RESUMEN

BACKGROUND: Maternal vaccination is safe and provides protection against COVID-19 in mothers and neonates, and it is necessary to evaluate its effect on the induction of immune responses through the levels of neutralizing antibodies present in maternal and neonatal blood. METHODS: An observational study with transversal analysis was carried out. Included in the research were neonates (<1 month) whose mothers had been immunized whilst pregnant with at least one dose of the vaccine BNT16b and had not shown any symptoms of COVID-19. The blood of the mothers and newborns was collected during the Guthrie test and sent to the laboratory for the detection of neutralizing antibodies against SARS-CoV-2. RESULTS: A total of 162 pairs of mothers and neonates were analyzed with an average age of 26.3 ± 5.97 years and 13.4 ± 6.90 days, respectively. All samples collected present neutralizing antibodies with an average percentage of 91% in the mothers and 92% in the neonates. The most satisfactory immune response was observed in neonates and mothers vaccinated during the second trimester of gestation. CONCLUSIONS: The vaccination of expectant mothers with the immunizer BNT162b2 has promoted a robust immunological response in both the mothers and the neonates.

RESUMEN

AIMS: The goal of this study was to evaluate the performance of the InspironTM coronary stent (Scitech Medical™, Goiás, Brazil). The InspironTM sirolimus-eluting stent uses an ultrathin L-605 cobalt-chromium alloy with a 75 µm strut thickness platform coated with an abluminal biodegradable polymer. The polymer is eliminated from the body through the tricarboxylic acid cycle in 6-9 months, releasing 80% of the drug within 30 days after its deployment. METHODS: It was a prospective, single-center registry. To represent clinical practice, all patients undergoing percutaneous coronary intervention were included in this registry. There were no exclusion criteria. Clinical follow-ups were performed at twelve months. The endpoints were the occurrence of all-cause death, definite stent thrombosis, and new revascularization. RESULTS: Between November 2017 and May 2019, 790 patients were included (1067 lesions). The mean age was 60.42 ± 14.94 years, and 74.7% presented with acute coronary syndrome. Diabetes mellitus was present in 43.9% of patients, and previous myocardial infarction and previous percutaneous coronary intervention were present in 17.9% and 11.3%, respectively. Angiographic success was achieved in 99.1%. The incidence of all-cause death was 11.5% (6.2% in-hospital and 5.3% in the follow-up) and definitive stent thrombosis was 0.2%. New revascularization was performed in only 5.8% (target lesion revascularization: 2.2%; progression of disease in another lesion: 3.6%). Based on the multivariate regression analysis, only chronic renal failure was an independent predictor of adverse events (OR: 3.3; 95% CI: 1.22-8.92). CONCLUSION: The result of this single-center registry demonstrates the safety and excellent performance of the InspironTM stent in daily clinical practice with a low rate of adverse cardiac events.

Asunto(s)

Síndrome Coronario Agudo , Plásticos Biodegradables/farmacología , Aleaciones de Cromo/farmacología , Stents Liberadores de Fármacos/efectos adversos , Intervención Coronaria Percutánea , Sirolimus/farmacología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/cirugía , Brasil/epidemiología , Materiales Biocompatibles Revestidos/farmacología , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/etiología , Reestenosis Coronaria/cirugía , Femenino , Humanos , Inmunosupresores/farmacología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Estudios Prospectivos , Diseño de Prótesis , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos

RESUMEN

Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker and has been proved to be related to a worse prognosis in heart diseases. However, the precise relationship between elevated CA125 in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been sufficiently studied. We set out to determine the association of CA125 with all-cause mortality at 6 months in STEMI. CA125, N-terminal pro brain natriuretic peptide (NTproBNP) and high sensitive C-reactive protein (hs-CRP) were measured in 245 patients admitted consecutively with STEMI undergoing coronary angioplasty. The mean age in our sample was 63.7 years, 64.9% were males, 28.3% had diabetes and 17.7% presented with acute heart failure (Killip ≥ 2). The median serum level of CA125 was 8.1 U/ml. At 6 months, the rate of all-cause mortality was 18% (44 patients). Receiver operating characteristic curve analysis demonstrated that CA125 presented similar performance to predict mortality as NTproBNP and hs-CRP. Patients with CA125 ≥ 11.48 had a higher rate of mortality (Hazard Ratio = 2.07, 95% confidence interval = 1.13-3.77, p = 0.017) than patients with CA125 < 11.48. This study suggests that elevated CA125 levels might be used to identify patients with STEMI with a higher risk of death at 6 months. CA125 seems to be a similar predictor of mortality compared to NTproBNP and hs-CRP.

Asunto(s)

Biomarcadores/sangre , Antígeno Ca-125/sangre , Infarto del Miocardio con Elevación del ST/mortalidad , Regulación hacia Arriba , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Pronóstico , Estudios Prospectivos , Curva ROC , Infarto del Miocardio con Elevación del ST/sangre , Análisis de Supervivencia

RESUMEN

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty

Asunto(s)

Humanos , Femenino , Adulto , Hemorragia Uterina/complicaciones , Mujeres , Stents , Angioplastia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Angioplastia Coronaria con Balón/métodos , Embolización Terapéutica/métodos , Leiomioma

RESUMEN

To verify the frequency and predictors associated with stent thrombosis (ST) in a developing country. Observational, case-control study including 2535 consecutive patients undergoing percutaneous coronary intervention (PCI) in two reference hospitals in Brazil, from October 2013 to December 2015. ST patients were matched to controls in a 1:3 ratio for gender, age, procedure indication, and performing hospital. From the total sample, 65 (2.5%) ST occurred and were matched with 195 controls (age 64.9 ± 11.8 years; hypertension, 78.8%; diabetes, 30%). Clopidogrel and aspirin early withdrawal (OR 19.25; 95% CI 1.66-23.52; p < 0.01 and OR 4.36; 95% CI 1.81-10.50; p = 0.001, respectively), hypertension (OR 3.64; 95% CI 1.38-9.61; p = 0.006), dyslipidemia (OR 2.84; 95% CI 1.48-5.45; p = 0.002), smoking (OR 3.09; 95% CI 1.28-7.43; p = 0.02), body mass index ≥ 30 kg/m2 (OR 2.10; 95% CI 1.02-4.49; p = 0.012), previous myocardial infarction (OR 2.98; 95% CI 1.14-7.47; p < 0.001), bifurcation lesion (OR 2.44; 95% CI 1.05-5.67; p = 0.03), and ≥ 3 stents (OR 3.90; 95% CI 1.78-8.52; p = 0.002) were associated with ST. Stent type, diameter or length, severity of coronary artery disease, calcified lesions, and thrombus were not associated with ST. We found a similar frequency of ST from developed countries and identified strong predictors (clopidogrel and aspirin withdrawal, hypertension, dyslipidemia, smoking, obesity, previous myocardial infarction, bifurcation lesion, number of stents), which are in line with reports from developed countries.

Asunto(s)

Trombosis Coronaria/etiología , Stents/efectos adversos , Anciano , Aspirina , Brasil , Estudios de Casos y Controles , Clopidogrel , Enfermedad de la Arteria Coronaria , Trombosis Coronaria/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Pronóstico , Diseño de Prótesis , Factores de Riesgo

RESUMEN

All patients with heart diseases should undergo risk stratification to predict those who are at high risk for short- and long-term adverse outcomes. Carbohydrate antigen 125 (CA125) is a glycoprotein produced by mesothelium that has clinical role in ovarian cancer monitoring. However, as it is not specific for ovarian cells, CA125 could also be used in heart diseases to monitor congestion and inflammation. Pericarditis, atrial fibrillation, heart failure and coronary artery disease are some scenarios in which this biomarker was studied.CA125 identifies patients at high risk of rehospitalizations and death, in addition to being associated with hemodynamic data (ejection fraction and right atrial pressure). Hence, CA125 is a tool for risk stratification in heart diseases.

Asunto(s)

Antígeno Ca-125/metabolismo , Cardiopatías/metabolismo , Biomarcadores/metabolismo , Humanos , Medición de Riesgo

RESUMEN

BACKGROUND: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. METHODS: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24h after randomization. RESULTS: Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. CONCLUSIONS: In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.

Asunto(s)

Adenosina/análogos & derivados , Clorhidrato de Prasugrel/administración & dosificación , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Terapia Trombolítica/métodos , Adenosina/administración & dosificación , Angiografía Coronaria , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Estudios Prospectivos , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Infarto del Miocardio con Elevación del ST/diagnóstico , Ticagrelor , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Acute kidney injury (AKI) is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. METHODS: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU) of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. RESULTS: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV) infection, HIV/acquired immunodeficiency syndrome (AIDS) (30%), tuberculosis (12%), leptospirosis (11%) and dengue (4%). Dialysis was performed in 70 cases (27.6%). The patients were classified as risk (4.4%), injury (63.6%) or failure (32%). The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01) and dengue (68±11, p-value=0.01). Death occurred in 159 cases (62.8%). Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02). A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. CONCLUSIONS: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.

Asunto(s)

Lesión Renal Aguda/mortalidad , APACHE , Lesión Renal Aguda/etiología , Estudios de Cohortes , Enfermedad Crítica/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.

Asunto(s)

Trombocitopenia/etiología , Enfermedad de Weil/complicaciones , Lesión Renal Aguda/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Causas de Muerte , Niño , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Centros de Atención Terciaria , Enfermedad de Weil/mortalidad , Adulto Joven

RESUMEN

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. .

Asunto(s)

Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Trombocitopenia/etiología , Enfermedad de Weil/complicaciones , Lesión Renal Aguda/complicaciones , Brasil , Causas de Muerte , Mortalidad Hospitalaria , Hospitalización , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Centros de Atención Terciaria , Enfermedad de Weil/mortalidad

RESUMEN

Introduction: Acute kidney injury (AKI) is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU) of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV) infection, HIV/acquired immunodeficiency syndrome (AIDS) (30%), tuberculosis (12%), leptospirosis (11%) and dengue (4%). Dialysis was performed in 70 cases (27.6%). The patients were classified as risk (4.4%), injury (63.6%) or failure (32%). The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01) and dengue (68±11, p-value=0.01). Death occurred in 159 cases (62.8%). Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02). A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases. .

Asunto(s)

Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesión Renal Aguda/mortalidad , APACHE , Lesión Renal Aguda/etiología , Estudios de Cohortes , Enfermedad Crítica/epidemiología , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Estudios Retrospectivos

RESUMEN

BACKGROUND: In the elderly, the ankle-brachial index (ABI) has greater than 90% sensitivity and specificity for peripheral artery disease identification. A well-known relation exists between peripheral artery disease and the number of diseased coronary vessels. Yet, other anatomical characteristics have important impacts on the type of treatment and prognosis. PURPOSE: To determine the relation between ABI and the complexity of coronary artery disease, by different anatomical classifications. METHODS: This study was a prospective analysis of patients ≥65 years old who were undergoing elective coronary angiography for ischemic coronary disease. The ABI was calculated for each leg, as the ratio between the lowest ankle pressure and the highest brachial pressure. The analysis of coronary anatomy was performed by three interventional cardiologists; it included classification of each lesion with >50% diameter stenosis, according to the American Heart Association criteria, and calculation of the SYNTAX score. RESULTS: The study recruited 204 consecutive patients (median age: 72.5 years). Stable angina was present in 51% of patients. Although only 1% of patients reported peripheral artery disease, 45% exhibited an abnormal ABI. The number of lesions per patient, the number of patients with complex lesions, and the median SYNTAX scores were greater in the group with abnormal ABI. However, among 144 patients with obstructive coronary artery disease, despite abnormal ABI being able to identify a higher rate of patients with B2 or C type lesions (70.9% versus 53.8%; P=0.039), the mean SYNTAX scores (13 versus 9; P=0.14), and the proportion of patients with SYNTAX score >16 (34.2% versus 27.7%; P=0.47), were similar, irrespective of ABI. CONCLUSION: In patients ≥65 years old the presence of peripheral artery disease could discriminate a group of patients with greater occurrence of B2 and C type lesions, but similar median SYNTAX score.

Asunto(s)

Índice Tobillo Braquial , Enfermedad de la Arteria Coronaria/fisiopatología , Anciano , Brasil , Intervalos de Confianza , Femenino , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Enfermedad Arterial Periférica/diagnóstico , Estudios Prospectivos , Sensibilidad y Especificidad

RESUMEN

OBJECTIVES: To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment. METHODS: This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764 RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality. CONCLUSIONS: In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients. .

Asunto(s)

Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad Hospitalaria , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Brasil , Fibrinolíticos/uso terapéutico , Modelos Logísticos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Volumen Sistólico/fisiología , Factores de Tiempo , Resultado del Tratamiento , Centros de Atención Terciaria/estadística & datos numéricos , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico

RESUMEN

As plaquetas estão envolvidas em vários processos biológicos, desde o combate a agentes infecciosos até a coordenação do controle da permeabilidade vascular e angiogênese. Entretanto, o seu principal foco de ação consiste na modulação da cascata de coagulação. A intervenção coronariana percutânea é um procedimento com alto risco trombogênico, que induz a ativação plaquetária e de monócitos, devido à lesão direta do endotélio e pelo contato de estruturas trombogênicas com o sangue, levando ao aumento da atividade inflamatória, tanto no local do dano vascular coronariano como de forma sistêmica. Os receptores plaquetários P2Y12 desempenham papel central na amplificação da agregação induzida por todos os agonistas plaquetários, como a adenosina difosfato, o colágeno, tromboxano A2, adrenalina e serotonina. Por esse motivo, têm sido o principal alvo das drogas antiplaquetárias. Apesar de atuarem no mesmo receptor, características farmacocinéticas e farmacodinâmicas distintas conferem peculiaridades a cada agente.

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Apart from their role in hemostasis and thrombosis, platelets are involved in many other biological processes such as wound healing and angiogenesis. Percutaneous coronary intervention is a highly thrombogenic procedure inducing platelets and monocytes activation through endothelial trauma and contact activation by intravascular devices. Platelet P2Y12 receptor activation by adenosine diphosphate facilitates non-ADP agonist-mediated platelet aggregation, dense granule secretion, procoagulant activity, and the phosphorylation of several intraplatelet proteins, making it an ideal drug target. However, not all compounds that target the P2Y12 receptor have similar efficacy and safety profiles. Despite targeting the same receptor, the unique pharmacologic properties of each of these P2Y12 receptor-directed compounds can lead to very different clinical effects.

Asunto(s)

Humanos , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/farmacología , Agregación Plaquetaria/efectos de los fármacos , /farmacología , /efectos de los fármacos , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/farmacología , Adenosina/análogos & derivados , Adenosina/farmacología , Piperazinas/farmacología , Tienopiridinas/farmacología , Tiofenos/farmacología

RESUMEN

Apart from their role in hemostasis and thrombosis, platelets are involved in many other biological processes such as wound healing and angiogenesis. Percutaneous coronary intervention is a highly thrombogenic procedure inducing platelets and monocytes activation through endothelial trauma and contact activation by intravascular devices. Platelet P2Y12 receptor activation by adenosine diphosphate facilitates non-ADP agonist-mediated platelet aggregation, dense granule secretion, procoagulant activity, and the phosphorylation of several intraplatelet proteins, making it an ideal drug target. However, not all compounds that target the P2Y12 receptor have similar efficacy and safety profiles. Despite targeting the same receptor, the unique pharmacologic properties of each of these P2Y12 receptor-directed compounds can lead to very different clinical effects.

Asunto(s)

Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/farmacología , Agregación Plaquetaria/efectos de los fármacos , Antagonistas del Receptor Purinérgico P2Y/farmacología , Receptores Purinérgicos P2Y12/efectos de los fármacos , Adenosina/análogos & derivados , Adenosina/farmacología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/farmacología , Humanos , Piperazinas/farmacología , Clorhidrato de Prasugrel , Tienopiridinas/farmacología , Tiofenos/farmacología , Ticagrelor

RESUMEN

OBJECTIVES: To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment. METHODS: This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764 RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality. CONCLUSIONS: In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients.

Asunto(s)

Mortalidad Hospitalaria , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Anciano , Brasil , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Volumen Sistólico/fisiología , Tenecteplasa , Centros de Atención Terciaria/estadística & datos numéricos , Terapia Trombolítica/métodos , Factores de Tiempo , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento

RESUMEN

Paciente jovem, com histórico de tabagismo, hipertensão arterial e uso de drogas ilícitas (cannabis, cocaína e crack), foi admitido com dor precordial após atividade física, com cerca de duas horas de evolução. O eletrocardiograma demonstrou supradesnivelamento do segmento ST de V1 a V4, e o paciente foi encaminhado para cateterismo cardíaco, que evidenciou oclusão total da artéria descendente anterior e grande quantidade de trombos na coronária direita. Foi tratado com implante direto de stents na artéria descendente anterior e terapia antiplaquetária tripla com aspirina, clopidogrel e abciximab associada a heparina não-fracionada, mantidas por 24 horas. Reavaliações angiográfica e ultrassonográfica após 48 horas demonstraram resolução completa dos trombos em ambas as coronárias.

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Young patient with a history of smoking, hypertension and use of illicit drugs (cannabis, cocaine and crack) was admitted with precordial pain after physical exercise within the previous two hours. Electrocardiogram demonstrated ST segment elevation in leads V1 to V4 and the patient was referred to cardiac catheterization, which showed total occlusion of the left anterior descending artery and a large amount of thrombi in the right coronary artery. The patient was treated with direct stenting in the left anterior descending artery and triple antiplatelet therapy with aspirin, clopidogrel and abciximab in combination with non-fractioned heparin for 24 hours. Angiography and intravascular ultrasound assessment after 48 hours demonstrated a complete resolution of thrombi in both coronary arteries.

Asunto(s)

Humanos , Masculino , Adulto , Angiografía Coronaria/métodos , Angiografía Coronaria , Cateterismo/métodos , Cateterismo , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico , Factores de Riesgo

RESUMEN

Introdução: O ultrassom intracoronário (USIC) é um método capaz de fornecer medida sensível e reprodutível das dimensões da artéria coronária, da placa aterosclerótica e do lúmen arterial. Avanços em sua tecnologia permitem agora a caracterização da composição e da morfologia das placasateroscleróticas. Embora estudos prévios tenham reportado dados utilizando USIC com análise de radiofrequência, o uso de uma nova modalidade (iMap®, Boston Scientific, Santa Clara, Estados Unidos) de caracterização da placa ateroscleróticaé muito pouco conhecida. Nosso objetivo será analisar as características morfológicas, teciduais e fenotípicas das placas ateroscleróticas consideradas angiograficamente “culpadas” e“não-culpadas” em pacientes submetidos a angiografia coronáriadecorrente de infarto agudo do miocárdio (IAM). Métodos: Estudo prospectivo, transversal, em único centro (Hospital São Paulo – Escola Paulista de Medicina – UniversidadeFederal de São Paulo/UNIFESP, São Paulo, SP, Brasil). Serão selecionados50 pacientes para análise ultrassonográfica, de acordo com os seguintes critérios de inclusão: idade < 75 anos, IAM sem supradesnivelamento do segmento ST ou IAM com supradesnivelamento do segmento ST recente, com ou sem uso de fibrinolítico prévio. Conclusões: O presente estudoobjetivará a caracterização morfológica, tecidual e fenotípica da placa aterosclerótica utilizando uma nova modalidade de imagem ainda pouco estudada em pacientes com IAM.

Asunto(s)

Humanos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Ultrasonografía/métodos , Ultrasonografía , Estudios Prospectivos , Estudios Transversales

RESUMEN

INTRODUÇÃO: A fibrinólise é frequentemente utilizada no tratamento das síndromes coronárias com supradesnivelamento do segmento ST (SCCSST). Desfechos cardíacos maiores foram reduzidos com a intensificação do tratamento antiplaquetário, porém com aumento do risco de sangramento. Nosso objetivo foi avaliar o risco de sangramentos de origem vascular em pacientes submetidos a intervenção coronária precoce pós-trombólise. MÉTODOS: Entre fevereiro de 2010 e dezembro de 2011, 5 prontos-socorros municipais da cidade de São Paulo e o Serviço de Atendimento Móvel de Urgência (SAMU) utilizaram tenecteplase (TNK) para tratamento de pacientes com SCCSST. Os pacientes foram encaminhados a um único hospital terciário e submetidos a cateterismo cardíaco precoce durante a internação. Todos os exames foram realizados por via femoral e os critérios do BARC foram utilizados para a classificação dos sangramentos. RESULTADOS: Foram avaliados 199 pacientes, dos quais 193 não apresentaram sangramento de origem vascular (grupo 1) e 6 (3%) evoluíram com essa complicação (grupo 2). A mediana de tempo entre a administração do fibrinolítico e o cateterismo foi de 24 horas no grupo 1 e de 14,7 horas no grupo 2. Segundo os critérios do BARC, 1 paciente apresentou sangramento do tipo 3a (hematoma em região inguinal com queda de hemoglobina de 3-5 g/dl), 2 pacientes apresentaram sangramento do tipo 3b (1 não relacionado ao acesso vascular e 1 hematoma de retroperitônio, com queda de hemoglobina ≥ 5 g/dl), e os demais apresentaram sangramentos do tipo 1 (pequenos hematomas em região inguinal). Nesse grupo foram necessárias duas hemotransfusões. Nenhum paciente teve óbito relacionado à complicação vascular pós-intervenção. CONCLUSÕES: Em nosso estudo, a cateterização precoce via femoral como parte de uma estratégia fármaco-invasiva, utilizando TNK como fibrinolítico, apresentou baixa taxa de sangramentos de origem vascular, comparável à das angioplastias eletivas.

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BACKGROUND: Fibrinolysis is often used in the treatment of acute coronary syndromes with ST segment elevation (STEMI). Major cardiac outcomes were reduced with antiplatelet therapy intensification, but with increased risk of bleeding. Our objective was to assess the risk of vascular bleeding in patients undergoing early percutaneous coronary intervention after thrombolysis. METHODS: Between February 2010 and December 2011, five public emergency rooms in the city of São Paulo and the Emergency Health Care Service (Serviço de Atendimento Móvel de Urgência - SAMU) used tenecteplase (TNK) to treat patients with STEMI. Patients were referred to a single tertiary hospital and were submitted to early cardiac catheterization during hospitalization. All examinations were performed via the femoral artery and BARC criteria were used to classify bleeding. RESULTS: We evaluated 199 patients, of whom 193 had no bleeding of vascular origin (group 1) and 6 (3%) developed this complication (group 2). The median time between the administration of the fibrinolytic agent and catheterization was 24 hours in group 1 and 14.7 hours in group 2. According to BARC criteria, 1 patient had type 3a bleeding (hematoma in the inguinal region with a hemoglobin decrease of 3-5 g/dL), 2 patients had type 3b bleeding (1 not related to vascular access and 1 retroperitoneal hematoma with a hemoglobin decrease ≥ 5 g/dL) and the remaining patients had type 1 bleeding (small inguinal hematomas). Blood transfusions were required in 2 patients. None of the patients died due to vascular complications after the intervention. CONCLUSIONS: In our study, early catheterization via the femoral artery as part of a pharmaco-invasive strategy, using TNK as a fibrinolytic agent, had a low vascular bleeding rate, comparable to that of elective angioplasties.

Asunto(s)

Humanos , Masculino , Femenino , Angioplastia/métodos , Angioplastia , Fibrinólisis , Hemorragia/complicaciones , Infarto del Miocardio/complicaciones , Aspirina/administración & dosificación , Electrocardiografía/métodos , Electrocardiografía , Estudios Observacionales como Asunto , Factores de Riesgo

Asunto(s)

Recolección de Muestras de Sangre/instrumentación , Sistemas de Atención de Punto , Vuelo Espacial , Análisis de los Gases de la Sangre/instrumentación , Recolección de Muestras de Sangre/métodos , Pruebas de Química Clínica/instrumentación , Oído Externo/irrigación sanguínea , Humanos