Browsing by Author "Rocha, S"
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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
- Admission glycemia: a predictor of death after acute coronary syndrome in non-diabetic patients?Publication . Rocha, S; Nabais, S; Magalhães, S; Salgado, A; Azevedo, P; Marques, J; Torres, M; Pereira, MA; Correia, ABACKGROUND: Previous studies have demonstrated that acute phase hyperglycemia is associated with increased in-hospital mortality in diabetic patients admitted with acute coronary syndrome (ACS), but this has not been clearly demonstrated in non-diabetic patients. The present study was designed to determine whether admission hyperglycemia (AG) is an independent predictor of in-hospital and six-month mortality after ACS in non-diabetic patients. METHODS: This was a retrospective cohort study of 426 non-diabetic patients consecutively admitted with ACS. The patients were stratified into quartile groups according to AG, which was also analyzed as a continuous variable. Vital status was obtained at six-month follow-up in 96.8% of the patients surviving hospitalization. Logistic regression analysis was used to identify independent predictors of in-hospital and six-month death. RESULTS: Of the 426 patients included in the study (age 62.6 years+/-13.1, 77% male), 22 (5.4%) patients died during hospitalization and 20 (5.2% of the patients surviving hospitalization) within six months of ACS. Mean AG was 134.89 mg/dl+/-51.95. The higher the AG, the more probable was presentation with ST-segment elevation ACS (STEMI), anterior STEMI, higher heart rate, Killip class higher than one (KK >1), higher serum creatinine and greater risk of in-hospital and six-month death. In multivariate analysis, only age (OR=1.10; 95% CI 1.04-1.17), STEMI (OR=3.02; 95% CI 1.07-8.50), AG (OR=1.073; 95% CI 1.004-1.146), serum creatinine (OR=1.10; 95% CI 1.009-1.204) and KK >1 on admission (OR=4.65; 95% CI 1.59-13.52) were independently associated with in-hospital death. Age (OR=1.07; 95% CI 1.03-1.12), serum creatinine (OR=1.09; 95% CI 1.01-1.18) and in-hospital development of heart failure (OR=2.34; 95% CI 1.07-5.10) were independently associated with higher risk of death within six months of ACS. CONCLUSIONS: AG is an independent predictive factor of in-hospital death after ACS in non-diabetic patients. Although it did not show an independent association with higher risk of six-month death, AG appears to contribute to it, since the risk is greater the higher the AG. Its predictive value may have been blunted by the insufficient power of the sample and/or by the time interval between acquisition of AG and the evaluated endpoint.
- An image is worth 1000 wordsPublication . Arantes, C; Galvão-Braga, C; Marques, J; Costa, J; Ribeiro, S; Martins, J; Abreu, G; Quina, C; Rocha, S
- An unusual trigger causing Takotsubo SyndromePublication . Abreu, G; Rocha, S; Bettencourt, N; Azevedo, P; Vieira, C; Rodrigues, C; Arantes, C; Braga, C; Martins, J; Marques, J
- Cardiogenic shock complicating acute coronary syndromesPublication . Abreu, G; Arantes, C; Galvão-Braga, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Salgado, A; Gaspar, A; Rocha, S; Marques, JINTRODUCTION: 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.
- 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
- Uma causa rara de insuficiência aórticaPublication . 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
- Uma causa rara de paralisia facial periférica recorrentePublication . Pinho, J; Rocha, S; Machado, A; Lourenço, ERecurrent peripheral facial palsy (PFP) is not uncommon and it is reported in 3 to 15% of idiopathic PFPs. Other etiologies include intracranial compressive tumors, parotid gland tumors or inflammation, recurrent otitis media, head trauma, multiple sclerosis, sarcoidosis, tuberculosis, Lyme disease, HIV, and the rare Melkersson-Rosenthal Syndrome (MRS). The MRS is a non-necrotizing granulomatous disease characterized by PFP, lingua plicata and orofacial edema, even though the classic triad is reported in only from 20 to 30% of the patients1. We describe a patient with recurrent alternating PFP with MRS.
- Choque cardiogénico…ou algo maisPublication . Arantes, C; Ribeiro, S; Marques, J; Vieira, C; Ramos, V; Galvão-Braga, C; Martins, J; Salgado, A; Oliveira, J; Pereira, E; Rocha, S; Correia, 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