HB - CAR - Comunicações e Conferências
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Browsing HB - CAR - Comunicações e Conferências by Author "Álvares-Pereira, M"
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- Acute coronary syndrome in elderly patients - prognostic impact of revascularizationPublication . Arantes, C; Abreu, G; Martins, J; Galvão-Braga, C; Ramos, V; Vieira, C; Azevedo, P; Álvares-Pereira, M; Rocha, S; Correia, A
- Are there differences on prognosis among patients with previous ischemic heart disease versus cerebrovascular disease admitted with acute coronary syndrome?Publication . Abreu, G; Galvão-Braga, C; Arantes, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Azevedo, P; Álvares-Pereira, M; Marques, JBackground: It is known that patients with previous vascular disease (PVD) have a poorer outcome than those without these previous conditions, and prognosis worsens as the number of affected vascular beds increases. Aim: To evaluate if there are differences in in-hospital and 6-month mortality among patients admitted with acute coronary syndromes with previous ischemic heart disease (IHD) versus cerebrovascular disease (CVD). Methods: We analysed 4871 patients (pts) admitted consecutively in our coronary care unit with a diagnosis of acute coronary syndrome and included in a prospective registry, from January 2002 to October 2013. Patients were divided in three groups: group 1 - pts without PVD, n=3718, 76,3%); group 2 – pts with previous IHD (n=825, 16.9%); group 3 - pts with previous CVD (n=257, 5.3%). We excluded pts with previous IHD plus CVD (n=71, 1.5%). For each group we compared clinical and laboratory features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 98% of patients. Results: The group with previous CVD were older (63±13 vs 67±12 vs 71±11; p<0.001), had higher proportion of women (25% vs 21.9% vs 32.3%; p<0.001) and hypertension (58% vs 73.1% vs 83.7%; p<0.001). Patients with previous IHD had more often body mass index >25kg/m2 (47.1% vs 52.5% vs 50.8%; p=0.016), dyslipidaemia (46% vs 69.3% vs 52.1%; p<0.001), diabetes (23.5% vs 38.8% vs 36.6%; p<0.001). They also were taking more often aspirin (11.6% vs 75% vs 35.8%; p<0.001) and statin (21.6% vs 70.5% vs 37.4%; p<0.001). Patients without PVD had more frequently history of smoking (29.5% vs 19.0% vs 12.8%; p<0.001) and absence of risk factors (8.7% vs 4.0% vs 3.9%; p<0.001). On admission, those with previous CVD presented more often with Killip >1 (19.6 % vs 29.6% vs 34.2%; p<0.001), anaemia (19.8% vs 28.6% vs 33.9%; p<0.001) and renal insufficiency (eGFR <60 ml/min) (19.2% vs 31% vs 40.9%; p<0,001). Patients with previous IHD presented more severe coronary artery disease (left main coronary artery or three vessels) (11.7% vs 22.2% vs 16.7%; p<0.001) and higher prevalence of left ventricular dysfunction (56.2% vs 61.8% vs 58.4%; p=0.034). ST-segment myocardial infarction was more prevalent in patients without PVD (54.5% vs 25.6% vs 51%; p<0.001) on the other hand myocardial infarction without ST-elevation was more frequent in patients with previous IHD (41.2% vs 65% vs 45.5%; p<0.001). In-hospital (4.5% vs 4.7% vs 7.0%; p<0.001) and 6-month mortality (8.7% vs. 10.6% vs. 16.5%; p<0.001) were higher in patients with previous CVD. In multivariate analysis and after adjusting for different baseline characteristics, patients with previous CVD had higher risk of 6-month mortality compared to those without PVD [OR 1.67, 95% CI (1.06-2.63), p=0.026]. Conclusion: Patients with previous vascular disease had higher prevalence of risk factors. Previous cerebrovascular disease remained as a strong predictor of 6-month mortality in patients admitted with acute coronary syndrome.
- Are there differences on prognosis among patients with previous ischemic heart disease versus cerebrovascular disease admitted with acute coronary syndrome?Publication . Abreu, G; Arantes, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Álvares-Pereira, M; Azevedo, P; Marques, JBackground: It is known that patients with previous vascular disease (PVD) have a poorer outcome than those without these previous conditions, and prognosis worsens as the number of affected vascular beds increases. Aim: To evaluate if there are differences in in-hospital and 6-month mortality among patients admitted with acute coronary syndromes with previous ischemic heart disease (IHD) versus cerebrovascular disease (CVD). Methods: We analysed 4871 patients (pts) admitted consecutively in our coronary care unit with a diagnosis of acute coronary syndrome and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups: group 1 - pts without PVD (n=3718, 76.3%); group 2 – pts with previous IHD (n=825, 16.9%); group 3 - pts with previous CVD (n=257, 5.3%). We excluded pts with previous IHD plus CVD (n=71, 1.5%). For each group we compared clinical features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 98% of patients. Results: Pts in group 3 were older (63±13 vs 67±12 vs 71±11;p<0.001), had higher proportion of women (25% vs 21.9% vs 32.3%;p<0.001) and hypertension (58% vs 73.1% vs 83.7%;p<0.001). Group 2 had more often body mass index >25kg/m2 (47.1% vs 52.5% vs 50.8%; p=0.016), dyslipidaemia (46% vs 69.3% vs 52.1%;p<0.001) and diabetes (23.5% vs 38.8% vs 36.6%;p<0.001). Group 1 had more frequently history of smoking (29.5% vs 19.0% vs 12.8%;p<0.001) and absence of conventional risk factors (8.7% vs 4.0% vs 3.9%;p<0.001). On admission, those with previous CVD presented more often Killip >1 (19.6 % vs 29.6% vs 34.2%;p<0.001), anaemia (19.8% vs 28.6% vs 33.9%;p<0.001) and renal insufficiency (eGFR <60 ml/min) (19.2% vs 31% vs 40.9%;p<0,001). Group 2 presented more severe coronary artery disease (11.7% vs 22.2% vs 16.7%;p<0.001) and higher prevalence of left ventricular dysfunction (56.2% vs 61.8% vs 58.4%;p=0.03). ST-segment myocardial infarction was more prevalent in Group 1 (54.5% vs 25.6% vs 51%;p<0.001), while myocardial infarction without ST-elevation was more frequent in group 2 (41.2% vs 65% vs 45.5%;p<0.001). In-hospital (4.5% vs 4.7% vs 7.0%;p<0.001) and 6-month mortality (8.7% vs 10.6% vs 16.5%;p<0.001) were higher in patients with previous CVD. In multivariate analysis and after adjusting for different baseline characteristics, pts with previous CVD had higher risk of 6-month mortality compared to those without PVD [OR 1.67, 95% CI (1.06-2.63),p=0.026]. Conclusion: Previous CVD remained as a strong predictor of 6-month mortality in patients admitted with acute coronary syndrome.
- Cardiomiopatia periparto – entidade rara, tratamento peculiar! (Caso clínico)Publication . Arantes, C; Gaspar, A; Abreu, G; Martins, J; Galvão-Braga, C; Ramos, V; Vieira, C; Azevedo, P; Álvares-Pereira, M; Rocha, S; Correira, A
- Cistatina C e valor prognóstico nas síndromes coronárias agudasPublication . Vieira, C; Nabais, S; Ramos, V; Ribeiro, S; Gaspar, A; Galvão-Braga, C; Salomé, N; Rocha, S; Azevedo, P; Álvares-Pereira, M; Correia, A
- Comparação das características clínicas entre EAM, miocardite aguda e miocardiopatia de stress – um desafio diagnósticoPublication . Galvão-Braga, C; Arantes, C; Martins, J; Abreu, G; Ramos, V; Vieira, C; Salgado, A; Gaspar, A; Azevedo, P; Álvares-Pereira, M; Magalhães, S; Correia, A
- Complicações mecânicas do EAM na era da reperfusão – tipo, incidência, fatores associados e prognósticoPublication . Galvão-Braga, C; Martins, J; Arantes, C; Abreu, G; Ramos, V; Vieira, C; Salgado, A; Gaspar, A; Azevedo, P; Álvares-Pereira, M; Magalhães, S; Correia, A
- Contrast-induced nephropathy after an acute coronary syndrome.Publication . Gaspar, A; Nabais, S; Ribeiro, S; Rocha, S; Azevedo, P; Álvares-Pereira, M; Brandão, A; Correia, APurpose: Contrast-induced nephropathy (CIN) is a form of hospital-acquired acute renal failure that sometimes develops after giving iodinated radiocontrast agents. The growing number of patients who undergo coronary angiography and percutaneous revascularization after acute coronary syndrome (ACS) brought more relevance to this entity. It’s actually one of the most frequent forms of hospital-acquired acute renal failure. The purpose of this study was to define the predictors and prognostic value of CIN in a population of patients admitted with ACS. Methods: A total of 558 patients consecutively admitted with ACS and submitted to cardiac catheterization procedure, from January 2004 to April 2006, were reviewed. CIN was defined as impairment of renal function occurring within 48 hours after administration of contrast media and manifested by an absolute increase in the serum creatinine level of at least 0.5 mg/dL or by a relative increase of at least 25% over the baseline value (in the absence of another cause). The patients were classified in 2 groups according to the occurrence of CIN. The primary endpoint was in-hospital mortality. Results: Of the 558 patients reviewed, 5% (n=28) developed CIN. Patients with CIN were older (69.6 ± 10.5 vs 61.5 ± 11.7; p <0.001) and more often had diabetes mellitus (42.9% vs 24%; p=0.02) and renal insufficiency (48% vs 14.7%; p <0.001). There were no differences regarding ACS presentation (with or without elevation in the ST segment) and in-hospital medical treatment. Patients with CIN had higher in-hospital mortality (10.7% vs 0.6%; p <0.001). After adjustment for confounding variables by multivariate analysis (age, renal insufficiency, heart rate on admission, systolic blood pressure on admission and Killip class on admission), CIN remained an independent predictor of in-hospital mortality. Conclusions: CIN occurred in 5% of our patients admitted with ACS. Risk factors associated with CIN were advanced age, diabetes and pre-existing renal insufficiency. CIN was an independent predictor of in-hospital mortality.
- Evolução do prognóstico das síndromes coronárias agudas ao longo de 12 anos – a realidade de um CentroPublication . Abreu, G; Nabais, S; Arantes, C; Martins, J; Galvão-Braga, C; Ramos, V; Vieira, C; Gaspar, A; Rocha, S; Costa, J; Álvares-Pereira, M; Correia, A
- Fibrilhação auricular de novo na Síndrome Coronária Aguda – evolução a longo prazoPublication . Arantes, C; Martins, J; Galvão-Braga, C; Abreu, G; Quina-Rodrigues, C; Ramos, V; Vieira, C; Salgado, A; Gaspar, A; Álvares-Pereira, M; Rocha, S; Marques, J
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