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Browsing by Author "Salgado, A"

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  • 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, A
    BACKGROUND: 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.
    2007Journal article Open access Show more
  • Anomalous coronary origin: From suspicion to surgical revascularization
    Publication . Vieira, C; Nabais, S; Salgado, A; Salomé, N; Sousa, P; Madureira, AJ; Pinho, P
    Congenital anomalies of the coronary arteries are uncommon and can present a diagnostic challenge. The authors present the case of a patient with recurrent chest pain during exertion admitted for acute coronary syndrome. Coronary angiography revealed no coronary lesions but showed that the right coronary artery originated from the anterolateral aortic wall, above the sinuses of Valsalva, leading to suspicion of compression by the pulmonary artery, confirmed by CT angiography. The patient underwent surgical revascularization with a good result. The authors highlight the need to consider compression of an anomalous coronary artery by the pulmonary artery in the differential diagnosis of recurrent chest pain on exertion and acute myocardial infarction without significant coronary stenosis.
    2014Journal article 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
  • Caseous calcification of the mitral annulus: A multi-modality imaging perspective
    Publication . Ribeiro, S; Salgado, A; Salomé, N; Bettencourt, N; Azevedo, P; Costeira, A; Correia, A
    Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment.
    2012Journal article 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
  • Choque cardiogénico…ou algo mais
    Publication . 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
    2013Conference object Open access Show more
  • Comparação das características clínicas entre EAM, miocardite aguda e miocardiopatia de stress – um desafio diagnóstico
    Publication . 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
    2014Conference object Open access Show more
  • Complicações mecânicas do EAM na era da reperfusão – tipo, incidência, fatores associados e prognóstico
    Publication . 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
    2014Conference object Open access Show more
  • Degenerescência caseosa da calcificação do anel mitral: uma perspectiva multi-imagem
    Publication . Ribeiro, S; Salgado, A; Salomé, N; Bettencourt, N; Azevedo, P; Costeira, A; Correia, A
    Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment.
    2012Journal article 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