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Sergio Raposeiras-Roubin Emad Abu-Assi Berenice Caneiro-Queija Rafael Cobas-Paz Lucía Rioboo-Lestón Cristina García Rodríguez Cruz Giraldez Lemos María Blanco Vidal Beatriz Ogando Guillán Isabel Pérez Martínez Emilio Paredes-Galán Víctor Jimenez-Díaz Jose Antonio Baz-Alonso Francisco Calvo-Iglesias Andrés Íñiguez-Romo 《Revista portuguesa de cardiologia》2018,37(3):239-245
Introduction
Beta-blocker doses that have been shown to be effective in randomized clinical trials are not commonly used in daily clinical practice. The aim of this study was to analyze whether there is a prognostic benefit of high rather than low doses of beta-blockers after an acute coronary syndrome (ACS).Methods
In this retrospective cohort study, 2092 ACS patients discharged from hospital between June 2013 and January 2016 were classified according to the beta-blocker dose prescribed: high dose (≥50% of the target dose tested in clinical trials) and low dose (<50%). Two groups of 501 matched patients were obtained through propensity score matching according to treatment with high or low doses of beta-blockers. The prognostic impact (mortality) during follow-up of high vs. low dose was analyzed by Cox regression and represented by Kaplan-Meier curves.Results
Of the 2092 patients, 80.5% were discharged under beta-blockers, with lower mortality during follow-up (18.6±9.7 months). Of the 1685 patients discharged under beta-blockers, only 31.4% received high doses. There were no differences in mortality during follow-up between patients under high-dose vs. low-dose beta-blockers (HR 0.935, 95% CI 0.628-1.392, p=0.740), and the equivalence between the two doses remained after propensity score matching (HR 1.183, 95% CI 0.715-1.958, p=0.513).Conclusion
No prognostic benefit was found in terms of mortality for high-dose vs. low-dose beta-blockers after an ACS. 相似文献3.
高龄急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床观察 总被引:1,自引:1,他引:1
目的评价高龄急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)的效果和预后。方法收集入住本院的61例行PCI术的高龄ACS患者的临床资料,其中男性38例,女性23例,年龄为80~88(82±2)岁。19例行急诊PCI术,42例为择期PCI术,观察近期(住院期间)和远期主要不良心脑血管事件(MACCE)的发生和临床预后。结果61例患者中3支血管病变39例(64%),双支血管病变16例(26%),单支血管病变6例(10%);完全闭塞病变25例(41%);14例(34%)患者合并肾动脉狭窄。手术操作成功率97%,术后心肌梗死溶栓试验3级达97%,术后并发症发生率13%,其中造影剂肾病6例(10%)。住院期间MACCE发生率3%,均为心源性死亡,4个月至4年9个月随访期间MACCE发生率22%,包括3例心脑源性死亡、2例其他原因死亡。结论高龄ACS患者行PCI术手术操作成功率高,住院期间病死率和随访期间MACCE发生率较低,但患者病变重,并发症尤其是造影剂肾病发生率相对较高。 相似文献
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Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome 总被引:1,自引:0,他引:1
Kini AS Lee PC Mitre CA Kim MC Kamran M Duffy ME Marmur JD Sharma SK 《The American journal of medicine》2003,115(9):708-714
BACKGROUND: The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention. METHODS: Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n = 974), intermediate-risk (three to four risk factors; n = 1339), and high-risk (five to seven risk factors; n = 188) groups, and outcomes were compared. RESULTS: Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P = 0.0009), more thrombotic lesions (P = 0.03), more multivessel disease (P <0.0001), and more American College of Cardiology/American Heart Association type B2/C lesions (P = 0.05). Although the risk score did not predict interventional technical success or intraprocedural complications, a high score was associated with prolonged hospital stay, higher postprocedural peak troponin levels, and 30-day major adverse cardiac events. Stepwise logistic regression showed that in conjunction with lesion length and patient sex, a high score was an independent predictor of 30-day major adverse cardiac events (odds ratio = 2.3; 95% confidence interval: 1.1 to 4.1; C statistic = 0.62). CONCLUSION: Although a higher TIMI risk score in patients with unstable angina or non-ST-elevation myocardial infarction who were undergoing percutaneous coronary intervention correlated with adverse clinical outcome, the score alone cannot be used to guide diagnostic or therapeutic strategies. 相似文献
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Jure Samardzic Miroslav Krpan Bosko Skoric Marijan Pasalic Mate Petricevic Davor Milicic 《Journal of thrombosis and thrombolysis》2014,38(4):459-469
High on-treatment platelet reactivity (HTPR) on clopidogrel correlates with adverse outcomes in patients treated with percutaneous coronary intervention (PCI). Whether HTPR is a modifiable risk factor for future events is not clear. We evaluated the effect of serial clopidogrel dose adjustment based on platelet function testing (PFT) during 12 months of dual antiplatelet therapy (DAPT) using Multiplate® analyzer in patients with HTPR after PCI in acute coronary syndrome on clinical outcome. Eighty-seven patients were randomized to interventional (n = 43) and control group (n = 44). Blood samples for PFT were drawn at day 1, 2, 3, 7, 30 and at month 2, 3, 6, 9 and 12. Clopidogrel dose was modified at each point of PFT in the interventional group with patients taking up to two additional 600 mg loading doses and a range of 75–300 mg maintenance dose to achieve and maintain optimal platelet reactivity (19–46 U). The incidence of the primary endpoint (composite of cardiovascular death, non-fatal myocardial infarction, target vessel revascularization and ischemic stroke) was significantly higher in the control group (36.3 vs 16.2 %; p = 0.034). There were no differences in total bleeding events (6.8 vs 4.6 %, p = ns). Patients in the interventional group maintained better P2Y12 inhibition during follow-up. We hypothesize that targeting the therapeutic window of platelet reactivity continuously throughout DAPT by dose adjustment of P2Y12 inhibitor may lead to better platelet reactivity control, and thus reduce the rate of ischemic complications in this high risk group of patients. 相似文献
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BACKGROUND: Prior aspirin use has been associated with poorer outcome in acute coronary syndrome, and forms part of the TIMI Risk Score. It is not known if prior use of clopidogrel is associated with similar risk. AIM: To assess if prior clopidogrel use is associated with higher risk in acute coronary syndrome. PARTICIPANTS: Participants were 869 consecutive admissions to a Scottish district general hospital with suspected acute coronary syndrome. METHODS: Incidence of death, recurrent myocardial infarction or urgent percutaneous intervention at 2 weeks was recorded. Odds ratios for sub-groups on clopidogrel, aspirin or neither were calculated. RESULTS: Odds ratios were: clopidogrel 1.46 (95% ci 0.62-3.33), aspirin 1.09 (95% ci 0.64-1.85), neither 0.91 (95% ci 0.53-1.54). CONCLUSION: No definite association was shown between clopidogrel use and outcome but there was a trend towards increased risk of major acute coronary events. 相似文献
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Kronish IM Rieckmann N Shimbo D Burg M Davidson KW 《The American journal of cardiology》2010,106(8):1090-1094
Persistent elevation of inflammatory markers such as C-reactive protein (CRP) has been associated with an increased risk of recurrent cardiac events after acute coronary syndromes (ACS). Conflicting evidence is available regarding whether aspirin can reduce CRP after ACS. We investigated whether the dosage and adherence to aspirin was associated with the CRP level 3 months after ACS. Adherence to aspirin was monitored for 3 months in a cohort of 105 patients enrolled within 1 week of an ACS using an electronic chip stored in the pill bottle cap. The CRP level was measured at baseline and 3 months. Logistic regression analysis was used to test whether poor adherence to aspirin and a lower aspirin dosage were associated with increased CRP levels, controlling for age, ACS type, disease co-morbidity, baseline CRP level, use of clopidogrel and statins, depressive symptoms, smoking, and adherence to other medications. Aspirin adherence was inversely correlated with the CRP level at 3 months (Spearman's r = -0.36, p < 0.001). In the adjusted model, every 10% decrease in aspirin adherence was associated with a 1.7 increased risk (95% confidence interval 1.2 to 2.4) of a CRP level of ≥ 3.0 mg/L at 3 months. Low-dose aspirin was associated with a 7.1 increased risk (95% confidence interval 1.5 to 33.3) of a CRP level of ≥ 3.0 mg/L. The Charlson co-morbidity index, depressive symptoms, and baseline CRP level were also predictive of a CRP level of ≥ 3.0 mg/L at 3 months. The association between aspirin adherence and CRP level was not attenuated by controlling for other risk-reducing behaviors. In conclusion, a strong association was found between aspirin adherence and the CRP level after an ACS. 相似文献
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Grace SL Abbey SE Kapral MK Fang J Nolan RP Stewart DE 《The American journal of cardiology》2005,96(9):1179-1185
Previous research has established a relation between depression at the time of cardiac hospitalization and patient mortality. The objective of this study was to examine the role of depressive history and symptomatology during hospitalization on 5-year all-cause mortality after admission for an acute coronary syndrome. We recruited 750 patients who had unstable angina pectoris and myocardial infarction from 12 coronary care units between 1997 and 1999. Measurements included sociodemographic and clinic data and the Beck Depression Inventory (BDI). Data were linked to an administrative database to determine 5-year all-cause mortality. Survival data were adjusted using a Cox's proportional hazards model. One hundred seventy-four participants (23.2%) self-reported a history of depressed mood for >2 weeks, 235 (31.3%) had elevated BDI scores at index hospitalization, with 105 (14.0%) reporting persistent depressive symptomatology. One hundred fifteen participants (15.3%) died by 5 years after hospitalization. After adjusting for prognostic indicators, such as cardiac disease severity, medical history, and smoking, depressive symptomatology during hospitalization was significantly predictive of mortality, but depressive history was not. Hazard ratios associated with BDI scores <10 versus those > or =10 at hospitalization ranged from 1.90 (95% confidence interval 1.12 to 3.24) at 2 years to 1.53 (95% confidence interval 1.04 to 2.24) at 5 years. In conclusion, the significance of depressive symptomatology at the time of, but not before, hospitalization underlines the need for early identification of increased distress and renews calls to identify treatments that not only improve quality of life but also decrease the risk of mortality. 相似文献
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BACKGROUND: Metabolic syndrome (MetSyn) has reached epidemic proportions; however, regular exercise can prevent its progression to type 2 diabetes. HYPOTHESIS: The study was undertaken to determine both the rate and predictors of routine exercise 1 year after an acute coronary syndrome (ACS) in patients with MetSyn. METHODS: In a registry of 1,199 patients presenting with ACS, those with MetSyn were identified using the modified NCEP-ATP III criteria. Baseline and 1-year exercise patterns were examined in these patients, and the characteristics of those who were exercising were then compared with those who were not. A multivariable logistic regression analysis was subsequently conducted to identify independent predictors of exercise at 1 year. RESULTS: Of 273 patients with MetSyn, baseline and 1-year data about patients' exercise patterns were available for 170, of whom only 92 (54.2%) were exercising at 1 year. Characteristics that differed between those who were and those who were not exercising at 1 year included exercise at baseline (40 vs. 16.7%, p<0.001), Caucasian race (92.4 vs. 79.5%, p = 0.01), and body mass index (BMI) (30.4 +/- 4.3 vs. 32.1 +/- 5.0, p = 0.02). In a multivariable analysis, significant independent predictors of exercise were routine exercise at the time of admission for ACS (odds ratio [OR] = 2.6,95% confidence interval [CI] = 1.1-6.4), younger age (OR = 0.67 per 10-year increase [95% CI = 0.45-0.99]), and lower BMI (OR = 0.4 per 10-unit increase [95% CI = 0.17-0.911). CONCLUSIONS: Almost half of patients with MetSyn did not participate in routine exercise 1 year after their admission for ACS. Innovative strategies are needed to increase exercise participation in such patients, particularly those not exercising at baseline as well as obese and older patients. 相似文献
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Depressive symptoms and treatment after acute coronary syndrome 总被引:5,自引:0,他引:5
Ellis JJ Eagle KA Kline-Rogers EM Erickson SR 《International journal of cardiology》2005,99(3):443-447
BACKGROUND: There is limited data regarding the effects of depression treatment adequacy on the mental component of health-related quality of life in a post-acute coronary syndrome population. METHODS: All patients diagnosed with an acute coronary syndrome and discharged from a university-affiliated hospital during a 3-year period were mailed a survey that included the SF-8, EQ-5D and other self-reported measures of disease and treatment (e.g. physical functioning, comorbidity, medication compliance and perceived cardiac severity). Patients were categorized based on self-report of depressive symptoms and antidepressant medication. Adjusted mean mental health-related quality of life scores were determined by least square mean analysis controlling for independent variables. RESULTS: Of 1217 eligible patients, 490 (40.3%) responded. Respondents averaged 65.2 (+/-11.3) years of age, 71% male, 92% Caucasian, 64% with MI history, 17% had their most recent cardiac event within 6 months. No depressive symptoms and no depression treatment (without depression) were reported by 59.8%, 27.6% reported untreated depressive symptoms (untreated), 8.6% reported depressive symptoms and antidepressant medication (undertreated), and 4.1% reported no symptoms and antidepressant medication (adequately treated). Adjusted mean SF-8 Mental Component Summary scores were 52.8, 52.5, 42.8 and 40.2 for patients without depression, adequately treated, untreated and undertreated, respectively (p<0.0001 for all pairwise comparisons except for patients without depression vs. adequately treated and untreated vs. undertreated). CONCLUSIONS: Depressive symptoms are common in patients diagnosed with acute coronary syndrome and appear to be related to lower mental health-related quality of life. These observations stress the importance of diagnosis and treatment of depression in this population. 相似文献
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In-hospital outcome in octogenarians with acute coronary syndrome undergoing emergent coronary angiography 总被引:1,自引:0,他引:1
Oe K Shimizu M Ino H Yamaguchi M Terai H Hayashi K Kiyama M Sakata K Hayashi T Inoue M Kaneda T Mabuchi H 《Japanese heart journal》2003,44(1):11-20
Very elderly patients have higher mortality rates than younger patients after acute coronary syndrome (ACS). However, the mechanism by which increasing age contributes to such mortality remains unclear. In addition, the efficacy and safety of invasive coronary procedures for octogenarians with ACS have not been well established. We compared the clinical characteristics and in-hospital outcome of 193 octogenarians (mean age, 83 years) with those of 1,462 younger patients (mean age, 64 years) with ACS who underwent emergent coronary angiography. Octogenarians included a greater number of females, had higher rates of cerebrovascular disease and multivessel disease, a higher Killip class, a higher Forrester class, and lower rates of smoking, diabetes, and hypercholesterolemia than the younger subjects. Interventions, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), were performed less frequently in octogenarians than in younger patients (88.0% versus 90.8%). The procedural success rate in octogenarians did not differ from that in younger patients. However, the in-hospital mortality rate for the octogenarians was about three times higher than for the younger patients (19.2% versus 6.9%). Multivariate analysis revealed that the predictors of in-hospital mortality in the octogenarians were a higher Killip class and a higher Forrester class. Octogenarians with ACS had fewer coronary risk factors and a similar success rate for the intervention, but had more greatly impaired hemodynamics and higher in-hospital mortality than the younger patients. Therefore, impaired myocardial reserve may contribute to a large portion of in-hospital deaths in octogenarians with ACS. 相似文献
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Alfredsson J Stenestrand U Wallentin L Swahn E 《Heart (British Cardiac Society)》2007,93(11):1357-1362
Objective
To study gender differences in management and outcome in patients with non‐ST‐elevation acute coronary syndrome.Design, setting and patients
Cohort study of 53 781 consecutive patients (37% women) from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS‐HIA), with a diagnosis of either unstable angina pectoris or non‐ST‐elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 1998 and 2002, and followed for 1 year.Main outcome measures
Treatment intensity and in‐hospital, 30‐day and 1‐year mortality.Results
Women were older (73 vs 69 years, p<0.001) and more likely to have a history of hypertension and diabetes, but less likely to have a history of myocardial infarction or revascularisation. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge.Revascularisation was, however, even after adjustment, performed more often in men (OR 1.15; 95% CI, 1.09 to 1.21). After adjustment, there was no significant difference in in‐hospital (OR 1.03; 95% CI, 0.94 to 1.13) or 30‐days (OR 1.07; 95% CI, 0.99 to 1.15) mortality, but at 1 year being male was associated with higher mortality (OR 1.12; 95% CI, 1.06 to 1.19).Conclusion
Although women are somewhat less intensively treated, especially regarding invasive procedures, after adjustment for differences in background characteristics, they have better long‐term outcomes than men.Since the beginning of the 1990s there have been numerous studies on gender differences in management of acute coronary syndromes (ACS). Many earlier studies,1,2,3,4,5,6,7,8 but not all,9 found that women were treated less intensively in the acute phase. In some of the studies, after adjustment for age, comorbidity and severity of the disease, most of the differences disappeared.6,7 There is also conflicting evidence on gender differences in evidence‐based treatment at discharge.1,3,5,6,8,10,11After acute myocardial infarction (AMI), a higher short‐term mortality in women is documented in several studies.2,5,6,7,12,13,14 After adjustment for age and comorbidity some difference has usually,2,5,12,13 but not always,11,14 remained. On the other hand, most studies assessing long‐term outcome have found no difference between the genders, or a better outcome in women, at least after adjustment.7,10,13,14 Earlier studies focusing on gender differences in outcome after an acute coronary syndrome have usually studied patients with AMI, including both ST‐elevation myocardial infarction and non‐ST‐elevation myocardial infarction (NSTEMI).2,5,6,7,12,13,14 However, the pathophysiology and initial management differs between these two conditions,15 as does outcome according to gender.11,16 In patients with NSTEMI or unstable angina pectoris (UAP), women seem to have an equal or better outcome, after adjustment for age and comorbidity.1,4,8,11,16,17 Studies on differences between genders, in treatment and outcome, in real life, contemporary, non‐ST‐elevation acute coronary syndrome (NSTE ACS) populations, large enough to make necessary adjustments for confounders, are lacking.The aim of this study was to assess gender differences in background characteristics, management and outcome in a real‐life intensive coronary care unit (ICCU) population, with NSTE ACS. 相似文献18.
Iván J. Núñez-Gil Pedro Marcos Alberca Nieves Gonzalo Luis Nombela-Franco Pablo Salinas Antonio Fernández-Ortiz 《Revista portuguesa de cardiologia》2018,37(2):203.e1-203.e5
A 66-year-old male ex-smoker with hypertension, type 2 diabetes mellitus and dyslipidaemia was admitted due to a non-ST segment elevation myocardial infarction. The catheterisation depicted an extensive and calcified disease: chronic total obstruction of the right coronary and severe disease with a giant aneurysm at the first marginal branch as the culprit vessel. After discussion, the right coronary was treated before the circumflex-giant aneurysm was closed with a stent graft and its multiple severe stenosis solved with two drug-eluting stents. We provide a multimodality approach for a complex case and briefly discuss the available options. 相似文献
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Sarcoidosis is a common multisystem granulomatous disease that affects 20 per 100,000 people in the world. Although primarily a pulmonary disease, sarcoidosis can affect multiple organ systems. Cardiac involvement of sarcoidosis is most commonly manifested as ventricular ectopy and arrhythmias; atrioventricular conduction disturbances, including complete heart block; congestive heart failure; and even may result in sudden death. Although myocardial infarction is most commonly the result of epicardial coronary artery disease, an infiltrative process such as sarcoidosis may simulate an acute coronary syndrome. Given the high prevalence of sarcoidosis, it is important to be aware of the myriad of cardiac manifestations of this infiltrative process. 相似文献
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ten Berg JM Kelder JC Suttorp MJ Verheugt FW Thijs Plokker HW 《Journal of the American College of Cardiology》2001,38(4):1061-1069
OBJECTIVES: The goal of this research was to study the effect of planned angiography on late clinical outcome after percutaneous coronary intervention. BACKGROUND: It is still largely unknown whether planned follow-up angiography after coronary angioplasty influences late outcome. METHODS: Randomization assigned 527 patients to clinical follow-up alone and 531 to clinical and six-month angiographic follow-up. The effect of planned angiography on clinical outcome at one and three years after coronary angioplasty was studied. RESULTS: The two groups were well matched. At one year, more events occurred in the angiographic group than in the clinical group: 122 (23.2%) versus 88 (16.7%) (p = 0.01). While the incidence of death or myocardial infarction (MI) was similar at one year, the revascularization rate was higher in the angiographic group: 113 (21.3%) versus 67 (12.7%) (relative risk = 1.7, 95% confidence interval: 1.3 to 2.3, p = 0.0003). At three years, still more events had occurred in the angiographic group (146 [34.5%] vs. 114 [26.3%], p = 0.03). More reinterventions did not improve late survival. However, there was a nonsignificant reduction in MI (7 [1.3%] vs. 13 [2.5%], p = NS) and a significant improvement in functional class at the end of follow-up (freedom from angina 81% vs. 74%, p = 0.03). The effect of follow-up angiography on the reintervention rate was similar for stented and nonstented patients. CONCLUSIONS: Planned follow-up angiography to evaluate the late results of coronary intervention led to a 1.7 times higher reintervention rate. This effect was similar for stented and nonstented patients. More reinterventions did not improve survival but tended to reduce the incidence of MI and led to a significantly better functional class at follow-up. 相似文献