seen by HF clinics and reducing clinic waiting times.


Assuntos
Síndrome Coronariana Aguda/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Desfibriladores Implantáveis , Fidelidade a Diretrizes/estatística & dados numéricos , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Idoso , Medicina Baseada em Evidências , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Guias de Prática Clínica como Assunto , Sistema de Registros , Estudos Retrospectivos , Volume Sistólico
17.
Circ Heart Fail ; 13(7): e007220, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32500721

RESUMO

The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.


Assuntos
Síndrome Coronariana Aguda/terapia , Arritmias Cardíacas/terapia , Infecções por Coronavirus/terapia , Insuficiência Cardíaca/terapia , Miocardite/terapia , Pneumonia Viral/terapia , Síndrome Coronariana Aguda/complicações , Antibacterianos/efeitos adversos , Antivirais/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/complicações , Azitromicina/efeitos adversos , Betacoronavirus , Cardiotônicos/uso terapêutico , Doença Crônica , Infecções por Coronavirus/complicações , Síndrome da Liberação de Citocina/complicações , Síndrome da Liberação de Citocina/terapia , Inibidores Enzimáticos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca/etiologia , Coração Auxiliar , Humanos , Hidroxicloroquina/efeitos adversos , Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Miocardite/complicações , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral/complicações , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Tromboembolia
20.
Am Heart J ; 225: 19-26, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32473355

RESUMO

Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage ≥3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy. RCT# NCT03357874.


Assuntos
Síndrome Coronariana Aguda/terapia , Clopidogrel/uso terapêutico , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Insuficiência Renal Crônica/complicações , Ticagrelor/uso terapêutico , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/prevenção & controle , Adolescente , Adulto , Idoso , Clopidogrel/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Prevenção Secundária , Trombose/prevenção & controle , Ticagrelor/efeitos adversos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA