HB - CAR - Comunicações e Conferências
Permanent URI for this collection
Browse
Recent Submissions
- Prevalence and outcomes of ST-segment elevation myocardial infarction patients resulting from definite stent thrombosisPublication . Abreu, G; Costa, J; Quina-Rodrigues, C; Arantes, C; Fonseca, S; Martins, J; Galvão-Braga, C; Vieira, C; Azevedo, P; Marques, J
- Prevalence of cancer and its impact on prognosis of acute coronary syndrome populationPublication . Abreu, G; Azevedo, P; Arantes, C; Quina-Rodrigues, C; Fonseca, S; Martins, J; Vieira, C; Álvares-Pereira, M; Marques, J
- Será o que parece?Publication . Abreu, G; Rocha, S; Bettencourt, N; Quina-Rodrigues, C; Arantes, C; Martins, J; Fonseca, S; Vieira, C; Barbosa, L; Azevedo, P; Marques, J
- 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
- Percutaneous coronary intervention of RIMAPublication . Abreu, G
- Atypical presentation of an intracardiac massPublication . Abreu, G; Azevedo, P; Bettencourt, N; Vieira, C; Arantes, C; Quina, C; Vilaça, A; Marques, J
- Prevalence of conventional cardiovascular risk factors in patients with acute coronary syndromePublication . Abreu, G; Azevedo, P; Arantes, C; Martins, J; Braga, C; Quina-Rodrigues, C; Vieira, C; Marques, JBackground: Primary prevention studies have shown that early detection and aggressive treatment of cardiovascular risk factors (CRF) prevent cardiovascular events. It is not well described the prevalence of CRF in patients, at the moment of admission due to acute coronary syndrome (ACS). Aim: To determine the prevalence of CRF among patients admitted with ACS. Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. We studied the prevalence of conventional risk factors (diabetes, hypertension, smoking, dyslipidaemia) and compared findings according to gender and type of ACS: ACS with ST elevation (STEMI), ACS without ST elevation (NSTEMI). Results: Men represented 75% (n=3658) of the total population, were younger than women (61.6±12,9 vs 70.9 ±11.8 years; p<0.001) and had more frequently body mass index ≥ 25 kg/m2 (70.9% vs 62.3%; p<0.001). The most frequent CRF was hypertension (62.4%; n=3038), followed by dyslipidaemia (50.6%, n=2467), smoking (43.2%; n=2106) and diabetes (27.2%; n=1324). In women, the more common CRF were hypertension (75%) and dyslipidaemia (51.2%), whereas in men were smoking (54.4%) and dyslipidaemia (50.5%). We identify, at least, one CRF in 92,4% of all patients and two or three risk factors in 58.1%. Women had more frequently 2 CRF than men (40.1% vs 36.3%; p=0.011), although mean had, more often, 4 CRF (8.9% vs 4.1%; p<0.001). Previous history of cerebrovascular disease was more observed in women (8.6% vs 6.1%; p=0.002), but men had more often history of previous revascularization (9.8% vs 6.8%; p<0.001). On admission men presented more frequently STEMI (50.8% vs 43.5%; p<0,001) and less frequently renal dysfunction (17.2% vs 39.6%; p<0.001) and anaemia (18.8% vs 33.3%; p<0.001). Hypertension was the most prevalent CFR as in patients STEMI (56.6%) as in NSTEMI patients (67.9%), followed by smoking (47.5%) in STEMI patients and by dyslipidaemia (55.7%) in NSTEMI patients. Conclusion: We found at least one CRF in 92.8% of patients and two or three in more than half. Hypertension emerged as the major CRF in both forms of presentation of ACS.
- Temporal trends of risk profile among patients admitted with acute coronary syndromePublication . Abreu, G; Azevedo, P; Arantes, C; Martins, J; Braga, C; Quina-Rodrigues, C; Vieira, C; Marques, JBackground: Clinical practice focuses on the primary prevention of cardiovascular (CVD) disease through the modification and pharmacological treatment of elevated risk factors, in order to minimize long-term CVD risk. Aim: To determine if there are differences in risk profile of patients admitted with acute coronary syndrome over time. Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups of 4 consecutive years: group 1 – from 2002 to 2005 (n=1245, 25.6%); group 2 – from 2006 to 2009 (n=1562, 32%); group 3 - from 2010 to 2013 (n=2064, 42.4%). For each group we studied the prevalence of conventional risk factors (CRF) including diabetes, hypertension, smoking and dyslipidaemia over time and compared findings according to sex and type of acute coronary syndrome: Results: Women were less prevalent in group 3 (26.2% vs 26.9% vs 22.6%, p=0.006). Temporal trends of age and diabetes didn’t show statistic signify. Group 2 and 3 evidenced higher body mass index (26.48±4.0 vs 27.13±5.8 vs 27.15±4.67 kg/m2; p<0.001), had higher prevalence of dyslipidaemia (43.1% vs 49.2% vs 56.3%; p<0.001), smoking (39.4% vs 65.0% vs 64.4%; p<0.001) and hypertension (55.7% vs 65.0% vs 64.4%; p<0.001). We found at least 1 CRF in 92,4% of patients. The first temporal period had higher prevalence of 1 or 2 CRF, on the contrary two thirds of patients in group 3 had 2 or 3 CRF. Over time, hypertension was more prevalent in women (69.3% vs 77,4% vs 78.6%; p=0,007), on the other hand, smoking and dyslipidaemia occurred more often in men. It was observed an increasing tendency of smoking (44% vs 41.6% vs 54%; p<0.001) and dyslipidemia (37.2% vs 45.3% vs 50.5%, p<0.001) over time. In those patients admitted with STEMI, it was observed an increased tendency on smoking. The last period registered LDL levels >100 mg/dl more often (66% vs 57% vs 68.8%; p=0.022), but higher control of systolic blood pressure below 140mmHg (54.2% vs 59.6% vs 65.7%, p<0.001. Conclusion: We found that the risk profile of patients presenting with acute coronary syndrome worsened over the years. In recent time, patients had more CRF, being smoking and hypertension the leaders.
- Modified shock index - a strong preditor of outcome among patients presenting ST-segment elevation myocardial infarctionPublication . Abreu, G; Braga, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Azevedo, P; Álvares-Pereira, M; Marques, JBackground: Prompt identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention will allow a more assertive strategy and approach. Aim: To evaluate the modified shock index (MSI) - a ratio of heart rate (HR) to mean blood pressure (MAP), as a predictor of in hospital and 6-month mortality among patients (pts) admitted with STEMI. Methods: We analyzed retrospectively 2389 pts admitted consecutively in our coronary care unit with acute coronary syndrome, from July of 2009 to June 2014 and we selected those who presented with STEMI (n=1140). They were divided in two groups: group 1 – pts with MSI <1.3, n=1076, 94.4%); group 2 – pts with MSI ≥1.3 (n=64, 5.6%). 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 99% of patients. Results: Patients of group 2 were older (62±14 vs 67±14; p=0.003), more frequent women (19% vs 37.5%; p<0.001), had more prevalence of atrial fibrillation (10.3% vs 20.3%; p<0.001) and previous stroke (5.9% vs 14.1%; p=0.016). On admission, group 2 presented more often lower MAP (96±18 vs 71±14; p<0.001) and higher HR (76±17 vs 108±19; p<0.001) values; Killip >1 (18.0% vs 56.3%; p<0.001), Killip=4 (2.9% vs 28.1%; p<0.001), anaemia (20.9% vs 48.4%; p<0.001) and renal insufficiency (eGFR<60 ml/min) (21.8% vs 42.6%; p<0,001). They also presented more severe coronary disease - left main coronary artery or 3 vessels disease (16.3% vs 31.3%; p=0.005) and higher prevalence of moderate to severe systolic dysfunction (48.3% vs 68.9%; p=0.009). They required more often aminergic support (7.4% vs 50%; p<0.001), intra-aortic balloon pump (2.9% vs 38.3%; p<0.001) and mechanical ventilation (2.6% vs 17.4%; p<0.001). They also had higher prevalence of malignant arrhythmias (6.1% vs 15.6%; p= 0.008) and mechanical complications (1.7 vs 6.3%; p=0.031). Compared with 1st group, the 2nd group had 6.42 times higher in hospital mortality [OR 6.42; 95% CI (4.07 – 12.67)]; p <0.001] and 7.18 times higher 6-month mortality [OR 7.18; 95% CI (3.30 - 12.46)]; p <0.001]. After adjusting for different baseline characteristics in multivariate analysis, MSI ≥1.3 remained as independent predictor of overall 6-month mortality [OR 3.81, 95% CI (1.81-8.03), p<0.001]. Conclusion: Modified shock index ≥1.3 is a stronger predictor of in hospital and 6 month mortality among patients with STEMI.
- Incidence of in-stent restenosis over 13 years - a study based on a national registryPublication . Abreu, G; Braga, C; Arante, C; Martins, J; Rodrigues, C; Azevedo, P; Álvares-Pereira, M; Costa, J; Marques, JBackground: In-stent restenosis (ISR) is one drawback of coronary angioplasty with stent implantation. Purpose: We investigated the incidence of ISR, its clinical presentation and treatment from a national registry. Methods: From all patients (pts) undergoing percutaneous coronary intervention (PCI) from 2002 to 2014, we selected those who had previous history of PCI (n=15326). ISR was defined as diameter stenosis ≥ 50% in stent segment, being selected the interventions in which, at least, 1 IRS lesion was treated (n=3069). They were divided in 3 temporal groups:2002-2003 (group 1, n=179, 5.8%)– bare metal stent era; 2004-2008 (group 2,n=816, 26.6%)– 1st generation stent era; 2009-2014 (group 3, n=2074, 67.6%)– 2nd generation stent era. For each group we compared clinical features and treatment. Results: Over time, it has been observed a reduction in IRS incidence (24.8 vs 23.5 vs 18.6%;p for trend <0.001). Pts from group 3 were older (p=0.01), had higher prevalence of hypertension (63.7 vs 75.6 vs 78.4%;p<0.001), dyslipidemia (61.5 vs 68.5 vs 73.9%;p<0.001) and diabetes (31.3 vs 33.5 vs 38.5%;p=0.012). They also had more frequently history of previous myocardial infarction (p<0.001). Although admissions were more frequently due to stable angina (41% of total) or post non-ST segment myocardial infarction (16.3% of total); it was noticed, over time, an increase in admissions due to ST segment elevation myocardial infarction (1.1 vs 7.4 vs 11.4%;p<0.001) and unstable angina (1.1 vs 1.8 vs 3.7%;p<0.001). Most of pts presented with good systolic ventricular function, but an increase of pts with moderated (2.6 vs 9.0 vs 11.2%;p<0.001) and severe (1.3 vs 1.4 vs 4.7%;p<0.001) systolic dysfunction was observed. From 3069 PCI performed, a total of 3461 IRS lesions were treated. It was observed, at most, 3 IRS lesions for PCI. Over time, the most frequent presentation was 1 lesion for PCI (88.4% of total), being noticed a decreasing in number of multiple IRS lesions (15.1 vs 11.3 vs 9.6%;p=0.035). Incidence of ISR has increased in left descendant coronary artery (34.5 vs 39.8 vs 42.4%;p<0.001) and treatment was more frequently performed in more complex lesions (p<0.001). It was noticed a reduction in treatment with stent (72.7 vs 74.4 vs 52.8%;p<0.001) and an increasing use of only PCI balloon (39.3 vs 57.8 vs 45.8%;p=0.002) and trombectomy (0.0 vs 2.2 vs 8.2%;p<0.001). Conclusion: In spite of increasing in risk profile of pts over time, it was observed a reduction of incidence of ISR and multiple ISR lesions. It also was observed an increasing number of interventions avoiding second stent implantation.