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OBJECTIVE: The authors aimed to investigate the role of CHA2DS2-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective cohort. SETTING: Single-center university-affiliated tertiary cardiac center. PARTICIPANTS: A total of 2,981 consecutive patients who underwent isolated CABG between 2010 and 2012 were included. INTERVENTIONS: All patients underwent isolated CABG and were followed until discharge or in-hospital death. The primary outcome was the development of new-onset POAF during the hospital course. MEASUREMENTS AND MAIN RESULTS: During hospitalization, continuous electrocardiogram monitoring was used to detect POAF episodes. New-onset POAF developed in 15.8% of patients following isolated CABG. Patients with POAF had significantly higher CHA2DS2-VASc scores than those without POAF (2.66 ± 1.51 v 2.12 ± 1.36, p < 0.001). After adjustment for potential confounders, CHA2DS2-VASc score was significantly associated with POAF (odds ratio [OR]: 1.295, 95% CI: 1.205-1.391). However, further analyses showed that this effect was restricted to patients with a CHA2DS2-VASc score of ≥2 (OR: 1.813, 95% CI: 1.220-2.694). In multivariate analysis of the CHA2DS2-VASc components, age ≥75 (OR: 3.737, 95% CI: 2.702-5.168), age 65 to 74 (OR: 2.126, 1.701-2.658), hypertension (OR: 1.310, 95% CI: 1.051-1.633), and cerebrovascular accident (OR: 1.807, 95% CI: 1.197-2.726) were independent predictors of POAF. However, the association between POAF and female sex, diabetes mellitus, congestive heart failure, and vascular disease was not statistically significant. CONCLUSIONS: CHA2DS2-VASc score is a useful tool for the prediction of POAF after isolated CABG. However, the risk should be interpreted cautiously, since the risk score's promising effect relies on only several of its components.
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Fibrilação Atrial , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis. MATERIALS AND METHODS: We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated. RESULTS: From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p < 0.001), and had fewer risk factors at the time of diagnosis. Mean age at diagnosis had an overall increasing trend during the study period. Increasing trend was seen in body-mass index, hypertension prevalence, diabetes mellitus. All lipid profile components (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) decreased over time. Of particular interest, opium consumption was associated with 2.2 year earlier age of CAD diagnosis. CONCLUSION: The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.
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Doença da Artéria Coronariana/epidemiologia , Estenose Coronária/epidemiologia , Fatores Etários , Idoso , Comorbidade , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Estudos Transversais , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Irã (Geográfico)/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Medição de Risco , Fatores Sexuais , Fatores de TempoRESUMO
We herein seek to expound on up-to-the-minute information regarding cardiovascular disease in the era of coronavirus disease 2019 (COVID-19) by highlighting acute myocardial injury caused by COVID-19 and probing into its pathophysiology, clinical signs, diagnostic tests, and treatment modalities. We aim to share the latest research findings vis-à-vis cardiovascular disease patients with confirmed or suspected COVID-19 on the association between hypertension and this infectious disease along with the relevant recommendations; describe the mechanism of coronary artery disease in such patients together with the necessary measures in the setting of non-ST-segment elevation acute coronary syndrome, ST-segment elevation myocardial infarction, and chronic coronary syndrome; discuss tachy- and bradyarrhythmias in the COVID-19 setting alongside their treatments; elucidate coagulopathies, venous thromboembolism, and its prophylactic measures in the context of this infection; set out the cardiopulmonary resuscitation protocol as well as the pertinent safety concerns during the current pandemic; and, finally, explicate drug-drug interactions between COVID-19 and cardiovascular medication in hypertension, acute coronary syndrome, heart failure, venous thromboembolism, and arrhythmias.
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COVID-19 , Doenças Cardiovasculares , Infarto do Miocárdio com Supradesnível do Segmento ST , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Humanos , Pandemias , SARS-CoV-2RESUMO
AIM: Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long-term outcomes in patients with and without stent postdilation. METHODS: A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)-comprising cardiac death, nonfatal MI, and repeat revascularization-and the device-oriented composite endpoint (DOCE)-consisting of cardiac death, target lesion revascularization, and target vessel revascularization. RESULTS: The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score-matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18-0.87], p = .021). CONCLUSIONS: Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.
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Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Stents , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Recidiva , Retratamento , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication of heart valve replacement. Based on the current guidelines, the treatment of a large number of these patients could be performed through the administration of thrombolytic agents. In the present study, we aim to assess the safety of thrombolytic therapy in patients with PVT who have high international normalized ratio (INR) levels. METHODS: In this study, we retrospectively analyzed outcomes of thrombolytic therapy in 65 PVT patients with different levels of INR at the time of fibrinolysis at a tertiary cardiac center. RESULTS: Mean age of patients was 51.6 ± 12.47 years. The tricuspid valve was the most common site of prosthetic valve thrombosis (64.6%). The Median (range) of INR was 2.1 (0.9-4.9). The majority of patients (50.8%) achieved a complete response following thrombolytic treatment. There were no cases of intracranial hemorrhage. Other major and minor bleedings occurred in 3 (4.6%) and 10 (15.4%) patients, respectively. No embolic stroke and systemic embolism were observed. We found no significant difference in the frequency of major (P-value = .809) and minor (P-value = .483) bleeding as well as response to thrombolytic therapy (P-value = .658) between patients with different levels of INR. Total administered dose of Streptokinase was also similar in PVT patients with or without major (P-value = .467) and minor (P-value = .221) bleeding complications. CONCLUSIONS: We concluded that there was no significant difference between PVT patients presenting with subtherapeutic and high INR levels who received thrombolytic treatments regarding both minor and major bleeding complications as well as response to thrombolysis.
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Fibrinolíticos/uso terapêutico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Coeficiente Internacional Normatizado , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Estreptoquinase/uso terapêutico , Terapia Trombolítica/métodos , Trombose/tratamento farmacológico , Trombose/etiologia , Adulto , Feminino , Fibrinolíticos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/cirurgia , Hemorragia/etiologia , Humanos , Coeficiente Internacional Normatizado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança , Estreptoquinase/efeitos adversos , Terapia Trombolítica/efeitos adversosRESUMO
BACKGROUND: Several risk factors have been associated with the development of postoperative atrial fibrillation (AF). However, some important factors that may play substantial roles have been neglected in the final suggested risk models. In this study, we aimed to derive a new clinical risk index to predict AF in coronary artery bypass graft (CABG) patients. METHODS: In this retrospective cohort study we enrolled 3047 isolated CABG patients. A random sample of 2032 patients was used to derive a risk index for the prediction of post-CABG AF. A multivariate logistic regression model identified the independent preoperative predictors of post-CABG AF, and a simple risk index to predict AF was constructed. This risk index was cross-validated in a validation set of 1015 patients with isolated CABG. RESULTS: Post-CABG AF occurred in 15.9% and 15.7% of the patients in the prediction and validation sets, respectively. Using multivariate stepwise analysis, four preoperative variables including advanced age, left atrial (LA) enlargement, hypertension and cerebrovascular accident contributed to the prediction model (area under the receiver operating characteristic curve curve = 0.66). The effect of advanced age appeared to be dominant [age ≥ 75 years; odds ratio: 4.134, 95% confidence interval (CI): 2.791-6.121, p < 0.001]. Moderate to severe LA enlargement had an odds ratio of 2.176 (95% CI: 1.240-3.820, p = 0.013) for developing AF in our risk index. CONCLUSIONS: LA size was an important factor in risk stratification of post-CABG AF, which remained significant in the final model. Future scoring system studies might benefit from the use of this variable to obtain a more robust predictive value.
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We describe a 70-year-old lady with rheumatic heart disease and a history of the mitral valve and tricuspid valve replacement, who underwent transcatheter aortic valve implantation and the tricuspid valve-in-valve procedure in a single session.
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Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Substituição da Valva Aórtica Transcateter/métodos , Estenose da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Idoso , Feminino , Humanos , Reoperação , Cardiopatia Reumática , Risco , Resultado do TratamentoRESUMO
We describe a 72-year-old woman, a known case of rheumatic heart disease with a history of mitral and aortic valve replacement 8 years previously, who underwent mitral valve-in-valve replacement supported by a transapically snared guidewire through septostomy.
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Bioprótese , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Septos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Idoso , Valva Aórtica/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Reoperação , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Pericardial effusion (PE), a common complication after open-heart surgery, accounts for 50% to 85% of patients. Although reversible in most of the cases, it could be life threatening in the occurrence of tamponade in large effusions. We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery. METHODS: The study is a prospective, randomized, triple-blind, placebo-controlled single-center trial at Tehran Heart Center. A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine (n = 74) or 1 tablet of placebo (n = 75) for 2 weeks and then underwent follow-up echocardiography. RESULTS: Baseline and clinical characteristics were not significantly different between the 2 study groups except for age (P = .02) and graft numbers (P = .005). There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups (P = .440 and .844, respectively). Median (25th-75th percentiles) of effusion changes was 5 mm (1-7.6 mm) in the colchicine group and 5 mm (1-6.6 mm) in the placebo group (P = .932). Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients (P = .607, .539, and .628, respectively). After adjustment for possible confounders, there was still no significant difference in postoperative PE between the 2 study groups (t = -0.285, P = .776). CONCLUSION: We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE. This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches.
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Colchicina/administração & dosagem , Ponte de Artéria Coronária/efeitos adversos , Derrame Pericárdico , Complicações Pós-Operatórias , Idoso , Ponte de Artéria Coronária/métodos , Monitoramento de Medicamentos , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamento farmacológico , Derrame Pericárdico/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do Tratamento , Moduladores de Tubulina/administração & dosagemRESUMO
INTRODUCTION: Using lengthening over an intramedullary nail as a technique for cosmetic purposes improves the individuals' quality of life and provides more satisfactory results due to less external fixator period. METHODS: This study reports a case series of 143 individuals who underwent bilateral tibial lengthening over an intramedullary nail for cosmetic purposes together with the review of parameters related to the surgery and complications. Level of satisfaction was measured with the standard visual analog scale at least 1 year after removal of external fixator. RESULTS: In this study, mean (SD) age of patients was 26.6 (7.26) years. 85 (59.4%) participants were male and 58 (40.6%) were female. Mean end lengthening of all individuals was 6.65 cm. The mean external fixator period was 93.7 days. Complication rate was 0.74 per segment but it decreased to 0.45 when pin-tract infection was excluded. Complications were categorized based on Paley et al.'s classification as 129 problems, 85 obstacles and no sequelae. Interestingly, 44 (30.8%) individuals had no problem and obstacle. CONCLUSIONS: Lengthening over an intramedullary nail provides bone formation in equal quality to that obtained by the conventional Ilizarov method, along with lower rate of complications. The large number of individuals involved in our study is a remarkable benefit which could be used as an appropriate sample to compare results for outcomes and complications.
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Alongamento Ósseo/métodos , Pinos Ortopédicos , Técnicas Cosméticas , Fixadores Internos , Desigualdade de Membros Inferiores/cirurgia , Tíbia/cirurgia , Adolescente , Adulto , Alongamento Ósseo/instrumentação , Técnicas Cosméticas/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
Background: Opium consumption has been an overlooked health issue in the Iranian population, and the prognostic role of opium consumption in patients undergoing coronary revascularization is unknown. Hypothesis: We aimed to assess the association between opium consumption and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Methods: We screened 2203 consecutive patients who underwent elective PCI between April 2009 and April 2010 at Tehran Heart Center. Exclusion criteria were unsuccessful PCI, non-elective PCI, and missing opium use data. Opium consumption was defined as self-reported ever use of any traditional opium substances. Outcomes of interest were all-cause mortality and a composite of major adverse cardiac and cerebrovascular events (MACCE). The association between opium use and study outcomes was evaluated using the inverse probability of treatment weighting (IPTW) method. Cumulative hazard curves were demonstrated to further assess the association visually. Furthermore, the effect of opium consumption on individual components of MACCE was evaluated in a competing risk setting. Results: A total of 2025 elective PCI patients were included (age: 58.7 ± 10.67, 29.1% women), among whom 297 (14.6%) patients were opium users. After a median follow-up of 10.7 years, opium consumption was associated with a higher risk of all-cause mortality (IPTW-hazard ratio [HR] = 1.705, 95% CI: 1.125-2.585; P = 0.012) and MACCE (IPTW-HR = 1.578, 95% CI: 1.156-2.153; P = 0.004). The assessment of MACCE components suggested a non-significant borderline trend for higher non-fatal myocardial infarction (IPTW-sub-distribution HR [SHR] = 1.731, 95% CI: 0.928-3.231; P = 0.084) and mortality (IPTW-SHR = 1.441, 95% CI: 0.884-2.351; P = 0.143) among opium users. Conclusions: Opium consumption is associated with a more than 50% increase in long-term risk of mortality and MACCE in patients undergoing PCI. These findings accentuate the importance of preventive strategies to quit opium addiction in this population.
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Ópio , Intervenção Coronária Percutânea , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Irã (Geográfico)/epidemiologia , Seguimentos , Fatores de Tempo , Dependência de Ópio/epidemiologia , Fatores de Risco , Doença da Artéria Coronariana/epidemiologia , Idoso , Estudos Retrospectivos , Taxa de Sobrevida/tendênciasRESUMO
PURPOSE: To investigate the effects of massage and presenting an attendant on pain, anxiety and satisfaction during labor to clarify some aspects of using an alternative complementary strategy. METHODS: 120 primiparous women with term pregnancy were divided into massage, attendant and control groups randomly. Massage group received firm and rhythmic massage during labor in three phases. After 30 min massage at each stage, pain, anxiety and satisfaction levels were evaluated. Self-reported present pain intensity scale was used to measure the labor pain. Anxiety and satisfaction were measured with the standard visual analog scale. RESULTS: Massage group had lower pain state in second and third phases (p < 0.05) in comparison with attendant group but reversely, the level of anxiety was lower in attendant group in second and third phases (p < 0.05) and satisfaction was higher in massage group in all four phases (p < 0.001). The massage group had lower pain and anxiety state in three phases in comparison with control group (p < 0.05). Data analysis of satisfaction level showed higher values in four phases in massage group compared with control (p < 0.001) and comparison of attendant and control groups showed higher satisfaction in attendant group in phases 2, 3 and 4 as well (p < 0.001). Duration of active phase was lower in massage group (p < 0.001). CONCLUSIONS: Findings suggest that massage is an effective alternative intervention, decreasing pain and anxiety during labor and increasing the level of satisfaction. Also, the supportive role of presenting an attendant can positively influence the level of anxiety and satisfaction.
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Ansiedade/terapia , Trabalho de Parto/psicologia , Massagem/psicologia , Manejo da Dor , Satisfação do Paciente , Adolescente , Adulto , Cuidadores/psicologia , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
OBJECTIVES: The long-term prognostic role of postoperative atrial fibrillation (POAF) in cardiovascular outcomes in patients undergoing cardiac surgery is uncertain. Our goal was to investigate the impact of new-onset POAF on midterm adverse cardiovascular events after coronary artery bypass graft (CABG) surgery. METHODS: We performed a retrospective cohort study of patients who underwent isolated CABG without a preoperative history of atrial fibrillation/flutter. POAF was defined as episodes of AF lasting ≥30 s during the hospitalization period. The effect of POAF on midterm all-cause mortality and cerebrovascular accidents/transient ischaemic attacks (CVA/TIA) was assessed using a Cox proportional hazard regression model in a competing risk setting. Additional analyses were performed on patients surviving an event-free early postoperative period (i.e. within 30 postoperative days after the index operation). RESULTS: A total of 9,310 patients were followed for a median duration of 48.7 months. New-onset POAF was associated with an increased risk of midterm all-cause mortality (HR = 1.648, 95% confidence interval: 1.402-1.937; P < 0.001) and CVA/TIA (subdistribution-HR = 1.635, 1.233-2.167; P = 0.001). After excluding patients who died during the early postoperative period, POAF remained significantly associated with higher late all-cause mortality (HR = 1.518, 1.273-1.811; P < 0.001). However, the risk of late CVA/TIA in patients who survived the early postoperative period without having a stroke was similar between those with and without POAF (subdistribution-HR = 1.174, 0.797-1.729; P = 0.418). CONCLUSIONS: New-onset POAF after CABG is associated with an increased risk of midterm overall mortality and stroke. However, late stroke risk is likely similar between patients with and without POAF who survive an event-free early postoperative period.
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Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
BACKGROUND & OBJECTIVE: Increased industrial activities leads to prolonged human exposure to industrial pollutant such as cadmium (Cd). |Chronic exposure to Cd in Mammals and also human being, can cause damages to various organs and particularly kidneys and liver. The goal of this study was to investigate the prophylactic effects of combined selenium (Se) and ascorbic acid supplement in rat cadmium toxicity. METHODS: Sixty adult male Wistar rats were divided to 10 groups: one control, one sham and two clusters of 4 intervention groups which were fed with 1 or 5 mg Cd /kg water, for 28 days. Ascorbic acid supplement was added to drinking water of four groups (10 mg/L). Four groups received intraperitoneal Se (1 mg/kg) at day 1, 5, 10, 15, 20 and 25. Finally, Cd concentration was measured by atomic absorption spectrophotometry in liver and kidney sections. Furthermore, pathological changes were investigated in these sections. RESULTS: The results showed weight gain in Cd groups which received ascorbic acid and Se, in contrast to weight loss in parallel groups without vitamin C and Se. The stronger necrosis and inflammation have been observed in group received 5 mg/kg Cd compared to group with 1 mg/kg Cd (P<0.05). In addition, cadmium level was higher in untreated groups without any supplements, significantly (P<0.05). CONCLUSION: Drinking water with ascorbic acid may have prophylactic effects across cadmium, and combination of Se and ascorbic acid are associated with higher prophylactic effects in both kidney and liver in rats to decrease the Cd toxicity.
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This study emphasizes that VSD should not be immediately diagnosed as a congenital disorder; instead, regional wall motion abnormalities in the left ventricle should also be taken into account since it may result from mechanical complications of neglected myocardial infarction.
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PURPOSE: Head-up tilt test (HUTT) is a reasonable diagnostic evaluation for patients with suspected vasovagal syncope; however, its lengthy duration is a remarkable limitation. Although adenosine (AD), as an alternative provocative agent, is a promising option for tackling this shortcoming, it received little appreciation in the literature. We aimed to compare the efficacy and the time to elicit a positive response to HUTT for sublingual trinitroglycerin (TNG) and intravenous AD. Furthermore, we evaluated patients' outcomes in the follow-up. METHODS: Patients with a chief complaint of transient loss of consciousness (TLOC) were evaluated. We randomized patients with the diagnosis of unexplained syncope after diagnostic evaluations, to undergo TNG-augmented HUTT or AD-augmented HUTT. They were crossed over to receive the other medication in case of negative response to the test. In the follow-up, we evaluated traumatic and non-traumatic TLOCs, hospitalization due to syncope, and death in patients. RESULTS: We randomized 132 patients (41.70 ± 19.37 years, 52.3% female) to receive TNG (n = 66) or AD (n = 66). Respectively, the positivity rate of TNG and AD for the first and the crossover-HUTT was 31.1% and 26.7%, and 20.5% and 26.2% with no statistically significant differences in both tests (P Ë 0.50). The time to positive response was significantly shorter for AD than TNG (P < 0.001). In the follow-up, re-admission was significantly more prevalent in HUTT-negative patients compared to HUTT-positive patients (P = 0.04). CONCLUSIONS: We found that diagnostic yield of TNG and AD in HUTT is comparable, while AD acts 4 times faster than TNG in evoking a vasovagal response.
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Adenosina , Nitroglicerina , Síncope Vasovagal , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Síncope , Síncope Vasovagal/diagnóstico , Teste da Mesa InclinadaRESUMO
Due to the importance of early treatment in the final prognosis of ST-elevation myocardial infarction (STEMI) patients, full-time provision of revascularization services should be available 24 hours a day, 7 days a week (24/7) in conjunction with a fully-coordinated pre-hospital emergency system and equipped centers with experienced medical teams. We reviewed the 24/7 primary percutaneous coronary intervention (PCI) management registry and evaluated the quality of care and patient management as well as the temporal trend of provided health care services. In the present cross-sectional study, we retrieved the data on 11,563 STEMI patients having undergone primary PCI at the thirty-one 24/7 PCI-capable hospitals through the national 24/7 STEMI management program between September 2015 and August 2017 in Iran. The median (25th-75th) age of the patients was 59 (51-68) years. The median (25th-75th) time of door-to-device was 64 (41-100) min and 68% of patients achieved door to device time of ≤90 min. There was no significant difference in the median door-to-device time between the general and heart hospitals. This is the first Iranian National attempt to provide a uniform guideline-driven standard management in patients with STEMI undergoing primary PCI in a 24/7 program. We demonstrated an acceptable door-to-device time consistent with the recommendations of the current guidelines. We observed higher door-to-device time in older patients, female patients, and those where the culprit lesion was other than the left anterior descending coronary artery. Efforts should be made to improve door-to-device time in all patients or groups.
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Infarto do Miocárdio , Intervenção Coronária Percutânea , Idoso , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI). We aimed to compare 1-month major adverse cardiac events (MACE) of patients undergoing primary PCI between 2 routine-hour and off-hour working shifts. In this cross-sectional study, 1791 STEMI patients were retrospectively evaluated who underwent primary PCI. The patients were classified into 2 groups of routine and off-hour according to the PCI start time and date [495 patients (27.7%) in routine-hour group; 1296 patients (72.3%) in off-hour group]. Cardiovascular risk factor, angiographic, procedural data, door-to-device time, and 1-month follow-up data of patients were compared between 2 groups. There was a statistical difference in door-to-device time between routine-hour and off-hour group [55 minutes (40-100 minutes) in off-hour group vs. 49 minutes (35-73 minutes) in routine-hour group; P ≤ 0.001]. However, most of the patients in both groups had door-to-device time ≤60 minutes. The frequency of 1-month MACE was 8.5% in off-hour group and 6.9% in routine-hour group (P = 0.260). After adjustment for possible confounders, the procedure result, in-hospital death, and 1-month MACE were not significantly different between both study groups. We found that STEMI patients treated with primary angioplasty during off-hour shifts had similar 1-month clinical outcomes to routine-hour shifts. Considering the high number of patients requiring primary PCI during off-hours, the importance of early revascularization in acute myocardial infarction, and the comparable clinical outcomes and procedural success, full-time provision of primary PCI services seems to be beneficial.
Assuntos
Plantão Médico , Doenças Cardiovasculares/mortalidade , Ponte de Artéria Coronária/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Institutos de Cardiologia , Estudos Transversais , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort. METHODS: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups. RESULTS: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively). CONCLUSION: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas/análise , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Glicemia , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to <90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI. OBJECTIVE: We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI. METHODS: In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time <90 and ≥90 minutes, and symptom-to-balloon time <180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, t test, and univariate and multivariate logistic regression analyses, and with a significance level of <.05 and 95% CIs for odds ratios (ORs). RESULTS: Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; P=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; P=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, P=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; P=.04). CONCLUSIONS: A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13161.