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1.
Expert Opin Investig Drugs ; 29(1): 33-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31869253

RESUMO

Introduction: Despite current guideline-based, secondary prevention strategies in patients with the acute coronary syndrome, the residual ischemic risk is still at an unacceptable rate, and there is a concomitant high bleeding event rate. These observations mandate investigations of novel treatment strategies to meet the unmet need to improve outcomes in patients with ACS.Areas covered: In this review, the author(s) focus on new agents with ongoing or recently completed phase II trials for the treatment of ACS. We searched MEDLINE and clinicaltrials.org for Phase II trials in ACS patients, and important original investigations are reviewed.Expert opinion: Some of the novel drugs evaluated in the Phase II trials hold promise for future therapies such as AZD5718, anakinra, tocilizumab, CSL112, MEDI 6102, inclisiran, PZ128, selatogrel, and RVX-208. Their efficacy and safety should be evaluated in large scale Phase III trials. The higher cost of the drug will be a major limitation for wide-spread use of novel agents in general practice in future.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Desenvolvimento de Medicamentos , Drogas em Investigação/farmacologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/prevenção & controle , Animais , Ensaios Clínicos Fase II como Assunto , Drogas em Investigação/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos
2.
Angiology ; 71(1): 17-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31129986

RESUMO

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/prevenção & controle , África do Norte/epidemiologia , Idade de Início , Idoso , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade Prematura , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Prevalência , Prevenção Primária , Prognóstico , Projetos de Pesquisa , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
3.
Clín. investig. arterioscler. (Ed. impr.) ; 31(3): 93-100, mayo-jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182702

RESUMO

Introducción y objetivos: El adecuado control lipídico tras un síndrome coronario agudo (SCA) es una estrategia de prevención secundaria crucial para disminuir el riesgo de reinfarto y muerte cardiovascular. Existen tablas que predicen la dosificación necesaria del tratamiento hipolipidemiante según el colesterol LDL (cLDL) inicial pero no han sido probadas en el SCA. Analizamos los factores asociados al control del cLDL tras un SCA y la utilidad de las tablas de Masana y Plana en este contexto. Métodos: Entre enero de 2015 y mayo de 2016 se incluyeron 326 pacientes con SCA. Se registraron las concentraciones basales de cLDL y el tratamiento hipolipidemiante al alta. Se analizaron las variables asociadas a un adecuado control del cLDL (< 70 mg/dL) en el seguimiento. Resultados: La edad media fue 66 ± 13 años, el 72% varones. El tratamiento hipolipidemiante al alta se ajustó a las recomendaciones de Masana en 196 (60%) pacientes. Tras 122 [66-184] días, en 148 (45%) se alcanzó el objetivo de cLDL, siendo este porcentaje mayor (109/196 -56%- vs. 39/130 -30%- pacientes) cuando el tratamiento fue planificado según las tablas de Masana y Plana (p < 0,001). En el análisis multivariante, el género masculino (p < 0,001), la ausencia de dislipidemia previa (p < 0,001) y la aplicación de las tablas de Masana y Plana (p = 0,007) fueron predictores independientes para alcanzar el cLDL objetivo. Conclusiones: El control lipídico adecuado tras un SCA se alcanza en menos de la mitad de casos. La dosificación de la terapia hipolipidemiante según las tablas de Masanay Plana mejora la consecución de este crucial objetivo terapéutico


Introduction and objectives: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. Methods: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (< 70 mg/dL) control during follow-up. Results: Among our patient population (72% male, age 66 ± 13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P < .001). The male gender (P < .001), the absence of prior history of dyslipemia (P < .001) and the adherence to Masana's recommendations (P = .007) were independent predictors for the achievement of targeted LDLc levels during follow-up. Conclusions: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , LDL-Colesterol/efeitos dos fármacos , Síndrome Coronariana Aguda/complicações , Prevenção Secundária , Fatores de Risco , Metabolismo dos Lipídeos/efeitos dos fármacos , LDL-Colesterol/metabolismo , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/prevenção & controle , Hipolipemiantes/administração & dosagem , Dislipidemias , Análise Multivariada , Lipídeos/sangue
4.
ESC Heart Fail ; 6(3): 457-463, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30861640

RESUMO

AIMS: Understanding the pathophysiological background on haemodynamic changes in acute myocardial infarction and during its interventional treatment is important to adequately use mechanical circulatory support. METHODS AND RESULTS: We describe haemodynamic simulations based on a real case scenario of infarct-related ischaemia with beginning haemodynamic compromise illustrating the advantage of active haemodynamic support. The patient case used for computer simulation is that of an acute coronary syndrome, slightly hypotonic. The right coronary artery is chronically occluded, and both left main and a saphenous vein graft to the left anterior descending coronary artery (LAD) show subtotal stenosis. In this scenario used for computer modelling of haemodynamics, we illustrate how unprotected percutaneous coronary intervention would limit coronary blood flow and constantly reduce myocardial contractility until cardiac arrest occurs. The simulation demonstrates how an intra-aortic balloon pump would delay but not prevent that compromise and how an Impella microaxial pump will actively support cardiac output and stabilize haemodynamics even when prolonged balloon inflations are performed, which will temporarily stop coronary perfusion. CONCLUSIONS: The simulation illustrates how temporary circulatory support with an Impella microaxial pump can stabilize haemodynamics and allow for a safe procedure in an unstable patient. Using computer simulation of haemodynamics to understand changes in haemodynamics when performing interventions in unstable patients might help to properly select a suitable support device if needed.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Ventrículos do Coração/fisiopatologia , Coração Auxiliar , Hemodinâmica/fisiologia , Modelos Cardiovasculares , Síndrome Coronariana Aguda/prevenção & controle , Humanos , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/prevenção & controle
6.
Clin Investig Arterioscler ; 31(3): 93-100, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30711338

RESUMO

INTRODUCTION AND OBJECTIVES: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. METHODS: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up. RESULTS: Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. CONCLUSIONS: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , LDL-Colesterol/sangue , Hipolipemiantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária/métodos , Fatores Sexuais , Resultado do Tratamento
7.
Med J Aust ; 210(2): 80-85, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30712304

RESUMO

OBJECTIVE: To determine the prevalence and identify predictors of people hospitalised with acute coronary syndrome (ACS) receiving intensive lipid-lowering therapy during the 12 months after their discharge from hospital. DESIGN: Retrospective observational analysis. SETTING: Data were extracted from CONCORDANCE, a prospective, Australian investigator-initiated ACS registry. PARTICIPANTS: Patients enrolled in CONCORDANCE during January 2015 - May 2016 who survived to hospital discharge, for whom information on lipid-lowering therapy 6 or 12 months after discharge from hospital were available. MAIN OUTCOME MEASURES: Not receiving intensive lipid-lowering therapy (with or without ezetimibe) at the most recent follow-up (6 or 12 months); predictors of not receiving intensive lipid-lowering therapy. RESULTS: 1876 of 3441 patients (55%) were receiving intensive lipid-lowering therapy 6 or 12 months after their hospitalisation with an ACS. Predictors of not receiving intensive lipid-lowering therapy included not been prescribed this treatment prior to their hospital admission (odds ratio [OR], 1.53; 95% CI, 1.26-1.85) or at hospital discharge (aOR, 7.24; 95% CI, 4.37-12.0), being a woman (aOR, 1.20; 95% CI, 1.02-1.41), and not being referred for cardiac rehabilitation (aOR 1.39; 95% CI, 1.09-1.78). Patients who were managed medically in hospital (not revascularised; aOR, 1.54; 95% CI, 1.25-1.91) or underwent coronary artery bypass grafting (aOR 1.55; 95% CI, 1.26-1.92) were less likely to be receiving intensive lipid-lowering therapy at follow-up than those with a percutaneous coronary intervention. Unmeasured hospital factors accounted for 17% of the variation in the likelihood of intensive lipid-lowering therapy. CONCLUSIONS: 45% of patients in Australia are not receiving intensive lipid-lowering therapy in the 12 months after their ACS. Optimising oral lipid-lowering therapy would reduce the recurrence of coronary events in this high risk group.


Assuntos
Síndrome Coronariana Aguda , Hipolipemiantes/uso terapêutico , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/prevenção & controle , Idoso , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco
8.
Herz ; 44(1): 45-52, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30671595

RESUMO

For life style modifications primary and secondary prevention of acute coronary syndrome (ACS) are approximately similar, even though in the postinfarction situation functional diagnostic programs have to be performed in a rehabilitative manner. All three life style pillars of fitness, nutrition and relaxation implicate prognostic significance and the efficacy is higher for secondary prevention than for primary. The pharmacotherapeutic indications for thrombocyte aggregation inhibition are connected to the presence of atherosclerosis and statin medication is already connected to cardiovascular risk factor stratification, for which scores are used. Depending on the postinfarction myocardial destruction after ACS, additional pharmacotherapies, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor antagonists, beta blockers and also mineral corticoid receptor antagonists are evident. New potential for prevention is ascribed to the new oral anticoagulants (NOAC) in the context of coincidental atrial fibrillation.


Assuntos
Síndrome Coronariana Aguda , Prevenção Secundária , Síndrome Coronariana Aguda/prevenção & controle , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticoagulantes/uso terapêutico , Humanos , Inibidores da Agregação de Plaquetas/uso terapêutico
9.
Ann Cardiol Angeiol (Paris) ; 68(1): 39-48, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30683484

RESUMO

OBJECTIVES: To study the use, efficiency and wishes for a "medicalization" of the electronic cigarette (EC) for smoking cessation in secondary prevention of acute coronary syndrome (ACS). PATIENTS AND METHOD: Prospective epidemiological study with inclusion of smoker patients hospitalized from 1st June 2015 to 31st March 2016 at the St Quentin Hospital (Picardy, France) for an ACS (except unstable angina), interviewed 1 year after their ACS, excluding patients over 75 years or with personal history of ACS. RESULTS: Eighty-one patients were included. 59 questionnaires (73%) were returned and analyzed. The average age was 53.3 years. There were 45 men (76.3%) and 14 women (23.7%). 11 patients (18.6%) had used the EC at least once before their ACS and 11 (18.6%) had used it after. That was the second most used smoking cessation method after the nicotine patches. One year after their SCA, 39 patients (66.1%) had stopped smoking: 63.6% (7/11) of EC users after the ACS against 66.7% (32/48) of non-users (P=0.848). After multivariate analysis, only cessation without help was associated with ceasing (P=0.013). CE users were significantly younger, were smoking more before their ACS, and had started smoking earlier. 50% of CE users would have appreciated to be better informed by their general practitioner and 53.3% expressed themselves in favor of a sale in pharmacies. CONCLUSION: EC is the second most common means of smoking cessation after an ACS. Further comparative studies are essential to know more about its efficiency and safety.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Prevenção Secundária , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Síndrome Coronariana Aguda/epidemiologia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
10.
J Atheroscler Thromb ; 26(6): 559-572, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30518728

RESUMO

AIMS: The EXPLORE-J study aimed to assess lipid management in patients hospitalized for acute coronary syndrome (ACS) and their cardiovascular risk despite undergoing standard therapy. Here, we focused on background characteristics of patients in the EXPLORE-J study to elucidate the current lipid-lowering therapy and its issues in Japan. METHODS: In this multicenter, prospective, observational study (UMIN000018946), consecutive Japanese ACS patients who required hospitalization were registered between April 2015 and August 2016. Background and lipid profile data collected within 14 days of hospitalization were analyzed according to risk factors such as diabetes mellitus status. RESULTS: In total, 1944 patients were analyzed (80.3% male). The mean and standard deviation (SD) age and body mass index of all patients were 66.0 years (SD: 12.2) and 24.24 kg/m2 (SD: 3.59), respectively. The most common lipid-modifying medication used at the time of ACS was statins (27.3%). The low-density lipoprotein cholesterol (LDL-C) level (first measurement after hospitalization) of patients overall was 121.2 mg/dL (SD: 39.7); 30.3% had an LDL-C level <100 mg/dL (current target level for secondary prevention of cardiovascular events in Japan), compared with 52.1% of patients with a previous history of coronary artery disease (CAD), and 57.2% of patients with a history of CAD and diabetes. CONCLUSIONS: Many patients were not meeting Japanese LDL-C target levels at the time of ACS, and a large proportion of patients meeting target levels developed ACS; therefore, more stringent management and further evaluation of the target LDL-C levels is warranted in high-risk patients and those with previous history of CAD.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Anticolesterolemiantes/uso terapêutico , Biomarcadores/sangue , Hiperlipidemias/complicações , Lipídeos/análise , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/etiologia , Idoso , LDL-Colesterol/sangue , Feminino , Seguimentos , Humanos , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/epidemiologia , Japão/epidemiologia , Masculino , Prognóstico , Estudos Prospectivos
11.
Int J Food Sci Nutr ; 70(5): 603-611, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30501542

RESUMO

The aim was to investigate the association between homocysteine (Hcy) and acute coronary syndrome (ACS) and to test the potential moderating role of Mediterranean diet. An age and gender matched case-control study was conducted among 1491 patients with a first ACS event and 3037 adults free of cardiovascular disease (CVD). Adherence to the Mediterranean diet was measured using the MedDietScore (range 0-55). An increase in Hcy levels was associated with a 1% and 3% higher likelihood of ACS among younger (<45 yrs) and middle-aged (45-60yrs) adults (p's < 0.05), but not in older adults (p = 0.13). Moreover, Hcy was associated with 3% (95%CI: 1.01-1.06) increase in the likelihood of ACS among those who did not adhere to the Mediterranean diet. Hence, Hcy is apparently independently associated with ACS among younger and middle-aged individuals. The inverse association between Mediterranean diet adherence and Hcy highlights a disease-preventing effect of the Mediterranean diet on CVD.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Dieta Mediterrânea , Homocisteína/uso terapêutico , Síndrome Coronariana Aguda/epidemiologia , Adulto , Fatores Etários , Idoso , Envelhecimento , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais
12.
Presse Med ; 48(2): 154-164, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30528147

RESUMO

Vitamin-K antagonists (VKA) have been the standard for oral anticoagulation. However, they carry several problems in older patients: frequent bleeding complications, complex management, risk of interactions with multiple drugs. Two classes of direct oral anticoagulants (DOA) are currently available in France: (a) direct thrombin inhibitors: dabigatran; and (b) direct factor Xa inhibitors: rivaroxaban, apixaban and others. Their management is easier: quickly effective after administration, they are given at fixed doses and do not need regular laboratory monitoring. Several randomized trials have shown that DOA are non-inferior to VKA for treating venous thromboembolic disease (prophylactic or curative treatment) and atrial fibrillation (prevention of associated embolisms). DOA might be also effective for long-term treatment of coronary disease, in some cases. No trial has specifically studied older patients. In the context of atrial fibrillation, subgroup analysis show similar results between patients above and below 75-years-old. Lower doses of dabigatran and apixaban should be used in many older people. All DOA are eliminated at least partly by kidneys. Their dose must be reduced in moderate renal failure (filtration glomerular rate (FGR) 30 to 50mL/min) and they are contraindicated in older patients with severe renal failure (FGR<30mL/min). DOA also have other problems: (a) important drug interactions are still possible, (b) the clinical application of specific coagulation tests need to be defined, (c) their safety in some subgroups of elderly patients, very different from patients included in clinical trials, is not known.


Assuntos
Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Tromboembolia/prevenção & controle , Síndrome Coronariana Aguda/prevenção & controle , Idoso , Anticoagulantes/farmacologia , Antitrombinas/farmacologia , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Contraindicações de Medicamentos , Relação Dose-Resposta a Droga , Interações de Medicamentos , Inibidores do Fator Xa/farmacologia , Próteses Valvulares Cardíacas , Hemorragia/induzido quimicamente , Humanos , Insuficiência Renal Crônica/complicações , Fatores de Risco , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Varfarina/farmacologia , Varfarina/uso terapêutico
13.
Am J Cardiol ; 123(3): 368-374, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30497653

RESUMO

Previous studies assessing healthcare provider compliance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines indicate a significant underuse of statin therapy at appropriate intensity. However, data are limited in primary prevention patients. Our study aimed to evaluate the impact of the 2013 ACC/AHA guidelines through a retrospective analysis of primary prevention patients presenting with first time acute coronary syndrome (ACS). We retrospectively calculated the 10-year predicted Atherosclerotic Cardiovascular Disease (10yASCVD) risk in 1,265 patients ages 40 to 75 who presented with ACS and no previous ASCVD. In patients without known ambulatory systolic blood pressure, a multivariable linear regression model was used to predict outpatient systolic blood pressure. Outcomes analyzed in each 10yASCVD category included statin status and statin intensity (high/medium/low) with further categorization by type of ACS event and date of left heart catheterization. In both primary analysis and sensitivity analysis (patients with predicted systolic blood pressure), statistical significance was shown with respect to overall statin status, ST Elevation Myocardial Infarction, and date of left heart catheterization. In summary, retrospective calculation of 10yASCVD in patients with a first ACS event showed a significant number of ACS patients would have qualified for statin therapy per 2013 ACC/AHA guidelines before their event but had not been initiated on one.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Corantes/uso terapêutico , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Prevenção Primária , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Estados Unidos
14.
Heart Lung Circ ; 28(2): 257-262, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29523466

RESUMO

BACKGROUND: We assessed the effect of a pre-discharge medication checklist on discharge prescription rates of guideline recommended medications following myocardial infarction. In addition, we assessed what proportion of the residual prescribing gap following implementation of the checklist was due to the presence of contraindications. METHODS: We examined baseline prescription rates of guideline recommended medications in 100 patients discharged from our institution following acute myocardial infarction. We then introduced a pre-discharge checklist and reassessed discharge medications and reasons for non-prescription of guideline recommended medications in 447 patients with acute myocardial infarction. RESULTS: We demonstrated a significant gap in the prescription of guideline recommended secondary prevention medications at the time of discharge in our pre-intervention cohort. Introduction of a pre-discharge checklist resulted in a significant improvement in the prescription rates of all guideline recommended secondary prevention medications, with aspirin increasing from 90% to 97% (p=0.004), Adenosine diphosphate (ADP) receptor antagonist from 84% to 96% (p=0.0001), B-blocker from 79% to 87% (p=0.03), statin from 88% to 96% (p=0.002) and angiotensin converting enzyme (ACE) inhibitor from 58% to 70% (p=0.03). The residual gap in prescribing was largely explained by the presence of contraindications or absence of an indication in the case of ACE-inhibitors. Once these were taken into account there was a residual gap of 0-4% which represents genuine non-adherence to the guidelines. CONCLUSIONS: Introduction of a pre-discharge checklist led to significant improvement in prescription rates of all five guideline recommended secondary prevention medications. The residual gap in medication prescription following introduction of the checklist was largely due to the presence of contraindications rather than non-adherence.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Fármacos Cardiovasculares/uso terapêutico , Prescrições de Medicamentos/normas , Fidelidade a Diretrizes , Infarto do Miocárdio/complicações , Prevenção Secundária/normas , Síndrome Coronariana Aguda/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos
15.
Basic Clin Pharmacol Toxicol ; 124(1): 84-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30098132

RESUMO

Acute coronary syndrome (ACS) has become a vital disease with high mortality worldwide. A combined antiplatelet therapy (aspirin and a P2Y12 antagonist) is commonly used to prevent re-infarction in ACS patients who have undergone percutaneous coronary intervention (PCI). Clopidogrel, a P2Y12 antagonist, plays an important role in the inhibition of platelet aggregation (IPA). However, it is a pro-drug requiring biotransformation by cytochrome P450 (CYP450). The aim of this study is to unravel the effect of clopidogrel-associated genetic variants on inhibition of platelet activity and clinical outcomes in ACS patients. In our study, a total of 196 patients with metabolic gene polymorphism of clopidogrel were enrolled, and their antiplatelet effect as well as their cardiovascular events were collected. Approximately 2 mL of venous blood samples were used for genotype detection and another 4 mL were collected for platelet reactivity with thrombelastography. The primary clinical end-point was defined as a combination of cardiovascular mortality and revascularization for targeted vascular lesion. Based on the results of IPA, the prevalence of high on-treatment platelet reactivity (HPR) was 17.3% and the majority of patients (82.7%) obtained normal on-treatment platelet reactivity (NPR). The HPR group had significantly higher body mass index (BMI) and lower arachidonic acid (AA) induced IPA (P < 0.05). Therapy including Glycoprotein (GP) IIb/IIIa antagonist increased IPA (P < 0.05). ADP-induced IPA effect was lower with the presence of CYP2C19*2, *3 and paraoxonase (PON)1 Q192R loss-of-function (LOF) alleles, respectively (P < 0.05). Multivariate logistic regression analysis demonstrated that aspirin resistance (AA-induced IPA < 50%) had a greater risk of the occurrence of major adverse cardiovascular events (MACE) (OR = 3.817; 95% CI: 1.672-8.700; P = 0.002). CYP2C19*2 LOF alleles were associated with high risk of MACE in 1-year post PCI operations (OR = 2.571; 95% CI: 1.143-5.780; P = 0.030). For the ACS patients, the presence of CYP2C19*2 and PON1 Q192R LOF alleles were the major drivers of HPR.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Clopidogrel/farmacologia , Variantes Farmacogenômicos/genética , Ativação Plaquetária/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/cirurgia , Idoso , Arildialquilfosfatase/genética , Aspirina/uso terapêutico , Biotransformação/genética , Clopidogrel/metabolismo , Clopidogrel/uso terapêutico , Citocromo P-450 CYP2C19/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/sangue , Recidiva , Resultado do Tratamento
16.
Int J Cardiol ; 275: 1-5, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30391064

RESUMO

BACKGROUND: Guidelines recommend exercise for secondary prevention of acute coronary syndrome (ACS), however adherence to guidelines is low. A paucity of data examining factors associated with objectively-measured exercise post-discharge in ACS survivors exists. The purpose of this study was to identify factors associated with exercise during the 5 weeks after ACS discharge. METHODS: A sample of 151 ACS patients treated at a university hospital were enrolled into an observational cohort study and wore an accelerometer for 35 days post-discharge. Days on which participants accumulated ≥30 min of moderate-to-vigorous physical activity in bouts ≥10 min were considered exercise days. Participants were categorized as non-exercisers (0 exercise days) or exercisers (≥1 exercise day). A multi-variable logistic regression model was used to examine the association between exercise and socio-demographics, depression, SF-12 physical and mental health scores, disease severity, length of hospitalization, and percutaneous coronary intervention. RESULTS: 39.7% of participants were non-exercisers. Factors associated with non-exercise were age (OR: 1.11; 95% CI: 1.06-1.17, p < 0.001), female sex (OR: 2.76; 95% CI: 1.10-6.95, p = 0.031), and lower SF-12 physical health score (OR: 0.94; 95% CI: 0.90-0.98, p = 0.005). CONCLUSION: In ACS patients in whom exercise participation was objectively measured for 5 weeks post-discharge, demographic and poor physical health factors were associated with non-exercise. These findings identify populations (e.g. older adults, women) at especially high risk for being physically inactive in whom more intense intervention may be warranted.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Terapia por Exercício/métodos , Exercício/fisiologia , Hospitalização , Pacientes Internados , Prevenção Secundária/métodos , Acelerometria , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Alta do Paciente/tendências , Estudos Retrospectivos
17.
Heart ; 105(1): 67-74, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30030335

RESUMO

OBJECTIVE: To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. METHODS: We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation. RESULTS: 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005). CONCLUSIONS: The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.


Assuntos
Síndrome Coronariana Aguda , Aspirina , Acidente Vascular Cerebral , Ticlopidina , Suspensão de Tratamento/estatística & dados numéricos , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/prevenção & controle , Idoso , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Escócia/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversos , Fatores de Tempo
18.
Drug Des Devel Ther ; 12: 3583-3594, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30498334

RESUMO

Background: Dual antiplatelet therapy is a standard protocol for secondary prevention after acute coronary syndrome, but despite a variety of new dual antithrombotic strategies, there is a dearth of studies evaluating the effects and safety of some popular therapies. This study used a network meta-analysis to compare the efficacy and safety of all available antithrombotic therapies. Methods: PubMed, MEDLINE, and Cochrane library databases were searched for randomized controlled trials, published up to July 1, 2017, that evaluated the efficacy of antithrombotic therapy in acute coronary syndrome treatment. The primary endpoints were clinically significant bleeding and major bleeding and secondary endpoints were major cardiovascular events, all-cause deaths, cardiac deaths, and myocardial infarction. Results: Compared with treatment with aspirin + new P2Y12 inhibitor, treatment with aspirin + new P2Y12 inhibitor converted to clopidogrel clinically reduced the risk of major cardiovascular events or significant bleeding (OR: 0.30, 95% credibility interval: 0.12-0.75). Both myocardial infarction risk (OR: 0.82, 95% credibility interval: 0.62-1.09) and major bleeding risk (OR: 0.18, 95% credibility interval: 0.01-1.68) were not significantly different between treatment regimens. There were no significant differences in major cardiovascular events, all-cause deaths, cardiac deaths, myocardial infarction, clinically significant bleeding, and major bleeding risk with rivaroxaban + new P2Y12 inhibitor therapy when compared with aspirin + new P2Y12 inhibitor. Compared with aspirin + clopidogrel, the conversion therapy further reduced the risk of myocardial infarction (OR: 1.81, 95%, credibility interval: 1.01-1.34) without an increased clinical risk of significant bleeding (OR: 0.41, 95%, credibility interval: 0.15-1.07). Treatment with aspirin + new P2Y12 inhibitors reduced all-cause deaths (OR: 0.91, 95% credibility interval: 0.84-0.98) and cardiac death risk (OR: 0.86, 95% credibility interval: 0.79-0.93). Conclusion: We concluded the following from our study: 1) an aspirin + new P2Y12 inhibitor/ clopidogrel conversion treatment strategy was not inferior to aspirin + new P2Y12 inhibitor; 2) compared with aspirin + clopidogrel, the conversion strategy may further reduce the risk of myocardial infarction without increasing the risk of bleeding; and 3) compared with aspirin + clopidogrel, treatment with aspirin + new P2Y12 inhibitors may result in reduced risk of death.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/prevenção & controle , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Prevenção Secundária , Humanos , Infarto do Miocárdio/tratamento farmacológico , Receptores Purinérgicos P2Y12/metabolismo
19.
Chin Med J (Engl) ; 131(22): 2699-2704, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30425196

RESUMO

Background: The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS) thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs) after percutaneous coronary intervention (PCI) with drug-eluting stents. However, the prognostic value of this score has not been fully evaluated in non-Euro-American PCI populations. Methods: We performed a prospective, observational study of 10,724 patients who underwent PCI in Fuwai hospital, China and evaluated the PARIS thrombotic risk score's predictive value of CTEs in the PCI population. The area under the receiver operating characteristic curve (AUROC) was used to assess the predictive value of the PARIS score for CTE. Results: Among 9782 patients without in-hospital events, a total of 95 CTEs occurred during the 2-year follow-up. The PARIS score was significantly higher in patients with CTEs (3.38 ± 2.04) compared with patients without events (2.53 ± 1.70, P < 0.001). According to the risk stratification of the PARIS thrombotic score, the risk of CTEs in the high-risk group was 3.14 times higher than that in the low-risk group (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.92-5.13; P < 0.001). However, the risk of CTEs in the intermediate-risk and low-risk groups was not significant (HR, 1.39; 95% CI, [0.86-2.24]; P = 0.184). The PARIS score showed prognostic value in evaluating CTEs in the overall population (AUROC, 0.621; 95% CI, 0.561-0.681), the acute coronary syndrome (ACS) population (AUROC, 0.617; 95% CI, 0.534-0.700; P = 0.003), and the non-ACS population (AUROC, 0.647; 95% CI, 0.558-0.736; P = 0.001). Conclusions: In a real-world Chinese population, the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI. This score also has a predictive value for CTEs in the ACS and non-ACS subgroup populations.


Assuntos
Trombose Coronária/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/prevenção & controle , Idoso , Grupo com Ancestrais do Continente Asiático , Trombose Coronária/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Estudos Prospectivos , Medição de Risco , Trombose/prevenção & controle
20.
G Ital Cardiol (Rome) ; 19(11): 620-627, 2018 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-30425391

RESUMO

Influenza infection, although considered a relatively benign pathology, is associated with a high number of hospital admissions and significant mortality, especially for the most vulnerable subjects. There is a great deal of evidence regarding the existence of an association between influenza and occurrence of cardiovascular events. Influenza vaccination by reducing the transmission of infection aims to reduce its complications, including cardiovascular events. The available studies have confirmed the safety of influenza vaccination in patients at high cardiovascular risk, even if performed during acute coronary syndrome hospitalization, and its efficacy in reducing coronary events. The cardiac benefit of influenza vaccination has been acknowledged by the cardiological scientific societies in the drafting of guidelines for both stable coronary artery disease and heart failure.


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/complicações , Infarto do Miocárdio/etiologia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Influenza Humana/prevenção & controle , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Guias de Prática Clínica como Assunto
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