RESUMO
INTRODUCTION: In current European guidelines for the management of myocardial infarction after coronary stent placement, there is no consensus on dual antiplatelet therapy (DAPT) ideal duration to prevent stent thrombosis-restenosis without significantly increasing the bleeding risk. OBJECTIVE: To report the percentage of major bleeding and presence of major cardiovascular events associated with prolonged DAPT in patients recruited at the National Institute of Cardiology, treated with primary percutaneous coronary intervention and stent. METHODS: A longitudinal, prospective, observational, non-experimental, descriptive study was carried out. Patients were recruited from November 2016 to December 2017. RESULTS: One hundred and thirty-five patients with a mean age of 57 ± 10 years who completed the three-year follow-up were selected. Obesity and hypertension stood out as the main risk factors. After using DAPT for three years, 3.7% of mortality, 1.48% of major bleeding, and 4.4% of thrombosis-restenosis were recorded. CONCLUSIONS: Prolonged use of DAPT would be justified by the high incidence of thrombosis-restenosis, without a significant increase in bleeding risk, as well as a decrease in major cardiovascular events.
INTRODUCCIÓN: En las guías actuales europeas para el manejo del infarto de miocardio posterior a la colocación de endoprótesis coronaria (stent), no existe consenso sobre la duración ideal de la terapia antiagregante plaquetaria dual (DAPT, dual antiplatelet therapy) para prevenir la trombosis-reestenosis del stent sin aumentar el riesgo significativo de sangrado. OBJETIVO: Reportar el porcentaje de sangrado mayor y de eventos cardiovasculares mayores asociados a la DAPT prolongada en pacientes atendidos en el Instituto Nacional de Cardiología y tratados con intervención coronaria percutánea primaria y stent. MÉTODOS: Se realizó un estudio longitudinal, prospectivo observacional y descriptivo no experimental. Los pacientes fueron captados de noviembre de 2016 a diciembre de 2017. RESULTADOS: Fueron seleccionados 135 pacientes con una media de edad de 57 ± 10 años, quienes cumplieron un seguimiento clínico por tres años. La obesidad y la hipertensión destacaron como principales factores de riesgo. Posterior al uso de DAPT durante tres años, se registró 3.7 % de mortalidad, 1.48 % de sangrado mayor y 4.4 % de trombosis-reestenosis. CONCLUSIONES: El uso prolongado de DAPT estaría justificado por la alta incidencia de trombosis-reestenosis, sin incremento significativo en el riesgo de sangrado y con disminución de los eventos cardiovasculares mayores.
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Stents Farmacológicos , Infarto do Miocárdio , Trombose , Humanos , Pessoa de Meia-Idade , Idoso , Inibidores da Agregação Plaquetária/efeitos adversos , Stents Farmacológicos/efeitos adversos , Estudos Longitudinais , Estudos Prospectivos , Infarto do Miocárdio/epidemiologia , Stents/efeitos adversos , Hemorragia/epidemiologia , Trombose/complicações , Resultado do TratamentoRESUMO
INTRODUCCIÓN: El significado de la elevación de la troponina I (Tn-I) después de una intervención coronaria percutánea (ICP) es tema de debate. OBJETIVO: Determinar el pronóstico cardiovascular a un año asociado con el incremento de Tn-I posterior a ICP electiva exitosa. MÉTODO: Estudio observacional, retrospectivo y longitudinal. Se incluyeron pacientes sometidos a ICP electiva exitosa. Se dividieron en dos grupos: con y sin elevación de Tn-I, para comparar la ocurrencia de eventos cardiacos adversos mayores (ECAM) a un año; la Tn-I pos-ICP se correlacionó con características demográficas y angiográficas. RESULTADOS: Se detectó elevación de Tn-I en 32 pacientes (35.2 %). La elevación fue más frecuente en pacientes con enfermedad coronaria multivascular, más compleja y con complicaciones peri-ICP. Los ECAM a un año fueron mayores en el grupo de Tn-I elevada (25 versus 3.4 %, p = 0.002). Los predictores independientes de ECAM fueron elevación cinco veces de Tn-I al valor normal (RM = 7.5, IC 95 % = 1.25-45, p = 0.027) y las complicaciones peri-ICP (RM = 7.5, IC 95 % = 1.25-45, p = 0.027). CONCLUSIÓN: En pacientes con enfermedad coronaria estable, la elevación de Tn-I posterior a ICP electiva se asoció con eventos cardiacos adversos a un año, complicaciones peri-ICP y enfermedad coronaria más extensa y compleja. INTRODUCTION: The significance of troponin I (Tn-I) elevation after percutaneous coronary intervention (PCI) is the subject of debate. OBJECTIVE: To determine cardiovascular prognosis associated with Tn-I elevation one year after successful elective PCI. METHODS: Observational, retrospective, longitudinal study. Patients who underwent successful elective PCI were included and divided in two groups: with and without Tn-I elevation, in order to compare the occurrence of major adverse cardiac events (MACE) at 1 year; post-PCI Tn-I was correlated with demographic and angiographic characteristics. RESULTS: Tn-I elevation was detected in 32 patients (35.2%). Elevation was more common in patients with multivascular and more complex coronary artery disease, and with peri-PCI complications. MACE incidence at one year was higher in the elevated Tn-I group (25% vs. 3.4%; p = 0.002). Independent predictors of MACE were Tn-I 5-fold elevation from normal value (OR: 7.5; 95% CI: 1.25-45; p = 0.027) and peri-PCI complications (OR: 7.5; 95% CI: 1.25-45; p = 0.027). CONCLUSIONS: In patients with stable coronary artery disease, Tn-I elevation after successful elective PCI is associated with adverse cardiac events at 1 year, more extensive and complex coronary artery disease and peri-PCI complications.
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Doenças Cardiovasculares/sangue , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/sangue , Troponina I/sangue , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: The non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation. MATERIAL AND METHODS: Retrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events. RESULTS: There were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease. Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2 years before the procedure. There were no deaths of cardiovascular origin. CONCLUSIONS: MPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up.
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Doenças Cardiovasculares , Transplante de Fígado , Imagem de Perfusão do Miocárdio , Adulto , Humanos , Pessoa de Meia-Idade , Transplante de Fígado/efeitos adversos , Estudos Retrospectivos , Doenças Cardiovasculares/diagnóstico por imagem , Fatores de Risco , Prognóstico , Imagem de Perfusão do Miocárdio/métodos , Fatores de Risco de Doenças CardíacasRESUMO
INTRODUCTION AND OBJECTIVES: Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS: Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS: We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS: At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.
Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Bloqueio de Ramo/complicações , Estudos Retrospectivos , Estimulação Cardíaca Artificial/efeitos adversos , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Arritmias Cardíacas/terapia , Marca-Passo Artificial/efeitos adversos , Eletrocardiografia , Resultado do Tratamento , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgiaRESUMO
BACKGROUND AND AIM: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS: This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49⯱â¯28â¯months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS: 1255 patients were included (55% male, age 75⯱â¯13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION: Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.
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Injúria Renal Aguda , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Estudos Retrospectivos , Ecocardiografia , Prognóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologiaRESUMO
OBJECTIVE: To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD: A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48 and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST- segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction) and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data was obtained from the medical history. The statistical analysis was performed with SPSS v.24 software. RESULTS: A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favoring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1 ± 38.2 vs. 187.3 ± 29.4, p < 0.001) and LDL-C (126.1 ± 31.9 vs. 113.5 ± 28.5, p = 0.001) at week 48, and in total cholesterol (201.1 ± 33.4 vs. 188.7 ± 33.9, p = 0.013) and HDL-C (54.2 ± 15.6 vs. 48.3 ± 14.3, p = 0.01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS: The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Infarto do Miocárdio , Humanos , Lamivudina , Emtricitabina/efeitos adversos , Estudos Retrospectivos , Adenina , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Cobicistat/efeitos adversos , Lipídeos/uso terapêutico , Colesterol/uso terapêutico , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Fumaratos/uso terapêuticoRESUMO
OBJECTIVE: To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD: A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical, and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48, and 120â¯weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction), and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data were obtained from the medical history. The statistical analysis was performed with SPSS v. 24 software. RESULTS: A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120â¯weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favouring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1±38.2 vs. 187.3±29.4, Pâ¯<â¯.001) and LDL-C (126.1±31.9 vs. 113.5±28.5, Pâ¯=â¯.001) at week 48, and in total cholesterol (201.1±33.4 vs. 188.7±33.9, Pâ¯=â¯.013) and HDL-C (54.2±15.6 vs. 48.3±14.3, Pâ¯=â¯.01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS: The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Infarto do Miocárdio , Humanos , Lamivudina , Emtricitabina/efeitos adversos , Estudos Retrospectivos , Adenina , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Cobicistat/efeitos adversos , Lipídeos/uso terapêutico , Colesterol/uso terapêutico , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Fumaratos/uso terapêuticoRESUMO
BACKGROUND: There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. METHODS: Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3-6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. RESULTS: Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96-2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07-15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2-11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05-1.02; p=0.053). CONCLUSIONS: In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.
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Hipertensão , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Hipertensão/epidemiologia , Estudos Prospectivos , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
INTRODUCTION: Community-acquired pneumonia increases the risk of cardiovascular events (CVE). The objective of this study was to analyze host, severity, and etiology factors associated with the appearance of early and late events and their impact on mortality. METHOD: Prospective multicenter cohort study in patients hospitalized for pneumonia. CVE and mortality rates were collected at admission, 30-day follow-up (early events), and one-year follow-up (late events). RESULTS: In total, 202 of 1,967 (10.42%) patients presented early CVE and 122 (6.64%) late events; 16% of 1-year mortality was attributed to cardiovascular disease. The host risk factors related to cardiovascular complications were: age ≥65 years, smoking, and chronic heart disease. Alcohol abuse was a risk factor for early events, whereas obesity, hypertension, and chronic renal failure were related to late events. Severe sepsis and Pneumonia Severity Index (PSI) ≥3 were independent risk factors for early events, and only PSI ≥3 for late events. Streptococcus pneumoniae was the microorganism associated with most cardiovascular complications. Developing CVE was an independent factor related to early (OR 2.37) and late mortality (OR 4.05). CONCLUSIONS: Age, smoking, chronic heart disease, initial severity, and S. pneumoniae infection are risk factors for early and late events, complications that have been related with an increase of the mortality risk during and after the pneumonia episode. Awareness of these factors can help us make active and early diagnoses of CVE in hospitalized CAP patients and design future interventional studies to reduce cardiovascular risk.
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Doenças Cardiovasculares , Infecções Comunitárias Adquiridas , Pneumonia , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/epidemiologia , Humanos , Pneumonia/epidemiologia , Estudos ProspectivosRESUMO
The use of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has changed the clinical practice of dyslipidemia and their effects in cardiovascular events. Nowadays 2active principles have been commercialized (evolocumab and alircumab) with indication in patients with low-density lipoprotein (LDL) cholesterol over 100mg/dl, history of cardiovascular events and higher statins doses prescribed. Clinical trials with PCSK9i have included chronic kidney disease (CKD) patients, although glomerular filtration rate has been limited up to 20ml/min/1,73m2 or higher. The published sub-analysis of them have demonstrated at least the same efficacy (in reduction of LDL and cardiovascular events) and safety in patients with CKD. However, as these drugs are very powerful in reducing LDL cholesterol, some safety concerns appeared in the past. Once safety is probed, we conclude that PCSK9i are beneficial for CKD patients.
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Dislipidemias/tratamento farmacológico , Dislipidemias/etiologia , Inibidores de PCSK9 , Insuficiência Renal Crônica/complicações , Humanos , Resultado do TratamentoRESUMO
Aspirin indication in primary prevention has been questioned in the last ten years due to the publication of several trials with neutral outcomes. In the last year, three research studies discussed in this review (ASCEND, ARRIVE, ASPREE) have weighed the benefit (cardiovascular events reduction) against the adverse effects (especially bleeding) in several situations such as general population with moderate cardiovascular risk, diabetics and elderly population. This review performs a detailed analysis of these trials and it also comments on a recent metanalysis that includes these projects along with others undertaken in the last 30 years. In addition, the current position of aspirin in primary prevention is established based on the latest evidence reviewed.
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Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Primária/métodos , Aspirina/efeitos adversos , Tomada de Decisão Clínica , Hemorragia/induzido quimicamente , Humanos , Inibidores da Agregação Plaquetária/efeitos adversosRESUMO
OBJECTIVES: To describe the characteristics of hypertensive urgencies at the emergency department, as well as the variables associated with early re-admission (<7 days) and re-admission at one month (<30 days). METHODS: We conducted a descriptive, retrospective study of all patients who were admitted to the emergency department of a third level hospital during 2013. Subsequently, a case-control analysis was performed to analyze the group of patients with readmission. RESULTS: A total of 398 hypertensive urgencies were collected (32.4% men, mean age 67.75 years), which led to an incidence of 3.28/1000 visits. Eighty point nine percent had a previous history of hypertension, and the mean Charlson Index was 2.23. Headache was the most frequent symptom (49.1%), followed by dizziness/instability (29.5%) and nausea/vomiting (17.1%). Eighty point seven percent of the patients were prescribed pharmacological treatment. The rates of cardiovascular events or mortality at one month were low (2.26% and 0.25% respectively). Despite this, 7.53% and 11.31% of patients were readmitted in under 7 days or 30 days, respectively. The variables associated with readmission in the multivariate analysis were elevated systolic blood pressure in the first determination, previous hypertension and the presence of palpitations. CONCLUSIONS: Hypertensive emergencies are high-incidence conditions in the Emergency Department. In our study, patients with a prior diagnosis of hypertension and elevated systolic blood pressure at the first determination had a higher risk of re-entry and would be candidates for closer follow-up on discharge.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hipertensão/terapia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Emergências , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
INTRODUCTION: Diastolic dysfunction is highly prevalent and a key pathophysiological contributor to several cardiovascular diseases, especially heart failure with preserved ejection fraction. In addition, some evidence suggests diastolic dysfunction is a risk factor for major adverse cardiovascular events. This study aimed to systematically review the evidence and to quantify the association between diastolic dysfunction and risk of cardiovascular events and death. METHODS: MEDLINE was systematically searched from 1974 up to October 2017. We included cohort studies that assessed diastolic function in adults in the community, providing a definition of diastolic dysfunction regarding the occurrence of any cardiovascular event or mortality. For the quantitative analysis, relative risk estimates comparing individuals with versus without diastolic dysfunction were combined using a random effects model. RESULTS: Nineteen studies were identified for inclusion in the systematic review, assessing a total of 63 802 participants. Nine studies were included in the meta-analysis. Diagnostic criteria and classification of diastolic dysfunction differed substantially between studies. The median prevalence of diastolic dysfunction in studies including individuals with and without diastolic dysfunction was 35.1% (range 5.3-65.2%). Comparing diastolic dysfunction with normal diastolic function, the summary relative risk estimate for cardiovascular events or mortality was 3.53 (95% CI: 2.75-4.53; I2=85.5%; nine studies). CONCLUSIONS: Although the definitions found in the literature differ, the diagnosis of diastolic dysfunction is associated with a 3.53-fold increased risk of cardiovascular events or death. This finding highlights the importance of developing easily applicable and consensual diagnostic criteria, as well as fostering research on effective treatment strategies when diastolic dysfunction is identified in the subclinical stage.
Assuntos
Diástole/fisiologia , Insuficiência Cardíaca , Adulto , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de RiscoRESUMO
INTRODUCTION: Obese patients are at higher cardiovascular risk in primary prevention. In secondary prevention, an obesity paradox has been reported. We analyzed a cohort of individuals from a previous cross-sectional study on the impact of metabolic syndrome (MS) on coronary artery disease (CAD), aiming to assess the occurrence of cardiovascular events in a long follow-up. METHODS: We analyzed 296 individuals in a mean follow-up of 6.9±2.2 years. Subjects were divided into four groups according to the presence of MS or CAD (defined as ≥70% coronary stenosis). RESULTS: The study population had a mean age of 65±9 years at the beginning of the study; 59.5% were male, 55.7% had MS and 41.6% had CAD. During follow-up 10.1% of the population suffered all-cause death, 3.7% cardiovascular death, 14.2% cardiovascular readmission and 22.0% the composite outcome (mortality, acute coronary syndrome, coronary revascularization, stroke/transient ischemic attack or heart failure admission). There were no significant differences in any type of mortality. Patients with CAD had more readmissions and composite outcomes (log-rank p<0.001 and p=0.001, respectively), but there was no difference according to the presence of MS. Only CAD was an independent predictor of cardiovascular admission (HR 3.21, 95% CI 1.66-6.21) and composite outcomes (HR 2.41, 95% CI 1.44-4.02). CONCLUSIONS: In patients with high cardiovascular risk or established CAD, the presence of MS is not associated with cerebral or cardiac events in long-term follow-up.
Assuntos
Doenças Cardiovasculares/etiologia , Lipídeos/sangue , Síndrome Metabólica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Causas de Morte/tendências , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Portugal/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
Resumen: Los antitrombóticos son fármacos que se utilizan para prevenir la formación de coágulos sanguíneos, también conocidos como trombos. Estos coágulos pueden causar graves problemas de salud, como infartos o enfermedades cerebrovasculares. En este artículo se analizan diferentes tipos de antitrombóticos, como los antiplaquetarios y los anticoagulantes, y se discuten sus mecanismos de acción. Además, se examinan los beneficios y los riesgos asociados con el uso de antitrombóticos. Por un lado, estos fármacos pueden reducir el riesgo de eventos trombóticos, lo que puede ser especialmente beneficioso en pacientes con condiciones de alto riesgo, como aquellos que han sufrido un infarto o que tienen fibrilación auricular. Por otro lado, también se discuten los posibles efectos secundarios de los antitrombóticos, como el aumento del riesgo de sangrado. Además, se proporcionan pautas para su uso seguro en diferentes escenarios clínicos. Finalmente, se abordan las estrategias de monitoreo y ajuste de la dosis de estos medicamentos para garantizar su eficacia y seguridad en los pacientes.
Abstract: Antithrombotics are drugs used to prevent the formation of blood clots, also known as thrombi. These clots can cause serious health problems, such as heart attacks or strokes. Different types of antithrombotics, such as antiplatelets and anticoagulants, are analyzed and their mechanisms of action are discussed. Additionally, the benefits and risks associated with the use of antithrombotics are examined. On the one hand, these drugs can reduce the risk of thrombotic events, which may be especially beneficial in patients with high-risk conditions, such as those who have suffered a heart attack or who have atrial fibrillation. On the other hand, the possible side effects of antithrombotics, such as the increased risk of bleeding, are also discussed and guidelines for their safe use in different clinical scenarios are provided. Additionally, monitoring and dose adjustment strategies for these medications are addressed to ensure their effectiveness and safety in patients.
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Resumen Introducción: el progreso en los tratamientos para el lupus eritematoso sistémico (LES) resultó en una disminución de la mortalidad; sin embargo, la enfermedad cardiovascular y las complicaciones infecciosas aún son las principales causas de muerte. La evidencia apoya la participación del sistema inmunológico en la generación de la placa aterosclerótica, así como su conexión con las enfermedades autoinmunes. Objetivos: describir la frecuencia de eventos cardiovasculares (ECV) en el Registro de Lupus Eritematoso Sistémico de la Sociedad Argentina de Reumatología (RELESSAR) transversal, así como sus principales factores de riesgo asociados. Materiales y métodos: estudio descriptivo y transversal para el cual se tomaron los pacientes ingresados en el registro RELESSAR transversal. Se describieron las variables sociodemográficas y clínicas, las comorbilidades, score de actividad y daño. ECV se definió como la presencia de al menos una de las siguientes patologías: enfermedad arterial periférica, cardiopatía isquémica o accidente cerebrovascular. El evento clasificado para el análisis fue aquel posterior al diagnóstico del LES. Se conformaron dos grupos macheados por edad y sexo 1:2. Resultados: 1515 pacientes mayores de 18 años participaron del registro. Se describieron 80 pacientes con ECV (5,3%). En este análisis se incluyeron 240 pacientes conformando dos grupos. La edad media fue de 47,8 (14,4) y 47,6 (14,2) en el grupo con y sin ECV respectivamente. Los pacientes con ECV tuvieron mayor duración del LES en meses, mayor índice de Charlson, mayor SLICC (Systemic Lupus International Collaborating Clinics/American College of Rheumatology), mayor frecuencia de manifestaciones neurológicas, síndrome antifosfolípido, hospitalizaciones y uso de ciclofosfamida. Las únicas variables asociadas en el análisis multivariado fueron el índice de Charlson (p=0,004) y el SLICC (p<0,001). Conclusiones: los ECV influyen significativamente en nuestros pacientes, y se asocian a mayor posibilidad de daño irreversible y comorbilidades.
Abstract Introduction: progress in treatments for systemic lupus erythematosus (SLE) has resulted in a decrease in mortality; however, cardiovascular and infectious diseases remain the leading causes of death. Evidence supports the involvement of the immune system in the generation of atherosclerotic plaque, as well as its connection to autoimmune diseases. Objectives: to describe the frequency of cardiovascular disease (CVD) in the cross-sectional RELESSAR registry, as well as its associated variables. Materials and methods: a descriptive and cross-sectional study was performed using patients admitted to the cross-sectional RELESSAR registry. Sociodemographic variables, clinical variables, comorbidities, activity and damage scores were described. CVD was defined as at least one of the following: peripheral arterial disease, ischemic heart disease, or cerebrovascular accident. All patients with at least one CVD were included in our analysis (heart attack, central nervous system vascular disease, and peripheral arteries atherosclerotic disease). The event classified for the analysis was that after the diagnosis of SLE. SLE diagnosis was previous to CVD. Two groups matched by age and sex, 1:2 were formed. Results: a total of 1515 patients older than 18 years participated in the registry. Eighty patients with CVD (5.3%) were described in the registry. Two-hundred and forty patients were included, according to two groups. The mean age was 47.8 (SD 14.4) and 47.6 (SD 14.2) in patients with and without CVD, respectively. Patients with CVD had a longer duration of SLE in months, a higher Charlson index, a higher SLICC, increased frequency of neurological manifestations, antiphospholipid syndrome, hospitalizations, and use of cyclophosphamide. The associated variables in the multivariate were the Charlson Index (p=0.004) and the SLICC (p<0.001). Conclusions: CVDs have a significant influence on our patients, being associated with a greater possibility of damage and comorbidities.
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Lúpus Eritematoso Sistêmico , Doenças Cardiovasculares , MortalidadeRESUMO
INTRODUCTION: Behavioral and emotional factors are triggers of cardiovascular events (CVEs). It is uncertain whether soccer fans, particularly individuals with coronary artery disease (CAD), are at increased risk for CVEs. OBJECTIVES: To assess the effect of watching soccer matches in patients with known CAD on the incidence of CVEs according to the match result. METHODS: We prospectively assessed 82 male soccer fans with a history of acute coronary syndrome during 23 matches of the 2015/2016 season. Each individual was assessed by Holter monitoring on the day of their team's match and on the control day. The primary endpoint was the composite of death, stroke, reinfarction, angina or sustained arrhythmia. Secondary endpoints assessed were episodes of non-sustained supraventricular or ventricular arrhythmia and mean heart rate (HR). RESULTS: Participants' mean age was 61±10 years. Compared with the control day, despite a significant increase in HR (p<0.001) that was independent of the result (p>0.97), the number of CVEs did not differ according to the result (p>0.05). Moreover, the number of non-sustained episodes of supraventricular and ventricular arrhythmia did not differ when stratified according to the match result (p>0.05). CONCLUSIONS: The match result was not associated with a difference in incidence of CVEs in patients with a past history of CAD, with ischemic and arrhythmic substrate, who watched soccer matches on television.
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Doença das Coronárias/complicações , Doença das Coronárias/psicologia , Futebol , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Fatores de RiscoRESUMO
INTRODUCTION: Mortality in patients with end-stage renal disease is higher than in the general population. This is linked to traditional and non-traditional cardiovascular (CV) risk factors, as well as with risk factors associated with end-stage renal disease itself. The aim of this study is to identify CV risk markers in patients beginning peritoneal dialysis (PD) and their association with CV events and CV mortality. METHODS: This was a retrospective cohort study of 112 incident PD patients, in which demographic, clinical and laboratory parameters, valvular calcifications, types of PD solutions, hospitalizations, CV events and death were analyzed. Occurrence of CV events or death due to a CV event after PD initiation was defined as the primary endpoint. The use of icodextrin solution was taken as a marker of hypervolemia. RESULTS: Mean age was 53.7±16.1 years. Patients were treated with PD for 29.3±17.4 months. Eighteen patients (16.1%) had valvular calcifications at baseline, 15 patients (13.4%) had major CV events and 11 patients (9.8%) died from CV-related causes. Cox proportional hazards analysis of CV events or CV-related mortality revealed that mitral calcification, use of icodextrin solution and low albumin were independent predictors of CV events or mortality. CONCLUSIONS: Traditional CV risk factors appear to have little impact on CV complications in PD patients. Nevertheless, hypervolemia, hypoalbuminemia and mitral calcifications were independent predictors of CV events or mortality in this group of patients.
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Calcinose/etiologia , Doenças Cardiovasculares/etiologia , Doenças das Valvas Cardíacas/etiologia , Hipoalbuminemia/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Valva Mitral , Diálise Peritoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Volume Sanguíneo , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The influence of fibrates on cardiovascular risk has been the focus of several clinical trials. This Cochrane Collaboration Systematic Review evaluated the efficacy of fibrates for secondary prevention of cardiovascular events and stroke, analyzing 13 randomized controlled trials, in a total of 16 112 participants with a history of cardiovascular disease. Fibrates showed a protective effect for the composite outcome of non-fatal stroke, non-fatal myocardial infarction (MI) and vascular death, mainly due to reduction in the risk of non-fatal or fatal MI. Nonetheless, these results largely relied on studies including clofibrate, a drug withdrawn from the market in 2002. No statistically significant differences regarding adverse events were found between fibrates and placebo. Although insufficient to support the routine prescription of fibrates in this setting, this evidence should be taken into account when deciding on lipid-modifying therapy in dyslipidemic patients with a history of cardiovascular disease.
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Doenças Cardiovasculares/prevenção & controle , Ácidos Fíbricos/uso terapêutico , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Resumen Introducción: En las guías actuales europeas para el manejo del infarto de miocardio posterior a la colocación de endoprótesis coronaria (stent), no existe consenso sobre la duración ideal de la terapia antiagregante plaquetaria dual (DAPT, dual antiplatelet therapy) para prevenir la trombosis-reestenosis del stent sin aumentar el riesgo significativo de sangrado. Objetivo: Reportar el porcentaje de sangrado mayor y de eventos cardiovasculares mayores asociados a la DAPT prolongada en pacientes atendidos en el Instituto Nacional de Cardiología y tratados con intervención coronaria percutánea primaria y stent. Métodos: Se realizó un estudio longitudinal, prospectivo observacional y descriptivo no experimental. Los pacientes fueron captados de noviembre de 2016 a diciembre de 2017. Resultados: Fueron seleccionados 135 pacientes con una media de edad de 57 ± 10 años, quienes cumplieron un seguimiento clínico por tres años. La obesidad y la hipertensión destacaron como principales factores de riesgo. Posterior al uso de DAPT durante tres años, se registró 3.7 % de mortalidad, 1.48 % de sangrado mayor y 4.4 % de trombosis-reestenosis. Conclusiones: El uso prolongado de DAPT estaría justificado por la alta incidencia de trombosis-reestenosis, sin incremento significativo en el riesgo de sangrado y con disminución de los eventos cardiovasculares mayores.
Abstract Introduction: In current European guidelines for the management of myocardial infarction after coronary stent placement, there is no consensus on dual antiplatelet therapy (DAPT) ideal duration to prevent stent thrombosis-restenosis without significantly increasing the bleeding risk. Objective: To report the percentage of major bleeding and presence of major cardiovascular events associated with prolonged DAPT in patients recruited at the National Institute of Cardiology, treated with primary percutaneous coronary intervention and stent. Methods: A longitudinal, prospective, observational, non-experimental, descriptive study was carried out. Patients were recruited from November 2016 to December 2017. Results: One-hundred and thirty-five patients with a mean age of 57 ± 10 years who completed the three-year follow-up were selected. Obesity and hypertension stood out as the main risk factors. After using DAPT for three years, 3.7% of mortality, 1.48% of major bleeding, and 4.4% of thrombosis-restenosis were recorded. Conclusions: Prolonged use of DAPT would be justified by the high incidence of thrombosis-restenosis, without a significant increase in bleeding risk, as well as a decrease in major cardiovascular events.