RESUMO
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)
Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Avaliação Nutricional , Alimentos, Dieta e NutriçãoRESUMO
The interest in zero-valent iron nanoparticles has been increasing significantly since the development of a green production method in which extracts from natural products or wastes are used. However, this field of application is yet poorly studied and lacks knowledge that allows the full understanding of the production and application processes. The aim of the present work was to evaluate the viability of the utilization of several tree leaves to produce extracts which are capable of reducing iron(III) in aqueous solution to form nZVIs. The quality of the extracts was evaluated concerning their antioxidant capacity. The results show that: i) dried leaves produce extracts with higher antioxidant capacities than non-dried leaves, ii) the most favorable extraction conditions (temperature, contact time, and volume:mass ratio) were identified for each leaf, iii) with the aim of developing a green, but also low-cost, method water was chosen as solvent, iv) the extracts can be classified in three categories according to their antioxidant capacity (expressed as Fe(II) concentration): >40 mmol L(-1); 20-40 mmol L(-1); and 2-10 mmol L(-1); with oak, pomegranate and green tea leaves producing the richest extracts, and v) TEM analysis proves that nZVIs (d=10-20 nm) can be produced using the tree leaf extracts.
