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1.
Eur Heart J Cardiovasc Pharmacother ; 9(8): 701-708, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-37653447

RESUMO

BACKGROUND: Guidelines recommend extended dual antiplatelet therapy, including ticagrelor 60 mg twice daily, in high-risk post-myocardial infarction (MI) patients who have tolerated 12 months and are not at high bleeding risk. The real-world utilization and bleeding and ischaemic outcomes associated with long-term ticagrelor 60 mg in routine clinical practice have not been well described. METHODS: Register and claims data from the USA (Optum Clinformatics, IBM MarketScan, and Medicare) and Europe (Sweden, Italy, UK, and Germany) were extracted. Patients initiating ticagrelor 60 mg ≥12 months after MI, meeting eligibility criteria for the PEGASUS-TIMI (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin - Thrombolysis in Myocardial Infarction 45) 54 trial, were included. The cumulative incidence of the composite of MI, stroke, or all-cause mortality and that of bleeding requiring hospitalization were calculated. Meta-analyses were performed to combine estimates from each source. RESULTS: A total of 7035 patients treated with ticagrelor 60 mg met eligibility criteria. Median age was 67 years and 29% were females; 12% had a history of multiple MIs. The majority (95%) had been treated with ticagrelor 90 mg prior to initiating ticagrelor 60 mg. At 12 months from initiation of ticagrelor 60 mg, the cumulative incidence [95% confidence interval (CI)] of MI, stroke, or mortality was 3.33% (2.73-4.04) and was approximately three-fold the risk of bleeding (0.96%; 0.69-1.33). CONCLUSIONS: This study provides insights into the use of ticagrelor 60 mg in patients with prior MI in clinical practice. Observed event rates for ischaemic events and bleeding generally align with those in the pivotal trials, support the established safety profile of ticagrelor, and highlight the significant residual ischaemic risk in this population.Clinical Trials.gov Registration NCT04568083.


Assuntos
Infarto do Miocárdio , Acidente Vascular Cerebral , Estados Unidos/epidemiologia , Feminino , Humanos , Idoso , Masculino , Ticagrelor/efeitos adversos , Inibidores da Agregação Plaquetária , Antagonistas do Receptor Purinérgico P2Y , Adenosina/efeitos adversos , Prevenção Secundária , Medicare , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Isquemia/tratamento farmacológico
2.
Enferm Intensiva (Engl Ed) ; 34(1): 12-18, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36774246

RESUMO

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.


Assuntos
Transplante de Coração , Coração Auxiliar , Humanos , Transplante de Coração/efeitos adversos , Estudos Retrospectivos , Hospitalização , Respiração Artificial
3.
Enferm. intensiva (Ed. impr.) ; 34(1): 12-18, Ene-Mar. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-214980

RESUMO

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)


Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. The objective of this study is to analyze the impact of mobility on these patients. Methods: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to “Hospital Universitario de Bellvitge” (Barcelona). Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24.5 g/L (IQR: 23-30) vs. 33 g/L (IQR: 26-36); p = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). There were no significant differences in appearance of pressure ulcers, or post-HT infections among mobility groups. Conclusions: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post-HT adverse events.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Transplante de Coração , Pacientes , Limitação da Mobilidade , Estado Nutricional , Evolução Clínica , Coração Auxiliar , Estudos Retrospectivos , Espanha , Cardiologia
5.
Med. intensiva (Madr., Ed. impr.) ; 44(8): 475-484, nov. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198555

RESUMO

OBJETIVO: Las guías de práctica clínica recomiendan la estrategia invasiva precoz ajustada al riesgo (EIPAR) en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST). El objetivo fue analizar la aplicación de la EIPAR, sus condicionantes e impacto sobre el pronóstico en pacientes con SCASEST ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC). DISEÑO: Estudio de cohortes prospectivo. ÁMBITO: UCIC de 8 hospitales en Cataluña. PACIENTES: Pacientes consecutivos con SCASEST entre octubre del 2017 y marzo del 2018. El perfil de riesgo se definió mediante los criterios de la Sociedad Europea de Cardiología. INTERVENCIONES: Se definió como EIPAR la realización de coronariografía en las primeras 6 h en pacientes de muy alto riesgo o en 24 h en pacientes de alto riesgo. VARIABLES DE INTERÉS: Mortalidad/reingreso a los 6 meses. RESULTADOS: Se incluyó a 629 pacientes (edad media 66,6 años), 225 (35,9%) de muy alto riesgo y 392 (62,6%) de alto riesgo. La estrategia invasiva fue mayoritaria (96,2%). La EIPAR se aplicó en 284 pacientes (45,6%), especialmente pacientes más jóvenes, con menos comorbilidades. Estos pacientes presentaron menor estancia en UCIC y hospitalaria, así como menor incidencia de SCA, revascularizaciones y menor incidencia de muerte/reingreso a 6 meses. Tras ajustar por factores de confusión, la asociación entre adherencia y muerte/reingreso a 6 meses persistió de manera significativa (razón de riesgos: 0,66 [0,45-0,97] p = 0,035). CONCLUSIONES: La EIPAR se aplica en una minoría de SCASEST ingresados en UCIC, asociándose con una menor incidencia de eventos


OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Unidades de Terapia Intensiva , Estudos de Coortes , Registros/normas , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio sem Supradesnível do Segmento ST/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Estudos Prospectivos , Cooperação e Adesão ao Tratamento
6.
J Nutr Health Aging ; 24(7): 723-729, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32744568

RESUMO

OBJECTIVES: Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. DESIGN: Observational prospective study. SETTING: Multicenter registry conducted in 44 hospitals in Spain. PARTICIPANTS: Consecutive patients with ACS aged 80≥years. MEASUREMENTS: A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. RESULTS: A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). CONCLUSIONS: Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.


Assuntos
Síndrome Coronariana Aguda/complicações , Diabetes Mellitus/etiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Síndrome Coronariana Aguda/mortalidade , Idoso de 80 Anos ou mais , Diabetes Mellitus/mortalidade , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Estudos Prospectivos
8.
Med Intensiva (Engl Ed) ; 44(8): 475-484, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31362838

RESUMO

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.

10.
Scand J Med Sci Sports ; 28(4): 1404-1411, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29237243

RESUMO

Physical activity has benefits on health. However, there is a small risk of effort-related adverse events. The aim of this study is to describe exercise-related severe cardiovascular events and to relate them with the type of sport performed. We performed a ten-year retrospective study in eight Spanish cardiac intensive care units. Adverse cardiac events were defined as acute myocardial infarction, cardiac arrest or syncope related to physical activity. From 117 patients included, 109 were male (93.2%), and mean age was 51.6 ± 12.3 years; 56 presented acute myocardial infarction without cardiac arrest (47.9%), 55 sudden cardiac death (47.0%) and six syncope (5.1%). The sports with higher number of events were cycling (33%-28.2%), marathon or similar running competitions (19%-16.2%), gymnastics (18%-15.3%) and soccer (17%-14.5%). Myocardial infarction was observed more frequently in cyclists compared to other sports (69.7% vs 39.3%, P = .001). The most common cause of sudden cardiac death was myocardial infarction in those >35 years (23%-63.9%) and idiopathic ventricular fibrillation in younger patients (5%-62.5%). Significant coronary artery disease was present in 85 (79.4%). Only one patient with cardiac arrest presented with a non-shockable rhythm (asystole). Eleven patients (9.4%) died during hospitalization; in all cases, they had presented cardiac arrest. All discharged patients were alive at the end of follow-up. Exercise-related severe cardiac events are mainly seen in men. Coronary heart disease is very frequent; about half present acute myocardial infarction and the other half cardiac arrest. In our cohort, prognosis was good in patients without cardiac arrest.


Assuntos
Doença das Coronárias/diagnóstico , Morte Súbita Cardíaca , Exercício Físico , Parada Cardíaca/diagnóstico , Infarto do Miocárdio/diagnóstico , Fibrilação Ventricular/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Esportes , Síncope/diagnóstico
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