ABSTRACT
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Nutrition Assessment , Diet, Food, and NutritionABSTRACT
BACKGROUND AND OBJECTIVE: Recent studies have related the consumption of ultra-processed foods with the development of cardiovascular diseases and have considered this relation with excessive sodium intake. While Brazilian studies have analysed that this consumption may have no direct relationship with the processing, but rather with the addition of salt. The purpose of this study is to investigate the contribution of the consumption of processed products in the daily intake of sodium ingestion by atherosclerotic disease patients. METHODS: A sub study, conducted with data from 630 cardiopathic patients who take part in "Effect of Brazilian Cardioprotective Food Program study on the reduction of events and risk factors in secondary prevention of cardiovascular disease part". Food was classified as: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, ultra-processed food and beverages. Twenty-four-hour food recall (R24h) was collected from patients, and the estimation of total calories and sodium intake were calculated, as well as the percentage of sodium contribution according to the categories already mentioned. For the adequacy ratio analysis, the daily values of sodium intake were used to compared to the recommendations of the World Health Organization (<2000 mg / day). RESULTS: The average sodium intake was 1970.87 mg for women and 2642.86 mg for men, being higher for males' patients aged 60-79. It was observed that 64% of the studied population demonstrated sodium intake > 2000 mg. When considered levels > 3001 mg, a higher incidence of consumption was observed in the male group. Only 21.1% were intaking sodium within the recommended amount. Industrialized foods contributed to 33% of the mineral intake. CONCLUSION: These findings have demonstrated that the majority of the studied patients exceeded the dietary sodium recommendation. It has also indicated that patient's male, have presented increased consumption of the mineral. Consequently, warning for the necessity of greater investments in the nutritional re-education of these patients.
