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1.
Arq. bras. cardiol ; 118(1): 24-32, jan. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360124

ABSTRACT

Resumo Fundamento O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. Objetivo Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). Métodos Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. Resultados Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (Grupo 2 vs. Grupo 1: RR: 1,141; IC95%: 0,599 a 2.171; Grupo 3 vs. Grupo 1: RR: 2,130; IC95%: 1,236 a 3,670; Grupo 4 vs. Grupo 1: RR: 2,602; IC95%: 1,461 a 4,634). Conclusão O hábito de fumar gradualmente aumenta o risco de mortalidade por todas as causas após STEMI.


Abstract Background The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released. Objective To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI). Methods This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: <20 package*years users, Group 3: 20-40 package*years users, Group 4: >40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant. Results There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634). Conclusion Smoking gradually increases the risk of all-cause mortality after STEMI.


Subject(s)
Humans , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Myocardial Infarction/diagnosis , Smoking/adverse effects , Proportional Hazards Models , Risk Factors , Treatment Outcome
2.
Acta Paul. Enferm. (Online) ; 34: eAPE00902, 2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1248522

ABSTRACT

Resumo Objetivo: Analisar as vivências masculinas de idosos em relação ao infarto agudo do miocárdio antes, durante e depois do diagnóstico clínico. Métodos: Trata-se de um estudo descritivo com abordagem qualitativa. A pesquisa foi realizada em dois hospitais localizados no município de Feira de Santana, Bahia, Brasil. Os participantes foram homens idosos com diagnóstico médico confirmado para infarto agudo do miocárdio. Os dados foram coletados utilizando-se a técnica da entrevista, guiada por um roteiro semiestruturado. Todas as falas foram gravadas mediante autorização, transcritas na íntegra e sistematizadas através do Discurso do Sujeito Coletivo. A interpretação dos dados respaldou-se na literatura científica acerca do infarto agudo do miocárdio e no referencial teórico de gênero, a partir da perspectiva da masculinidade hegemônica. Resultados: O Discurso do Sujeito Coletivo evidenciou que as vivências dos homens idosos em relação ao infarto agudo do miocárdio antes, durante e depois do diagnóstico estiveram impregnadas por marcadores da masculinidade hegemônica, os quais os impediram de reconhecer a gravidade dos sinais e sintomas e a necessidade de buscar pelo cuidado. As falas revelam que todo o processo de adoecimento e terapêutica pós-diagnóstico foi marcado por conflitos emocionais, visto que os idosos tiveram que adotar mudanças no estilo de vida e reconhecer a sua vulnerabilidade. Conclusão: Os achados despontam para a relevância dos profissionais de saúde compreenderem e considerarem os marcadores de gênero durante as ações de prevenção e tratamento das doenças cardiovasculares, tendo em vista que estes influenciam fortemente no cuidado à saúde dos homens idosos.


Resumen Objetivo: Analizar las vivencias masculinas de ancianos respecto al infarto agudo de miocardio antes, durante y después del diagnóstico clínico. Métodos: Se trata de un estudio descriptivo con enfoque cualitativo. La investigación fue realizada en dos hospitales ubicados en el municipio de Feira de Santana, estado de Bahia, Brasil. Los participantes fueron hombres ancianos con diagnóstico médico confirmado de infarto agudo de miocardio. Los datos fueron recopilados utilizando la técnica de entrevista, conducida con guion semiestructurado. Todas las conversaciones fueron grabadas con autorización, transcriptas totalmente y sistematizadas a través del Discurso del Sujeto Colectivo. La interpretación de los datos se respaldó en la literatura científica sobre infarto agudo de miocardio y en el marco referencial teórico de género, a partir de la perspectiva de masculinidad hegemónica. Resultados: El Discurso del Sujeto Colectivo reveló que las vivencias de los hombres ancianos respecto al infarto agudo de miocardio antes, durante y después del diagnóstico estuvieron impregnadas de marcadores de masculinidad hegemónica, los que impiden que puedan reconocer la gravedad de los signos y síntomas y la necesidad de buscar ayuda. Los relatos exponen que todo el proceso de enfermedad y terapia posdiagnóstico fue marcado por conflictos emocionales, dado que los ancianos tuvieron que adoptar cambios en su estilo de vida y reconocer su vulnerabilidad. Conclusión: Los descubrimientos recuerdan la importancia de que los profesionales de la salud comprendan y consideren los marcadores de género durante las acciones de prevención y tratamiento de enfermedades cardiovasculares, teniendo en cuenta que estos influyen fuertemente en el cuidado de la salud de los hombres ancianos.


Abstract Objective: To analyze the experiences of elderly men in relation to acute myocardial infarction before, during and after clinical diagnosis. Methods: This is a descriptive and qualitative study. The research was carried out in two hospitals located in the municipality of Feira de Santana, Bahia, Brazil. Elderly men with a confirmed medical diagnosis for acute myocardial infarction participated in the study. Data were collected using the interview technique, guided by a semi-structured script. All speeches were recorded with authorization, transcribed in full and systematized through the Discourse of the Collective Subject. The interpretation of the data was supported in the scientific literature about acute myocardial infarction and in the theoretical framework of gender from the perspective of hegemonic masculinity. Results: The Discourse of the Collective Subject showed that the experiences of elderly men in relation to acute myocardial infarction before, during and after diagnosis were impregnated with markers of hegemonic masculinity, which prevented them from recognizing the severity of signs and symptoms and the need to seek care. The statements reveal that the entire process of illness and post-diagnosis therapy was marked by emotional conflicts, since elderly men had to adopt lifestyle changes and recognize their vulnerability. Conclusion: The findings stand out for the relevance of health professionals to understand and consider gender markers during prevention and treatment of cardiovascular diseases, considering that they strongly influence the health care of elderly men.


Subject(s)
Humans , Male , Middle Aged , Aged , Men's Health , Gender Analysis in Health , Myocardial Infarction/diagnosis , Epidemiology, Descriptive , Interviews as Topic , Risk Factors , Evaluation Studies as Topic , Masculinity
4.
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
7.
Rev. inf. cient ; 99(3): 241-253, mayo.-jun. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126943

ABSTRACT

RESUMEN Introducción: En el Hospital General Docente "Octavio de la Concepción y la Pedraja" de Baracoa, provincia Guantánamo, Cuba, hasta la fecha no se ha caracterizado la prescripción de la trombolisis coronaria sistémica en el infarto agudo del miocardio. Objetivo: Caracterizar la prescripción de la trombolisis coronaria sistémica en el infarto agudo del miocardio en el citado hospital durante el trienio 2017-2019. Método: Se realizó un estudio descriptivo, retrospectivo, de corte transversal, del total de pacientes infartados en el periodo antes dicho (n=75). Se estudiaron las variables: edad, sexo, localización topográfica del infarto, tratamiento, evolución clínica, estado al egreso y causas de muerte. Resultados: El 72,0 % de los pacientes fueron hombres, el 37,3 % tenía 50 y 59 años de edad. La letalidad fue del 14,7 %. Fue más común el infarto anterior del ventrículo izquierdo (53,4 %). Se trombolizó el 28,0 %, pues en el 68,5 % la ventana isquémica fue superior a doce horas. La encefalopatía isquémica-hipóxica posparada cardiorrespiratoria secundaria a fibrilación ventricular (54,5 %) fue la causa directa de muerte más frecuente. Conclusiones: Fue insuficiente el porcentaje de pacientes tratados con trombolisis coronaria sistémica, sobre todo, por solicitar atención médica después de 12 horas del inicio de los síntomas.


ABSTRACT Introduction: In the General Teaching Hospital "Octavio de la Concepción y la Pedraja" of Baracoa, Guantánamo province, Cuba, the prescription of Thrombolysis in Myocardial Infarction (TIMI) has not been characterized so far. Objective: To charactirize the prescription of thrombolysis in myocardial infarction during the three-year period 2017-2019. Method: Of the total number of patients with heart attacks in the above-mentioned period (n=75) a descriptive, retrospective, cross-sectional study was carried out. Variables studied: age, sex, topographic location of the infarction, treatment, clinical evolution, state at discharge and causes of death. Results: 72.0 % of the patients were men, 37.3 % were 50 and 59 years old. The case fatality rate was 14.7%. Left ventricular infarction was the most common (53.4%) dysfunction. 28.0% of the patients received thrombolytic therapy, because in 68.5% of them, the ischemic was longer than twelve hours. Post-cardiorespiratory moderate ischemic-hypoxic encephalopathy with ventricular fibrillation (54.5%) was the most frequent direct cause of death. Conclusions: The patients´ rate treated with systemic coronary thrombolysis was insufficient, mainly due to the fact that they attend medical attention 12 hours after the onset of symptoms.


Subject(s)
Humans , Thrombolytic Therapy , Myocardial Infarction/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies
8.
Arq. bras. cardiol ; 112(6): 715-719, Jun. 2019. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1011222

ABSTRACT

Abstract Background: Platelets are important in the initiation of thrombosis, and their morphological and functional changes are closely related with the occurrence and development of coronary artery thrombosis. Platelet parameters might be valuable in distinguishing between acute myocardial infarction (AMI) and stable coronary artery disease (SCAD). Objective: This study was designed to detect and compare changes in platelet parameters, such as mean platelet volume (MPV) in patients with acute myocardial infarction (AMI) and stable coronary artery disease (SCAD) and to investigate their roles in these diseases. Methods: Specimen collection: Between January 2011 and December 2013, 2 mL of elbow vein blood was drawn from each of 31 patients primarily diagnosed with AMI, 34 SCAD patients and 50 healthy subjects; and placed in EDTA-K2 anticoagulant tubes. Platelet count (PLT), MPV, plateletcrit (PCT), platelet distribution width (PDW), white blood cell (WBC) and neutrophil (NEU) counts were determined using an STKS automated hematology analyzer (Beckman Courter). Results: Compared with the control group, MPV levels were significantly higher in the AMI and SCAD groups (p < 0.05), while PLT was significantly lower (p < 0.05). Conclusion: These results suggest that MPV and other related parameters have a certain value in the diagnosis of SCAD and AMI.


Resumo Fundamento: As plaquetas são importantes no início da trombose e suas alterações morfológicas e funcionais estão intimamente relacionadas com a ocorrência e o desenvolvimento de trombose da artéria coronária. Os parâmetros plaquetários podem ser valiosos na distinção entre infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE). Objetivo: O objetivo desse estudo foi detectar e comparar alterações nos parâmetros plaquetários, como o volume plaquetário médio (VPM) em pacientes com infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE) e investigar seu papel nessas doenças. Métodos: Coleta de amostras: Entre janeiro de 2011 e dezembro de 2013, foram retirados 2 mL de sangue da veia do antebraço de cada um dos 31 pacientes diagnosticados principalmente com IAM, 34 pacientes com DACE e 50 indivíduos saudáveis; e colocado em tubos com anticoagulante EDTA-K2. As contagens de plaquetas (PQT), VPM, massa total de plaquetas (MTP), Amplitude de Distribuição de Plaquetas (PDW, do inglês platelet distribution width), contagem de glóbulos brancos (WBC, do inglês white blood cells) e neutrófilos (NEU) foram determinadas utilizando-se um analisador de hematologia automatizado STKS (Beckman Courter). Resultados: Comparado com o grupo controle, os níveis de VPM foram significativamente maiores nos grupos IAM e DACE (p < 0,05), enquanto os níveis de PQT foram significativamente menores (p < 0,05). Conclusão: Esses resultados sugerem que o VPM e outros parâmetros associados têm um certo valor no diagnóstico de DACE e IAM.


Subject(s)
Humans , Male , Female , Aged , Platelet Count/methods , Coronary Artery Disease/blood , Mean Platelet Volume/methods , Myocardial Infarction/blood , Coronary Artery Disease/diagnosis , Biomarkers/blood , Case-Control Studies , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity , Middle Aged , Myocardial Infarction/diagnosis
11.
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
12.
Arch. cardiol. Méx ; 89(1): 5-11, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038470

ABSTRACT

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.


Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carotid Artery Diseases/complications , Coronary Angiography , Stroke/etiology , Plaque, Atherosclerotic/complications , Myocardial Infarction/etiology , Carotid Artery Diseases/diagnosis , Survival Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Disease Progression , Stroke/diagnosis , Stroke/mortality , Myocardial Infarction/diagnosis
14.
Rev. bras. ter. intensiva ; 31(1): 93-105, jan.-mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003622

ABSTRACT

RESUMO As troponinas cardíacas T e I são marcadores considerados altamente sensíveis e específicos para o diagnóstico de infarto agudo do miocárdio. Atualmente, com o advento dos ensaios ultrassensíveis, uma série de anormalidades não primariamente cardíacas pode se manifestar por meio da elevação destes ensaios. A redução de seu limiar de detecção promoveu maior precocidade no diagnóstico e na utilização de medidas terapêuticas baseadas em evidência, no entanto, esta característica aumentou o espectro de doenças cardíacas não coronarianas detectáveis, trazendo desafios para a caracterização das síndromes coronarianas agudas e um novo papel para estes testes nas desordens conhecidas no ambiente das unidades de tratamento intensivo, em especial na sepse. A abordagem de pacientes por meio de um maior entendimento do comportamento destes marcadores deve ser redimensionada para sua correta interpretação.


ABSTRACT Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.


Subject(s)
Humans , Troponin I/blood , Troponin T/blood , Heart Diseases/diagnosis , Biomarkers/blood , Sensitivity and Specificity , Early Diagnosis , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/blood , Heart Diseases/blood , Intensive Care Units , Myocardial Infarction/diagnosis , Myocardial Infarction/blood
15.
Arq. bras. cardiol ; 112(3): 230-237, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989327

ABSTRACT

Abstract Background: High-sensitivity cardiac troponin I (hs-cTnI) has played an important role in the risk stratification of patients during the in-hospital phase of acute coronary syndrome (ACS), but few studies have determined its role as a long-term prognostic marker in the outpatient setting. Objective: To investigate the association between levels of hs-cTnI measured in the subacute phase after an ACS event and long-term prognosis in a highly admixed population. Methods: We measured levels of hs-cTnI in 525 patients 25 to 90 days after admission for an ACS event; these patients were then divided into tertiles according to hs-cTnI levels and followed for up to 7 years. We compared all-cause and cardiovascular mortality using Cox proportional hazards models and adopting a significance level of 5%. Results: After a median follow-up of 51 months, patients in the highest tertile had a greater hazard ratio (HR) for all-cause mortality after adjustment for age, sex, known cardiovascular risk factors, medication use, and demographic factors (HR: 3.84, 95% CI: 1.92-8.12). These findings persisted after further adjustment for estimated glomerular filtration rate < 60 ml/min/1.73 m2 and left ventricular ejection fraction < 0.40 (HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly higher in the highest tertile after adjustment for age and sex (HR: 5.65, 95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27). Conclusions: Elevated hs-cTnI levels measured in the stabilized phase after an ACS event are independent predictors of all-cause and cardiovascular mortality in a highly admixed population.


Resumo Fundamento: A troponina cardíaca de alta sensibilidade I (TnI-as) tem desempenhado um papel importante na estratificação de risco dos pacientes durante a fase intra-hospitalar da síndrome coronariana aguda (SCA), mas poucos estudos determinaram seu papel como marcador prognóstico de longo prazo no ambiente ambulatorial. Objetivo: Investigar a associação entre os níveis de TnI-as medidos na fase subaguda após um evento de SCA e o prognóstico a longo prazo, em uma população altamente miscigenada. Métodos: Medimos os níveis de TnI-as em 525 pacientes em um período de 25 a 90 dias após a entrada em hospital por um evento de SCA; esses pacientes foram então divididos em tercis conforme os níveis de TnI-as, e acompanhados por até 7 anos. Comparamos as mortalidades por todas as causas e cardiovascular através de modelos de riscos proporcionais de Cox e adotando um nível de significância de 5%. Resultados: Após um acompanhamento médio de 51 meses, os pacientes no tercil mais alto apresentaram uma taxa de risco (HR) maior para mortalidade por todas as causas, após ajustes para idade, sexo, fatores de risco cardiovascular conhecidos, uso de medicação e fatores demográficos (HR: 3,84 IC 95%: 1,92-8,12). Esses achados persistiram após um ajuste adicional para uma taxa de filtração glomerular (TFG) estimada < 60 ml/min/1,73 m2 e uma fração de ejeção do ventrículo esquerdo < 0,40 (HR: 6,53; IC95%: 2,12-20,14). A mortalidade cardiovascular foi significativamente maior no tercil mais alto, após ajustes para idade e sexo (RR: 5,65; IC95%: 1,94-16,47) e tanto no primeiro modelo de ajuste multivariado (HR: 4,90; IC 95%: 1,35-17,82) quanto no segundo (HR: 5,89; IC95%: 1,08-32,27). Conclusões: Níveis elevados de TnI-as, medidos na fase estabilizada após um evento de SCA, são preditores independentes de mortalidade por todas as causas e de mortalidade cardiovascular em uma população altamente miscigenada.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Troponin I/blood , Acute Coronary Syndrome/mortality , Prognosis , Brazil/epidemiology , Biomarkers/blood , Proportional Hazards Models , Risk Factors , Follow-Up Studies , Cause of Death , Troponin T/blood , Myocardial Infarction/diagnosis
16.
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
17.
Rev. Esc. Enferm. USP ; 53: e03442, 2019. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-985075

ABSTRACT

ABSTRACT Objective: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP®) for patients with acute myocardial infarction using the Activities of Living Model. Method: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. Results: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. Conclusion: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment.


RESUMEN Objetivo: Elaborar el subconjunto terminológico de la Clasificación Internacional para la Práctica de Enfermería (CIPE®) para la persona con infarto agudo del miocardio, utilizando el Modelo de Actividades de Vida. Método: Estudio metodológico, que siguió las orientaciones del Consejo Internacional de Enfermeros y tuvo como base teórica el Modelo de Actividades de Vida para su elaboración. La validación de contenido fue realizada por 22 enfermeros expertos. Resultados: Fueron elaborados 22 diagnósticos y 22 resultados de enfermería. De esos, 17 enunciados de diagnósticos y 17 resultados de enfermería presentaron Índice de Validez de Contenido (IVC) ≥ 0,80. De las 113 intervenciones enfermeras diseñadas, 42 alcanzaron IVC ≥ 0,80 y, después de sugerencias de los expertos, 51 intervenciones compusieron el subconjunto terminológico. Conclusión: La CIPE® se mostró adecuada para empleo con el Modelo de Actividades de Vida, contando con términos compatibles con los utilizados en la práctica clínica enfermera, siendo válido para la construcción del subconjunto terminológico para la persona con infarto agudo del miocardio y probablemente para la facilitación del juicio clínico enfermero.


RESUMO Objetivo: Elaborar o subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem (CIPE®) para a pessoa com infarto agudo do miocárdio, utilizando o Modelo de Atividades de Vida. Método: Estudo metodológico, que seguiu as orientações do Conselho Internacional de Enfermeiros e teve como base teórica o Modelo de Atividades de Vida para a sua elaboração. A validação de conteúdo foi realizada por 22 enfermeiros especialistas. Resultados: Foram elaborados 22 diagnósticos e 22 resultados de enfermagem. Destes, apresentaram Índice de Validade de Conteúdo (IVC) ≥ 0,80 17 enunciados de diagnósticos e 17 resultados de enfermagem. Das 113 intervenções de enfermagem elaboradas, 42 alcançaram IVC ≥ 0,80, e, após sugestões dos especialistas, 51 intervenções compuseram o subconjunto terminológico. Conclusão: A CIPE® mostrou-se adequada para uso com o Modelo de Atividades de Vida possuindo termos compatíveis com os utilizados na prática clínica do enfermeiro, sendo válida para a construção do subconjunto terminológico para a pessoa com infarto agudo do miocárdio e provavelmente para a facilitação do julgamento clínico de enfermagem.


Subject(s)
Nursing Diagnosis , Myocardial Infarction/classification , Myocardial Infarction/diagnosis , Myocardial Infarction/nursing
18.
Rev. baiana enferm ; 33: e33591, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1098706

ABSTRACT

Objetivo caracterizar a apresentação clínica de adultos jovens diagnosticados com infarto agudo do miocárdio. Método pesquisa documental com abordagem quantitativa. Utilizou-se um formulário sobre aspectos sociodemográficos e clínicos. A amostra foi composta por 12 prontuários, de pacientes com idade entre 25 e 45 anos. Os dados coletados foram tabulados em uma planilha do Excel e, após análise, foram apresentados em frequências absolutas. Resultados predominou o sexo masculino, com Supra de ST, faixa etária entre 35 e 45 anos de idade, com sobrepeso e sem antecedentes familiares. Dor torácica foi encontrada em 91,66% dos jovens, 58,33% não faziam uso de medicação contínua e 100% tiveram elevação da troponina e realizaram cateterismo cardíaco. Conclusão o quadro de apresentação clínica na população jovem estudada ficou dentro dos parâmetros gerais para o diagnóstico do infarto agudo do miocárdio.


Objetivo caracterizar el cuadro clínico de adultos jóvenes con diagnóstico de infarto agudo de miocardio. Método investigación documental con enfoque cuantitativo. Se utilizó un formulario sobre aspectos sociodemográficos y clínicos. La muestra estuvo compuesta por 12 registros médicos de pacientes entre 25 y 45 años de edad. Los datos se recolectaron en una planilla de Excel y, después del análisis, se presentaron en frecuencias absolutas. Resultados se registró un predominio del sexo masculino, con Supra de ST, grupo etario de 35 a 45 años, con sobrepeso y sin antecedentes familiares. Se encontró dolor de tórax en el 91,66% de los jóvenes, el 58,33% no tomaban ningún medicamento en forma continua y el 100% tuvo una suba de la troponina y se sometían a cateterismo cardíaco. Conclusión el cuadro de presentación clínica en la población joven estudiada estuvo dentro de los parámetros generales correspondientes al diagnóstico de infarto agudo de miocardio.


Objective to characterize the clinical presentation of young adults diagnosed with acute myocardial infarction. Method a documentary research with a quantitative approach. A form on sociodemographic and clinical aspects was used. The sample consisted of 12 medical records, from patients aged between 25 and 45 years old. The collected data were tabulated in an Excel spreadsheet and, after analysis, were presented in absolute frequencies. Results predominantly males, with Supra ST, aged between 35 and 45 years old, overweight and without family history. Chest pain was found in 91.66% of the young people, 58.33% did not use continuous medication and 100% had troponin elevation and cardiac catheterization. Conclusion the clinical presentation in the studied young population was within the general parameters for acute myocardial infarction diagnosis.


Subject(s)
Humans , Male , Female , Adult , Risk Factors , Cardiovascular Nursing , Myocardial Infarction , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology
19.
Clinics ; 74: e1237, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039571

ABSTRACT

OBJECTIVES: To explore the clinical significance and correlation of microRNA-21 (miR-21) and the neutrophil-lymphocyte ratio (NLR) in patients with acute myocardial infarction (AMI). METHODS: The observation group contained 184 patients, while the control group contained 150 patients. The expression of miR-21 in the serum of each group was detected by qRT-PCR. RESULTS: A total of 184 patients and their family members were followed-up for 30 days, among which 35 patients died and 149 patients survived, resulting in a survival rate of 80.97%. According to univariate analysis, there were significant differences in age, cardiac troponin (cTn), heart rate, Killip grade, percutaneous coronary intervention (PCI) operation rate, miR-21 and NLR. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) values of miR-21 and NLR for the diagnosis of AMI were 0.909 and 0.868, respectively, and the area under the combined detection curve was 0.960. In the Kaplan-Meier survival analysis, the survival of patients with high miR-21 expression and NLR was significantly higher than that of patients with low miR-21 expression and NLR (p=0.027; p=0.001). The correlation showed that miR-21 expression in serum was positively correlated with the NLR in the observation group (r=0.528, p<0.05). cTn, heart rate, Killip classification, PCI operation rate, miR-21, NLR are independent risk factors for AMI. CONCLUSION: miR-21 and NLR play a role in the diagnosis of AMI and can be used as predictors for the survival of AMI.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Lymphocyte Count , MicroRNAs/genetics , Myocardial Infarction/diagnosis , Myocardial Infarction/blood , Neutrophils , Biomarkers , Case-Control Studies , Risk Factors , ROC Curve , Sensitivity and Specificity , Kaplan-Meier Estimate , Real-Time Polymerase Chain Reaction , Myocardial Infarction/genetics
20.
Arch. cardiol. Méx ; 88(3): 178-189, jul.-sep. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1088748

ABSTRACT

Resumen Antecedentes: El infarto agudo de miocardio representa la primera causa de muerte no trasmisible a nivel mundial. Su diagnóstico es una tarea altamente compleja que se ha intentado modelar mediante métodos automáticos. Se expone una revisión sistemática de estudios de pruebas diagnósticas de los síndromes coronarios agudos mediante sistemas inteligentes. Métodos: Revisión sistemática de la literatura a partir de Medline, Embase, Scopus, IEEE/IET Electronic Library, ISI Web Of Science, Latindex y LILACS de la evaluación diagnóstica de los síndromes coronarios agudos mediante sistemas inteligentes. Fue realizada por 2 revisores de manera independiente y las discrepancias se resolvieron por una tercera persona. Se extrajeron las características operativas de cada herramienta. Resultados: En total, 35 artículos cumplieron los criterios de inclusión. En 22 (62.8%) se utilizaron redes neuronales. Cinco comparan varias herramientas de sistemas inteligentes. En 13 se abarcaba todos los síndromes coronarios agudos y en 22 solo los infartos. En 21 los datos de entrada fueron la clínica y el electrocardiograma, en 10 solo el electrocardiograma. La mayoría utilizan como referente estándar el contexto clínico. Se encontraron altos niveles de precisión diagnóstica con un mejor rendimiento en el caso de redes neuronales y máquinas de soporte de vectores en comparación con las herramientas estadísticas de reconocimiento de patrones y árboles de decisiones. Conclusiones: Encontramos una amplia evidencia de que los abordajes a través de las herramientas de sistemas inteligentes alcanzan un alto nivel de precisión por lo que deberían ser consideradas como herramientas para el soporte de las decisiones diagnósticas de los síndromes coronarios agudos.


Abstract Background: Acute myocardial infarction is the leading cause of non-communicable deaths worldwide. Its diagnosis is a highly complex task, for which modelling through automated methods has been attempted. A systematic review of the literature was performed on diagnostic tests that applied intelligent systems tools in the diagnosis of acute coronary syndromes. Methods: A systematic review of the literature is presented using Medline, Embase, Scopus, IEEE/IET Electronic Library, ISI Web of Science, Latindex and LILACS databases for articles that include the diagnostic evaluation of acute coronary syndromes using intelligent systems. The review process was conducted independently by 2 reviewers, and discrepancies were resolved through the participation of a third person. The operational characteristics of the studied tools were extracted. Results: A total of 35 references met the inclusion criteria. In 22 (62.8%) cases, neural networks were used. In five studies, the performances of several intelligent systems tools were compared. Thirteen studies sought to perform diagnoses of all acute coronary syndromes, and in 22, only infarctions were studied. In 21 cases, clinical and electrocardiographic aspects were used as input data, and in 10, only electrocardiographic data were used. Most intelligent systems use the clinical context as a reference standard. High rates of diagnostic accuracy were found with better performance using neural networks and support vector machines, compared with statistical tools of pattern recognition and decision trees. Conclusions: Extensive evidence was found that shows that using intelligent systems tools achieves a greater degree of accuracy than some clinical algorithms or scales and, thus, should be considered appropriate tools for supporting diagnostic decisions of acute coronary syndromes.


Subject(s)
Humans , Artificial Intelligence , Acute Coronary Syndrome/diagnosis , Myocardial Infarction/diagnosis , Algorithms , Decision Trees , Neural Networks, Computer , Electrocardiography , Support Vector Machine , Models, Theoretical
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