Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.754
Filtrar
1.
Ther Adv Cardiovasc Dis ; 13: 1753944719893274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31823688

RESUMO

Oral antiplatelet drugs are crucially important for patients with acute coronary syndrome or stable coronary artery disease undergoing percutaneous coronary intervention (PCI). In recent decades, several clinical trials have focused on reducing periprocedural ischemic events in patients undergoing PCI by means of more rapid platelet inhibition with the use of intravenous antiplatelet drugs. Glycoprotein IIb/IIIa receptor inhibitors (GPIs) block the final common pathway of platelet aggregation and enable potent inhibition in the peri-PCI period. In recent years, however, the use of GPIs has decreased due to bleeding concerns and the availability of more potent oral P2Y12 inhibitors. Cangrelor is an intravenous P2Y12 receptor antagonist. In a large-scale regulatory trial, cangrelor administration during PCI allowed for rapid, potent and rapidly reversible inhibition of platelet aggregation, with an anti-ischemic benefit and no increase in major bleeding. This article aims to provide an overview of general pharmacology, supporting evidence and current status of intravenous antiplatelet therapies (GPIs and cangrelor), with a focus on contemporary indications for their clinical use.


Assuntos
Síndrome Coronariana Aguda/terapia , Monofosfato de Adenosina/análogos & derivados , Plaquetas/efeitos dos fármacos , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Agregação Plaquetária/efeitos dos fármacos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Administração Intravenosa , Animais , Plaquetas/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Hemorragia/induzido quimicamente , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/metabolismo , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
Kardiologiia ; 59(11): 14-20, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849295

RESUMO

AIM: The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event. MATERIALS AND METHODS: Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index. RESULTS: At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome. CONCLUSION: ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.


Assuntos
Síndrome Coronariana Aguda , Fibrilação Atrial , Infarto do Miocárdio , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/terapia , Idoso , Humanos , Inibidores da Agregação de Plaquetas , Testes de Função Plaquetária , Sistema de Registros , Fatores de Risco , Resultado do Tratamento
4.
Angiol Sosud Khir ; 25(3): 63-67, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503248

RESUMO

Despite implementation of antiproliferative drug-eluting stents (DES) and intention to perform maximally full myocardial revascularization during a single hospital stay even in acute coronary syndrome (ACS) the frequency of repeat interventions after endovascular revascularization remains at a sufficiently stable level. In order to examine the causes of repeat hi-tech medical care rendered by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation we carried out a retrospective single-centre study. It included a total of 93 patients suffering from ischaemic heart disease (IHD), who in 2017 endured this type of medical care twice. The cases of repeat revascularization were analysed based on medical history taking, physical examination, ECG pattern, ultrasonographic examination, laboratory findings, data of electronic case report forms and video recordings of the previous and latest coronary angiographies (CAG). The obtained findings revealed the main causes of repeat hi-tech medical care rendered within 1 year by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation, which were as follows: progression of atherosclerosis in the previously non-revascularized arteries, the emergence of the clinical course of ACS in borderline stenosis; the development of acute coronary syndrome in patients with a significant lesion of the coronary bed, who were scheduled for this or that reason to undergo elective staged transcutaneous coronary intervention (TCI); restenosis in the previously implanted stents.


Assuntos
Síndrome Coronariana Aguda , Stents Farmacológicos , Infarto do Miocárdio , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Resultado do Tratamento
5.
Int Heart J ; 60(5): 1043-1049, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484867

RESUMO

Acute coronary syndrome (ACS) is the major cause of out-of-hospital cardiac arrest (OHCA). The relationship between the findings from the study of coronary images and return of spontaneous circulation (ROSC) interval is still unknown. Hence, we investigated this relationship in ACS patients with OHCA.A cohort of 2779 patients was admitted to our emergency center due to cardiopulmonary arrest (CPA) between April 2011 and March 2015. We included ACS patients who had CPA with ventricular fibrillation (VF) as an initial rhythm, were successfully resuscitated, underwent coronary angiography (CAG), had a culprit lesion, and were diagnosed with ACS (n = 58; age, 63.7 ± 12.0 years; 93.1% male).We divided the 58 patients into two groups, an early ROSC group (ROSC ≤ 20 minutes: E-ROSC) and a late ROSC group (ROSC > 20 minutes: L-ROSC), and then analyzed their characteristics.The finding of a collateral artery for the culprit lesion location, Rentrop II-III, and TIMI III flow on CAG on arrival presented no significant differences between the two groups (Rentrop II-III: 25.0% versus 23.5%, P = 0.90; TIMI III: 33.3% versus 35.3%, P = 0.88). The incidence of multivessel coronary artery disease (MVD) was lower in the E-ROSC group than in the L-ROSC group (16.7% versus 58.8%, P = 0.001).Collateral and TIMI flow were not associated with ease of resuscitation, but MVD may have a negative impact on resuscitation, especially in VF patients.


Assuntos
Síndrome Coronariana Aguda/terapia , Reanimação Cardiopulmonar/métodos , Doença da Artéria Coronariana/terapia , Circulação Coronária/fisiologia , Parada Cardíaca Extra-Hospitalar/terapia , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Idoso , Reanimação Cardiopulmonar/mortalidade , Causas de Morte , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Intervenção Coronária Percutânea/mortalidade , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
6.
N Engl J Med ; 381(16): 1524-1534, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31475799

RESUMO

BACKGROUND: The relative merits of ticagrelor as compared with prasugrel in patients with acute coronary syndromes for whom invasive evaluation is planned are uncertain. METHODS: In this multicenter, randomized, open-label trial, we randomly assigned patients who presented with acute coronary syndromes and for whom invasive evaluation was planned to receive either ticagrelor or prasugrel. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. A major secondary end point (the safety end point) was bleeding. RESULTS: A total of 4018 patients underwent randomization. A primary end-point event occurred in 184 of 2012 patients (9.3%) in the ticagrelor group and in 137 of 2006 patients (6.9%) in the prasugrel group (hazard ratio, 1.36; 95% confidence interval [CI], 1.09 to 1.70; P = 0.006). The respective incidences of the individual components of the primary end point in the ticagrelor group and the prasugrel group were as follows: death, 4.5% and 3.7%; myocardial infarction, 4.8% and 3.0%; and stroke, 1.1% and 1.0%. Definite or probable stent thrombosis occurred in 1.3% of patients assigned to ticagrelor and 1.0% of patients assigned to prasugrel, and definite stent thrombosis occurred in 1.1% and 0.6%, respectively. Major bleeding (as defined by the Bleeding Academic Research Consortium scale) was observed in 5.4% of patients in the ticagrelor group and in 4.8% of patients in the prasugrel group (hazard ratio, 1.12; 95% CI, 0.83 to 1.51; P = 0.46). CONCLUSIONS: Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups. (Funded by the German Center for Cardiovascular Research and Deutsches Herzzentrum München; ISAR-REACT 5 ClinicalTrials.gov number, NCT01944800.).


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Cloridrato de Prasugrel/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticagrelor/uso terapêutico , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso , Trombose Coronária/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/efeitos adversos , Cloridrato de Prasugrel/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Stents , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Ticagrelor/efeitos adversos
7.
Cardiology ; 143(1): 14-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390616

RESUMO

BACKGROUND: Statins are recommended for secondary prevention. Our aims were to describe the proportion of very elderly patients receiving statins after non-ST segment elevation acute coronary syndrome (NST-ACS) and to determine the prognostic implications of statins use. METHODS: This prospective registry was performed in 44 hospitals that included patients ≥80 years discharged after a NST-ACS from April 2016 to September 2016. RESULTS: We included 523 patients, the mean age was 84.2 ± 4.0 years and 200 patients (38.2%) were women. Previous statin treatment was recorded in 282 patients (53.4%), and 135 (32.5%) had LDL cholesterol levels >2.6 mmol/L. Mean LDL cholesterol levels during admission were 2.3 ± 0.9 mmol/L. Statins were prescribed at discharge to 474 patients (90.6%). Compared with patients discharged on statins, those that did not receive statins were more often frail (22 [47.8%] vs. 114 [24.4%], p < 0.01) and underwent an invasive approach less frequently (30 [61.2%] vs. 374 [78.9%], p = 0.01). During a 6-month follow-up, 50 patients died (9.5%). There was a nonsignificant trend to higher mortality in patients not treated with statins (6 [15%] vs. 44 [9.6%], p = 0.30), but statins were not independently associated with lower mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.30-2.11, p = 0.65), nor with a reduction in the combined endpoint mortality/hospitalizations (HR 0.89; 95% CI 0.52-1.55, p = 0.69). CONCLUSIONS: Although most octogenarians presenting a NST-ACS are already on statins before the episode, their LDL cholesterol is frequently >2.6 mmol/L. Octogenarians who do not receive statins have a high-risk profile, with significant frailty and comorbidity.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso de 80 Anos ou mais , LDL-Colesterol/sangue , Comorbidade , Feminino , Seguimentos , Idoso Fragilizado , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Alta do Paciente , Prognóstico , Estudos Prospectivos , Sistema de Registros , Espanha/epidemiologia
8.
Cardiology ; 143(1): 22-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31352455

RESUMO

BACKGROUND: Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. OBJECTIVES: To assess long-term mortality and explore its association with the baseline variables in women and men. METHODS: We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. RESULTS: At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. CONCLUSION: For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso , Fibrilação Atrial/mortalidade , Creatinina/análise , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Revascularização Miocárdica , Inibidores da Agregação de Plaquetas/uso terapêutico , Psicotrópicos/uso terapêutico , Fatores Sexuais , Choque Cardiogênico/mortalidade , Suécia/epidemiologia
9.
MMW Fortschr Med ; 161(Suppl 5): 21-24, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31313267

RESUMO

BACKGROUND: For patients undergoing acute coronary syndrome, participation in cardiac rehabilitation includes, in addition to lifestyle modification, optimal adjustment to secondary preventive medication. As a result, follow-up events can be prevented very effectively. METHOD: The PATIENT-CARE registry study examined the treatment of patients during rehabilitation. Of particular interest was whether LDL cholesterol (LDL-C) targets were met. RESULTS: The rate of treated patients increased in almost all classes of medication. At discharge, 96.7% of patients received statins, 98.5% antithrombotics and 22.3% antidiabetics. LDL-C was significantly reduced during rehabilitation - on average by 21.3 mg/dl (0.55 mmol/l). 41.9% of the patients achieved the LDL-C target value. CONCLUSION: The results show that the optimization of secondary drug prevention in the outpatient sector must be continued unconditionally and consistently.


Assuntos
Síndrome Coronariana Aguda/terapia , Reabilitação Cardíaca , LDL-Colesterol/sangue , Fibrinolíticos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemiantes/uso terapêutico , Humanos , Sistema de Registros , Resultado do Tratamento
10.
J Cardiovasc Med (Hagerstown) ; 20(8): 525-530, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31260420

RESUMO

AIM: Differences exist in the diagnosis and treatment of acute coronary syndrome (ACS) between men and women. However, recent advancements in the management of ACSs might have attenuated this sex gap. We evaluated the status of ACS management in a multicenter registry in 10 tertiary Spanish hospitals. METHODS: We enrolled 1056 patients in our study, including only those with type 1 myocardial infarctions or unstable angina presumably not related to a secondary cause in an 'all-comers' design. RESULTS: The women enrolled (29%) were older than men (71.0 ±â€Š12.8 vs. 64.0 ±â€Š12.3, P = 0.001), with a higher prevalence of hypertension (71.0 vs. 56.5%, P < 0.001), insulin-treated diabetes (13.7 vs. 7.9%, P = 0.003), dyslipidemia (62.2 vs. 55.3%, P = 0.038), and chronic kidney disease (16.9 vs. 9.1%, P = 0.001). Women presented more frequently with back or arm pain radiation (57.3 vs. 49.7%, P = 0.025), palpitations (5.9 vs. 2.0%, P = 0.001), or dyspnea (33.0 vs. 19.4%, P = 0.001). ACS without significant coronary stenosis was more prevalent in women (16.8 vs. 8.1%, P = 0.001). There were no differences in percutaneous revascularization rates, but drug-eluting stents were less frequently employed in women (75.4 vs. 67.8%, P = 0.024); women were less often referred to a cardiac rehabilitation program (19.9 vs. 33.9%, P = 0.001). There were no significant differences in in-hospital complications such as thrombosis or bleeding. CONCLUSION: ACS presenting with atypical symptoms and without significant coronary artery stenosis is more frequent in women. Selection of either an invasive procedure or conservative management is not influenced by sex. Cardiac rehabilitation referral on discharge is underused, especially in women.


Assuntos
Síndrome Coronariana Aguda/terapia , Angina Instável/terapia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Infarto do Miocárdio/terapia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angina Instável/diagnóstico por imagem , Angina Instável/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Prevalência , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Resultado do Tratamento
11.
Anatol J Cardiol ; 22(1): 5-12, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31264653

RESUMO

OBJECTIVE: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. METHODS: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). RESULTS: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. CONCLUSION: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.


Assuntos
Síndrome Coronariana Aguda , Angina Estável , Angiografia Coronária/métodos , Intervenção Coronária Percutânea/métodos , Exposição à Radiação , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angina Estável/diagnóstico , Angina Estável/terapia , Angiografia Coronária/efeitos adversos , Feminino , Artéria Femoral , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
12.
J Cardiovasc Med (Hagerstown) ; 20(8): 504-509, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259857

RESUMO

: Advances in technology have led to an improvement in the ability to detect and quantify acute cardiomyocyte injury with the measurement of high-sensitivity cardiac troponin as compared with conventional assays. The upper reference limit for the high-sensitivity cardiac troponin assays is defined as the 99th percentile cutoff value in a healthy reference population. Since sex-related threshold levels of high-sensitivity cardiac troponin assays have been proposed, this review will focus on the diagnostic and prognostic implications of adopting sex-specific threshold troponin values in patients with a suspected acute coronary syndrome.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Troponina/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/terapia , Fatores Etários , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Fatores Sexuais , Regulação para Cima
14.
G Ital Cardiol (Rome) ; 20(6): 351-360, 2019 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-31184321

RESUMO

BACKGROUND: An increasing amount of evidence confirms that abnormalities in glucose metabolism are associated with cardiovascular morbidity and mortality in acute coronary syndromes (ACS). The in-hospital management of hyperglycemic diabetic patients with ACS is complex, and the traditional clinical-organizational approaches show a high degree of heterogeneity nationwide in Italy. METHODS: The current survey (March 2016-January 2017), carried out through the Delphi method, was focused on some management issues to verify the modalities/possibilities of resolution in daily clinical practice. In addition to the 12 members of the Board, who defined the web-based questionnaire and coordinated the various stages of the process, 66 specialists, cardiologists or diabetologists, were involved in 6 Italian Regions (Lombardy, Tuscany, Lazio, Friuli-Venezia Giulia, Puglia and Sicily). Three iterative rounds of evaluation of the 24 statements included in the questionnaire were scheduled. For each statement, the median evaluation value and the degree of convergence of the Panel of specialists were determined. RESULTS AND CONCLUSIONS: The final analysis reveals two key aspects with a broad convergence of opinions: (i) the need, since admission to hospital, of a close collaboration between cardiologists and diabetologists in the assistance of high-risk patients; and (ii) the opportunity of a specific diagnostic therapeutic care pathway extended to post-discharge management, where the role of the general practitioner should be adequately emphasized.


Assuntos
Síndrome Coronariana Aguda/terapia , Angiopatias Diabéticas/terapia , Equipe de Assistência ao Paciente , Síndrome Coronariana Aguda/etiologia , Cardiologia , Técnica Delfos , Endocrinologia , Humanos
15.
Medicine (Baltimore) ; 98(22): e15681, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145281

RESUMO

BACKGROUND: Studies that used short message service (SMS) programs as an intervention to promote health care have shown beneficial results in the control of risk factors for ischemic heart disease in patients of high-income countries, but evidence is lacking in low or middle-income countries. AIMS: The purpose of this study is to evaluate whether the use of SMS increases risk factor control within 6 months after discharge by acute coronary syndrome (ACS) in a middle-income country. METHODS: It will be a 2-arm, parallel, double-blind, randomized clinical trial of 160 patients discharged after an ACS from a single center with 6 months of follow-up. The intervention group will receive 4 SMS per week offering advice, motivation and information about medication adherence, increase of regular physical activity, adoption of healthy dietary measures, and smoking cessation (if appropriate). The primary outcome is achieving 4 or 5 points in a risk factor control score, which combines the cluster effect of 5 main modifiable risk factors for ACS [low-density lipoprotein cholesterol, LDL-C <70 mg/dL, blood pressure <140/90 mm Hg, regular exercise (≥5 days/week × 30 minutes of moderate exercise per session), nonsmoker status, and body mass index, BMI <25 kg/m]. Secondary outcomes are plasma LDL-C level, level of physical activity, blood pressure, medication adherence, proportion of nonsmokers, BMI, rehospitalization, cardiovascular death, and death from any cause. This study, as a randomized clinical trial protocol, followed the recommendations of the Standard Protocol Items (SPIRIT). EXPECTED OUTCOMES: This study aims to provide evidence of whether SMS interventions are effective in improving cardiovascular disease risk factors control in post-ACS patients in a middle-income country. CLINICALTRIALS. GOV IDENTIFIER: NCT03414190 (First posted on January 29, 2018; last update on May 14, 2018) - Retrospectively registered.


Assuntos
Síndrome Coronariana Aguda/terapia , Prevenção Secundária/métodos , Telemedicina/métodos , Mensagem de Texto , Síndrome Coronariana Aguda/sangue , Pressão Sanguínea , LDL-Colesterol/sangue , Método Duplo-Cego , Exercício , Terapia por Exercício , Feminino , Humanos , Renda , Masculino , Adesão à Medicação , Motivação , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
17.
Diab Vasc Dis Res ; 16(5): 399-414, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31044622

RESUMO

Diabetes is a common comorbidity in patients hospitalized for an acute coronary syndrome event, and prevalence is increasing. Among patients hospitalized with acute myocardial infarction, diabetes can be an independent predictor of mortality and new cardiovascular events; both short- and long-term outcomes are worse for patients with diabetes relative to those without, and undiagnosed diabetes is associated with greater mortality. The impact of glycemic control on cardiovascular outcomes and the best approach to treat hyperglycemia upon hospital admission for acute coronary syndrome in patients with or without known diabetes remain open questions. This review assesses available evidence for hyperglycemia management at the time of admission for acute coronary syndrome and, thereafter, finds that (1) admission plasma glucose plays a role in predicting adverse events, especially in patients with unknown diabetes; (2) glycated haemoglobin is a likely predictor of events in patients with unknown diabetes; and (3) hypoglycemia at the time of acute myocardial infarction hospital admission is an important predictor for mortality in patients with and without diabetes. Whether glucose-targeted insulin and glucose infusion have advantages over glucose-insulin-potassium infusion remains controversial. Evidence for the effect of novel glucose-lowering agents used at the time of an acute cardiovascular event is limited and requires more dedicated studies.


Assuntos
Síndrome Coronariana Aguda/terapia , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Humanos , Hipoglicemiantes/efeitos adversos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Herz ; 44(4): 365-378, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31087108

RESUMO

Dual antiplatelet therapy (DAPT) is the cornerstone of maintenance medication following elective percutaneous coronary intervention and also after acute coronary syndrome (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina pectoris); however, DAPT is not sufficient for stroke prevention in atrial fibrillation (SPAF). For SPAF, oral anticoagulation (OAC) with vitamin K antagonists (VKA) or non-vitamin K-dependent anticoagulants (NOAC) is required. If a patient who is receiving anticoagulants for SPAF, requires a coronary intervention, triple therapy consisting of OAC plus DAPT is given, at least for a limited time following the procedure. This article reviews the current data from studies testing strategies with NOACs plus one or two antiplatelet substances in comparison to triple therapy with VKA.


Assuntos
Anticoagulantes , Fibrilação Atrial , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas , Síndrome Coronariana Aguda/terapia , Administração Oral , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Quimioterapia Combinada , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA