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Browsing by Author "Quina-Rodrigues, C"

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  • 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, J
    Background: 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.
    2015Conference object Open access Show more
  • 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, J
    Background: 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.
    2015Conference object Open access Show more
  • Cardiogenic shock complicating acute coronary syndromes
    Publication . Abreu, G; Arantes, C; Galvão-Braga, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Salgado, A; Gaspar, A; Rocha, S; Marques, J
    INTRODUCTION: Despite advances in the treatment of patients with acute coronary syndromes (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. PURPOSE: Determine characteristics and management of patients with an ACS complicated by CS. Determine predictors of development of CS during hospitalization and predictors of in-hospital mortality. METHODS: Retrospective study of 2064 patients consecutively admitted for ACS in a Coronary Unit over a period of 4 years. RESULTS: During the years under study, 111 patients (5.4%) developed CS. Patients with CS were more likely to be older (69.8 ± 13.2 vs 63.5 ± 13.1 years, p<0.001); there were no significant differences in other clinical characteristics. Myocardial Infarction with ST segment elevation (STEMI) was more frequent in patients with CS (p<0.001). Patients with CS underwent less often coronary angiography (p<0.001), revascularization (p = 0.004) and were less treated with β-blocker (p <0.001) and ACE inhibitors therapy (p <0.001). In multivariate analysis, predictors of occurrence of CS during hospitalization were: tachycardia (OR 3.2, 95% CI 1.6-6.3), systolic blood pressure <100 mmHg (OR 4.1, 95% CI 2.1-8.0), GFR <60ml/min (OR 2.5, 95% CI 1.2-5.2), STEMI (OR 4.1, 95% CI 2.0-8.0) and Killip class > 1 (OR 3.5, 95% CI 1.8-6.8) at admission. The in-hospital mortality of patients with CS was 45%, compared with 1.7% in those who did not develop CS. Factors associated with an increased mortality in patients with CS included absence of coronary revascularization (OR 4.9, 95% CI 1.5-16.0), GFR <60ml/min (OR 4.4, 95% CI 1.3-15.6), advanced age (OR 6.4, 95% CI 1.6-26.2) and LVEF ≤ 35 % (OR 3.9, 95% CI 1.3-12.4). CONCLUSION: According to the literature, our review showed that CS in the context of ACS is associated with a high mortality. We identified clinical markers that are associated with the development of CS and may spot patients at risk earlier. Absence of coronary revascularization remains an independent predictor of mortality in CS.
    2015Conference object Open access Show more
  • Uma causa rara de insuficiência aórtica
    Publication . Arantes, C; Salomé, N; Salgado, A; Carneiro, A; Vieira, C; Abreu, C; Galvão-Braga, C; Martins, J; Quina-Rodrigues, C; Moutinho, J; Rocha, S; Costeira, A; Marques, J
    2015Conference object Open access Show more
  • Early discharge in selected patients after an acute coronary syndrome – can it be safe?
    Publication . Abreu, G; Azevedo, P; Arantes, C; Quina-Rodrigues, C; Fonseca, S; Martins, J; Vieira, C; Salgado, A; Marques, J
    2016Conference object Open access Show more
  • Endocardite de válvula protésica – registo de 15 anos
    Publication . Arantes, C; Vieira, C; Costa, P; Martins, J; Abreu, G; Quina-Rodrigues, C; Galvão-Braga, C; Costeira, A; Salomé, N; Salgado, A; Rocha, S; Marques, J
    2015Conference object Open access Show more
  • Fibrilhação auricular de novo na Síndrome Coronária Aguda – evolução a longo prazo
    Publication . 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
    2015Conference object Open access Show more
  • Um gigante “incidentaloma”…
    Publication . Arantes, C; Vieira, C; Salomé, N; Rodrigues, MJ; Pinho, P; Quina-Rodrigues, C; Abreu, G; Martins, J; Salgado, A; Costeira, A; Rocha, S; Marques, J
    2015Conference object Open access Show more
  • High-grade atrioventricular block in ST-segment elevation myocardial infarction patients: insights of a terciary centre
    Publication . Abreu, G; Braga, C; Arantes, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Salgado, A; Azevedo, P; Marques, J
    Background: High-grade atrioventricular block (HABV) is associated with poorer outcomes in the setting of acute coronary syndromes. Limited information is available on the incidence and death associated with HABV in STEMI patients (pts) receiving contemporary treatment. Aim: To evaluate the incidence of HABV and its impact on outcome of STEMI patients, in primary percutaneous coronary intervention era. Methods: We analysed retrospectively 1149 STEMI pts admitted, consecutively, in our coronary care unit, from July of 2009 to June 2014. They were divided in two groups: group 1 – pts without HABV, n=1057, 92%); group 2 – pts with HABV (n=92, 8%). 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 99,8% of patients. Results: Patients of group 2 were older (62±13 vs 69±15;p<0.001), more frequent women (19% vs 30.4%;p=0.014), had higher prevalence of hypertension (57.3% vs 71.7%;p=0.008) and known aortic stenosis (1.7% vs 6.5%;p=0.002). On admission, group 2 presented more often Killip >1 (18.0 % vs 42.4%;p<0.001), cardiogenic shock (2.9% vs 23.1%;p<0.001), anaemia (20.7% vs 39.8%;p<0.001), renal insufficiency (eGFR<60 ml/min) (20.7% vs 50.6%;p<0,001) and higher prevalence of right systolic dysfunction (5% vs 25%;p<0.001). They required more often aminergic support (7.2% vs 42.4%;p<0.001), intra-aortic balloon pump (4.3% vs 9.6%;p=0.05) and mechanical ventilation (2.6% vs 14.5%;p<0.001). They also had higher prevalence of malignant arrhythmias at first 24h (6.5% vs 14.1%;p=0.017) and in-hospital mortality (3.7% vs 24.2%;p<0.001). Among 2nd group of patients, HAVB was present on admission in 43.5%; 15.2% (n=14) had anterior myocardial infarction (AMI) and 84.8% (n=78) inferior myocardial infarction (IMI). Those with AMI implanted temporary pacemaker more frequently (71.4% vs 60.3%), presented more often KK>1 (71.4% vs 37,2%;p<0.001), left ventricular dysfunction (100% vs 34.8%;p<0.001), but less right ventricular dysfunction (7.1% vs 28.4%;p<0.001). Compared with IMI pts, AMI pts had higher risk of in hospital [OR 9.04, 95% CI (2.87-28.50);p<0.001] and 6-month mortality [OR 10.88; 95% CI (3.33 – 35.53);p<0.001]. After adjusting for different baseline characteristics in multivariate analysis, HABV patients had higher risk of overall 6-month mortality compared to those without HABV [OR 2.18, 95% CI (1.25-3.79),p=0.006]. Conclusion: Besides low incidence of HABV, this complication continues to have a high risk of in-hospital and 6-month mortality and occurring with AMI the risk increases significantly.
    2015Conference object Open access Show more
  • Low serum albumin – another prognostic marker?
    Publication . Arantes, C; Quina-Rodrigues, C; Abreu, G; Martins, J; Galvão-Braga, C; Vieira, C; Azevedo, P; Álvares-Pereira, M; Rocha, S; Marques, J
    Introduction: Population-based studies have suggested an association between low serum albumin levels and coronary atherosclerosis and heart failure. The role of albumin in the context of acute coronary syndromes (ACS) remains unclear, however, seems to associate with an adverse prognosis. Aim: The aim of the present study was to determine whether low serum albumin levels are associated with development of heart failure in ACS. Methods: Study of patients consecutively admitted for ACS in a Coronary Unit over 6 months. Patients with infectious complications were excluded. Results: One hundred sixty-eight patients were eligible for analysis. Males were predominant (81.5%) and the mean age was 61.7±13.4 years old. Low serum albumin levels (serum albumin <3.5g/dl) were present in 44.6%. No significant differences were observed regarding demographic characteristics, except higher mean age (p <0.001) and a higher prevalence of hypertension (p = 0.04) in the hypoalbuminemia group. This group had lower values of hemoglobin (p<0.001) and higher levels of pro-BNP (p=0.018) and C Reactive Protein (p<0.001). In univariate analysis, hypoalbuminemia was associated with a higher prevalence of heart failure (p=0.015, OR 2.45 CI95% 1.17-5.10) and the use of intra-aortic balloon (p = 0.005) during hospitalization. There were no statistically significant differences in the use of ionotropic drugs and invasive ventilation as well as in-hospital mortality. At follow-up at 6 months showed a positive association between hypoalbuminemia and mortality (p <0.05). Conclusions: The hypoalbuminemia was associated with an increased risk of heart failure during hospitalization and death at 6 months. Although the etiology of hypoalbuminemia remain unclear, albumin assay may be useful in risk stratification of acute coronary syndromes.
    2015Conference object Open access Show more