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1.
Rev. esp. cardiol. (Ed. impr.) ; 76(2): 94-102, feb. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-215046

RESUMO

Introducción y objetivos El papel de la coronariografía urgente y angioplastia, si procede, en los pacientes con parada cardiaca extrahospitalaria (PCEH) recuperada que no presentan elevación del segmento ST es controvertido. Nuestro objetivo fue evaluar si la coronariografía urgente y la angioplastia mejoran la supervivencia con buen pronóstico neurológico en esta población. Métodos En este ensayo clínico multicéntrico, aleatorizado, abierto, incluimos 69 pacientes supervivientes a una PCEH sin elevación del ST y se aleatorizaron a recibir una coronariografía urgente (CU) o diferida (CD). El objetivo primario de eficacia fue el combinado de supervivencia hospitalaria libre de dependencia. El objetivo de seguridad fue un compuesto de eventos cardiacos mayores, incluyendo muerte, reinfarto, sangrado y arritmias ventriculares. Resultados Se incluyó a 66 pacientes en el análisis primario (95,7%). La supervivencia hospitalaria fue 62,5% en el grupo CU y 58,8% en el grupo CD (HR = 0,96; IC95%, 0,45-2,09; p=0,93). La supervivencia hospitalaria con buen pronóstico neurológico fue 59,4% en el grupo CU y 52,9% en el grupo CD (HR = 1,29; IC95%, 0,60-2,73; p=0,4986). No se encontraron diferencias en los objetivos secundarios, salvo por la incidencia de fracaso renal agudo, que fue más frecuente en el grupo CU (15,6 frente a 0%, p=0,002) y de infecciones, más prevalentes en el grupo CD (46,9 frente a 73,5%, p=0,003). Conclusiones En este estudio aleatorizado de pacientes con una PCEH sin elevación del ST, una CU no fue beneficiosa en términos de supervivencia con buen pronóstico neurológico comparada con una CD (AU)


Introduction and objectives The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. We aimed to assess whether emergency CAG and PCI would improve survival with good neurological outcome in this population. Methods In this multicenter, randomized, open-label, investigator-initiated clinical trial, we randomly assigned 69 survivors of OHCA without STEMI to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was a composite of in-hospital survival free of severe dependence. The safety endpoint was a composite of major adverse cardiac events including death, reinfarction, bleeding, and ventricular arrhythmias. Results A total of 66 patients were included in the primary analysis (95.7%). In-hospital survival was 62.5% in the immediate CAG group and 58.8% in the delayed CAG group (HR, 0.96; 95%CI, 0.45-2.09; P=.93). In-hospital survival free of severe dependence was 59.4% in the immediate CAG group and 52.9% in the delayed CAG group (HR, 1.29; 95%CI, 0.60-2.73; P=.4986). No differences were found in the secondary endpoints except for the incidence of acute kidney failure, which was more frequent in the immediate CAG group (15.6% vs 0%, P=.002) and infections, which were higher in the delayed CAG group (46.9% vs 73.5%, P=.003). Conclusions In this underpowered randomized trial involving patients resuscitated after OHCA without STEMI, immediate CAG provided no benefit in terms of survival without neurological impairment compared with delayed CAG (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Arritmias Cardíacas/cirurgia , Parada Cardíaca Extra-Hospitalar/cirurgia , Intervenção Coronária Percutânea , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Angiografia Coronária , Resultado do Tratamento , Análise de Sobrevida , Prognóstico
2.
Rev Esp Cardiol (Engl Ed) ; 76(2): 94-102, 2023 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35750580

RESUMO

INTRODUCTION AND OBJECTIVES: The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. We aimed to assess whether emergency CAG and PCI would improve survival with good neurological outcome in this population. METHODS: In this multicenter, randomized, open-label, investigator-initiated clinical trial, we randomly assigned 69 survivors of OHCA without STEMI to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was a composite of in-hospital survival free of severe dependence. The safety endpoint was a composite of major adverse cardiac events including death, reinfarction, bleeding, and ventricular arrhythmias. RESULTS: A total of 66 patients were included in the primary analysis (95.7%). In-hospital survival was 62.5% in the immediate CAG group and 58.8% in the delayed CAG group (HR, 0.96; 95%CI, 0.45-2.09; P=.93). In-hospital survival free of severe dependence was 59.4% in the immediate CAG group and 52.9% in the delayed CAG group (HR, 1.29; 95%CI, 0.60-2.73; P=.4986). No differences were found in the secondary endpoints except for the incidence of acute kidney failure, which was more frequent in the immediate CAG group (15.6% vs 0%, P=.002) and infections, which were higher in the delayed CAG group (46.9% vs 73.5%, P=.003). CONCLUSIONS: In this underpowered randomized trial involving patients resuscitated after OHCA without STEMI, immediate CAG provided no benefit in terms of survival without neurological impairment compared with delayed CAG. CLINICALTRIALS: gov Identifier: NCT02641626.


Assuntos
Parada Cardíaca Extra-Hospitalar , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Angiografia Coronária/efeitos adversos , Parada Cardíaca Extra-Hospitalar/terapia , Intervenção Coronária Percutânea/efeitos adversos , Arritmias Cardíacas/complicações , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-26343306

RESUMO

BACKGROUND: Bipolar disorder (BD) is a severe mental disorder with a strong genetic component. The assessment of child and adolescent offspring of patients diagnosed with BD (BDoff) provides an opportunity to investigate vulnerability factors and the first abnormalities associated with the disorder. Previous literature in child and adolescent BDoff is scarce and controversial. However, some studies concur in identifying significant impairment in executive functions, memory and attention. The present study aims to compare global neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder with a group of offspring of parentswith no history of psychotic disorder, and to assess the influence of psychopathology on neuropsychological performance. METHODS: This research was part of The Bipolar and Schizophrenia Young Offspring Study (BASYS). A group of BDoff (N= 90) and a group of offspring of parents with no history of psychotic disorder (CC) (N = 107) were assessed with a complete neuropsychological battery. Intellectual quotient, working memory, processing speed, verbal memory and learning, visual memory, attention and executive functions were included in the cognitive assessment. RESULTS: BDoff showed significantly worse performance in processing speed and immediate recall of visual memory relative to CC. When the presence of any lifetime psychopathology was analysed, the results showed that belonging to the BDoff group was the main explicative factor for the scores obtained in both processing speed and visual memory immediate recall, regardless of the presence of psychopathology. CONCLUSIONS: These findings suggest that processing speed and visualmemory should be taken into consideration in future research on vulnerability markers of BD.


Assuntos
Transtorno Bipolar , Filho de Pais com Deficiência/psicologia , Adolescente , Atenção , Criança , Cognição , Função Executiva , Feminino , Humanos , Inteligência , Testes de Inteligência , Estudos Longitudinais , Masculino , Memória , Memória de Curto Prazo , Testes Neuropsicológicos
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