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[PMID]:29099107
[Au] Autor:Sánchez GB; Covarrubias HÁ; Rodríguez GP; Uribe EA; Ramírez-Arias E; Peralta MR; Dávila JA
[Ad] Endereço:Coordinación de Unidades Médicas de Alta Especialidad, México.
[Ti] Título:Impacto de la implementación de Código Infarto en pacientes con infarto agudo de miocardio con elevación del segmento ST en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI.
[So] Source:Gac Med Mex;153(Supl. 2):S13-S17, 2017.
[Is] ISSN:0016-3813
[Cp] País de publicação:Mexico
[La] Idioma:eng
[Ab] Resumo:Objective: To evaluate the impact of the implementation of the Infarction Code strategy in patients with acute myocardial infarction diagnosis. Methods: Consecutive patients with ST-elevation acute myocardial infarction ≤12 hours of evolution, were included in the infarction code strategy, before (Group I) and after (Group II). Times of medical attention and major cardiovascular events during hospitalization were analyzed. Results: 1227 patients were included, 919 men (75%) and 308 women (25%) with an average age of 62 ± 11 years. Among Group I and Group II, percutaneous coronary intervention reperfusion therapy changed (16.6% to 42.6%), fibrinolytic therapy (39.3% to 25%), and patients who did not receive any form of reperfusion therapy (44% to 32.6%; p < 0.0001). Times of medical attention decreased significantly (door-to-needle time decreased from 92 to 72 minutes, p = 0.004; door-to-balloon time decreased from 140 to 92 minutes, p < 0.0001). Kidney failure (24.6% vs. 17.9%; p = 0.006), major complications (35.3% to 29.3%), and death (21% vs. 12%; odds ratio: 0.52; 95% confidence interval: 0.38-0.71; p = 0.004). also decreased. Conclusion: The Infarction Code strategy improved treatment, times of medical attention and decreased complications and death in these patients.
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[St] Status:In-Data-Review
[do] DOI:110.24875/GMM.M17000002


  2 / 190679 MEDLINE  
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[PMID]:29078214
[Au] Autor:Kahles F; Schuh A; Lehrke M; Burgmaier M; Marx N; Reith S
[Ti] Título:[Non-ST-Segment Elevation Myocardial Infarction Caused by Spontaneous Coronary Thrombosis by Intimal Rupture].
[Ti] Título:Akuter Vorderwandinfarkt durch Koronarthrombus aufgrund eines spontanen Intimaeinrisses..
[So] Source:Dtsch Med Wochenschr;142(22):1686-1689, 2017 Nov.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:We report on a 51-year-old male patient with thoracic pain of acute onset with radiation in the left arm. His cardiovascular risk factors include obesity, smoking and arterial hypertension. ECG showed no signs of ischemia. The blood test revealed increasing troponin (37 pg/ml; Norm < 14 pg/ml). Therefore we performed cardiac catheterization. The RIVA demonstrated a medial filling defect. Use of OCT imaging showed intimal rupture associated with thrombus. The lesion was stented with a drug eluting stent. We initiated a medication with aspirin, ticagrelor, metoprolol and simvastatin. Coronary thrombosis of our patient was caused by spontaneous coronary artery dissection (SCAD). SCAD is an important differential diagnosis in patients with ACS. Further prospective studies and guideline recommendations are needed in the future.
[Mh] Termos MeSH primário: Trombose Coronária
Anomalias dos Vasos Coronários
Infarto do Miocárdio sem Supradesnível do Segmento ST
Doenças Vasculares/congênito
[Mh] Termos MeSH secundário: Dor no Peito
Humanos
Masculino
Meia-Idade
Fatores de Risco
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171027
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-118633


  3 / 190679 MEDLINE  
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[PMID]:28966327
[Au] Autor:Sato A; Suzuki S; Watanabe S; Shimizu T; Nakamura Y; Misaka T; Yokokawa T; Shishido T; Saitoh SI; Ishida T; Kubota I; Takeishi Y
[Ad] Endereço:Department of Cardiovascular Medicine, Fukushima Medical University.
[Ti] Título:DPP4 Inhibition Ameliorates Cardiac Function by Blocking the Cleavage of HMGB1 in Diabetic Mice After Myocardial Infarction.
[So] Source:Int Heart J;58(5):778-786, 2017 Oct 21.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:High mobility group box 1 (HMGB1), a ubiquitous DNA-binding protein, promotes angiogenesis and tissue repair, resulting in restored cardiac function after myocardial infarction (MI). Although dipeptidyl peptidase 4 (DPP4) degrades certain peptides, it remains unclear as to whether HMGB1 is a substrate of DPP4 and whether DPP4 inhibition prevents the cleavage of HMGB1.In transgenic mice with cardiac-specific overexpression of HMGB1 (TG) and wild-type mice (WT), a diabetic state was induced by streptozotocin, and MI was created by ligation of the left anterior descending coronary artery. To inhibit DPP4 activity, a DPP4 inhibitor anagliptin was used. The plasma levels of HMGB1, infarct size, echocardiographic data, angiogenesis, and vascular endothelial growth factor (VEGF) expression in the peri-infarct area were compared among non-diabetic MI WT/TG, diabetic MI WT/TG, and anagliptin-treated diabetic MI WT/TG mice.DPP4 activity was increased in the diabetic state and blocked by anagliptin administration. The HMGB1 plasma levels were reduced in the diabetic TG compared with the non-diabetic TG mice, but DPP4 inhibition with anagliptin increased HMGB1 plasma levels in the diabetic TG mice. The infarct area was significantly larger in the diabetic TG than in the non-diabetic TG mice, and it was reduced by DPP4 inhibition. Cardiac function, angiogenesis, and VEGF expression were impaired in the diabetic TG mice, but they were ameliorated by the DPP4 inhibition to levels similar to those found in the non-diabetic TG mice.The DPP4 inhibitor ameliorated cardiac function by inhibiting the inactivation of HMGB1 in diabetic mice after MI.
[Mh] Termos MeSH primário: Diabetes Mellitus Experimental/complicações
Dipeptidil Peptidase 4/efeitos de drogas
Proteína HMGB1/biossíntese
Infarto do Miocárdio/metabolismo
Miocárdio/metabolismo
Pirimidinas/farmacologia
Função Ventricular Esquerda/efeitos de drogas
[Mh] Termos MeSH secundário: Animais
Western Blotting
Dipeptidil Peptidase 4/metabolismo
Inibidores da Dipeptidil Peptidase IV/farmacologia
Ecocardiografia
Ensaio de Imunoadsorção Enzimática
Proteína HMGB1/efeitos de drogas
Masculino
Camundongos
Camundongos Transgênicos
Infarto do Miocárdio/diagnóstico
Infarto do Miocárdio/etiologia
Miocárdio/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dipeptidyl-Peptidase IV Inhibitors); 0 (HMGB1 Protein); 0 (HMGB1 protein, mouse); 0 (Pyrimidines); 0 (anagliptin); EC 3.4.14.5 (Dipeptidyl Peptidase 4); EC 3.4.14.5 (Dpp4 protein, mouse)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171002
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-547


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[PMID]:28966323
[Au] Autor:Srisuwantha R; Shiheido Y; Aoyama N; Sato H; Kure K; Laosrisin N; Izumi Y; Suzuki JI
[Ad] Endereço:Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University.
[Ti] Título:Porphyromonas Gingivalis Elevated High-Mobility Group Box 1 Levels After Myocardial Infarction in Mice.
[So] Source:Int Heart J;58(5):762-768, 2017 Oct 21.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:High mobility group box 1 (HMGB1) is a nuclear protein released from necrotic cells, inducing inflammatory responses. Epidemiological studies suggested a possible association between periodontitis and cardiovascular diseases (CVDs). Due to tissue damage and necrosis of cardiac cells following myocardial infarction (MI), HMGB1 is released, activating an inflammatory reaction. However, it remains unclear whether periodontitis is also involved in myocardial damage. The purpose of this study was to determine the effect of the periodontal pathogen Porphyromonas gingivalis (P.g.) after MI in mice.C57BL/6J wild type mice in post-MI were inoculated with P.g. in the infected group (P.g.-inoculated MI group) and with phosphate buffer saline (PBS) in the control group (PBS-injected MI group). Plasma samples and twelve tissue samples from mice hearts after MI were obtained. We determined the expression of HMGB1 by ELISA and immunohistochemistry.The level of HMGB1 protein in the P.g.-inoculated MI group was significantly higher than in the PBS-injected MI group on day 5, but not on day 14. Immunohistochemistry analysis revealed that HMGB1 was mainly expressed in cardiomyocytes, immune cells, and vascular endothelial cells in the PBS-injected MI group, while HMGB1 was seen broadly in degenerated cardiomyocytes, extracellular fields, immune cells, and vascular endothelial cells in the P.g.-inoculated MI group. A significant increase in the number of HMGB1 positive cells was observed in the P.g.-inoculated MI group compared to the PBS-injected MI group.Infection with P.g. after MI enhanced myocardial HMGB1 expression. There is a possible relationship between periodontitis and post-infarction myocardial inflammation through HMGB-1.
[Mh] Termos MeSH primário: Infecções por Bacteroidaceae/complicações
Proteína HMGB1/biossíntese
Infarto do Miocárdio/metabolismo
Miocárdio/metabolismo
Porphyromonas gingivalis/metabolismo
[Mh] Termos MeSH secundário: Animais
Infecções por Bacteroidaceae/metabolismo
Infecções por Bacteroidaceae/microbiologia
Biomarcadores/metabolismo
Modelos Animais de Doenças
Ensaio de Imunoadsorção Enzimática
Imuno-Histoquímica
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Infarto do Miocárdio/etiologia
Infarto do Miocárdio/patologia
Miocárdio/patologia
Miócitos Cardíacos/metabolismo
Miócitos Cardíacos/patologia
Porphyromonas gingivalis/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (HMGB1 Protein); 0 (HMGB1 protein, mouse)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171002
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-500


  5 / 190679 MEDLINE  
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[PMID]:28966314
[Au] Autor:Kim DW; Her SH; Park MW; Cho JS; Kim TS; Kang H; Sim DS; Hong YJ; Kim JH; Ahn Y; Chang K; Chung WS; Seung KB; Jeong MH; Rho TH
[Ad] Endereço:Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
[Ti] Título:Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction.
[So] Source:Int Heart J;58(5):674-685, 2017 Oct 21.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:This study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI ≤ 2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.
[Mh] Termos MeSH primário: Circulação Coronária/fisiologia
Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia
Intervenção Coronária Percutânea/métodos
Cuidados Pós-Operatórios/métodos
Sistema de Registros
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
Terapia Trombolítica/métodos
[Mh] Termos MeSH secundário: Angiografia Coronária
Feminino
Seguimentos
Humanos
Masculino
Meia-Idade
Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico
Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia
Valor Preditivo dos Testes
Estudos Prospectivos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171002
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-448


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[PMID]:28966310
[Au] Autor:Tong MS; Sung PH; Liu CF; Chen KH; Chung SY; Chua S; Chen CJ; Lee WC; Chai HT; Yip HK; Chang HW
[Ad] Endereço:Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.
[Ti] Título:Impact of Double Loading Regimen of Clopidogrel on Final Angiographic Results, Incidence of Upper Gastrointestinal Bleeding and Clinical Outcomes in Patients with STEMI Undergoing Primary Coronary Intervention.
[So] Source:Int Heart J;58(5):686-694, 2017 Oct 21.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:This study tested the therapeutic impact of double-loading dose (i.e., 600 mg) versus standard-loading dose (i.e., 300 mg) of clopidogrel on ST-segment-elevation-myocardial-infarction (STEMI) patients undergoing primary-coronary-intervention (PCI).Between January 2005 and December 2013, a total of 1461 STEMI patients undergoing PCI were consecutively enrolled into the study and categorized into group 1 (600 mg/clopidogrel; n = 508) and group 2 (300 mg/clopidogrel; n = 953). We assessed angiographic thrombolysis-in-myocardial-infarction (TIMI) flow in the infarct-related-artery, 30-day mortality and upper-gastrointestinal-bleeding (UGIB) within 30 days as primary-endpoints and later incidents of UGIB as secondary-endpoints.The results showed that the incidences of advanced Killip score (defined as ≥ score 3) upon presentation (23.8% versus 24.6%) and advanced heart failure (defined as ≥ NYHAFc-3) (10.2% versus 10.4%) did not differ between groups 1 and 2 (all P > 0.4). Primary-endpoints, which were final TIM-3 flow (91.3% versus 91.7%) in the infarct-related-artery, incidences of 30-day mortality (5.8% vs. 7.1%), and UGIB ≤ 30 day (7.8% versus 8.9%) did not differ between group 1 and group 2 (all P > 0.33). The secondary-endpoints which were incidences of ≥ 30-day < one-year (5.2% versus 4.7) and > one-year (8.9% versus 10.1%) UGIB did not differ between groups 1 and 2 (all P > 0.45). One-year mortality did not differ between two groups (10.74% versus 12.9%) (P > 0.25). Multiple-stepwise-logistic-regression analysis showed that age and advanced-Killip score were independently predictive of 30-day mortality (all P < 0.001).Double-loading dose of clopidogrel did not confer an additional benefit to the final angiograph results, 30-day/one-year clinical outcomes; and age and advanced Killip-score were powerful predictors of 30-day mortality.
[Mh] Termos MeSH primário: Angiografia Coronária/métodos
Hemorragia Gastrointestinal/epidemiologia
Intervenção Coronária Percutânea/métodos
Medição de Risco/métodos
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
Terapia Trombolítica/efeitos adversos
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Relação Dose-Resposta a Droga
Feminino
Seguimentos
Hemorragia Gastrointestinal/induzido quimicamente
Oclusão de Enxerto Vascular/diagnóstico
Oclusão de Enxerto Vascular/prevenção & controle
Humanos
Incidência
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/administração & dosagem
Inibidores da Agregação de Plaquetas/efeitos adversos
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
Taxa de Sobrevida/tendências
Taiwan/epidemiologia
Terapia Trombolítica/métodos
Ticlopidina/administração & dosagem
Ticlopidina/efeitos adversos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171002
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-325


  7 / 190679 MEDLINE  
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[PMID]:28954878
[Au] Autor:Rannikmäe K; Sivakumaran V; Millar H; Malik R; Anderson CD; Chong M; Dave T; Falcone GJ; Fernandez-Cadenas I; Jimenez-Conde J; Lindgren A; Montaner J; O'Donnell M; Paré G; Radmanesh F; Rost NS; Slowik A; Söderholm M; Traylor M; Pulit SL; Seshadri S; Worrall BB; Woo D; Markus HS; Mitchell BD; Dichgans M; Rosand J; Sudlow CLM; Stroke Genetics Network (SiGN), METASTROKE Collaboration, and International Stroke Genetics Consortium (ISGC)
[Ad] Endereço:From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München
[Ti] Título: is associated with lacunar ischemic stroke and deep ICH: Meta-analyses among 21,500 cases and 40,600 controls.
[So] Source:Neurology;89(17):1829-1839, 2017 Oct 24.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether common variants in familial cerebral small vessel disease (SVD) genes confer risk of sporadic cerebral SVD. METHODS: We meta-analyzed genotype data from individuals of European ancestry to determine associations of common single nucleotide polymorphisms (SNPs) in 6 familial cerebral SVD genes ( , , , , , and ) with intracerebral hemorrhage (ICH) (deep, lobar, all; 1,878 cases, 2,830 controls) and ischemic stroke (IS) (lacunar, cardioembolic, large vessel disease, all; 19,569 cases, 37,853 controls). We applied data quality filters and set statistical significance thresholds accounting for linkage disequilibrium and multiple testing. RESULTS: A locus in was associated (significance threshold < 3.5 × 10 ) with both lacunar IS (lead SNP rs9515201: odds ratio [OR] 1.17, 95% confidence interval [CI] 1.11-1.24, = 6.62 × 10 ) and deep ICH (lead SNP rs4771674: OR 1.28, 95% CI 1.13-1.44, = 5.76 × 10 ). A SNP in was associated (significance threshold < 5.5 × 10 ) with lacunar IS (rs79043147: OR 1.23, 95% CI 1.10-1.37, = 1.90 × 10 ) and less robustly with deep ICH. There was no clear evidence for association of common variants in either or with non-SVD strokes or in any of the other genes with any stroke phenotype. CONCLUSIONS: These results provide evidence of shared genetic determinants and suggest common pathophysiologic mechanisms of distinct ischemic and hemorrhagic cerebral SVD stroke phenotypes, offering new insights into the causal mechanisms of cerebral SVD.
[Mh] Termos MeSH primário: Hemorragia Cerebral/genética
Colágeno Tipo IV/genética
Polimorfismo de Nucleotídeo Único/genética
Acidente Vascular Cerebral Lacunar/genética
[Mh] Termos MeSH secundário: Hemorragia Cerebral/epidemiologia
Europa (Continente)/epidemiologia
Estudos de Associação Genética
Humanos
Acidente Vascular Cerebral Lacunar/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (COL4A2 protein, human); 0 (Collagen Type IV)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004560


  8 / 190679 MEDLINE  
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[PMID]:28931015
[Au] Autor:Toyota T; Shiomi H; Morimoto T; Natsuaki M; Kimura T
[Ad] Endereço:Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan.
[Ti] Título:Short versus prolonged dual antiplatelet therapy (DAPT) duration after coronary stent implantation: A comparison between the DAPT study and 9 other trials evaluating DAPT duration.
[So] Source:PLoS One;12(9):e0174502, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIMS: The Dual Antiplatelet Therapy (DAPT) study demonstrated that DAPT beyond 1-year after drug-eluting stent (DES) implantation, as compared with aspirin therapy alone, significantly reduced the risk of major cardiovascular and cerebrovascular events, which was mainly driven by the large risk reduction for myocardial infarction (MI). We sought to compare the largest DAPT study with other trials evaluating DAPT durations after DES implantation. METHODS AND RESULTS: By a systematic literature search, we identified 9 trials comparing prolonged- versus short-DAPT in addition to the DAPT study. The result from the DAPT study (N = 9961) with public-private collaboration was different from the pooled result of the 9 other investigator-driven trials (N = 22174) in terms of the effect of prolonged-DAPT on MI (odds ratio [OR] 0.48 [95%CI 0.38-0.62] versus pooled OR 0.88 [95%CI 0.67-1.15]: P = 0.001 for difference), while the trends for excess risk of prolonged-DAPT relative to short-DAPT for all-cause death (OR 1.31 [95%CI 0.97-1.78] versus pooled OR 1.16 [95%CI 0.92-1.45]: P = 0.53 for difference), and bleeding (OR 1.62 [95%CI 1.21-2.17] versus pooled OR 2.08 [95%CI 1.51-2.84]: P = 0.25 for difference) were consistently seen in both the DAPT and other trials. The annual rate of MI during aspirin mono-therapy in the DAPT study was much higher than that those in the other trials (2.7% versus 0.6-1.6%). CONCLUSIONS: Given the difference between the DAPT study and other trials, future studies should focus on certain subgroups of patients that are more or less likely to benefit from longer duration DAPT.
[Mh] Termos MeSH primário: Aspirina/uso terapêutico
Doenças Cardiovasculares/terapia
Antagonistas do Receptor Purinérgico P2Y/uso terapêutico
[Mh] Termos MeSH secundário: Doenças Cardiovasculares/complicações
Doenças Cardiovasculares/mortalidade
Bases de Dados Factuais
Stents Farmacológicos
Hemorragia/etiologia
Humanos
Infarto do Miocárdio/etiologia
Razão de Chances
Fatores de Risco
Acidente Vascular Cerebral/etiologia
Trombose/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Purinergic P2Y Receptor Antagonists); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0174502


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[PMID]:28893379
[Au] Autor:Enezate TH; Omran J; Al-Dadah AS; Alpert M; Mahmud E; Patel M; Aronow HD; Bhatt DL
[Ad] Endereço:University of Missouri, Columbia, Missouri. Electronic address: enezatet@health.missouri.edu.
[Ti] Título:Comparison of Outcomes of ST-Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention During Off-Hours Versus On-Hours.
[So] Source:Am J Cardiol;120(10):1742-1754, 2017 Nov 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Previous studies have reported worse outcomes and longer door-to-balloon times (DBTs) in patients presenting with ST-elevation myocardial infarction (STEMI) after normal working hours, during weekends, and on holidays (off-hours) compared with normal business hours (on-hours). Recent studies, however, have reported similar outcomes regardless of presentation time. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through December 2016. Only studies comparing STEMI outcomes during off-hours versus on-hours with percutaneous coronary intervention were included. A random-effects meta-analysis model was used to pool outcomes across the studies. Clinical end points included short- (<30 days of presentation), intermediate- (at 1 to 2 years), and long-term (at 3 to 4 years) stent thrombosis, mortality, recurrent myocardial infarction (MI), and major adverse cardiovascular events (MACEs). A total of 86,776 patients (62 years and 74.5% male) were identified from 39 studies. There was no significant difference between both groups with regard to mean DBT (odds ratio [OR] 0.74, 95% confidence interval [CI] -2.73 to 4.22, p = 0.67) or median DBT (p = 0.19). There was no significant difference between the 2 groups for short-term end points including mortality (OR 1.11, 95% CI 0.99 to 1.25, p = 0.08), MI (OR 1.25, 95% CI 0.90 to 1.74, p = 0.18), MACE (OR 1.06, 95% CI 0.93 to 1.20, p = 0.40), or stent thrombosis (OR 1.23, 95% CI 0.83 to 1.82, p = 0.31). Similarly, intermediate-term end points were not statistically different for mortality (OR 0.97, 95% CI 0.89 to 1.05, p = 0.46), MI (OR 0.86, 95% CI 0.73 to 1.02, p = 0.08), or MACE (OR 1.00, 95% CI 0.92 to 1.08, p = 0.98). Long-term end points did not differ statistically between groups for mortality (OR 0.95, 95% CI 0.83 to 1.09, p = 0.46), MI (OR 1.19, 95% CI 0.77 to 1.84, p = 0.44), or MACE (OR 0.98, 95% CI 0.89 to 1.08, p = 0.67). In conclusion, patients presenting with STEMI during off-hours and treated with percutaneous coronary intervention had similar short-, intermediate-, and long-term outcomes compared with patients presenting during on-hours. DBT was not affected by the time of presentation.
[Mh] Termos MeSH primário: Intervenção Coronária Percutânea/métodos
Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Humanos
Admissão do Paciente/estatística & dados numéricos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170912
[St] Status:MEDLINE


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[PMID]:28867129
[Au] Autor:Abela GS; Kalavakunta JK; Janoudi A; Leffler D; Dhar G; Salehi N; Cohn J; Shah I; Karve M; Kotaru VPK; Gupta V; David S; Narisetty KK; Rich M; Vanderberg A; Pathak DR; Shamoun FE
[Ad] Endereço:Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Division of Pathology, Department of Physiology, Michigan State University, East Lansing, Michigan. Electronic address: george.abela@ht.msu.edu.
[Ti] Título:Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury.
[So] Source:Am J Cardiol;120(10):1699-1707, 2017 Nov 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 µm had significantly elevated interleukin-1 beta (IL-1ß) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1ß levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1ß), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.
[Mh] Termos MeSH primário: Colesterol/metabolismo
Oclusão Coronária/complicações
Vasos Coronários/metabolismo
Inflamação/metabolismo
Infarto do Miocárdio/complicações
Intervenção Coronária Percutânea
Placa Aterosclerótica/metabolismo
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Proteína C-Reativa/metabolismo
Angiografia Coronária
Circulação Coronária/fisiologia
Oclusão Coronária/diagnóstico
Oclusão Coronária/metabolismo
Vasos Coronários/diagnóstico por imagem
Vasos Coronários/fisiopatologia
Citocinas/metabolismo
Ensaio de Imunoadsorção Enzimática
Feminino
Seguimentos
Humanos
Incidência
Inflamação/diagnóstico
Masculino
Meia-Idade
Infarto do Miocárdio/metabolismo
Infarto do Miocárdio/cirurgia
Placa Aterosclerótica/complicações
Placa Aterosclerótica/epidemiologia
Estudos Retrospectivos
Fatores de Risco
Análise Espectral
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cytokines); 9007-41-4 (C-Reactive Protein); 97C5T2UQ7J (Cholesterol)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE



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