Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial
Am. heart j
; 215: 187-197, Set. 2019. graf, tab
Article
in English
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1023356
Responsible library:
BR79.1
Localization: BR79.1
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)
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
Health problem:
Goal 9: Noncommunicable diseases and mental health
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Target 3.4: Reduce premature mortality due to noncommunicable diseases
Database:
Sec. Est. Saúde SP
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SESSP-IDPCPROD
Main subject:
Cardiovascular Diseases
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Nutrition Assessment
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Diet, Food, and Nutrition
Type of study:
Controlled clinical trial
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Prognostic study
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Systematic review of observational studies
Aspects:
Implementation research
Limits:
Humans
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
Am. heart j
Year:
2019
Document type:
Article
Institution/Affiliation country:
Associação Veranense de Assistência em Saúde/BR
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COTENUT/BR
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Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Su/BR
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Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul/BR
/
Hospital São Lucas/BR
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Hospital São Vicente de Paulo/BR
/
Hospital Universitário Alcides Carneiro/BR
/
Hospital Universitário Ana Bezerra/BR
/
Hospital Universitário Associação Educadora São Carlos/BR
/
Hospital Universitário Maria Aparecida Pedrossian/BR