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1.
BMC Med ; 21(1): 365, 2023 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-37743496

RESUMO

BACKGROUND: Syncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs. METHODS: A multicentre pre-post study in five Dutch hospitals comparing two groups of syncope patients visiting the emergency department: one before intervention (usual care; from March 2017 to February 2019) and one afterwards (from October 2017 to September 2019). The intervention consisted of the simultaneous implementation of the ESC Syncope Guidelines with quick referral routes to a syncope unit when indicated. The primary objective was to compare diagnostic accuracy using logistic regression analysis accounting for the study site. Secondary outcome measures included diagnostic yield, syncope-related healthcare and societal costs. One-year follow-up data were used to define a gold standard reference diagnosis by applying ESC criteria or, if not possible, evaluation by an expert committee. We determined the accuracy by comparing the treating physician's diagnosis with the reference diagnosis. RESULTS: We included 521 patients (usual care, n = 275; syncope guidelines intervention, n = 246). The syncope guidelines intervention resulted in a higher diagnostic accuracy in the syncope guidelines group than in the usual care group (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and a higher diagnostic yield (89% vs. 76%, 95% CI of the difference 6 to 19%). Syncope-related healthcare costs did not differ between the groups, yet the syncope guideline implementation resulted in lower total syncope-related societal costs compared to usual care (saving €908 per patient; 95% CI €34 to €1782). CONCLUSIONS: ESC Syncope Guidelines implementation in the emergency department with quick referral routes to a syncope unit improved diagnostic yield and accuracy and lowered societal costs. TRIAL REGISTRATION: Netherlands Trial Register, NTR6268.


Assuntos
Cardiologia , Humanos , Serviço Hospitalar de Emergência , Custos de Cuidados de Saúde , Síncope/diagnóstico , Síncope/terapia , Países Baixos
2.
Br J Dermatol ; 169(2): 389-97, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23551191

RESUMO

BACKGROUND: The burden of disease, describing loss of health and death due to a disease, has not been fully studied for melanoma in the general population over time. OBJECTIVES: To determine the burden of disease due to melanoma in the Netherlands. METHODS: Age- and sex-specific incidence data from all patients with melanoma in the Netherlands between 1991 and 2010 were obtained from the Netherlands Cancer Registry. Melanoma-specific mortality and life expectancy data were obtained from Statistics Netherlands. Melanoma duration was calculated using the DISMOD software from the World Health Organization. The years of life lived with disability (YLD) and years of life lost (YLL) due to melanoma were calculated using Dutch disability weights, incidence and mortality of melanoma, and the life expectancy from the general population. The number of disability-adjusted life-years (DALYs) was estimated by adding YLD and YLL. RESULTS: The world-standardized incidence rates of melanoma have more than doubled for both men (7·1 per 100 000 inhabitants in 1991 to 17·0 in 2010) and women (9·4 per 100 000 inhabitants in 1991 to 19·8 in 2010). Likewise, the burden of melanoma to society has increased rapidly. The YLD for men increased from 4795 (1991-4) to 12 441 (2007-10), and for women from 7513 (1991-4) to 16 544 (2007-10). In 2007-10 the total YLL due to melanoma was 30 651 for men and 26 244 for women compared with 17 238 and 16 900, respectively, in 1991-4. The DALYs increased by 96% for men, from 22 033 (1991-4) to 43 092 (2007-10), and by 75% for women, from 24 413 (1991-4) to 42 788 (2007-10). CONCLUSIONS: Melanoma is becoming a great burden to Dutch society.


Assuntos
Efeitos Psicossociais da Doença , Melanoma/mortalidade , Neoplasias Cutâneas/mortalidade , Adulto , Distribuição por Idade , Idade de Início , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura/tendências , Países Baixos/epidemiologia , Sistema de Registros , Distribuição por Sexo , Adulto Jovem
4.
Neth Heart J ; 19(4): 183-91, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22020997

RESUMO

BACKGROUND: Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG). AIM: To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches. MATERIALS AND METHODS: Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous 'therapeutic' embolisation (PTE group) or surgical ligation (SL group). RESULTS: In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one. CONCLUSIONS: Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs.

5.
Neth Heart J ; 19(12): 523-30, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21960176

RESUMO

AIM: To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF). MATERIALS AND METHODS: We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954-2010. RESULTS: The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70-87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset. CONCLUSIONS: A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.

6.
Cancer Epidemiol ; 33(5): 391-5, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19896919

RESUMO

A reduced incidence of nonmelanoma skin cancer among users of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARb) has been reported. A similar effect is suggested for cutaneous melanoma. We aimed to investigate the possible association between use of ACEi and ARb and the risk of cutaneous melanoma. A general population-based case control study with the PHARMO database, containing drug-dispensing records from community pharmacies and the national pathology database (PALGA) was conducted. Cases were patients with a primary cutaneous melanoma between January 1st 1991 and December 14th 2004, aged > or =18 years and having > or =3 years of follow-up prior to diagnosis. Finally, 1272 cases and 6520 matched controls were included. Multivariable conditional logistic regression showed no statistically significant associations between the incidence of melanoma and the use of ACEi (adjusted OR=1.0, 95%CI: 0.8-1.3) or ARb (adjusted OR=1.0, 95%CI: 0.7-1.5). Thus, in this study, the use of ACEi or ARb does not seem to protect against the development of cutaneous melanoma. However, we cannot exclude an association between ACEi and ARb exposure and an increased or decreased incidence of cutaneous melanoma.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Ann Oncol ; 20(2): 358-64, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18725391

RESUMO

BACKGROUND: Multiple studies showed conflicting results on the association between oral contraceptive (OC) use and the development of cutaneous melanoma (CM). We investigated the association between estrogen use and CM incidence. PATIENTS AND METHODS: Data from PHARMO Pharmacy database and PALGA, the pathology database in The Netherlands, were linked. Women, >or=18 years, with a pathology report of a primary CM from 1 January 1991 to 14 December 2004 and >or=3 years of follow-up before CM diagnosis were eligible cases. Controls were matched for age and geographic region. Multivariate logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between CM incidence and estrogen use, OCs and hormonal replacement therapy (HRT), separately. RESULTS: In total, 778 cases and 4072 controls were included. CM risk was significantly associated with estrogen use (>or=0.5 year; adjusted OR = 1.42, 95% CI 1.19-1.69). This effect was cumulative dose dependent (P trend < 0.001). CM risk was also significantly associated with the use of HRT (>or=0.5 year: OR = 2.08; 95% CI 1.37-3.14) and OC (>or=0.5 year: OR = 1.28; 95% CI 1.06-1.54). CONCLUSION: Our study suggests a cumulative dose-dependent increased risk of CM with the use of estrogens.


Assuntos
Anticoncepcionais Orais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Melanoma/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Humanos , Incidência , Modelos Logísticos , Melanoma/epidemiologia , Análise Multivariada , Países Baixos/epidemiologia , Razão de Chances , Vigilância da População , Fatores de Risco , Neoplasias Cutâneas/epidemiologia
9.
Eur J Cancer ; 43(17): 2580-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17950596

RESUMO

BACKGROUND: Statins show anticancer activity in melanoma cells. We investigated the association between statins and incidence and Breslow thickness of cutaneous melanoma (CM). METHODS: Data were used from PHARMO, a pharmacy database, and PALGA, a pathological database, in the Netherlands. Cases had a primary CM diagnosis between January 1st 1991 and December 14th 2004, were 18 years and had 3 years of follow up in PHARMO before CM diagnosis. Controls were matched for gender, date of birth and geographic region. Analyses were adjusted for age, gender, year of diagnosis, number of medical diagnoses and the use of NSAIDs and oestrogens. FINDINGS: Finally, 1318 cases and 6786 controls were selected. CM risk was not associated with statin use (> or = 0.5 years) (adjusted odds ratio (OR)=0.98, 95% confidence interval (CI)=0.78-1.2). However, statin use was associated with a reduced Breslow thickness (-19%, 95% CI=-33, -2.3, p=0.03). CONCLUSION: Our study suggests protective effects of statins on melanoma progression.


Assuntos
Antineoplásicos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Feminino , Humanos , Masculino , Melanoma/patologia , Melanoma/secundário , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica/prevenção & controle , Projetos Piloto , Análise de Regressão , Neoplasias Cutâneas/patologia
10.
J ECT ; 20(3): 154-9, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15342999

RESUMO

The efficacy of electroconvulsive therapy (ECT) has been firmly established in the treatment of depression. However, prediction of the speed of response to ECT is an issue that needs to be further explored. This study aims to examine the presence of predictors for the speed of response. In a retrospective chart review using 57 patients suffering from major depression who received ECT, the relation of several patient and ECT variables with the speed of response was explored. Response was defined as a drop of at least 35% in Hamilton rating scale of depression (HRSD) score from baseline after 3 or 4 ECT sessions. Patients received ECT with an aged-based stimulus dosage in a clinical setting. Multiple regression analysis showed that high baseline HRSD score and high seizure energy index (SEI) were significantly and independently associated with a rapid response. In a regression model, baseline HRSD score and SEI can be used to predict the speed of response to ECT. Rapid responders to ECT achieved remission significantly more often than slow responders did. SEI can be modified by the clinician. This offers the possibility to optimize ECT treatment.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
11.
Eur J Cardiothorac Surg ; 19(3): 260-5, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11251263

RESUMO

OBJECTIVES: To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications. METHODS: A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated. Follow-up began from the moment of acceptance until the procedure took place for cardiac death, myocardial infarction and unstable angina requiring hospital admission. RESULTS: The median (25-75th percentile) waiting time in the two priority groups was 100 (79-119) days for the routine group and 69 (38-91) days for the urgent group. Overall, eight patients died, seven suffered a myocardial infarction, and 33 episodes of unstable angina requiring immediate hospitalization occurred. The majority of events took place during the first 30 days on the waiting list. Unstable angina less than 3 months before acceptance was identified as an independent predictor (hazard ratio 2.5, 95% confidence interval 1.2-5.1) for complications during the wait. The prognostic value of smoking and familial cardiovascular disease was found to vary depending on the priority assigned to the patient. CONCLUSIONS: Complications occur relatively early during the time on the waiting list. If complications in coronary heart disease cannot be predicted more accurately, the only way to diminish the complication rate is drastic reduction of waiting times.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Ponte de Artéria Coronária/estatística & dados numéricos , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Triagem , Listas de Espera , Idoso , Análise de Variância , Angina Instável/epidemiologia , Angina Instável/etiologia , Estudos de Coortes , Comorbidade , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Países Baixos/epidemiologia , Seleção de Pacientes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
12.
Cardiovasc Surg ; 6(1): 76-80, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9546850

RESUMO

Reports in the literature frequently concern miscellaneous types of dissections. This makes correct interpretation of data difficult. In order to assess the determinants of hospital mortality, the results of 148 consecutive patients over a 23-year period, all operated on for a type A dissection, were reviewed. Mean(s.d.) age was 56(13.1) years, 64% were male. An acute dissection (surgery within 14 days after onset of symptoms) was performed in 139 patients. Stigmata of the Marfan syndrome were present in 6.1% (n = 9). Peripheral vascular ischaemic complications were observed in 27.7%. Nowadays, diagnosis is primarily confirmed using transoesophageal echocardiography (75 correct diagnoses among 76 performed). Operation consisted of repair or replacement of the ascending aorta. Resuspension of the aortic valve was performed in 74 patients, and arch replacement in 25. In 74 patients, distal repair was done under deep hypothermic circulatory arrest. Hospital mortality rate was 23.6% (35 patients), though mortality rate calculated over the period 1990-1993 was 17.4% (P = n.s.). Univariate analysis revealed the following variables to be statistically significant predictors of hospital mortality (P < 0.05): preoperative ischaemic complications, preoperative resuscitation, haemopericardium, postoperative neurological complications, rethoracotomy, renal insufficiency and intestinal ischaemia. Multivariate stepwise logistic regression indicated preoperative resuscitation, postoperative haemodialysis and postoperative neurological complications as the only independent predictors of hospital death. Dissections arising from a primary intimal tear in the descending aorta had a more favourable outcome (P = 0.06, odds ratio 0.1). Although hospital mortality has declined over the past few years, no decline was seen in operative mortality since gelatine-resourcine-formol (GRF) glue is used as a routine. Transoesophageal echocardiography is the first choice in confirming diagnosis. Early operation is advocated, with careful haemostasis, before the development of cardiac tamponade or end-organ ischaemia, as the cornerstone of a successful treatment of a type A dissection. Reduction of neurological complications will further improve the results.


Assuntos
Aneurisma Aórtico/mortalidade , Dissecção Aórtica/mortalidade , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Combinação de Medicamentos , Feminino , Formaldeído , Gelatina , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Reoperação , Resorcinóis , Estudos Retrospectivos , Fatores de Risco , Adesivos Teciduais
13.
Circulation ; 93(1): 42-7, 1996 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-8616939

RESUMO

BACKGROUND: The long-term clinical effects of smoking and smoking cessation after venous coronary bypass surgery have not been well established. METHODS AND RESULTS: Four hundred fifteen patients who underwent venous coronary bypass surgery between April 1976 and April 1977 were followed up prospectively for 15 years. Multivariate Cox survival analysis revealed that patients who smoked at the time of surgery had no elevated risks for clinical events compared with nonsmokers. However, smoking behavior at 1 and 5 years after surgery appeared to be an important predictor of clinical events during the subsequent follow-up period. Compared with patients who stopped smoking since surgery, smokers at 1 year after surgery had more than twice the risk for myocardial infarction and reoperation. Patients who were still smoking at 5 years after surgery had even more elevated risks for myocardial infarction and reoperation and a significantly increased risk for angina pectoris compared with patients who stopped smoking since surgery and patients who never smoked. Patients who started to smoke again within 5 years after surgery had increased risks for reoperation and angina pectoris. No differences in outcome were found between patients who stopped smoking since surgery and nonsmokers. CONCLUSIONS: Our results show that smoking cessation after coronary bypass surgery may have important beneficial effects on clinical events during long-term follow-up.


Assuntos
Ponte de Artéria Coronária , Cardiopatias/fisiopatologia , Fumar , Adulto , Idoso , Feminino , Seguimentos , Cardiopatias/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Abandono do Hábito de Fumar , Resultado do Tratamento
14.
Eur Heart J ; 16(9): 1200-6, 1995 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8582382

RESUMO

BACKGROUND: Knowledge is still lacking about pre-operative and postoperative factors which predict the long-term prognosis of patients who undergo venous coronary artery bypass graft surgery. METHODS AND RESULTS: Four hundred and twenty-eight consecutive patients who underwent isolated venous coronary artery bypass graft surgery with or without left ventricular aneurysm surgery between 1 April 1976 and 1 April 1977, were followed prospectively. Follow-up was 99.8% complete and averaged 15.4 years for the survivors. Two prognostic models were set up to illustrate the influence of 21 variables, present at and, 5 years after, surgery, on the occurrence of six different clinical events. Multivariate analysis was performed using the Cox regression model. Age, left ventricular function, pre-operative severity of angina and diabetes mellitus are continuous incremental risk factors for one or more events. Revascularization with sequential grafts only, and obesity at operation are incremental risk factors for acute myocardial infarction. From the 'classical' risk factors present 5 years after surgery hypertension is an incremental risk factor for both overall and cardiac mortality, diabetes mellitus for cardiac mortality, myocardial infarction, balloon angioplasty and smoking for all clinical events except mortality. CONCLUSIONS: Well-known pre-operative factors including 'classical' risk factors, present late after surgery, influence the occurrence of clinical events. Treatment of these factors may result in better long-term prognosis after venous bypass graft surgery.


Assuntos
Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/estatística & dados numéricos , Doença das Coronárias/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida
15.
Circulation ; 88(5 Pt 2): II87-92, 1993 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8222201

RESUMO

BACKGROUND: Although the long-term results of isolated venous coronary artery bypass surgery are well known, there are few multivariate statistical data on such patient groups. METHODS AND RESULTS: We report on 428 consecutive patients, 383 men and 45 women with a mean age of 52.6 years, who underwent isolated venous aortocoronary bypass graft surgery with or without left ventricular aneurysm surgery between April 1, 1976, and April 1, 1977, and whom we followed prospectively. A multivariate analysis using the Cox regression model was performed to establish the determinants of long-term outcome. The hospital mortality and myocardial infarction rates were 3% and 6.3%, respectively. Complete revascularization was obtained in 77.6%. Follow-up was 99.8% complete and averaged 13.4 years (range, 1.5 months to 16.6 years). Actuarial survival after 5, 10, and 15 years is 94.2%, 82.4%, and 63%, respectively. The cumulative probability of event-free survival for cardiac death, acute myocardial infarction, reintervention, and angina pectoris at 5, 10, and 15 years, respectively, are 97.8%, 90.1%, 74.4%; 98.5%, 89.0%, 77.4%; 97.0%, 83.0%, 62.1%; and 77.8%, 52.1%, 26.8%. Left ventricular function and the number of vessels diseased are the independent preprocedural predictors of cardiac survival. Obesity and hypertriglyceridemia are preprocedural predictors of late myocardial infarction. Preoperative validity (Canadian Cardiovascular Society) and the number of diseased vessels are the predictors of recurrent angina. CONCLUSIONS: We conclude that the long-term results of isolated venous bypass graft surgery are dependent not only on well-known preprocedural factors such as number of vessels diseased, left ventricular function, and age but also on obesity and hypertriglyceridemia.


Assuntos
Ponte de Artéria Coronária/mortalidade , Doença das Coronárias/cirurgia , Veia Safena/transplante , Análise Atuarial , Doença das Coronárias/mortalidade , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Hipertrigliceridemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Obesidade/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
16.
Am J Cardiol ; 71(8): 710-3, 1993 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-8447270

RESUMO

One hundred twenty-four consecutive patients (85%) with paroxysmal atrial fibrillation (AF) and 21 (15%) with atrial flutter (AFI) were studied immediately after pharmacologic or electrical cardioversion to sinus rhythm. Mean age was 59 +/- 13 years (range 23 to 79). Patients with reduced left ventricular function were excluded from the study. After restoration to sinus rhythm, the clinical course of all patients was followed for the first recurrence of paroxysmal AF or AFI irrespective of the therapeutic approach. Mean follow-up was 23 +/- 16 months. After 12 months of follow-up, 50% of all patients remained in sinus rhythm. Univariate analysis indicated that coronary artery disease (relative risk 1.9; 95% confidence interval 0.9-3.9), history of paroxysmal AF or AFI (2.3; 1.1-5.0), female sex (2.3; 1.1-4.6), pulmonary disease (3.9; 1.9-7.6) and valvular heart disease (4.4; 2.2-8.8) were associated with an increased risk for recurrent or frequent episodes of paroxysmal AF or AFI. No predictors were found to be associated with a decrease in length of the recurrence-free period after successful conversion to sinus rhythm. Multivariate analysis identified history of AF or AFI (odds ratio 2.5; 95% confidence interval 0.9-6.4), coronary artery disease (3.1; 1.1-8.2) and female sex (3.4; 1.3-8.9) as independent predictors for recurrent or frequent episodes of paroxysmal AF or AFI. The presence of these risk factors should be taken into account when prophylactic therapy with antiarrhythmic drugs is being considered in the treatment of paroxysmal AF or AFI.


Assuntos
Fibrilação Atrial/terapia , Flutter Atrial/terapia , Cardioversão Elétrica , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Flutter Atrial/complicações , Flutter Atrial/fisiopatologia , Doença das Coronárias/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
17.
Eur Heart J ; 13(2): 238-42, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1555622

RESUMO

A total of 1124 consecutive patients who were selected for coronary artery bypass graft surgery were studied. Of patients awaiting surgery (mean waiting time 98 days) 25 patients (2.2%) died before operation (mean waiting time 63 days). To assess patient characteristics predictive for early mortality before surgery, 25 deceased patients were analysed and compared to 50 controls matched for age, gender, type of surgery and waiting-list priority. Univariate analysis showed that the deceased patients had a higher rate of severe angina pectoris class III-IV (odds ratio (OR) 2.9), unstable angina prior to angiography (OR 4.8), cardiac enlargement on chest X-ray (OR 13.5), positive exercise testing of short duration (less than or equal to 6 min) (OR 6.0), coumarin treatment (OR 4.2), smoking (OR 3.0), severe left main or three-vessel disease (OR 4.1), abnormal end-diastolic volume (OR 3.1) and an abnormal left ventricular wall motion score (OR 3.0). Using multivariate analysis, cardiac enlargement (OR 14.4), positive exercise testing of short duration (OR 13.3), smoking (OR 8.7), coumarin treatment (OR 7.1), unstable angina (OR 6.5) and/or left main or three-vessel disease (OR 5.4) were independent predictors for death while awaiting coronary revascularisation. Thus, patients with the above mentioned independent characteristics have an increased short-term mortality while awaiting coronary bypass graft surgery. These indicators may contribute important information for determination of priority in high risk patients awaiting coronary artery bypass graft surgery.


Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/mortalidade , Complicações Pós-Operatórias/mortalidade , Listas de Espera , Adulto , Idoso , Angina Pectoris/mortalidade , Angina Pectoris/cirurgia , Causas de Morte , Doença das Coronárias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida
18.
Am J Cardiol ; 68(11): 1163-9, 1991 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-1951075

RESUMO

To investigate the effectiveness and safety of low-dose sotalol (a class III antiarrhythmic beta-blocking agent) in the prevention of supraventricular tachyarrhythmias (SVTs) and to identify predictors for the occurrence of these arrhythmias shortly after coronary artery bypass grafting, 300 consecutive patients were randomized in a double-blind, placebo-controlled fashion. Patients with severely depressed left ventricular function or other contraindications for beta blockers were excluded. Beginning at 4 hours and up to the sixth day after surgery, 150 patients received 40 mg of sotalol every 6 hours. SVT was observed in 24 (16%) of 150 low-dose sotalol-and in 49 (33%) of 150 placebo-treated patients [p less than 0.005]. In patients receiving sotalol, atrial fibrillation was the only noted tachyarrhythmia, whereas in the placebo group, 42 (28%) patients had atrial fibrillation, 3 (2%) atrial flutter, 1 (0.7%) atrial tachycardia and 3 (2%) sinus tachycardia. Drug-related adverse effects necessitating discontinuation of the drug were noted in only 2 (1%) sotalol-treated patients and 4 (3%) placebo-treated patients (p = not significant). For both groups, univariate analysis indicated that older age, 1- or 2-vessel coronary artery disease, long bypass (greater than or equal to 150 minutes) and aorta cross-clamp time (greater than or equal to 120 minutes) were predictive variables for the occurrence of SVTs. Multivariate analysis showed that male sex (odds ratio 2.3), 1- or 2-vessel coronary artery disease (odds ratio 2.0) and older age (odds ratio 1.1) were independent risk factors for increased occurrence of postoperative SVT.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Sotalol/uso terapêutico , Taquicardia Supraventricular/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sotalol/efeitos adversos , Taquicardia Supraventricular/etiologia
19.
J Thorac Cardiovasc Surg ; 100(6): 921-6, 1990 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2246915

RESUMO

Supraventricular tachyarrhythmias are reported in up to 40% of patients early after coronary artery bypass graft operations. In a randomized study, we compared the efficacy and safety of the class III antiarrhythmic beta-blocking drug sotalol versus propranolol at low and high doses in the prevention of supraventricular tachyarrhythmias in 429 consecutive patients after coronary artery bypass graft operations. Patients with severely depressed left ventricular function and other contraindications for beta-blockers were excluded. From the fourth hour up to the sixth day after coronary artery bypass, 74 patients received low-dose sotalol (40 mg every 8 hours), 66 patients low-dose propranolol (10 mg every 6 hours), 133 patients high-dose sotalol (80 mg every 8 hours), and 156 patients high-dose propranolol (20 mg every 6 hours). Baseline characteristics were comparable in all groups. Supraventricular tachyarrhythmia was observed in 10 of 72 (13.9%) who received low-dose sotalol, 12 of 64 (18.8%) who received low-dose propranolol, 13 of 119 (10.9%) who received high-dose sotalol, and 19 of 139 (13.7%) who received high-dose propranolol (not significant). Drug-related adverse effects necessitating discontinuation of the drug occurred in four receiving low doses (2.9%) and in 31 receiving high doses (10.7%) (p less than 0.02). In conclusion, no medication was found to be superior, although supraventricular tachyarrhythmias tended to be less prevalent in patients treated with sotalol than in those treated with propranolol. Moreover, significantly fewer adverse effects were noted in both low-dose groups. Therefore, low-dose beta-blocking treatment, especially low-dose sotalol, seems preferable.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Propranolol/administração & dosagem , Sotalol/administração & dosagem , Taquicardia Supraventricular/prevenção & controle , Administração Oral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propranolol/efeitos adversos , Propranolol/uso terapêutico , Estudos Prospectivos , Sotalol/efeitos adversos , Sotalol/uso terapêutico , Taquicardia Supraventricular/etiologia , Fatores de Tempo
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