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1.
Femina ; 50(1): 61-64, 20220131. ilus
Article in Portuguese | LILACS | ID: biblio-1358222

ABSTRACT

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)


Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiology
2.
Arq. bras. cardiol ; 118(2): 435-445, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364333

ABSTRACT

Resumo Fundamento O pterostilbeno (PS), um composto polifenólico natural e antioxidante, surge como uma intervenção promissora para minimizar danos do infarto agudo do miocárdio (IAM). Objetivo Este estudo teve como objetivo avaliar o desempenho do PS na promoção da homeostase redox nos pulmões e no ventrículo direito (VD) de animais infartados. Métodos Ratos Wistar machos (60 dias de idade) foram randomizados em três grupos: SHAM, IAM (infarto) e IAM+PS (IAM + pterostilbeno). Sete dias após o procedimento de IAM, os ratos foram tratados com PS (100 mg/kg/dia) por gavagem por oito dias. Os animais foram depois sacrificados e os pulmões e VD foram coletados para análise do balanço redox (diferenças foram consideradas significativas quando p<0,05). Resultados Nossos resultados mostram que o IAM desencadeia a interrupção redox no VD e nos pulmões, o que pode contribuir para danos induzido pelo IAM nesses órgãos. Consistentemente, o PS mitigou o estresse oxidativo e restaurou as defesas antioxidantes (Glutationa - GSH nos pulmões: SHAM = 0,79 ± 0,07; IAM = 0,67 ± 0,05; IAM + PS = 0,86 ± 0,14; p<0,05), indicando seu papel protetor neste cenário. Conclusão Nosso trabalho evidencia o potencial do uso de PS como abordagem terapêutica adjuvante após IAM para proteção dos tecidos pulmonares e cardíacos direitos.


Abstract Background Pterostilbene (PS), a natural and antioxidant polyphenolic compound emerges as a promising intervention in improving the myocardial infarction (MI) damages. Objetives This study aimed to evaluate PS actions in promoting redox homeostasis in lungs and right ventricle (RV) of infarcted animals. Methods Male Wistar rats (60 day-old) were randomized into three groups: SHAM, MI (infarcted), and MI+PS (MI+pterostilbene). Seven days after MI procedure, rats were treated with PS (100 mg/kg/day) via gavage for eight days. Animals were euthanized and the lungs and RV were harvested for analyses of redox balance (Differences were considered significant when p<0.05). Results Our results show that MI triggers a redox disruption scenario in RV and lungs, which can contribute to MI-induced damage on these organs. Consistently, PS mitigated oxidative stress and restored antioxidant defenses (GSH in lungs: SHAM= 0.79±0.07; MI=0.67±0.05; MI+PS=0.86±0.14; p<0.05), indicating its protective role in this scenario. Conclusions Our work evidences the PS potential use as an adjuvant therapeutic approach after MI focusing on protecting pulmonary and right-sided heart tissues.


Subject(s)
Animals , Male , Rats , Stilbenes/pharmacology , Oxidative Stress/drug effects , Heart Ventricles/drug effects , Lung/drug effects , Myocardial Infarction/complications , Myocardial Infarction/drug therapy , Rats, Wistar
3.
Rev. Méd. Clín. Condes ; 31(5/6): 487-490, sept.-dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1224145

ABSTRACT

OBJETIVO Informar Sobre Un Caso De Infarto Simultáneo Cardio-Cerebral Y Sus Características, Comparado Con Lo Descrito En La Actualidad. CASO CLÍNICO Paciente Femenina De 64 Años, Con Infarto Simultáneo Cardio-Cerebral (Isquemia En Territorio De Arteria Cerebral Media Derecha Y Elevación Del Segmento St En Cara Antero Inferior), Tratada Con Fibrinólisis. RESULTADOS Evoluciona Con Sensorio Fluctuante, Requiriendo Intubación Orotraqueal Y Manejo En Unidad De Terapia Intensiva Por Sangrado Cerebral CONCLUSIONES El infarto simultáneo cardio-cerebral es infrecuente y representa un desafío para el equipo de salud a fin de evitar que el manejo temprano de una condición retrase la otra


OBJETIVE To Report On A Case Of Simultaneous Cardio-Cerebral Infarction And Its Characteristics, Compared With What Is Currently Described. CLINICAL CASE A 64-year-old female patient with simultaneous cardio-cerebral infarction (ischemia in the territory of the right middle cerebral artery and elevation of the st segment in the lower anterior aspect), treated with fibrinolysis. RESULTS It evolves with fluctuating sensory, requiring orotracheal intubation and management in intensive therapy unit due to cerebral bleeding. CONCLUSIONS The Simultaneous Cardio-Cerebral Infarction Is Infrequent And Represents A Challenge For The Health Team In Order To Avoid That The Early Management Of One Condition Delays The Other


Subject(s)
Humans , Female , Middle Aged , Stroke/complications , Myocardial Infarction/complications , Stroke/diagnosis , Stroke/therapy , Electrocardiography , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy
4.
Geriatr., Gerontol. Aging (Impr.) ; 14(2): 108-113, 30/06/2020.
Article in English | LILACS | ID: biblio-1103695

ABSTRACT

OBJECTIVES: To assess clinical and coronary angiographic characteristics, previous medical history, and clinical course, by age group, in older adults after myocardial infarction who underwent primary percutaneous coronary intervention (pPCI). METHODS: Single-center, cohort study that enrolled all patients with ST-segment elevation myocardial infarction who underwent pPCI at a specialized cardiology reference center in the South of Brazil. Older adults were defined as age ≥60 years, as set out in Brazilian legislation. Patients in the following age groups were compared: 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, and ≥80 years. Patients' clinical course was assessed at initial hospital admissions and after 2 years of clinical follow-up. Data were analyzed using SPSS 19, and significance was established at p <0.05. RESULTS: From December 2015 to December 2018, a total of 636 patients were enrolled consecutively. Angiographic success rates were around 90% in all age groups. There were no differences in medications used, except for glycoprotein IIb/IIIa inhibitors, which were more frequently used in patients of lower age groups. Older patients had more in-hospital acute renal failure and higher in-hospital mortality. Predictors of mortality were age over 75, chronic renal failure, need for ventilatory support, severe arrhythmia, and sepsis. CONCLUSIONS: pPCI in older adult patients is a safe procedure with a high success rate.


OBJETIVOS: Avaliar características clínicas e angiográficas, história clínica pregressa e evolução clínica, por faixa etária, em idosos submetidos a intervenção coronária percutânea primária (ICPp) após infarto do miocárdio. METODOLOGIA: Estudo de coorte, de centro único, que incluiu todos os pacientes com infarto do miocárdio com supradesnivelamento do segmento ST submetidos ICPp em um centro de referência especializado em cardiologia no sul do Brasil. Os idosos foram definidos como aqueles com idade ≥60 anos, conforme estabelecido na legislação brasileira. Os pacientes nas seguintes faixas etárias foram comparados: 60 a 64 anos, 65 a 69 anos, 70 a 74 anos, 75 a 79 anos e ≥80 anos. O curso clínico dos pacientes foi avaliado nas admissões hospitalares iniciais e após 2 anos de acompanhamento clínico. Os dados foram analisados usando o SPSS 19, e p <0,05 foi considerado significativo. RESULTADOS: De dezembro de 2015 a dezembro de 2018, 636 pacientes foram incluídos consecutivamente. As taxas de sucesso angiográfico foram de cerca de 90% em todas as faixas etárias. Não houve diferenças nos medicamentos utilizados, com exceção dos inibidores da glicoproteína IIb/IIIa, que foram mais frequentemente utilizados em pacientes em faixas etárias mais baixas. Pacientes mais velhos apresentaram mais insuficiência renal aguda intra-hospitalar e maior mortalidade hospitalar. Os preditores de mortalidade foram: idade superior a 75 anos, insuficiência renal crônica, necessidade de suporte ventilatório, arritmia grave e sepse. CONCLUSÕES: O ICPp em pacientes idosos é um procedimento seguro e com alta taxa de sucesso.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Angioplasty , Myocardial Infarction/complications , Myocardial Infarction/therapy , Brazil , Health Services for the Aged
5.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 37(3): 45-51, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1100152

ABSTRACT

Introducción: las lesiones cardiacas son entidades desafiantes en la ci-rugía de emergencia, su alta mortalidad obliga a tomar decisiones rápidas y precisas. Metodología: serie de casos que analizó las historias clínicas de pacien-tes con trauma cardiaco atendidos en el Centro de Trauma y Emergencia del Hospital Vicente Corral Moscoso (HVCM) durante el período noviembre del 2015 ­ abril 2017. Objetivos: presentar el manejo de esta patología, así como su mortalidad en nuestro medio Resultados: durante el período analizado se atendieron 18 pacientes con trauma cardiaco, 12 por lesión penetrante, 2 iatrogénicas y 4 contusos. El sexo masculino fue el más expuesto a estas lesiones. Dentro de las lesiones por violencia la más frecuente fue: lesión por arma blanca 8 casos y fuego 4. La incisión más utilizada para la reparación cardiaca fue la toracotomía lateral izquierda. El ventrículo izquierdo fue el más afectado en 6 pacientes y el derecho en 5. La mortalidad en este grupo de pacientes fue del 17%. Conclusión: la mortalidad en esta serie de casos fue del 17%, el aborda-je quirúrgico fue preferentemente por toracotomía lateral izquierda en un 67%.(AU).


Introduction: cardiac injuries are challenging entities in emergency surgery, their high mortality forces to make prompt and precise decisions.Methodology: there was a series of cases that analyzed the medical records of patients with cardiac trauma treated at the Trauma and Emergency Center of the Vicente Corral Moscoso Hospital (HVCM) during the period November 2015 - April 2017.Objectives: to expose the management of this pathology, as well as its mortality in our environment Results: a total of 18 patients with cardiac trauma, 12 due to penetrating injury, 2 iatrogenic and 4 contusions were treated during the analyzed period. The male sex was the most exposed to these injuries. Among the violence injuries, the most frequent was: 8 white weapon injuries and 4 gunshot. The incision most used for cardiac repair was the left lateral thoracotomy. The left ventricle was the most affected in 6 patients and the right ventricle in 5 patients. The mortality in this group of patients was 17%.Conclusion: the mortality in these cases was 17%, the surgical approach was preferably by left lateral thoracotomy in 67%.(AU)


Subject(s)
Humans , Chest Pain/diagnosis , Myocardial Infarction/complications
6.
Rev. bras. cir. cardiovasc ; 34(5): 550-559, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1042035

ABSTRACT

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brain Ischemia/etiology , Brain Ischemia/epidemiology , Carotid Stenosis/etiology , Carotid Stenosis/epidemiology , Stroke/epidemiology , Cardiac Surgical Procedures/adverse effects , Reference Values , Brazil/epidemiology , Incidence , Prevalence , Retrospective Studies , Risk Factors , Age Distribution , Risk Assessment , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/epidemiology , Diabetes Complications/epidemiology , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/epidemiology , Myocardial Infarction/complications , Myocardial Infarction/epidemiology
7.
Rev. cuba. med ; 58(2): e1089, abr.-jun. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139012

ABSTRACT

Introducción: La hemoglobina glucosilada pudiera convertirse en una herramienta en la estratificación inicial de pacientes infartados según el balance metabólico previo. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada para muerte y complicaciones cardíacas mayores en el período intrahospitalario en pacientes con diagnóstico de infarto agudo del miocardio con elevación del segmento ST. Métodos: Se realizó un estudio observacional analítico de cohorte prospectivo en pacientes atendidos en la Unidad de Cuidados Coronarios del Hospital Universitario Arnaldo Milián Castro entre noviembre de 2018 y marzo de 2019 por presentar diagnóstico de infarto del miocardio agudo con elevación del segmento ST (N=73), de los cuales se seleccionó una muestra de 62 pacientes. Se realizó un análisis de conglomerados de K-medias y se valoró el área bajo la curva ROC de la hemoglobina glucosilada para predecir mortalidad y complicaciones mayores. Resultados: Existieron diferencias estadísticamente significativas entre los diferentes cluster en las variables estado al egreso (p=0,001; V=0,489) y ocurrencia de complicaciones cardíacas mayores (p=0,050; V=0,307). El análisis del estadístico C de la hemoglobina glucosilada demostró su capacidad predictiva para mortalidad tanto en diabéticos (C=0,810; p=0,014) como en no diabéticos (C=0,817; p=0,006), así como para complicaciones cardíacas mayores en diabéticos (C=0,799; p=0,015) y no diabéticos (C=0,683; p=0,052). Se estableció el punto de corte en 7,8 por ciento, por encima del cual la hemoglobina glucosilada constituyó un factor pronóstico de mortalidad y complicaciones cardíacas mayores. Conclusiones: Se determinó que la hemoglobina glucosilada posee capacidad para predecir mortalidad y complicaciones cardíacas mayores en el período intrahospitalario. Su valor por encima del punto de corte constituyó un predictor independiente(AU)


Introduction: Glycated hemoglobin could become a tool in the initial stratification of infarcted patients according to the previous metabolic balance. Objective: To determine the prognostic value of death glycated hemoglobin and major cardiac complications in the in-hospital period in patients diagnosed with acute myocardial infarction with ST-segment elevation. Methods: A prospective cohort analytical observational study was conducted in patients treated in the Coronary Care Unit at Arnaldo Milián Castro University Hospital from November 2018 to March 2019. They presented diagnosis of acute myocardial infarction with ST segment elevation ( N = 73); a sample of 62 patients was selected. Cluster analysis of K-means was performed and the area under ROC curve of glycated hemoglobin was assessed to predict mortality and major complications. Results: There were statistically significant differences between the clusters in the variables such as state at discharge (p = 0.001; V = 0.489) and occurrence of major cardiac complications (p = 0.050; V = 0.307). The analysis of C statistic of glycated hemoglobin established the predictive capacity for mortality in both diabetics (C = 0.810; p = 0.014) and non-diabetics (C = 0.817; p = 0.006), as well as for major cardiac complications in diabetics ( C = 0.799; p = 0.015) and non-diabetics (C = 0.683; p = 0.052). The cut-off point was established at 7.8 percent, above which glycated hemoglobin was a prognostic factor for mortality and major c. Conclusions: Glycosylated hemoglobin was stablished to have the ability to predict mortality and major cardiac complications in the in-hospital period. Its value above the cut-off point was an independent predictor(AU)


Subject(s)
Humans , Male , Female , Glycated Hemoglobin A/therapeutic use , Myocardial Infarction/complications , Prognosis
8.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 217-226, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1002227

ABSTRACT

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce. Objective: To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon. Methods: Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014. Results: A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 - 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 - 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 - 39.54, p = 0.001) were predictors of mortality after CABG. Conclusion: A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications , Brazil/epidemiology , Hospitals, Public , Myocardial Revascularization/mortality , Comorbidity , Sex Factors , Statistical Analysis , Risk Factors , Age Factors , Treatment Outcome , Acute Coronary Syndrome/complications , Observational Study , Infections/complications , Angina, Unstable/complications , Myocardial Infarction , Myocardial Infarction/complications
9.
Rev. medica electron ; 41(2): 357-367, mar.-abr. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1004273

ABSTRACT

RESUMEN Introducción: el infarto agudo de miocardio es una de las formas más graves de cardiopatía isquémica. Representa un problema de salud de relevancia mundial. Se realizó un estudio descriptivo con el objetivo de determinar el comportamiento de pacientes portadores de infarto agudo del miocardio tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey, en el período comprendido desde 2013 a 2015. Objetivo: determinar el comportamiento de pacientes portadores de infarto agudo de miocardio, tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey. Materiales y métodos: la muestra la conformó los 146 pacientes que ingresaron, en el período antes mencionado, en el Servicio de Gariatría, Hospital Provincial Docente "Amalia Simoni". Se emplearon métodos de estadística descriptiva y se determinó la frecuencia y el porcentaje. Resultados: reveló un predominio de hombres entre 60 y 79 años, con antecedentes de hipertensión arterial y en un elevado porcentaje de fumadores, clasificados en Killip Kimball I y II, con excelentes resultados los tratados antes de las 3 h, y con complicaciones inmediatas sobre el músculo cardiaco. Conclusiones: el tratamiento trombólitico es muy efectivo en las 3 h primeras del comienzo de los síntomas.


ABSTRACT Introduction: the myocardial acute infarct is one of the forms of the ischemic heart disease, being a health problem around the world. The authors carried out a descriptive study with the objective of determining the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey, in the period from 2013 to 2015. Objective: to determine the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey. Material and methods: the simple was formed by all the 146 patients who entered the Teaching Provincial Hospital "Amalia Simoni" in the before-mentioned period with a diagnosis of myocardial acute infarct. Descriptive statistic methods were used and frequency and percentage were determined. Results: the study showed the predominance of men aged 60-79 years, with antecedents of arterial hypertension and a high number of cigarette smokers, classified in Killip&Kimball I and II. The patients treated before 3 hours passed showed excellent results, and with immediate complications on the heath muscle. Conclusions: thrombolytic treatment is very effective in the first 3 hours after the symptoms beginning.


Subject(s)
Humans , Streptokinase/therapeutic use , Thrombolytic Therapy/mortality , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Epidemiology, Descriptive , Observational Study
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(2): 163-176, mar.-abr. 2019. tab, graf
Article in English | LILACS | ID: biblio-988222

ABSTRACT

Acute myocardial infarction (AMI) is less frequent in young individuals (≤ 45 years) than in older ones (> 45 years). Young AMI patients differ from older AMI patients in different ways. This article aims to assess the differences between young and older AMI patients. A search was made in the database of Cochrane Library, PubMed, BioMed Central and Embase, sence their establishment to December 2016, using the key words: risk factors, clinical characteristics, acute myocardial infarction and young. Meta-analysis was performed by using the Review Manager 5.3 software, pooled odds ratios and 95% confidence intervals were used to assess the strength of differences. Eight studies with fairly quality, enrolling 13,358 patients in the analysis. Compared with older AMI patients, young AMI patients had a higher rate of smoking and obesity (OR = 2.71,95%CI:1.87 to 3.92; OR = 1.76,95%CI:1.13 to 2.74), higher rate of family history of coronary artery disease and alcohol consumption (OR = 2.36,95%CI:1.22 to 4.59; OR = 1.76,95%CI:1.04 to 2.97). Moreover, Young AMI patients had a lower rate of hypertension and diabetes mellitus (OR = 0.52,95%CI:0.37 to 0.73; OR = 0.58,95%CI:0.50 to 0.67). No significant differences were observed in hyperlipidemia, a subgroup data-analysis showed a higher total cholesterol, triglyceride lipase, and low-density lipoprotein levels (p < 0.05), and lower levels of high-density lipoprotein (p < 0.01) in young AMI patients. Smoking, family history of coronary artery disease, obesity and alcohol consumption are the most main risk factors of AMI among young individuals, and young AMI patients have better prognosis than older ones


Subject(s)
Humans , Male , Female , Risk Factors , Myocardial Infarction/complications , Myocardial Infarction/mortality , Aged , Alcohol Drinking , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Smoking , Statistical Analysis , Age Factors , Coronary Angiography/methods , Meta-Analysis , Diabetes Mellitus , Young Adult , Hypertension , Obesity
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(1 (Supl)): 97-99, jan.-mar. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1015196

ABSTRACT

A dissecção aguda da aorta (DAA) é uma emergência cardiovascular que acarreta mortalidade alta, 50% a 68% em 48 horas e até 85% em um mês. Este caso refere-se a um homem com 65 anos, ex-tabagista, que teve precordialgia com queimação irradiada para membros superiores, associada a náuseas. O eletrocardiograma mostrou upradesnivelamento ST em parede inferolateral. Recebeu tratamento para infarto agudo do miocárdio com AAS, clopidogrel, enoxaparina e tenecteplase. O cateterismo cardíaco evidenciou DAA tipo A de Stanford e coronárias sem obstruções. O ecocardiograma transtorácico mostrou insuficiência aórtica moderada e dissecção estendendo-se da raiz da aorta até a porção descendente proximal. O paciente foi submetido à cirurgia de Bentall de Bono e enxerto safeno-coronário direito devido à obstrução durante a cirurgia, com boa evolução pós-operatória. A DAA continua a ser um desafio diagnóstico na sala de emergência. De acordo com International Registry of Acute Aortic Dissection, os achados clínicos nas dissecções tipo A incluem dor torácica súbita e intensa (86%), irradiação dorsal (47%), sopro de insuficiência aórtica (44%), assimetria de pressão arterial (50%) e pulsos (30%), alargamento de mediastino à radiografia de tórax (63%) e supradesnivelamento de ST (4%), majoritariamente por oclusão de óstio da coronária direita. O caso destaca-se pela evolução favorável a despeito do tratamento com potencial catastrófico inicialmente direcionado para doença coronariana aguda aterotrombótica


Acute Aortic Dissection (AAD) is a cardiovascular emergency that entails high mortality - 50-68% in 48 hours and up to 85% in one month. This case involves a 65-year-old male ex-smoker who had onset of precordial pain with a burning sensation, radiating into the upper limbs, in combination with nausea. Electrocardiogram showed inferolateral wall ST elevation. He received treatment for acute myocardial infarction with acetylsalicylic acid, clopidogrel, enoxaparin and tenecteplase. Cardiac catheterization revealed Stanford type A AAD and unobstructed coronary arteries. Transthoracic echocardiogram showed moderate aortic regurgitation and aortic dissection extending from the aortic root to its proximal descending portion. The patient underwent a Bentall-De Bono procedure and right coronary artery bypass grafting using the saphenous vein due to obstruction during surgery, with good postoperative progress. AAD remains a diagnostic challenge in the emergency room. According to the International Registry of Acute Aortic Dissection, clinical findings in type A dissections include: sudden severe chest pain (86%), dorsal irradiation (47%), aortic regurgitation murmur (44%), asymmetric blood pressure (50%) or pulse (30%), mediastinal widening on chest radiograph (63%) and ST-segment elevation (4%), mainly due to right coronary ostium occlusion. The case is distinctive because of favorable progress in spite of the potentially catastrophic treatment initially targeting acute coronary atherothrombotic disease


Subject(s)
Humans , Male , Aged , Aorta , Dissection , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Aortic Valve Insufficiency/complications , Aortography/methods , Echocardiography/methods , Cardiac Catheterization/methods , Cardiovascular Diseases/diagnosis , Risk Factors , Electrocardiography/methods
12.
The Egyptian Journal of Hospital Medicine ; 77(3): 5167-5172, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1272794

ABSTRACT

Background: Speckle-tracking echocardiography has emerged as a unique technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking measured under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability. Objective: The aim of the current study was to evaluate stress speckle tracking to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients. Patients and methods: 74 patients were prospectively enrolled in 18-month's study. Dobutamine stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 3 months with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 3 months. Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. Meanwhile it provided 81.82% sensitivity and 82.6% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI. Moreover, it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission


Subject(s)
Echocardiography, Stress , Egypt , Magnetic Resonance Imaging , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imaging
13.
Rev. bras. enferm ; 71(6): 2998-3005, Nov.-Dec. 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-977616

ABSTRACT

ABSTRACT Objective: Describe the first stages of the cross-cultural adaptation process of the General Comfort Questionnaire for myocardial infarction patients in intensive care units. Method: This is a study of qualitative and quantitative research and analysis techniques. Conceptual, item, semantic and operational equivalence was performed. Fifteen items were added to the original instrument to better represent the comfort experienced by myocardial infarction patients in intensive care units. The content validity index was applied to analyze the answers of the experts; it was considered adequate above 0.78. Results: Some changes suggested by the experts for better understanding were adopted. All items were kept, obtaining a scale of sixty-three items. In the pre-test conducted with 30 subjects, the instrument was considered adequate to the target audience. Conclusion: The adapted version of the General Comfort Questionnaire for people with myocardial infarction is adequate to the target audience.


RESUMEN Objetivo: Describir las etapas iniciales del proceso de adaptación transcultural del General Comfort Questionnaire para personas con infarto de miocardio internadas en terapia intensiva. Método: Estudio cuyas técnicas de investigación y análisis fueron de naturaleza cualitativa y cuantitativa. Se realizó la equivalencia conceptual, de ítems, semántica y operacional. Quince elementos fueron añadidos al instrumento original para retratar mejor el confort experimentado por personas con infarto en terapia intensiva. Se aplicó el índice de validez de contenido para análisis de las respuestas de los especialistas y fue considerado adecuado por encima de 0,78. Resultados: Algunas alteraciones fueron sugeridas por los expertos para una mejor comprensión, las cuales fueron adoptadas. Todos los ítems fueron mantenidos, obteniéndose una escala con sesenta y tres ítems. En el pre-test, realizado con 30 sujetos, se constató la adecuación del instrumento al público objetivo. Conclusión: El General Comfort Questionnaire para personas con infarto de miocardio es una versión propicia para la aplicación al público objetivo.


RESUMO Objetivo: Descrever as etapas iniciais do processo de adaptação transcultural do General Comfort Questionnaire para pessoas com infarto do miocárdio internadas em terapia intensiva. Método: Estudo cujas técnicas de investigação e análise foram de natureza qualitativa e quantitativa. Realizou-se a equivalência conceitual, de itens, semântica e operacional. Quinze itens foram acrescentados ao instrumento original para retratar melhor o conforto experienciado por pessoas com infarto em terapia intensiva. Aplicou-se o índice de validade de conteúdo para análise das respostas dos especialistas, sendo considerado adequado acima de 0,78. Resultados: Algumas alterações foram sugeridas pelos especialistas para melhor compreensão, as quais foram adotadas. Todos os itens foram mantidos, obtendo-se uma escala com 63 itens. No pré-teste, realizado com 30 sujeitos, constatou-se a adequação do instrumento ao público - alvo. Conclusão: O General Comfort Questionnaire para pessoas com infarto do miocárdio configura-se como uma versão propícia a aplicação ao público alvo.


Subject(s)
Humans , Male , Female , Adult , Psychometrics/standards , Quality of Health Care/standards , Patient Comfort/standards , Myocardial Infarction/complications , Psychometrics/instrumentation , Psychometrics/methods , Translating , Brazil , Cross-Cultural Comparison , Cross-Sectional Studies , Surveys and Questionnaires , Reproducibility of Results , Myocardial Infarction/psychology
14.
Arq. bras. cardiol ; 111(6): 796-807, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-973812

ABSTRACT

Abstract Background: Cystatin C seems promising for evaluating the risk of cardiovascular events and mortality. Objective: To evaluate the association between high levels of cystatin C and the development of cardiovascular events or mortality. Methods: The articles were selected in the Medline/PubMed, Web of Science, and Scielo databases. The eligibility criteria were prospective cohort observational trials that assessed the association of high serum levels of cystatin C with the development of cardiovascular events or mortality in individuals with normal renal function. Only studies that evaluated the mortality outcome compared the fourth with the first quartile of cystatin C and performed multivariate Cox's proportional hazard regression analysis were included in the meta-analysis. A p value < 0,05 was considered significant. Results: Among the 647 articles found, 12 were included in the systematic review and two in the meta-analysis. The risk of development of adverse outcomes was assessed by eight studies using the hazard ratio. Among them, six studies found an increased risk of cardiovascular events or mortality. The multivariate regression analysis was performed by six studies, and the risk of developing adverse outcomes remained significant after the analysis in four of these studies. The result of the meta-analysis [HR = 2.28 (1.70-3.05), p < 0.001] indicated that there is a significant association between high levels of cystatin C and the risk of mortality in individuals with normal renal function. Conclusion: There is a significant association between high levels of cystatin C and the development of cardiovascular events or mortality in individuals with normal renal function.


Resumo Fundamento: A cistatina C tem-se mostrado promissora para avaliação do risco de eventos cardiovasculares e mortalidade. Objetivo: Avaliar a associação entre níveis elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade. Métodos: A seleção dos artigos foi realizada por meio das bases de dados Medline/PubMed, Web of Science e Scielo. Os critérios de elegibilidade foram estudos observacionais de coorte prospectivos que avaliaram a associação entre níveis séricos elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade em indivíduos com função renal normal. Apenas os estudos que avaliaram o desfecho mortalidade, que compararam o quarto com o primeiro quartil de cistatina C e que realizaram análise de regressão multivariada de riscos proporcionais de Cox foram incluídos na meta-análise. Foi considerado significativo o valor p < 0,05. Resultados: Dentre os 647 artigos encontrados, 12 foram incluídos na revisão sistemática e dois na meta-análise. O risco de desenvolvimento dos desfechos adversos foi avaliado por oito estudos por meio do cálculo do hazard ratio. Dentre estes, seis estudos encontraram um maior risco de eventos cardiovasculares ou mortalidade. A análise de regressão multivariada foi realizada por seis destes estudos, e o risco de desenvolvimento dos desfechos adversos permaneceu significativo após realização desta análise em quatro destes estudos. O resultado da meta-análise [HR = 2,28 (1,70-3,05), p < 0,001] indicou que há uma associação significativa entre níveis elevados de cistatina C e o risco de mortalidade nos indivíduos com função renal normal. Conclusão: Há uma associação significativa entre níveis elevados de cistatina C e o desenvolvimento de eventos cardiovasculares ou mortalidade em indivíduos com função renal normal.


Subject(s)
Humans , Cardiovascular Diseases/blood , Cystatin C/blood , Biomarkers/blood , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Multivariate Analysis , Risk Assessment , Observational Studies as Topic , Cystatin C/standards , Immunoturbidimetry/methods , Glomerular Filtration Rate , Heart Failure/complications , Heart Failure/blood , Kidney/physiology , Myocardial Infarction/complications , Myocardial Infarction/blood
15.
Arq. bras. cardiol ; 111(6): 784-793, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-973807

ABSTRACT

Abstract Background: The role of myocardial perfusion scintigraphy (MPS) in the follow-up of asymptomatic patients after percutaneous coronary intervention (PCI) is not established. Objectives: To evaluate the prognostic value and clinical use of MPS in asymptomatic patients after PCI. Methods: Patients who underwent MPS consecutively between 2008 and 2012 after PCI were selected. The MPS were classified as normal and abnormal, the perfusion scores, summed stress score (SSS), and summed difference score (SDS) were calculated and converted into percentage of total perfusion defect and ischemic defect. The follow-up was undertaken through telephone interviews and consultation with the Mortality Information System. Primary endpoints were death, cardiovascular death, and nonfatal acute myocardial infarction (AMI), and secondary endpoint was revascularization. Logistic regression and COX method were used to identify the predictors of events, and the value of p < 0.05 was considered statistically significant. Results: A total of 647 patients were followed for 5.2 ± 1.6 years. 47% of MPS were normal, 30% were abnormal with ischemia, and 23% were abnormal without ischemia. There were 61 deaths, 27 being cardiovascular, 19 non-fatal AMI, and 139 revascularizations. The annual death rate was higher in those with abnormal perfusion without ischemia compared to the groups with ischemia and normal perfusion (3.3% × 2% × 1.2%, p = 0.021). The annual revascularization rate was 10.3% in the ischemia group, 3.7% in those with normal MPS, and 3% in those with abnormal MPS without ischemia. The independent predictors of mortality and revascularization were, respectively, total perfusion defect greater than 6%, and ischemic defect greater than 3%. Forty-two percent of the patients underwent MPS less than 2 years after PCI, and no significant differences were observed in relation to those who underwent it after that period. Conclusion: Although this information is not contemplated in guidelines, in this study MPS was able to predict events in asymptomatic after PCI patients, regardless of when they were performed.


Resumo Fundamentos: O papel da cintilografia de perfusão miocárdica (CPM) no seguimento de pacientes assintomáticos após intervenção coronariana percutânea (ICP) não está estabelecido. Objetivos. Avaliar o valor prognóstico e o uso clínico da CPM em pacientes assintomáticos após ICP. Métodos: Foram selecionados pacientes que realizaram CPM consecutivamente entre 2008 e 2012 após ICP. As CPM foram classificadas em normais e anormais, os escores de perfusão, escore somado do estresse (SSS) e escore somado da diferença (SDS) foram calculados e convertidos em porcentagem de defeito perfusional total e de defeito isquêmico. O seguimento foi por meio de entrevistas telefônicas e consulta ao Sistema de Informação de Mortalidade. Desfechos primários foram morte, morte cardiovascular e infarto agudo do miocárdio (IAM) não fatal e desfecho secundário foi revascularização. Regressão logística e método de COX foram utilizados para identificar os preditores de eventos e o valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: 647 pacientes foram acompanhados por 5,2 ± 1,6 anos. 47% das CPM foram normais, 30% anormais com isquemia e 23% anormais sem isquemia. Ocorreram 61 mortes, 27 cardiovasculares, 19 IAM não fatais e 139 revascularizações. A taxa anual de óbitos foi superior naqueles com perfusão anormal sem isquemia comparada aos grupos com isquemia e perfusão normal (3,3% × 2% × 1,2%, p = 0,021). A taxa anual de revascularização foi 10,3% no grupo com isquemia, 3,7% naqueles com CPM normal e 3% naqueles com CPM anormal sem isquemia. Foram preditores independentes de mortalidade e revascularização, respectivamente, defeito perfusional total maior que 6% e defeito isquêmico maior que 3%. Quarenta e dois por cento dos pacientes realizaram CPM menos de 2 anos após ICP e não foram observadas diferenças relevantes em relação aos que realizaram após esse período. Conclusão: Embora esta informação não esteja contemplada em diretrizes, neste estudo a CPM foi capaz de predizer eventos em pacientes assintomáticos após ICP, independente do momento de realização.


Subject(s)
Male , Female , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Myocardial Perfusion Imaging/methods , Percutaneous Coronary Intervention/methods , Myocardial Infarction/diagnostic imaging , Prognosis , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Survival Analysis , Predictive Value of Tests , Surveys and Questionnaires , Retrospective Studies , Risk Factors , Follow-Up Studies , Age Factors , Diabetes Complications/complications , Exercise Test/methods , Hypertension/complications , Myocardial Infarction/complications , Myocardial Infarction/mortality , Myocardial Revascularization/statistics & numerical data
16.
Notas enferm. (Córdoba) ; 18(32): 5-14, dic. 2018. ilus, tab
Article in Spanish | LILACS, BDENF, BINACIS, UNISALUD | ID: biblio-1005446

ABSTRACT

El infarto agudo de miocardio (IAM) representa la tercera causa de morbimortalidad en el país. Tener datos sobre la realidad de esta entidad en la institución es de suma importancia como punto de partida para el desarrollo de políticas de prevención, así también mejorar el tratamiento, cuidado y calidad de atención al paciente. OBJETIVO: Determinar el perfil epidemiológico de la población que se les indica tratamiento con Tirofiban durante infarto agudo de miocardio (IAM)...


Acutemyocardialinfarction (AMI) represents the third cause ofmorbidity and mortality in the country. Having information about the reality of this entity in the institution is of the utmost importance as a starting point for the development of prevention policies, as well as improving the treatment, care and quality of patientcare. OBJECTIVE: To determine the epidemiological profile of the population that is being treated with Tirofiban during acute myocardialinfarction (AMI)...


Subject(s)
Humans , Male , Adult , Angioplasty , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Myocardial Infarction , Myocardial Infarction/complications , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Nursing Care
17.
Arq. bras. cardiol ; 111(5): 676-683, Nov. 2018. tab
Article in English | LILACS | ID: biblio-973788

ABSTRACT

Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.


Resumo Fundamento: Os pacientes com doença cardíaca, depressão e transtornos de ansiedade são altamente prevalentes e persistentes. A depressão e a ansiedade desempenham um papel significativo na progressão da doença cardiovascular e são reconhecidas como fatores de risco independentes. No entanto, há muito pouca análise relacionada ao gênero em relação às doenças cardiovasculares e transtornos emocionais. Objetivo: Avaliar os níveis de depressão e ansiedade em pacientes com infarto do miocárdio (IM) no primeiro mês após o IM e avaliar a relação entre os fatores de risco para doença cardiovascular, indicadores demográficos e distúrbios emocionais, bem como determinar se existem diferenças ou semelhanças baseadas no sexo do paciente. Métodos: Esta pesquisa incluiu questões demográficas, características clínicas, questões sobre fatores de risco de doença cardiovascular e a Escala Hospitalar de Ansiedade e Depressão [HADS]. Todos os testes estatísticos foram bilaterais, e valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Determinou-se que 71,4% dos pacientes do sexo feminino e 60,4% dos pacientes do sexo masculino apresentavam sintomatologia concomitante de ansiedade e/ou depressão (p = 0,006). Utilizando os homens como o ponto de referência, as mulheres mostraram um risco elevado de apresentar qualquer distúrbio psiquiátrico (odds ratio, 2,86, p = 0,007). O escore da HADS-D foi notavelmente maior nas mulheres (8,66 ± 3,717) do que nos homens (6,87 ± 4,531, p = 0,004). Foi determinado que os pacientes do sexo masculino que desenvolveram depressão eram em média mais jovens do que aqueles sem depressão (p = 0,005). Conclusões: As mulheres demonstraram risco mais elevado de apresentar distúrbio de ansiedade e/ou depressão em comparação aos homens. Além disso, a gravidade da depressão aumentou com a idade entre os homens, enquanto o gravidade da ansiedade diminuiu. Em contraste, a gravidade da depressão e ansiedade foram semelhantes para mulheres de todas as idades após o IM. Um maior escore de depressão foi associado com diabetes e inatividade física, e o maior escore de ansiedade foi associado ao tabagismo nos homens. A hipercolesterolemia foi associada tanto aos maiores escores de ansiedade e depressão, enquanto um maior escore de depressão foi associado à inatividade física entre mulheres.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anxiety/etiology , Depression/etiology , Myocardial Infarction/complications , Anxiety/diagnosis , Anxiety Disorders/diagnosis , Anxiety Disorders/etiology , Psychiatric Status Rating Scales , Severity of Illness Index , Smoking , Sex Factors , Risk Factors , Age Factors , Diabetes Complications/complications , Depression/diagnosis , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Diabetes Mellitus , Sedentary Behavior , Hypercholesterolemia/complications
19.
Autops. Case Rep ; 8(3): e2018032, July-Sept. 2018. ilus
Article in English | LILACS | ID: biblio-911898

ABSTRACT

The diagnosis of perioperative myocardial infarction can be missed if the pain is masked by postoperative analgesia and the possibility is not considered. This report is the case of a patient with a missed diagnosis of perioperative myocardial infarction. Myocardial injury and infarction from noncardiac surgery is currently the subject of intense interest and research. This report illustrates the importance of the diagnosis and suggests clues that can be used to make the diagnosis.


Subject(s)
Humans , Male , Middle Aged , Diagnostic Errors/prevention & control , Myocardial Infarction/complications , Autopsy , Cognitive Dysfunction , Fatal Outcome , Myocardial Infarction/diagnosis , Myocardial Infarction/prevention & control , Perioperative Care
20.
Rev. Assoc. Med. Bras. (1992) ; 64(9): 853-860, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-976853

ABSTRACT

SUMMARY INTRODUCTION Heart failure due to an acute myocardial infarction is a very frequent event, with a tendency to increase according to improvements in the treatment of acute conditions which have led to larger numbers of infarction survivors. OBJECTIVE The aim of this study is to synthesize the evidence, through a systematic review, on efficacy and safety of the device in patients with this basic condition. METHODS Studies published between January 2002 and October 2016 were analysed, having as reference databases Embase, Medline, Cochrane Library, Lilacs, Web of Science and Scopus. The selection of studies, data extraction and methodological quality assessment of studies were examined by two independent reviewers, with disagreements resolved by consensus. RESULTS Only prospective studies without control group were identified. Six studies were included, with averages of 34 participants and follow-up of 13 months. Clinical, functional, hemodynamic and quality of life outcomes were evaluated. The highest mortality rate was 8.4% with 12-month follow-up for unspecified cardiovascular reasons, and heart failure rehospitalization was 29.4% with 36-month follow-up. Statistically significant improvements were found only in some of the studies which evaluating changes in left ventricular volume indices, the distance measured by the six-minute walk test, New York Heart Association functional classification, and quality of life, in pre and post-procedure analysis. CONCLUSIONS The present review indicates that no available quality evidence can assert efficacy and safety of PARACHUTE® in the treatment of heart failure after apical or anterior wall myocardial infarction.


RESUMO INTRODUÇÃO Insuficiência cardíaca após infarto agudo do miocárdio é um evento bastante frequente, que tende a aumentar conforme as melhorias que o tratamento dos quadros agudos têm acarretado a números maiores de sobreviventes de infarto. OBJETIVO A revisão sistemática sumarizou as evidências relativas à eficácia e segurança do dispositivo de partição ventricular (PARACHUTE®) em pacientes com IC pós-IAM apical ou de parede anterior. MÉTODOS Foram analisados estudos publicados entre janeiro de 2002 e outubro de 2016 nas bases Embase, Medline, Colaboração Cochrane, Lilacs, Web of Science e Scopus. A seleção dos estudos, a extração dos dados e a avaliação de qualidade metodológica foram realizadas por dois revisores independentes, com as discordâncias resolvidas por consenso. RESULTADOS Somente estudos prospectivos sem grupo controle foram identificados. Seis estudos foram incluídos, com média de 34 participantes e de follow-up de 13 meses. Foram avaliados desfechos clínicos, funcionais, hemodinâmicos e qualidade de vida. O maior percentual de re-hospitalização por IC foi de 29,4%, com 36 meses de seguimento, e de mortalidade foi de 8,4%, com 12 meses de seguimento, por motivos cardiovasculares não especificados. Melhorias estatisticamente significantes foram constatadas em alguns dos estudos que avaliaram mudanças nos índices de volume do ventrículo esquerdo, distância medida pelo teste de caminhada de 6 minutos, classificação funcional da New York Heart Association e qualidade de vida, em análises do tipo antes e depois do procedimento. CONCLUSÕES A presente revisão indica que não existem evidências de qualidade disponíveis que permitam afirmar a eficácia e segurança do PARACHUTE® no tratamento da condição de base.


Subject(s)
Humans , Prostheses and Implants/standards , Heart Failure/etiology , Heart Failure/therapy , Myocardial Infarction/complications , Quality of Life , Reproducibility of Results , Treatment Outcome , Ventricular Dysfunction, Left/therapy , Equipment Design
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