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1.
Int. j. cardiovasc. sci. (Impr.) ; 35(2): 202-213, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364977

ABSTRACT

Abstract Background Short message service (SMS) to promote healthcare improves the control of cardiovascular risk factors, but there is a lack of evidence in low and middle-income countries, particularly after acute coronary syndromes (ACS). Objective This study aims to evaluate whether the use of SMS increases risk factor control after hospital discharge for ACS. Methods IMPACS is a 2-arm randomized trial with 180 patients hospitalized due to ACS at a tertiary hospital in Brazil. Eligible patients were randomized (1:1) to an SMS intervention (G1) or standard care (G2) upon hospital discharge. The primary endpoint was set to achieve 4 or 5 points in a risk factor control score, consisting of a cluster of 5 modifiable risk factors: LDL-C <70mg/dL, blood pressure (BP) <140/90mmHg, regular exercise (≥5 days/week, 30 minutes/session), nonsmoker status, and body mass index (BMI) <25 kg/m2] at 6 months. Secondary outcomes were components of the primary outcome plus rehospitalization, cardiovascular death, and death from any cause. Results are designated as significant if p<0.05. Results From randomized patients, 147 were included in the final analysis. Mean age was 58 (51-64) years, 74% males. The primary outcome was achieved by 12 (16.2%) patients in G1 and 15 (20.8%) in G2 (OR=0.73, 95%CI 0.32-1.70, p=0.47). Secondary outcomes were also similar: LDL-C<70 mg/dl (p=0.33), BP<140/90 mmHg (p=0.32), non-smoker (p=0.74), regular exercise (p=0.97), BMI (p=0.71), and rehospitalization (p=0.06). Death from any cause occurred in three participants (2%), including one cardiovascular death in each group. Conclusion SMS intervention did not significantly improve cardiovascular risk factor control when compared to standard care in patients discharged after ACS in Brazil.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Acute Coronary Syndrome/prevention & control , Secondary Prevention/methods , Text Messaging , Patient Discharge , Double-Blind Method , Follow-Up Studies , Longitudinal Studies , Telemedicine/methods , Heart Disease Risk Factors , Health Promotion/methods
2.
Int. j. cardiovasc. sci. (Impr.) ; 34(5,supl.1): 68-77, Nov. 2021. tab
Article in English | LILACS | ID: biblio-1346332

ABSTRACT

Abstract Background Acute myocardial infarction (AMI), with and without ST-segment elevation (STEMI and NSTEMI, respectively), is the principal cause of cardiovascular morbidity and mortality in Brazil and around the world. Modifiable risk factors (RF) and quality of life (QOL) may correlate with the type of AMI. Objective To evaluate the influence of QOL and RF on the type of AMI and in-hospital cardiovascular events in STEMI and NSTEMI patients. Methods This was an observational, cross-sectional study. Patients with AMI attending four referral hospitals (three private and one public) for cardiovascular disease treatment were assessed for QOL using the Brazilian version of the 36-item short form survey. A p < 0.05 was considered statistically significant. Results We evaluated 480 volunteers; 51% were treated in one of the private hospitals. In total, 55.6% presented with STEMI, and 44.4% with NSTEMI. Patients from the public hospital were 8.56 times more likely to have STEMI compared to those from the private hospitals. There was a higher prevalence of smokers in STEMI (p < 0.028) patients. QOL was not associated with the type of AMI. A negative patient perception of the physical health and pain domains was observed. Although a significant difference between the physical and the mental health domains was not observed, individual domains were correlated with some in-hospital outcomes. Conclusion There was a higher prevalence of smokers among individuals with STEMI. Domains of QOL showed a statistically significant relationship with the occurrence of in-hospital cardiovascular events, with no difference between the types of AMI.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Quality of Life , Acute Coronary Syndrome/prevention & control , Non-ST Elevated Myocardial Infarction/prevention & control , ST Elevation Myocardial Infarction/prevention & control , Heart Disease Risk Factors , Prevalence , Cross-Sectional Studies , Hospital Mortality , Acute Coronary Syndrome/epidemiology , Non-ST Elevated Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/epidemiology , Hospitalization , Life Style
3.
Arq. bras. cardiol ; 116(2): 285-294, fev. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1153009

ABSTRACT

Resumo Fundamento O maior risco de se desenvolver diabetes com o uso de estatinas é um desafio para a segurança do uso dessa classe de medicamentos em longo prazo. No entanto, poucos estudos analisaram essa questão durante síndromes coronarianas agudas (SCA). Objetivos Investigar a associação entre início precoce da terapia com estatina e níveis de glicemia em pacientes admitidos com SCA. Métodos Este foi um estudo retrospectivo de pacientes hospitalizados por SCA. Pacientes que nunca haviam usado estatinas foram incluídos e divididos segundo uso ou não de estatina nas primeiras 24 horas de internação. O desfecho primário foi a incidência de hiperglicemia na internação (definida como pico de glicemia > 200mg/dL). Modelos de regressão logística e modelos lineares multivariados foram usados para ajuste quanto a fatores de confusão e um modelo de pareamento por escore de propensão foi desenvolvido para comparações entre os dois grupos de interesses. Um valor de p menor que 0,05 foi considerado estatisticamente significativo. Resultados Um total de 2357 pacientes foram incluídos, 1704 deles alocados no grupo que receberam estatinas e 653 no grupo que não receberam estatinas nas primeiras 24 horas de internação. Após os ajustes, uso de estatina nas primeiras 24 horas foi associado com uma menor incidência de hiperglicemia durante a internação (OR ajustado = 0,61, IC95% 0,46-0,80; p < 0,001) e menor necessidade de uso de insulina (OR ajustado = 0,56, IC 95% 0,41-0,76; p < 0,001). Essas associações mantiveram-se similares nos modelos de pareamento por escore de propensão, bem como após análises de sensibilidade, como exclusão de pacientes que desenvolveram choque cardiogênico, infecção grave ou pacientes que foram a óbito durante a internação hospitalar. Conclusões Entre os pacientes internados com SCA que não receberam estatinas previamente, a terapia precoce com estatina associou-se independentemente com menor incidência de hiperglicemia durante a internação. (Arq Bras Cardiol. 2021; 116(2):285-294)


Abstract Background Increased risk of new-onset diabetes with statins challenges the long-term safety of this drug class. However, few reports have analyzed this issue during acute coronary syndromes (ACS). Objective To explore the association between early initiation of statin therapy and blood glucose levels in patients admitted with ACS. Methods This was a retrospective analysis of patients hospitalized with ACS. Statin-naïve patients were included and divided according to their use or not of statins within the first 24 hours of hospitalization. The primary endpoint was incidence of in-hospital hyperglycemia (defined as peak blood glucose > 200 mg/dL). Multivariable linear and logistic regression models were used to adjust for confounders, and a propensity-score matching model was developed to further compare both groups of interest. A p-value of less than 0.05 was considered statistically significant. Results A total of 2,357 patients were included, 1,704 of them allocated in the statin group and 653 in the non-statin group. After adjustments, statin use in the first 24 hours was associated with a lower incidence of in-hospital hyperglycemia (adjusted OR=0.61, 95% CI 0.46-0.80; p < 0.001) and lower need for insulin therapy (adjusted OR = 0.56, 95% CI 0.41-0.76; p < 0.001). These associations remained similar in the propensity-score matching models, as well as after several sensitivity analyses, such as after excluding patients who developed cardiogenic shock, severe infection or who died during index-hospitalization. Conclusions Among statin-naïve patients admitted with ACS, early statin therapy was independently associated with lower incidence of in-hospital hyperglycemia. (Arq Bras Cardiol. 2021; 116(2):285-294)


Subject(s)
Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Acute Coronary Syndrome/prevention & control , Acute Coronary Syndrome/epidemiology , Hyperglycemia/epidemiology , Incidence , Retrospective Studies , Follow-Up Studies
4.
Arq. bras. cardiol ; 106(1): 33-40, Jan. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-771048

ABSTRACT

Abstract Background: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established. Objective: To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS. Methods: Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records. Results: The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure. Conclusion: A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS.


Resumo Fundamento: A síndrome coronariana aguda (SCA) constitui uma das principais causas de morbimortalidade no mundo moderno. O sedentarismo, presente em 85% da população brasileira, é considerado fator de risco para o surgimento de doença arterial coronariana. Porém, não está bem estabelecida a correlação do sedentarismo com a ocorrência de eventos cardiovasculares (ECV) durante o internamento de portadores da SCA. Objetivo: Determinar o grau de atividade física de portadores de SCA, mediante a utilização do Questionário Internacional de Atividade Física (IPAQ), associando com o prognóstico intra-hospitalar. Métodos: Estudo observacional, transversal e analítico com 215 sujeitos admitidos consecutivamente com diagnóstico de SCA em um hospital de referência cardiológica no período de julho de 2009 a fevereiro de 2011. Todos os voluntários responderam à versão curta do IPAQ e foram seguidos quanto ao aparecimento de ECV durante o internamento, a partir de avaliação padronizada administrada pelo pesquisador, corroborada com dados do prontuário médico. Resultados: Os pacientes foram internados com diagnósticos de angina instável (34,4%), infarto agudo do miocárdio (IAM) sem supradesnivelamento de ST (41,4%) e IAM com supradesnivelamento de ST (24,2%). De acordo com o nível de atividade física, foram classificados em não ativos (56,3%) e ativos (43,7%). Constatou-se a presença de ECV em 35,3% da amostra. A ocorrência de complicação intra-hospitalar esteve associada ao tempo de internamento (odds ratio [OR] = 1,15) e inatividade física (OR = 2,54) e foi independente da idade, pressão arterial sistólica e insuficiência cardíaca congestiva prévia. Conclusão: Estilo de vida fisicamente ativo reduz o risco de ECV durante o internamento em pacientes com SCA.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/prevention & control , Cardiovascular Diseases/prevention & control , Exercise Therapy/statistics & numerical data , Exercise/physiology , Hospitalization , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/physiopathology , Cardiovascular Diseases/etiology , Epidemiologic Methods , Hypertension/complications , Prognosis , Risk Factors , Sedentary Behavior , Sex Factors , Smoking/adverse effects
6.
Article in English | LILACS | ID: biblio-962158

ABSTRACT

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.


RESUMO OBJETIVO : Analisar se variáveis demográficas e socioeconômicas e intervenção coronária percutânea estão associadas ao uso de medicamentos para prevenção secundária da síndrome coronariana aguda. MÉTODOS : Neste estudo de coorte, foram incluídos 138 pacientes com síndrome coronariana aguda, com idade igual ou superior a 30 anos e de ambos os sexos. Os dados foram coletados no momento da alta hospitalar e após seis e 12 meses da alta. O desfecho do estudo foi o uso simultâneo dos medicamentos recomendados para prevenção secundária da síndrome coronariana aguda: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina. As variáveis independentes foram: sexo, idade, escolaridade em anos de estudo, renda mensal em tercis e intervenção coronária percutânea. Descreveu-se a prevalência do uso de cada grupo de medicamento com respectivos intervalos de confiança de 95%, bem como o uso simultâneo dos quatro, em todos os períodos analisados. Na análise bruta verificou-se a associação do desfecho com as variáveis independentes para cada período por meio do teste Qui-quadrado. A análise ajustada foi realizada por Regressão de Poisson. RESULTADOS : Mais de um terço dos pacientes (36,2%; IC95% 28,2;44,3) recebeu prescrição dos quatro medicamentos, simultaneamente, no momento da alta. Não foram observadas diferenças nas prevalências de uso na comparação com os dois períodos de seguimento. A classe de medicamento mais prescrita na alta foi antiagregante plaquetário (91,3%). Na análise bruta, as variáveis demográficas e socioeconômicas não se associaram ao desfecho em nenhum dos três períodos. CONCLUSÕES : A prevalência de uso simultâneo dos medicamentos na alta e nos seguimentos apontou para a subutilização dessa terapêutica na prática clínica. São necessárias estratégias de intervenção para melhoria da qualidade da atenção dada aos pacientes que se estendam além da alta hospitalar, um ponto crítico de transição no cuidado.


Subject(s)
Humans , Male , Female , Adult , Aged , Cardiovascular Agents/classification , Acute Coronary Syndrome/prevention & control , Brazil , Cardiovascular Agents/administration & dosage , Cohort Studies , Practice Guidelines as Topic , Evidence-Based Medicine , Drug Therapy, Combination , Secondary Prevention , Middle Aged
7.
Medicina (B.Aires) ; 74(3): 245-253, jun. 2014.
Article in Spanish | LILACS, BINACIS | ID: biblio-1165181

ABSTRACT

A group of interdisciplinary experts (cardiologists, clinicians, infectologists met with the purpose of analyzing the evidence revealed by the relationship between respiratory diseases caused by influenza, pneumococcal diseases and cardiovascular events, and the role played by immunization strategies applied in cardiovascular prevention. The present statement summarizes the conclusions reached by the expertise of the aforementioned professionals. Systematic revisions imply consistent evidence that influenza and pneumococcal infection lead to acute myocardial infarction and cardiovascular death. Studies published during the last 15 years suggest that vaccination against influenza and S. pneumoniae reduce the risk of acute coronary syndromes. With the current evidence, and considering cost-effectiveness, reducing operating expenses and safety profile of the vaccines, scientific societies, national and international government health agencies strongly recommend incorporating immunization programs in those patients with chronic cardiovascular disease.


Subject(s)
Humans , Pneumococcal Infections/prevention & control , Vaccination/economics , Pneumococcal Vaccines/administration & dosage , Influenza, Human/prevention & control , Acute Coronary Syndrome/prevention & control , Myocardial Infarction/prevention & control , Argentina , Review Literature as Topic , Cardiovascular Diseases/prevention & control , Immunization/economics , Cost-Benefit Analysis , Government Agencies
8.
Medicina (B.Aires) ; 74(2): 99-103, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-708588

ABSTRACT

Se comparó la adherencia a la prevención secundaria de enfermedad coronaria mediante el uso indicado de fármacos de probada eficacia, al momento del egreso hospitalario y a 3 años de seguimiento, en una cohorte de pacientes afiliados al Plan de Salud del Hospital Italiano. Se realizó un estudio de cohorte retrospectivo que incluyo 125 pacientes menores de 80 años de edad, afiliados a una red integrada de salud, con internación por síndrome coronario agudo. En el análisis se utilizó el test de McNemar. La edad media de los participantes fue 63.7 años (DS 10.08) y el 65.6% (IC95% 56.6-73.9) fue de sexo masculino. El 76.8% (IC95% 68.4-83.9) presentó como evento calificante un síndrome coronario agudo sin elevación del segmento ST. El tiempo de seguimiento promedio fue 2.94 años (DS 0.25). Se observó que el uso de drogas de probada eficacia en la prevención secundaria de enfermedad coronaria descendió entre el momento del egreso hospitalario y los 3 años de seguimiento: antiagregantes de 97.6 a 88.0% (p = 0.012); beta-bloqueantes de 94.4 a 84.8% (p = 0.021); estatinas 91.2 a 83.7% (p = 0.035). Uso combinado de antiagregantes, betabloqueantes y estatinas de 86.4 a 66.3% (p < 0.0001). Es necesario estudiar las causas de la disminución de la adherencia a drogas cardioprotectoras a largo plazo.


We compared the use of evidence-based secondary prevention drugs for coronary artery disease at hospital discharge and 3 years of follow-up in a group of patients associated to an integrated network of health services. We conducted a retrospective group study that included 125 patients under 80 years of age who were hospitalized for acute coronary syndrome. McNemar´s test was used to compare values at baseline and 3 years. The mean age of of participants was 63.7 years (SD ± 10.08) and 65.6% (95% CI 56.6-73.9) of male sex. The average follow-up time was 2.94 years (SD ± 0.25). The use of secondary prevention drugs for coronary heart disease decreased at 3 years of follow-up: anti-platelet 97.6 to 88.0% (p = 0.012), beta-blockers 94.4 to 84.8% (p = 0.021) and statins 83.7 to 91.2% (p = 0.035). Patients medicated with a combination of anti-platelet, beta blockers and statins showed a decrease from 86.4 to 66.3% (p < 0.0001). It is necessary to study the causes for the decreased adherence to long-term cardio-protective drugs.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/prevention & control , Medication Adherence , Secondary Prevention , Acute Coronary Syndrome/drug therapy , Adrenergic beta-Antagonists/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Cohort Studies , Drug Therapy, Combination , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/administration & dosage , Retrospective Studies
11.
Article in English | IMSEAR | ID: sea-144785

ABSTRACT

Background & objectives: India contributes a significant number of deaths attributed to coronary artery disease (CAD) compared to the rest of the world. Data on catastrophic health expenditure (CHE) related to acute coronary syndrome (ACS), the major cause of deaths in CAD, are limited in the literature. We estimated the magnitude of CHE and studied the strategies used to cope with CHE. Methods: Two hundred and ten ACS patients (mean age 56 yr, 83% men) were randomly selected proportionately from six hospitals in Thiruvananthapuram district, Kerala, India. Information on demographics, ACS-related out-of-pocket expenditure and coping strategies was collected using a pre-tested structured interview schedule. CHE, defined as ACS-related expenditures exceeding 40 per cent of a household's capacity to pay, was estimated using the World Health Organization methods. Health security was defined as protection against out-of-pocket expenditure through an employer or government provided social security scheme. Socio-demographic variables, effect on participants’ employment, loans or asset sales for treatment purposes, health security coverage and type of treatment were considered as potential correlates of CHE. Multiple logistic regression analyses were conducted to identify the correlates of CHE. Results: CHE was experienced by 84 per cent (95% CI: 79.04, 88.96) of participants as a consequence of treating ACS. Participants belonging to low socio-economic status (SES) were 15 times (odds ratio (OR): 14.51, 95% CI: 1.69-124.41), whose jobs were adversely affected were seven times (OR: 7.21, CI: 1.54-33.80), who had no health security were six times (OR: 6.00, CI: 2.02-17.81) and who underwent any intervention were three times (OR: 3.24, CI: 1.03-10.16) more likely to have CHE compared to their counterparts. The coping strategies adopted by the participants were loans (41%), savings (14%), health insurance (8%) and a combination of the above (37%). Interpretation & conclusions: Our findings show that viable financing mechanism for treating ACS is warranted to prevent CHE particularly among low SES participants, those having no health security, requiring intervention procedures and those with adversely affected employment.


Subject(s)
Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/prevention & control , Adaptation, Psychological , Adult , Female , Health/economics , Humans , India/epidemiology , Life Style , Male , Socioeconomic Factors
12.
Rev. cuba. med. gen. integr ; 28(3): 290-298, jul.-set. 2012.
Article in Spanish | LILACS | ID: lil-656378

ABSTRACT

El síndrome coronario agudo es un problema de salud y constituye la primera causa de muerte en el mundo desarrollado y en Cuba. Esta enfermedad, que incluye infarto de miocardio, angina de pecho y muerte súbita, causa más muertes cada año que el resto de las enfermedades combinadas. El factor causal de mayor relevancia del infarto del miocardio, radica en la formación y evolución crónica de un ateroma, o eventos que son favorecidos por el estrés oxidativo, las citocinas proinflamatorias, la trombina y el no control de los factores de riesgo. La presente revisión se realizó con el propósito de explicar los mecanismos moleculares y la influencia de los factores de riesgo implicados en la fisiopatología de estas enfermedades. Se concluyó que las especies reactivas del oxígeno y el estrés oxidativo, desempeñan un papel importante en la fisiopatología de estas afecciones cardiovasculares, de relevancia para el diagnóstico y la terapéutica


Acute coronary syndrome is a health problem and is the leading cause of death in Europe, North America, and Cuba. This disease, which includes heart attack, angina and sudden death, causes more deaths each year than all other diseases combined. The most important causal factor of myocardial infarction lies in the formation and chronic evolution of atheroma, or events that are favored by oxidative stress, proinflammatory cytokines, thrombin and no control of risk factors. This review was conducted in order to explain the molecular mechanisms and the influence of the risk factors involved in the pathophysiology of these diseases. It was concluded that reactive oxygen species and oxidative stress play an important role in the pathophysiology of such cardiovascular disorders, of relevance for its diagnosis and therapy


Subject(s)
Humans , Male , Female , Atherosclerosis/etiology , Molecular Mechanisms of Pharmacological Action , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/prevention & control , Health Education , Risk Factors
13.
Arq. bras. endocrinol. metab ; 54(7): 612-619, Oct. 2010. graf, tab
Article in English | LILACS | ID: lil-564066

ABSTRACT

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4 percent vs. 9.2 percent, p = 0.047) and peripheral artery disease (13.0 percent vs. 3.6 percent, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2 percent vs. 10.4 percent, p = 0.103) or MACE (32.1 percent vs. 23.0 percent, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.


OBJECTIVO: Avaliar se a insulinoterapia prévia influencia de forma independente o prognóstico de diabéticos após uma síndrome coronária aguda (SCA). SUJEITOS E MÉTODOS: 375 doentes diabéticos com SCA, divididos em 2 grupos: Grupo A (n = 69) - sob insulinoterapia prévia e Grupo B (n = 306) - sem insulinoterapia prévia. Os preditores de mortalidade a um ano e de eventos cardíacos adversos maiores (MACE) foram determinados pela regressão de Cox. RESULTADOS: Verificou-se maior proporção de acidente vascular cerebral prévio (17,4 por cento vs. 9,2 por cento, p = 0,047) e doença arterial periférica (13,0 por cento vs. 3,6 por cento, p = 0,005) no Grupo A. Esses doentes apresentaram glicemia na admissão significativamente mais elevada e LDL inferior. Não houve diferenças estatisticamente significativas no tipo de SCA, na mortalidade (18,2 por cento vs. 10,4 por cento, p = 0,103) e MACE (32,1 por cento vs. 23,0 por cento, p = 0,146) em um ano entre os 2 grupos. Na análise multivariada, a insulinoterapia prévia não foi preditor independente nem de mortalidade, nem de MACE em 1 ano. CONCLUSÃO: Apesar da doença aterosclerótica mais avançada, os diabéticos previamente insulino-tratados têm um prognóstico semelhante aos não insulino-tratados. A insulinoterapia crônica poderá proteger os diabéticos da evolução desfavorável própria da doença aterosclerótica avançada.


Subject(s)
Aged , Female , Humans , Male , Acute Coronary Syndrome/prevention & control , Diabetes Mellitus/drug therapy , Diabetic Angiopathies/prevention & control , Insulin/adverse effects , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/etiology , Diabetic Angiopathies/epidemiology , Epidemiologic Methods , Insulin/therapeutic use , Prognosis , Treatment Outcome
14.
Medisan ; 14(1)ene.-feb. 2010.
Article in Spanish | LILACS | ID: lil-576469

ABSTRACT

Síndrome coronario agudo constituye una de las principales entidades clínicas atendidas en los servicios de urgencias médicas del sistema de salud, donde se incluyen la angina inestable aguda y el infarto agudo del miocardio. Con la nueva estrategia de realizar tratamiento fibrinolítico en los policlínicos de urgencias se aspira a disminuir la mortalidad por esta causa. Se llevó a cabo una revisión actualizada y exhaustiva de las principales características relacionadas con dicho síndrome, a fin de profundizar en su diagnóstico y tratamiento para atender mejor a quienes lo padecen.


The acute coronary syndrome constitutes one of the main clinical entities assisted in the services of medical emergencies of the health system, in which the acute unstable angina and the myocardial infarction are included. With the new strategy of carrying out fibrinolytic treatment in the emergency polyclinics the desire is to diminish the mortality due to this cause. It was carried out an up-to-date and exhaustive review of the main characteristic related with this syndrome, in order to deepen in their diagnosis and treatment to assist better those who suffer it.


Subject(s)
Humans , Angina, Unstable , Cardiovascular Diseases , Emergencies , Myocardial Infarction , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/prevention & control , Acute Coronary Syndrome/therapy
15.
ACM arq. catarin. med ; 38(2): 80-89, abr.-jul. 2009. tab, graf
Article in Portuguese | LILACS | ID: lil-528902

ABSTRACT

Objetivo: Descrever as características pessoais, clínicas, de tratamento, evolução para óbito e correlacionar escore TIMI ao número de internaçõesem UTI e transferência para cineangicoronariografia. Métodos: estudo prospectivo transversal empacientes internados no Hospital Nossa Senhora da Conceição em Tubarão-SC, nos períodos de novembro de 2006 a abril de 2007. Resultados: A média foi de idade de 62 anos, com predominância do sexo masculino (61,9%). Da amostrade 42 pacientes, 54,8% apresentou angina instável e 45,2%; infarto agudo do miocárdio sem supra de ST. Osfatores de risco prevalentes foram em ordem decrescente de freqüência: hipertensão arterial (78,6%),hereditariedade (57,1%), tabagismo (52,4%), dislipidemia (50%) e diabetes (38,1%). A angina prévia estava presente em 42,8% dos pacientes, o IAM em 33,3% e arevascularização miocárdica prévia em 7,1%. A maioria dos pacientes apresentou o ECG normal (35,7%) e umescore TIMI de alto, moderado e baixo risco respectivamente em 4,7%, 57,1% e 38%. Os medicamentos usados na emergência em ordem decrescente de freqüência foram: Nitrato (89,7%), AAS(87,2%), oxigênio (48,7%) e morfina (37,8%). E durante a internação os resultados foram: AAS (97,6%),clopidogrel (92,8%), nitrato (87,8%), HBPM (85,7%), IECA (78,5%), betabloqueador (54,7%), estatina (52,8%), bloqueador de cálcio (11,9%) e HNF (9,5%). O escore de TIMI foi referido no prontuário de 1 paciente apenas. Conclusão: O escore TIMI foi pouco registrado nos prontuários. A taxa de mortalidade foi inferior àapresentada pela literatura. Os IECA, estatina, o clopidogrel, a heparina e o AAS durante a internação foram bem utilizados enquanto que o AAS na admissão, o betabloqueador e a estatina podem estar sendo subutilizados. Os pacientes de alto risco pelo escoreTIMI receberam atendimento intensivo na UTI mesmo não havendo significância estatística.


Objective: to describe the personal characteristic, clinical treatment, grown to death and correlate TIMI score to ICU internment or transference to the cardiaccatheterization. Methods: Was made transversal study in intern patients of the Nossa Senhora da Conceição Hospital, between November 2006 to April 2007. Results: The mean rate of age was 62 years old, with predominance of male (61,9%). From the sample 42 patients, 54,8% showed UA and 45,2% NSTEMI. The prevalence of risk factor in decrease attendance order were: arterial hypertension (78,6%), heredity (57,1%), abusive smoking ou tabagysm (52,4%),hyperlipidemia (50%), diabetes (38,1%) The previous angine was present in 42,8% of the patients, the IAM in 33,3% and the previous miocardic revascularization in 7,1%. High, moderate and low TIMI score, respectively in 4,7%, 57,1% and 38%. The medicaments used in emergence in decrease attendance order were: Nitrate(89,7%), SAA (87,2%), Oxygen (48,7%), and Morphine (37,8%), During the internment the results were: SAA (97,6%), clopidogrel (92,8%), nitrate (87,8%), LMWH (85,7%), ACEI (78,5%), â blocker (54,7%), statin(52,8%), calcium blocker (11,9%) and HNF (9,5%). Only one patient had reference to TIMI. Conclusion: The TIMI score was little register in the medical record. The mortality rate was lower than showed in the literature. The use of de ACEI, statin, o clopidogrel, heparin and the SAA during the internmentwere used, however SAA in entrance/admission, the â blocker and a statin can be poor available. The patientswith high risk by means of TIMI score received intensive attendance in the UTI service in spite of no statistic significance.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Acute Coronary Syndrome , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/metabolism , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/pathology , Acute Coronary Syndrome/prevention & control , Acute Coronary Syndrome/rehabilitation
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