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2.
Korean Circulation Journal ; : 406-417, 2020.
Article in English | WPRIM | ID: wpr-816677

ABSTRACT

BACKGROUND AND OBJECTIVES: Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST).METHODS: Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI.RESULTS: A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09–0.41; p<0.001).CONCLUSIONS: Functional CR showed a higher increment of exercise duration than functional IR.


Subject(s)
Angina, Stable , Exercise Test , Humans , Myocardial Infarction , Myocardial Ischemia , Percutaneous Coronary Intervention , Prognosis , Prospective Studies
4.
Article in English | WPRIM | ID: wpr-786215

ABSTRACT

BACKGROUND AND OBJECTIVES: The impact of SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score (SS) and SS II in patients who receive percutaneous coronary intervention with second-generation everolimus-eluting stents (EES) has not been fully validated.METHODS: The SS, SS II were calculated in 1,248 patients with left main and/or 3-vessel disease treated with EES. Patient-oriented composite endpoint (POCE; all-cause death, any myocardial infarction (MI), any revascularization) and target lesion failure (TLF: cardiac death, target-vessel MI, target lesion revascularization) were analyzed.RESULTS: The mean SS was 21.1±9.6. Three-year POCE increased according to the SS group (15.2% vs. 19.9% vs. 27.4% for low (≤22), intermediate (≥23, ≤32), high (≥33) SS groups, p<0.001). By multivariate Cox proportional hazard analysis, SS group was an independent predictor of 3-year POCE (hazard ratio, 1.324; 95% confidence interval, 1.095–1.601; p=0.004). The receiver operating characteristic curves revealed that the SS II was superior to the SS for 3-year POCE prediction (area under the curve [AUC]: 0.611 vs. 0.669 for SS vs. SS II, p=0.019), but not for 3-year TLF (AUC: 0.631 vs. 0.660 for SS vs. SS II, p=0.996). In subgroup analysis, SS II was superior to SS in patients with cardiovascular clinical risk factors, and in those presenting as stable angina.CONCLUSIONS: The usefulness of SS and SS II was still valid in patients with left main and/or 3-vessel disease. SS II was superior to SS for the prediction of patient-oriented outcomes, but not for lesion-oriented outcomes.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00698607ClinicalTrials.gov Identifier: NCT01605721


Subject(s)
Angina, Stable , Death , Drug-Eluting Stents , Humans , Myocardial Infarction , Percutaneous Coronary Intervention , Risk Factors , ROC Curve , Stents , Taxus , Thoracic Surgery
5.
Arq. bras. cardiol ; 112(1): 40-47, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-973839

ABSTRACT

Abstract Background: In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS). Objectives: To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS. Methods: Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE. Results: We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%. Conclusion: FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.


Resumo Fundamentos: Em pacientes multiarteriais e lesões moderadas, a reserva de fluxo fracionada (FFR) avalia cada lesão e direciona o tratamento, podendo ser útil no custo-efetividade (CE) de implante de stents não farmacológicos (SNF). Objetivos: Avaliar CE e impacto clínico da angioplastia + FFR versus angioplastia + angiografia (ANGIO), em multiarteriais, utilizando SNF. Métodos: pacientes com doença multiarteriais foram randomizados prospectivamente durante ±5 anos para FFR ou ANGIO, e acompanhados por até 12 meses. Foram avaliados eventos cardíacos maiores (ECAM), reestenose e CE. Resultados: foram incluídos 69 pacientes, 47(68,1%) homens, 34(49,2%) no FFR e 35(50,7%) no ANGIO, idade 62,0 ± 9,0 anos, com angina estável e Síndrome Coronariana Aguda estabilizada. No FFR, havia 26 com doença (76,5%) biarterial e 8 (23,5%) triarterial, e no grupo ANGIO, 24(68,6%) biarteriais e 11(31,4%) triarteriais. Ocorreram 12(17,3%) ECAM - 3(4,3%) óbitos: 2(5,8%) no FFR e 1(2,8%) no ANGIO, 9(13,0%) anginas, 4(11,7%) no FFR e 5(14,2%) no ANGIO, 6 reestenoses: 2(5,8%) no FFR e 4 (11,4%) no ANGIO. Angiografia detectou 87(53,0%) lesões no FFR, 39(23,7%) com ICP e 48(29,3%) com tratamento clínico; e 77(47,0%) lesões no ANGIO, todas submetidas à angioplastia. Quanto aos stents, registrou-se 39(33,3%) (0,45 ± 0,50 stents/lesão) no FFR e 78(66,6%) (1,05 ± 0,22 stents/lesão) no ANGIO (p = 0,0001); ANGIO utilizou 51,4% a mais que o FFR. Análise de CE revelou um custo de R$5045,97 e R$5.430,60 nos grupos ANGIO e FFR, respectivamente. A diferença de efetividade foi 1,82%. Conclusões: FFR diminuiu o número de lesões tratadas e de stents e necessidade de revascularização do vaso-alvo, com CE comparável ao da angiografia.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Angiography/methods , Fractional Flow Reserve, Myocardial/physiology , Acute Coronary Syndrome/therapy , Angina, Stable/therapy , Time Factors , Angioplasty, Balloon, Coronary/economics , Stents , Prospective Studies , Treatment Outcome , Coronary Angiography/economics , Cost-Benefit Analysis , Statistics, Nonparametric , Coronary Restenosis/mortality , Coronary Restenosis/therapy , Kaplan-Meier Estimate , Acute Coronary Syndrome/economics , Acute Coronary Syndrome/pathology , Angina, Stable/economics , Angina, Stable/mortality
6.
Chinese Medical Journal ; (24): 1461-1466, 2019.
Article in English | WPRIM | ID: wpr-771210

ABSTRACT

BACKGROUND@#Low handgrip strength (HS) and declining gait speed (GS) are increasingly obvious with aging, requiring effective, and safe medication for treatment. Trimetazidine (TMZ) modified release tablets, a common anti-angina drug, has potential benefits for alleviating the condition, but this has not yet been fully studied and therefore is the aim of this study.@*METHODS@#This is a prospective randomized controlled study. Fifty-eight eligible patients will be randomly assigned to one of two study groups: TMZ group or control group. For the TMZ group, a dose of 35 mg of oral TMZ will be administered with a meal twice a day for 3 months, in addition to any conventional treatments for angina. Only conventional treatments for angina will be administrated in the control group. The primary outcome will be the 6-min walking distance and the secondary outcomes will be: muscle strength (HS and pinch strength), GS, muscle endurance (five times sit-to-stand test), balance maintenance (tandem standing test), and the frequency of angina per week. Additionally, body mass index, circumferences (biceps, waist, hip, and calf), albumin levels, and the score on a five-question scale for sarcopenia will be obtained during the study.@*DISCUSSION@#This study aims to evaluate the usefulness of TMZ in a population with poor muscle function. The results may provide an effective and safe medical treatment to people with low muscle strength or physical performance.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR1800015000; www.chictr.org.cn/showproj.aspx?proj=25445.


Subject(s)
Aged , Angina, Stable , Drug Therapy , Female , Humans , Male , Middle Aged , Muscle, Skeletal , Prospective Studies , Treatment Outcome , Trimetazidine , Therapeutic Uses , Vasodilator Agents , Therapeutic Uses
7.
Article in Chinese | WPRIM | ID: wpr-773647

ABSTRACT

To systemically evaluate the benefits and side effects of Shensong Yangxin Capsules( SYC) in the adjuvant treatment of stable angina pectoris( SAP). Chinese and English databases( PubMed,EMbase,the Cochrane Library,CBM,CNKI,VIP,Wan Fang database) were retrieved to collect the randomized controlled trials( RCTs) about therapeutic efficacy of SYC combined with routine drug( trial group) vs routine drug( control group) in the treatment of SAP. The methodological quality of the RCTs was evaluated based on the cochrane risk of bias assessment tool. The data were extracted and Meta-analyzed by Reviewer Manager 5. 3. TSA 0. 9 software was used for trial sequential analysis( TSA) of the total effective rate of symptoms improvement. A total of 15 RCTs with 1 316 participants were included. RESULTS:: of Meta-analysis showed that the total effective rate of angina symptoms improvement( RR = 1. 15,95% CI[1. 09,1. 21],P<0. 001) of trial group were significantly higher than those of control group,with statistical significance,the total effective rate of electrocardiograms( ECG) improvement( RR = 1. 10,95% CI[0. 94,1. 29],P = 0. 25) of trial group were significantly higher than those of control group,but the difference was not statistically significant. After treatment,the improvement of the total time of 24 h general ischemia( SMD =-1. 21,95%CI[-1. 97,-0. 45],P = 0. 002),the ST-segment depression amplitude( SMD =-1. 30,95%CI [-1. 52,-1. 09],P<0. 001),the duration of angina pectoris attack( SMD =-1. 16,95% CI[-1. 36,-0. 95],P< 0. 001),the angina pectoris attack every week( SMD =-0. 80,95%CI[-1. 10,-0. 50],P<0. 001),the onsumption of nitroglycerin every week( SMD=-0. 72,95%CI[-1. 05,-0. 39],P<0. 001) in the trial group were better than that of the control group,and the difference was statistically significant. Besides,the improvement of the blood lipid and high sensitivity C reactive protein( hs-CRP) in the trial group were better than those of the control group after treatment,and the difference was statistically significant( P< 0. 001). Funnel plots and Egger's linear regression showed that there was no publication bias. By sensitivity analysis,it showed that the results of this study were stable and reliable. No obvious adverse drug reactions were observed in all studies. TSA analysis showed that the evidence of Meta-analysis was reliable. SYC combined with routine Western medicine treatment for SAP can improve the total effective rate of angina pectoris,reduce 24 h total ischemia time,ST segment depression amplitude,duration of angina pectoris attack,frequency of angina pectoris attack and nitroglycerin dosage,and also can improve blood lipid and hs-CRP levels.


Subject(s)
Adjuvants, Pharmaceutic , Angina, Stable , Drug Therapy , C-Reactive Protein , Capsules , Drugs, Chinese Herbal , Therapeutic Uses , Electrocardiography , Humans , Lipids , Blood , Randomized Controlled Trials as Topic
8.
Article in English | WPRIM | ID: wpr-776617

ABSTRACT

BACKGROUND@#Many patients with chronic angina experience anginal episodes despite successful recanalization, antianginal and antiischemic medications. Empirical observations suggested that Shenzhu Guanxin Recipe Granules (, SGR), a Chinese herbal compound, exerted potential impacts on increased treadmill exercise performance and angina relieve. However, there has been no systematic study to clarify the impact of SGR on exercise tolerance in patients with stable angina. The SERIES (ShEnzhu guanxin Recipe for Improving Exercise tolerance in patients with Stable angina) trial is designed to determine the effects of SGR on exercise duration, electrocardiographic (ECG) evidence of myocardial ischemia, and incidence of major adverse cardiac events (MACE) in stable anginal patients.@*METHODS@#A total of 184 eligible patients with stable angina will be randomly assigned to receive placebo or SGR (10 g/day for 12 weeks) in a 1:1 ratio. The primary outcome will be the change from baseline in total exercise tolerance duration, time to onset of angina and ECG ischemia during exercise treadmill testing performed over a 12-week study period. The secondary outcome will include ECG measures, the occurrence and composite of MACE and the Seattle Angina Questionnaire score. Moreover, the coronary microcirculation will be evaluated to explore the possible effects in response to treatment of SGR. After the procedure, all participants will be followed up by interview at 3 and 6 months, enquiring about any cardiac events, hospitalizations, cardiac functional level and medication usage. Additionally, the occurrence of adverse events will be evaluated at each follow-up.@*DISCUSSION@#This study may provide novel evidence on the efficacy of SGR in improving exercise tolerance and potentially reducing clinical adverse events. (Trial registration No. ChiCTR-TRC-14004504).


Subject(s)
Angina, Stable , Drug Therapy , Coronary Circulation , Double-Blind Method , Drugs, Chinese Herbal , Therapeutic Uses , Exercise Test , Exercise Tolerance , Physiology , Humans , Placebos , Sample Size
9.
Rev. bras. cir. cardiovasc ; 33(2): 183-188, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-958400

ABSTRACT

Abstract Objective: On pump beating/non-beating coronary artery bypass grafts (CABG) has been compared in patients with unstable angina and/or severe left ventricular dysfunction. There is scarce evidence regarding the beneficial use of on-pump beating CABG in patients with stable angina and normal left ventricular function. Our aim was to study the postoperative results using both techniques in this group of patients. Methods: One thousand one hundred and forty-five patients with stable angina underwent on-pump isolated CABG in Uruguay from 2011 to 2015. Patients were grouped into beating/non-beating CABG. Operative mortality and long-term survival were evaluated as primary outcome. Logistic regression analysis was performed to define the predictive role of aortic cross clamp (AXC) on prolonged inotropic support, ventilator support and intraoperative glycemia. Results: Among the included patients, 988 underwent aortic cross clamp. No differences were found in operative mortality, stroke and long-term survival among both groups. Patients without AXC showed higher intraoperative values of glycemia and higher incidence of postoperative prolonged mechanical ventilator support (7.6% vs. 2.4%; P=0.001). The need for prolonged inotropic support was lower in this group of patients (27.4% vs. 49.5%; P<0.001). Conclusion: On-pump beating CABG has similar operative mortality and long-term survival compared with conventional AXC. Higher intraoperative glycemia and higher incidence for prolonged mechanical ventilator is associated with on-pump beating CABG. On the contrary, higher incidence for prolonged inotropic support is associated with AXC. Taking these factors into consideration, both techniques are safe and allow the surgeon to choose the most comfortable option.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cardiopulmonary Bypass/methods , Coronary Artery Bypass/methods , Ventricular Dysfunction, Left/surgery , Angina, Stable/surgery , Time Factors , Cardiopulmonary Bypass/mortality , Logistic Models , Coronary Artery Bypass/mortality , Multivariate Analysis , Reproducibility of Results , Retrospective Studies , Risk Factors , Ventricular Function, Left , Treatment Outcome , Ventricular Dysfunction, Left/mortality , Constriction , Kaplan-Meier Estimate , Angina, Stable/mortality
10.
Rev. bras. cir. cardiovasc ; 33(1): 47-53, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897987

ABSTRACT

Abstract Objective: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. Methods: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. Results: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. Conclusion: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.


Subject(s)
Humans , Male , Female , Aged , Preoperative Care/methods , Coronary Artery Bypass/methods , Adrenergic beta-Agonists/administration & dosage , Angina, Stable/surgery , Survival Analysis , Coronary Artery Bypass/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Diabetes Mellitus , Angina, Stable/complications , Angina, Stable/mortality , Hypertension
12.
Korean Circulation Journal ; : 507-515, 2018.
Article in English | WPRIM | ID: wpr-738718

ABSTRACT

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the status of health-promoting behaviors in patients after percutaneous coronary intervention (PCI) and explore what factors affect healthy lifestyle behaviors. METHODS: A total of 120 patients with coronary artery disease after PCI was included in this study. The Health Promoting Lifestyle Profile (HPLP) II was used to assess health-promoting lifestyle behavior. Data analysis was performed by t-test, analysis of variance, and multiple linear stepwise regression analyses. RESULTS: The average age of the participants was 60.10±9.84 (range, 37–81) years old. Among the participants, 86.7% were men and 13.3% were women. In all, 24.2% of the patients had an excellent level of health-promoting lifestyle and 74.2% had a moderate level of health-promoting lifestyle. The spiritual growth scores were the highest, while stress management and physical activity scores were the lowest. The level of health-promoting lifestyle was higher for people with higher income and a diagnosis of stable angina. CONCLUSIONS: Healthcare providers should focus on promoting physical exercise and stress management for patients after PCI. It is also necessary to keep an eye out for patients with low income and severe illness to encourage a health-promoting lifestyle in these subsets of patients.


Subject(s)
Angina, Stable , Cardiovascular Diseases , Coronary Artery Disease , Diagnosis , Exercise , Female , Health Personnel , Health Promotion , Humans , Life Style , Male , Motor Activity , Percutaneous Coronary Intervention , Statistics as Topic
13.
Yonsei Medical Journal ; : 937-944, 2018.
Article in English | WPRIM | ID: wpr-717936

ABSTRACT

PURPOSE: The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50–69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). MATERIALS AND METHODS: Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. RESULTS: Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p < 0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. CONCLUSION: The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.


Subject(s)
Angina, Stable , Angiography , Arteries , Body Weight , Cohort Studies , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Stenosis , Diagnosis , Humans , Incidence , Information Systems , Prospective Studies
14.
J. bras. econ. saúde (Impr.) ; 9(2): http://www.jbes.com.br/images/v9n2/164.pdf, ago. 2017.
Article in Portuguese | LILACS, ECOS | ID: biblio-868023

ABSTRACT

Objetivo: Avaliar o custo-efetividade da trimetazidina (TMZ) associada ao tratamento convencional (diurético, ácido acetilsalicílico [AAS], betabloqueador, inibidores da enzima de conversão da angiotensina (IECA), nitrato, estatina, digitálico e antagonista dos canais de cálcio) versus tratamento convencional isolado no tratamento de pacientes diabéticos com angina estável não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio sob a perspectiva do Sistema Público de Saúde (SUS). Métodos: Foi elaborado um modelo de Markov, com ciclos de 1 ano, que acompanhou os pacientes ao longo do curso natural da doença até o final de suas vidas. Dados clínicos foram obtidos a partir de revisão da literatura. Custos unitários foram extraídos de bases de dados oficiais. Apenas custos médicos diretos foram contemplados. Custos e benefícios foram descontados a uma taxa de 5% ao ano. Desfecho clínico foi expresso como episódio de hospitalização por angina pectoris (EHAP) evitado. Análise de sensibilidade univariada foi realizada para determinar os parâmetros de maior influência nos resultados, variando-os em mais ou menos 20% comparado ao cenário base. Resultados: O tratamento com TMZ mostrou maior benefício comparado ao tratamento convencional e gerou uma Razão de Custo-Efetividade Incremental de R$ 7.344,96 por EHAP evitado. O parâmetro de maior impacto no resultado foi o número de episódios de angina pectoris. Apesar do alto impacto, este não alterou o resultado da análise, mantendo-o custo-efetivo. Conclusão: TMZ associada ao tratamento convencional mostrou ser uma alternativa eficaz, segura e custo-efetiva para o tratamento de pacientes diabéticos com angina estável não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio.


Objective: To assess the cost-effectiveness analysis of trimetazidine (TMZ) associated with conventional treatment (diuretic, acetylsalicylic acid [ASA], beta blocker, angiotensin converting enzyme inhibitor (ACEI), nitrate, statine, digitalis and calcium channel antagonist) versus conventional treatment alone in the treatment of diabetic patients with stable angina non-responders to beta blockers, nitrates and calcium channel blockers from the perspective of the Public Health System (SUS). Methods: A Markov model was developed, with one year cycles, to follow the patients along the natural course of disease until the end of your lifes. Clinical data were obtained from the literature review. Unit costs were extracted from official databases. Only direct medical costs were included. Costs and benefits were discounted at a rate of 5% per year. Outcome were expressed as hospitalization due to angina pectoris (HAP) avoided. Univariate sensitivity analysis was performed to determine the parameters of greatest influence on the results, varying them by plus or minus 20% compared to the baseline scenario. Results: Treatment with TMZ showed greater benefit compared to conventional treatment and generated an Incremental Cost-Effectiveness Ratio of USD 2,225.75 per HAP avoided (1USD = 3.30BRL). The parameter with the greatest impact on outcome was the number of angina pectoris episodes. Despite the high impact, it did not change the result, keeping it cost-effective. Conclusion: TMZ associated with conventional treatment has been shown to be an effective, safe and cost-effective alternative for the treatment of diabetic patients with stable angina non-responders to beta blockers, nitrates and calcium channel blockers.


Subject(s)
Humans , Angina, Stable , Coronary Disease , Cost-Effectiveness Evaluation , Diabetes Mellitus , Trimetazidine
15.
Korean Circulation Journal ; : 898-906, 2017.
Article in English | WPRIM | ID: wpr-90204

ABSTRACT

BACKGROUND AND OBJECTIVES: This trial evaluated the safety and efficacy of the Genoss drug-eluting coronary stent. METHODS: This study was a prospective, multicenter, randomized trial with a 1:1 ratio of Genoss drug-eluting stent (DES)™ and Promus Element™. Inclusion criteria were the presence of stable angina, unstable angina, or silent ischemia. Angiographic inclusion criteria were de novo coronary stenotic lesion with diameter stenosis >50%, reference vessel diameter of 2.5–4.0 mm, and lesion length ≤40 mm. The primary endpoint was in-stent late lumen loss at 9-month quantitative coronary angiography follow-up. Secondary endpoints were in-segment late lumen loss, binary restenosis rate, death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis during 9 months of follow-up. RESULTS: We enrolled 38 patients for the Genoss DES™ group and 39 patients for the Promus Element™ group. In-stent late lumen loss at 9 months was not significantly different between the 2 groups (0.11±0.25 vs. 0.16±0.43 mm, p=0.567). There was no MI or stent thrombosis in either group. The rates of death (2.6% vs. 0%, p=0.494), TLR (2.6% vs. 2.6%, p=1.000), and TVR (7.9% vs. 2.6%, p=0.358) at 9 months were not significantly different. CONCLUSION: This first-in-patient study of the Genoss DES™ stent showed excellent angiographic outcomes for in-stent late lumen loss and major adverse cardiac events over a 9-month follow-up.


Subject(s)
Angina, Stable , Angina, Unstable , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Drug-Eluting Stents , Follow-Up Studies , Humans , Ischemia , Mortality , Myocardial Infarction , Polymers , Prospective Studies , Sirolimus , Stents , Thrombosis
16.
Korean Circulation Journal ; : 694-704, 2017.
Article in English | WPRIM | ID: wpr-78954

ABSTRACT

BACKGROUND AND OBJECTIVES: The effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation. SUBJECTS AND METHODS: Drawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs. RESULTS: For the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60–1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027). CONCLUSION: Adjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.


Subject(s)
Acute Coronary Syndrome , Angina, Stable , Coronary Artery Disease , Death , Drug-Eluting Stents , Humans , Myocardial Infarction , Stents , Treatment Outcome
17.
Article in English | WPRIM | ID: wpr-98377

ABSTRACT

BACKGROUND AND OBJECTIVES: The recently discovered myokine irisin has a proposed role in adipose tissue metabolism. The aim of this study was to evaluate the relationship between serum irisin level and the coronary artery severity in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS: Sixty-three patients who underwent coronary angiography (CA) diagnosed with stable CAD and twenty-six patients with normal coronary artery (NCA) were enrolled in the study. Stable CAD patients were divided into two groups as high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score (≥23) and lower SYNTAX score (<23). Serum irisin level measurement was carried out using human irisin colorimetric enzyme-linked immunosorbent assay (ELISA) commercial kit (AG-45A-0046EK-KI01, Adipogen, San Diego, CA, USA) as recommended by the manufacturer's protocol. RESULTS: The patients with stable CAD with a higher SYNTAX score (score ≥23) had significantly lower serum irisin levels (127.91±55.38 ng/mL), as compared the patients with a low SYNTAX score (score <23) (224.69±92.99 ng/mL) and control group (299.54±123.20 ng/mL). Irisin levels showed significant differences between all groups (p<0.001). CONCLUSION: Serum irisin level is an independent predictor of coronary artery severity in patients with stable CAD.


Subject(s)
Adipose Tissue , Angina, Stable , Atherosclerosis , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Enzyme-Linked Immunosorbent Assay , Humans , Metabolism , Percutaneous Coronary Intervention , Taxus , Thoracic Surgery
18.
Lima; s.n; jun. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848617

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología sanitaria acerca de la eficacia y seguridad del medicamento Trimetazidina 35mg para el tratamiento de pacientes con cardiopatía isquémica refractaria y no tributarios a revascularización miocárdica percutánea o quirúrgica. Aspectos Generales: La angina pectoris estable es un síndrome clínico de dolor, presión o molestia temporal en el pecho pudiéndose extender a la mandíbula, hombro, espalda o brazo. Es la manifestación clínica más común de la cardiopatía isquémica, la cual es la principal causa de muerte en los Estados Unidos. Los factores pronósticos más importantes de la angina pectoris son la función sistólica ventricular y clase funcional además de co-morbilidades como la diabetes mellitus y la enfermedad vascular periférica. Tecnología Sanitaria de Interés: El medicamento Trimetazidina (Vastarel®, Laboratorios Servier) es un anti-angínico, inhibidor parcial de la oxidación de ácidos grasos, con fórmula química Trimetazidina-1-(2,3,4 trimetoxi benzil)-piperazina dihidroclorido, que inhibe la enzima [3-Ketoacil-CoA tiolasa, la cual forma parte del proceso de oxidación de ácidos grasos en las células. METODOLOGIA: Estrategia de Busqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto a la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio - antagonistas y beta bloqueadores en dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Para la búsqueda primaria se revisó la información disponible por entes reguladoras y normativas como la Administración de Drogas y Alimentos (FDA), la EMA y la DIGEMID. Posteriormente se buscaron Guías de Práctica Clínica a través de los metabuscadores: Translating Research into Practice (TRIPDATABASE), National Library of Medicine (Pubmed-Medline), The National Guideline of Clearinghouse, y Health Systems Evidence. Finalmente, se realizó una búsqueda dentro de la información generada por grupos internacionales que realizan revisiones sistemáticas, evaluación de tecnologías sanitarias y guías de práctica clínica, tales como The Cochrane Library, The National Institute for Health and Care Excellence (NICE), The Canadian Agency for Drugs and Technologies in Health (CADTH), The Scottish Medicines Consortium (SMC), que a su vez fue complementada con una búsqueda en www.clinicaltrials.gov, para identificar estudios primarios en elaboración o que no hayan sido publicados aún. RESULTADOS: Tras la búsqueda bibliográfica se encontró evidencia que sustenta la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio ­ antagonistas y beta bloqueadores a dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Sinopsis de la Evidencia: Se encontró evidencia acerca de la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio - antagonistas y beta bloqueadores a dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. CONCLUSIONES: En la presente evaluación de tecnología sanitaria se ha encontrado evidencia acerca de la eficacia y seguridad de TMZ en pacientes con cardiopatía isquémica refractaria y que no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Los resultados de las revisiones sistemáticas de ensayos clínicos aleatorizados evidencian que TMZ no ha demostrado ser superior a otros agentes anti-angínicos como monoterapia de primera línea. Sin embargo, se encontraron resultados de eficacia muy limitada para el tratamiento con TMZ como medicamento concomitante a otras terapias óptimas como beta-bloqueadores, calcio-antagonistas y nitratos en pacientes cuya condición clínica no haya sido controlada adecuadamente por los mismos o que sean intolerantes a ellas. Se encontró que la eficacia mínima de TMZ en terapia combinada, fue evaluada para desenlaces secundarios y no relevantes para la evaluación establecida en el presente Dictamen. No existen en la actualidad estudios que evalúen desenlaces duros y clínicamente importantes desde la perspectiva del paciente. El Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, no aprueba el uso de Trimetazidina MR 35mg BID para el tratamiento de pacientes con cardiopatía isquémica refractaria y que no son tributarios a revascularización miocárdica percutánea o quirúrgica. El presente Dictamen Preliminar tiene vigencia de dos años a partir de la fecha de su publicación.


Subject(s)
Humans , Trimetazidine/administration & dosage , Myocardial Ischemia/drug therapy , Angina, Stable/physiopathology , Myocardial Revascularization/methods , Treatment Outcome , Cost-Benefit Analysis
19.
Int. braz. j. urol ; 42(1): 123-131, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-777334

ABSTRACT

ABSTRACT Objective To investigate the association between the severity of erectile dysfunction (ED) and coronary artery disease (CAD) in men undergoing coronary angiography for angina or acute myocardial infarct (AMI). Material and Methods We studied 132 males who underwent coronary angiography for first time between January and November 2010. ED severity was assessed by the international index of erectile function (IIEF-5) and CAD severity was assessed by the Syntax score. Patients with CAD (cases) and without CAD (controls) had their IIEF-5 compared. In the group with CAD, their IIEF-5 scores were compared to their Syntax score results. Results We identified 86 patients with and 46 without CAD. The IIEF-5 score of the group without CAD (22.6±0.8) was significantly higher than the group with CAD (12.5±0.5; p<0.0001). In patients without ED, the Syntax score average was 6.3±3.5, while those with moderate or severe ED had a mean Syntax score of 39.0±11.1. After adjustment, ED was independently associated to CAD, with an odds ratio of 40.6 (CI 95%, 14.3-115.3, p<0.0001). The accuracy of the logistic model to correctly identify presence or absence of CAD was 87%, with 92% sensitivity and 78% specificity. The average time that ED was present in patients with CAD was 38.8±2.3 months before coronary symptoms, about twice as high as patients without CAD (18.0±5.1 months). Conclusions ED severity is strongly and independently correlated with CAD complexity, as assessed by the Syntax score in patients undergoing coronariography for evaluation of new onset coronary symptoms.


Subject(s)
Humans , Male , Female , Severity of Illness Index , Coronary Artery Disease/physiopathology , Coronary Artery Disease/diagnostic imaging , Coronary Angiography/methods , Erectile Dysfunction/physiopathology , Time Factors , Coronary Artery Disease/complications , Risk , ROC Curve , Analysis of Variance , Statistics, Nonparametric , Angina, Stable/complications , Angina, Stable/physiopathology , Angina, Stable/diagnostic imaging , Erectile Dysfunction/etiology , Angina, Unstable/complications , Angina, Unstable/physiopathology , Angina, Unstable/diagnostic imaging , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Myocardial Infarction/diagnostic imaging
20.
Article in English | WPRIM | ID: wpr-227308

ABSTRACT

BACKGROUND/AIMS: This study appraised the long term clinical outcomes of patients treated with percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease. There are limited data regarding long-term clinical outcomes after PCI for ULMCA disease. METHODS: From 2001 to 2011, a total of 448 patients who underwent PCI for ULMCA disease and had 2-year clinical follow-up, were analyzed. The study patients were divided into two groups: group I (stable angina pectoris [SAP], n = 60, 48 men, 62 ± 10 years) and group II (acute coronary syndrome [ACS], n = 388, 291 men, 64 ± 10 years). We evaluated clinical and angiographic characteristics and major adverse cardiac events (MACE) during 2-year clinical follow-up. RESULTS: Mean age of studied patients was 64 ± 10 years with 339 male patients. Average stent diameter was 3.6 ± 0.4 mm and stent length was 19.7 ± 6.3 mm. Stent implantation techniques and use of intravascular ultrasound guidance were not different between two groups. In-hospital mortality was 0% in group I and 7% in group II (p = 0.035). One-month mortality was 0% in group I and 7.7% in group II (p = 0.968). Two-year survival rate was 93% in the group I and 88.4% in the group II (p = 0.921). Predictive factors for 2-year MACE were hypertension, Killip class ≥ 3, and use of intra-aortic balloon pump by multivariate analysis. CONCLUSIONS: Although in-hospital mortality rate was higher in ACS than in SAP, clinical outcomes during 2-year clinical follow-up were similar between SAP and ACS after PCI of ULMCA.


Subject(s)
Acute Coronary Syndrome , Angina Pectoris , Angina, Stable , Coronary Artery Disease , Coronary Vessels , Follow-Up Studies , Hospital Mortality , Humans , Hypertension , Male , Mortality , Multivariate Analysis , Percutaneous Coronary Intervention , Stents , Survival Rate , Ultrasonography
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