RESUMEN
OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.
Asunto(s)
Cardiología/normas , Adhesión a Directriz/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Edad , Anciano , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations. .
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cardiología/normas , Adhesión a Directriz/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Edad , Hospitales Universitarios/estadística & datos numéricos , Unidades de Cuidados Intensivos , Modelos Logísticos , Oportunidad Relativa , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Os sinais e sintomas cardiovasculares das doenças de tiroide são achados clinicamente relevantes que acompanham tanto o hipertiroidismo quanto o hipotiroidismo. Com o conhecimento dos mecanismos celulares da ação dos hormônios da tiroide no coração e no sistema cardiovascular, podemos entender as alterações no débito cardíaco, contratilidade miocárdica, pressão arterial, resistência vascular e distúrbios do ritmo que resultam da disfunção da tiroide. A importância do reconhecimento dos efeitos da doença da tiroide sobre o coração também vem da observação de que a normalização da função da tiroide reverte as alterações hemodinâmicas. Nesta revisão, discutiremos os testes de função da tiroide necessários para o diagnóstico, bem como o tratamento necessário para restaurar o estado de eutiroidismo. A avaliação da função da tiroide em pacientes com doenças crônicas é difícil, especialmente pacientes na Unidade de Terapia Intensiva.Muitos destes pacientes têm baixos níveis séricos tanto de tiroxina(T4) quanto de triiodotironina (T3), e os seus níveis séricos detirotropina (TSH) também podem estar baixos. Apesar destas anormalidades, o tratamento desses pacientes com hormônio tiroidiano, além de controverso, parece ser de pouco benefício,inclusive podendo ser deletério. É possível que as alterações nas funções da tiroide durante doenças graves sejam protetoras, pois previnem excessivo catabolismo tecidual. Nós também revisamos as alterações no metabolismo do hormônio tiroidiano e o seu tratamento em pacientes com alterações dos testes de função tiroidiana induzidos por amiodarona.
The cardiovascular signs and symptoms of thyroid disease areclinically relevant findings that accompany both hyperthyroidism and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiacoutput, cardiac contractility, blood pressure, vascular resistance,and rhythm disturbances that result from thyroid dysfunction. The importance of the recognition of the effects of thyroid disease on the heart also derives from the observation that restoration of normal thyroid function most often reverses the abnormal cardiovascular hemodynamics. In the present review, we discuss the appropriate thyroid function tests to establish a suspected diagnosis as well asthe treatment modalities necessary to restore patients to a euthyroidstate. Assessment of thyroid function in patients with nonthyroidalillness is difficult, especially among those hospitalized in an intensive care unit. Many of them have low serum concentrations of both thyroxine (T4) and triiodothyronine (T3), and their serumthyrotropin (TSH) concentration also may be low. Despite these abnormalities, treatment of these patients with thyroid hormone,while controversial, appears to be of little benefit, and may beharmful. It is possible that the changes in thyroid function during severe illness are protective in that they prevent excessive tissue catabolism. We also review the alterations in thyroid hormone metabolism and the approach to the management of patients with amiodarone-induced alterations in thyroid function tests.
Asunto(s)
Humanos , Cardiomegalia/complicaciones , Glándula Tiroides/patología , Hipertensión Pulmonar/complicaciones , Tiroxina/efectos adversos , Amiodarona/uso terapéutico , Unidades de Cuidados Intensivos/historiaAsunto(s)
Enfermedades Cardiovasculares/cirugía , Complicaciones Intraoperatorias/prevención & control , Atención Perioperativa/normas , Anticoagulantes/uso terapéutico , Brasil , Enfermedades Cardiovasculares/diagnóstico , Electrocardiografía/normas , Humanos , Monitoreo Intraoperatorio/métodos , Revascularización Miocárdica/normas , Alta del Paciente/normas , Periodo Perioperatorio/normas , Inhibidores de Agregación Plaquetaria/uso terapéutico , Medición de Riesgo , Sociedades MédicasAsunto(s)
Cardiología/normas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/cirugía , Atención Perioperativa/normas , Brasil , Electrocardiografía , Medicina Basada en la Evidencia , Humanos , Periodo Perioperatorio , Complicaciones Posoperatorias/prevención & control , Sociedades MédicasAsunto(s)
Cardiología/normas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/cirugía , Atención Perioperativa/normas , Brasil , Electrocardiografía , Medicina Basada en la Evidencia , Periodo Perioperatorio , Complicaciones Posoperatorias/prevención & control , Sociedades MédicasRESUMEN
INTRODUCTION: The accuracy of perioperative evaluation methods available is better than chance, but their performance is not ideal. OBJECTIVES: To compare a new evaluation method (EMAPO) to the American College of Physicians method for determining the risk of cardiovascular complications in noncardiac surgeries and to look for new influencing variables. METHODS: Evaluations through EMAPO and the American College of Physicians method were employed for 700 patients. Cardiac events and deaths were recorded, the risk variables related to the occurrence of complications were verified, and the models were compared by analyzing the areas under the receiver operating characteristic curves. RESULTS: Mortality rate was 3.4%, and the incidence of cardiovascular complications was 5.3%. Renal failure (P = 0.01), major surgery (P = 0.004), and emergency surgery (P = 0.003) were independently related to the occurrence of cardiovascular complications. The two methods produced similar results. CONCLUSION: EMAPO is as good as the American College of Physicians method in determining the risk of cardiovascular complications in noncardiac surgeries. New variables related to surgical risk were identified.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Atención Perioperativa , Complicaciones Posoperatorias/epidemiología , Guías de Práctica Clínica como Asunto/normas , Procedimientos Quirúrgicos Operativos/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , American Heart Association , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/mortalidad , Insuficiencia Renal/complicaciones , Procedimientos Quirúrgicos Operativos/mortalidadRESUMEN
INTRODUCTION: The accuracy of perioperative evaluation methods available is better than chance, but their performance is not ideal. OBJECTIVES: To compare a new evaluation method (EMAPO) to the American College of Physicians method for determining the risk of cardiovascular complications in noncardiac surgeries and to look for new influencing variables. METHODS: Evaluations through EMAPO and the American College of Physicians method were employed for 700 patients. Cardiac events and deaths were recorded, the risk variables related to the occurrence of complications were verified, and the models were compared by analyzing the areas under the receiver operating characteristic curves. RESULTS: Mortality rate was 3.4 percent, and the incidence of cardiovascular complications was 5.3 percent. Renal failure (P = 0.01), major surgery (P = 0.004), and emergency surgery (P = 0.003) were independently related to the occurrence of cardiovascular complications. The two methods produced similar results. CONCLUSION: EMAPO is as good as the American College of Physicians method in determining the risk of cardiovascular complications in noncardiac surgeries. New variables related to surgical risk were identified.
INTRODUÇÃO: A precisão dos métodos de avaliação perioperatória disponíveis é melhor que o acaso, porém está longe do ideal. OBJETIVOS: Comparar um novo método de avaliação perioperatória (EMAPO) ao método do American College of Physicians para determinar o risco cardíaco em cirurgias não cardíacas e buscar novas variáveis envolvidas na determinação deste risco. MÉTODOS: O EMAPO e o método do American College of Physicians foram aplicados em 700 pacientes. A ocorrência de eventos cardíacos e de mortes foi documentada, a relação entre as variáveis de risco e as complicações foi estabelecida e os métodos foram comparados analisando as áreas sob a curva ROC. RESULTADOS: A mortalidade foi 3.4 por cento e a incidência de complicações cardiovasculares 5.3 por cento. A presença de insuficiência renal (p=0.01), cirurgia de grande porte (p=0.004) e cirurgia de emergência (p=0.003) se correlacionaram com a ocorrência de complicações cardiovasculares na análise multivariada. Não houve diferença entre os dois métodos. CONCLUSÕES: O EMAPO é tão eficaz quanto o método do American College of Physicians para determinar o risco de complicações cardiovasculares em cirurgias não cardíacas. Novas variáveis relacionadas com o risco perioperatório foram encontradas.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Atención Perioperativa , Guías de Práctica Clínica como Asunto , Complicaciones Posoperatorias/prevención & control , American Heart Association , Brasil , Métodos Epidemiológicos , Insuficiencia RenalRESUMEN
JUSTIFICATIVA E OBJETIVOS: A monitorização de funções vitais é uma das mais importantes e essenciais ferramentas no manuseio de pacientes críticos na UTI. Hoje é possível detectar e analisar uma grande variedade de sinais fisiológicos através de diferentes técnicas, invasivas e não-invasivas. O intensivista deve ser capaz de selecionar e executar o método de monitorização mais apropriado de acordo com as necessidades individuais do paciente, considerando a relação risco-benefício da técnica. Apesar do rápido desenvolvimento de técnicas de monitorização não-invasiva, a monitorização hemodinâmica invasiva com o uso do cateter de artéria pulmonar (CAP) ainda é um dos procedimentos fundamentais em UTI. O objetivo destas recomendações é estabelecer diretrizes para o uso adequado dos métodos básicos de monitorização hemodinâmica e CAP. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MedLine de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes a 55 questões sobre monitorização da pressão venosa central, pressão arterial invasiva e cateter de artéria pulmonar. Com relação ao CAP, além de recomendações quanto ao uso correto foram discutidas as indicações em diferentes situações clínicas. CONCLUSÕES: A avaliação da pressão venosa central e da pressão arterial, além das variáveis obtidas com o CAP permite o entendimento da fisiologia indispensável para o cuidado de pacientes graves. Entretanto, a correta utilização dessas ferramentas é fundamental para os possíveis benefícios decorrentes do uso.
BACKGROUND AND OBJECTIVES: Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. CONCLUSIONS: Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.
Asunto(s)
Unidades de Cuidados Intensivos , Monitoreo del AmbienteRESUMEN
JUSTIFICATIVA E OBJETIVOS: A interpretação do débito cardíaco e da pré-carga como números absolutos não traz grandes informações sobre a hemodinâmica do paciente crítico. Em contrapartida, a monitorização da resposta do débito cardíaco à expansão volêmica ou suporte inotrópico é uma ferramenta muito útil na unidade de terapia intensiva, quando o paciente apresenta algum sinal de má perfusão tecidual. Apesar do CAP ser considerado como " padrão-ouro" na avaliação destes parâmetros, foram desenvolvidas tecnologias alternativas bastante confiáveis para a sua monitorização. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MEDLINE de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes à análise da variação da pressão arterial durante ventilação mecânica, débito cardíaco contínuo por contorno de pulso arterial, débito cardíaco por diluição do lítio, Doppler transesofágico, bioimpedância transtorácica, ecocardiografia e reinalação parcial de gás carbônico. CONCLUSÕES: As novas e menos invasivas técnicas para medida do débito cardíaco, pré-carga e fluidoresponsividade apresentam adequada precisão e podem ser uma alternativa ao uso do CAP em pacientes graves.
BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal Doppler waveform, thoracic electrical bioimpedance, echocardiography and partial CO2 rebreathing for monitoring cardiac output and preload were created. CONCLUSIONS: The new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.
Asunto(s)
Unidades de Cuidados Intensivos , Monitoreo del AmbienteRESUMEN
BACKGROUND AND OBJECTIVES: Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. CONCLUSIONS: Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.
RESUMEN
BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal Doppler waveform, thoracic electrical bioimpedance, echocardiography and partial CO2 rebreathing for monitoring cardiac output and preload were created. CONCLUSIONS: The new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.
RESUMEN
BACKGROUND: Exercise-induced dyspnea is a frequent feature in patients with hyperthyroidism. HYPOTHESIS: Data from clinical studies to elucidate the origin of this symptom are lacking. In the current study, we examined the hemodynamic and oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism and their relationship with dyspnea. METHODS: Hemodynamic studies were performed under resting conditions and after isotonic exercise in 15 patients with hyperthyroidism and 11 control subjects. Exercise was applied using a bicycle ergometer, with progressive loads. In the hyperthyroid group, measurements were repeated at rest and during supine exercise after administering 15 mg of intravenous metoprolol. RESULTS: End-diastolic pulmonary artery pressure and cardiac index were higher in the hyperthyroid group than in controls (18.6 +/- 5.3 vs. 11.2 +/- 4.9 mmHg; p = 0.02, and 6.0 +/- 1.7 vs. 2.8 +/- 0.5 l/min/m2; p = 0.0001, respectively). After exercise, there was an increase in end-diastolic pulmonary artery pressure in the hyperthyroid group (18.6 +/- 5.3 to 25.5 +/- 9.9 mmHg; p = 0.02), revealing impaired cardiocirculatory reserve. Pulmonary arteriolar resistance increased significantly in parallel with end-diastolic pulmonary artery pressure after drug administration, suggesting an inadequate cardiovascular response after beta blockade in patients with hyperthyroidism. CONCLUSION: We observed that functional left ventricular reserve is impaired in patients with hyperthyroidism, suggesting an explanation for the frequent symptom of dyspnea and impaired exercise tolerance. Moreover, we also suggest that beta-adrenergic blockade may adversely affect cardiovascular function in patients with hyperthyroidism.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Ejercicio Físico/fisiología , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/fisiopatología , Consumo de Oxígeno/efectos de los fármacos , Adulto , Diástole/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Metoprolol/uso terapéutico , Persona de Mediana Edad , Presión Esfenoidal Pulmonar/efectos de los fármacos , Estadística como Asunto , Volumen Sistólico/efectos de los fármacos , Resultado del Tratamiento , Resistencia Vascular/efectos de los fármacosRESUMEN
OBJECTIVES: This prospective, randomized, placebo-controlled, double-blind clinical trial was performed to analyze the effect of atorvastatin compared with placebo on the occurrence of a 6-month composite of cardiovascular events after vascular surgery. Cardiovascular complications are the most important cause of perioperative morbidity and mortality among patients undergoing vascular surgery. Statin therapy may reduce perioperative cardiac events through stabilization of coronary plaques. METHODS: One hundred patients were randomly assigned to receive 20 mg atorvastatin or placebo once a day for 45 days, irrespective of their serum cholesterol concentration. Vascular surgery was performed on average 30 days after randomization, and patients were prospectively followed up over 6 months. The cardiovascular events studied were death from cardiac cause, nonfatal myocardial infarction, unstable angina, and stroke. RESULTS: Fifty patients received atorvastatin, and 50 received placebo. During the 6-month follow-up primary end points occurred in 17 patients, 4 in the atorvastatin group and 13 in the placebo group. The incidence of cardiac events was more than three times higher with placebo (26.0%) compared with atorvastatin (8.0%; P =.031). The risk for an event was compared between the groups with the Kaplan-Meier method, as event-free survival after vascular surgery. Patients given atorvastatin exhibited a significant decrease in the rate of cardiac events, compared with the placebo group, within 6 months after vascular surgery (P =.018). CONCLUSION: Short-term treatment with atorvastatin significantly reduces the incidence of major adverse cardiovascular events after vascular surgery.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Ácidos Heptanoicos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Pirroles/uso terapéutico , Procedimientos Quirúrgicos Vasculares , Anciano , Atorvastatina , LDL-Colesterol/sangre , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Cooperación del Paciente , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS: In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4 +/- 11.5 to 59.9 +/- 12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9 +/- 15.2 and 57.7 +/- 11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3 +/- 8.6 to 60.5 +/- 9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1 +/- 9.1 and 62.1 +/- 7.9 years, P=0.0001). CONCLUSION: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.