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[PMID]:29206397
[Au] Autor:Edgerly D
[Ti] Título:Shortness of Breath: Standardized treatment doesn't work for all patients.
[So] Source:JEMS;42(1):22, 2017 01.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/diagnóstico
Infarto Miocárdico de Parede Anterior/terapia
Dispneia/diagnóstico
Dispneia/terapia
Serviços Médicos de Emergência
Tratamento de Emergência
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:28941605
[Au] Autor:Bastiany A; Grenier ME; Matteau A; Mansour S; Daneault B; Potter BJ
[Ad] Endereço:Cardiology Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
[Ti] Título:Prevention of Left Ventricular Thrombus Formation and Systemic Embolism After Anterior Myocardial Infarction: A Systematic Literature Review.
[So] Source:Can J Cardiol;33(10):1229-1236, 2017 Oct.
[Is] ISSN:1916-7075
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anterior myocardial infarction (MI) with apical dysfunction is associated with an increased risk of left ventricular thrombus (LVT) formation and systemic embolism (SE). However, the role for prophylactic anticoagulation in current practice is a matter of debate. METHODS: We conducted a systematic review of peer-reviewed original articles in either English or French on the benefit of combining anticoagulation with standard therapy for the prevention of LVT/SE after MI by searching PubMed, Ovid/MedLine/Embase, the Cochrane Library, and Google Scholar. RESULTS: Of 7382 identified records, 14 were retained for analysis. Nine articles addressed anticoagulation for patients not treated with percutaneous coronary intervention (PCI). Another 5 included at least some patients treated with PCI. Only 1 study specifically addressed exclusively a primary PCI population. Some studies showed a benefit for combining anticoagulation with standard therapy in patients not treated with PCI, but results were inconsistent. No evidence of benefit was reported when PCI patients were included and 1 study reported a signal for net harm. There was important interstudy heterogeneity and methodological limitations. Studies were likely individually underpowered. CONCLUSIONS: The available studies of LVT/SE prevention after MI lacked statistical power and are heterogeneous in terms of treatments, revascularization methods, background medical therapy, and study design. We conclude that there is presently no compelling evidence for or against combining anticoagulation with standard therapy for post-MI patients with apical dysfunction after primary PCI, and inconsistent evidence supporting prophylaxis after thrombolysis. An appropriately powered randomized trial is required to answer this clinically relevant question.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/complicações
Embolia/etiologia
Cardiopatias/etiologia
Terapia Trombolítica/métodos
Trombose/etiologia
[Mh] Termos MeSH secundário: Embolia/prevenção & controle
Cardiopatias/prevenção & controle
Ventrículos do Coração
Seres Humanos
Fatores de Risco
Trombose/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170925
[St] Status:MEDLINE


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[PMID]:28545279
[Au] Autor:Shen QN; Wang DX; Zhai HB; Dong ZC; Liu J; Zhang B
[Ad] Endereço:Department of Cardiology, First Affiliated Hospital, Dalian Medical University, Dalian 116011, China.
[Ti] Título:[Impact of gender and age on in-hospital major adverse cardiovascular and cerebrovascular events of patients with acute ST-segment elevation myocardial infarction].
[So] Source:Zhonghua Xin Xue Guan Bing Za Zhi;45(4):288-293, 2017 Apr 24.
[Is] ISSN:0253-3758
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the impact of gender and age on in-hospital major adverse cardiovascular and cerebrovascular events of patients with acute ST-segment elevation myocardial infarction (STEMI). This is a retrospective single-center study. A total of consecutive 1 102 patients with acute STEMI admitted to our hospital from January 2001 to December 2010 were recruited and clinical data were analyzed. The primary end point was in-hospital death due to any cause, and the secondary end point was in-hospital composite end point including death, re-infarction and stroke. Multivariate logistic regression analyses were performed to identify the risk factors of in hospital death and composite end point. The study population included 283(25.7%(283/1 102)) female patients and female patients were older than male patients ((68.7±11.2)years vs. (59.2±12.5)years, <0.001). Compared with male patients, less female patients received primary percutaneous coronary intervention (50.9%(144/283) vs. 70.9%(581/819), <0.001), had higher rates of in hospital death(10.6%(30/283)vs. 6.0%(36/819), <0.001) and composite endpoint(14.1%(40/283)vs. 7.0%(57/819), <0.001). Among STEMI patients aged <60 years, no differences were found in in-hospital mortality (1.7%(1/58)vs. 1.4%(6/437)) and composite endpoint(3.6%(3/58)vs. 3.4%(15/437)) rates between female and male patients (both >0.05). Among STEMI patients aged ≥60 years, female patients had higher in-hospital mortality (12.9%(29/225)vs. 7.9%(30/382), <0.001), and there was no difference on composite endpoint between female and male patients (16.4%(37/225)vs. 11.0%(42/382), =0.054). Multivariate logistic regression analysis showed that female gender was not the independent risk factor of in-hospital death( =1.029, 95% 0.564-1.877, =0.926) and composite end point( =1.593, 95% 0.989-2.566, =0.055), but age was the independent risk factor of in-hospital death( =1.065, 95% 1.037-1.094, <0.001) and composite end point( =1.050, 95% 1.029-1.071, <0.001)in STEMI patients. Multivariate logistic regression analysis also showed that female was not the independent risk factor of in-hospital death( =1.539, 95% 0.572-4.142, =0.394) and composite end point( =1.563, 95% 0.689-3.546, =0.285), but age was the independent risk factor of in-hospital death( =1.052, 95% 1.011-1.096, =0.013) and composite end point( =1.042, 95% 1.008-1.077, =0.016)in STEMI patients received primary percutaneous coronary intervention. Female patients with STEMI have higher incidence of in-hospital major adverse cardiovascular and cerebrovascular events than male patients, and age is the independent risk factor of in-hospital major adverse cardiovascular and cerebrovascular events of STEMI patients.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/complicações
Mortalidade Hospitalar
Acidente Vascular Cerebral
[Mh] Termos MeSH secundário: Idoso
Feminino
Hospitais
Seres Humanos
Incidência
Masculino
Meia-Idade
Intervenção Coronária Percutânea
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0253-3758.2017.04.007


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[PMID]:28545277
[Au] Autor:Wang YY; Li T; Liu YW; Liu BJ; Hu XM; Wang Y; Gao WQ; Wu P; Huang L; Li X; Peng WJ; Ning M
[Ad] Endereço:Key Laboratory for Artificial Cells of Tianjin, Artificial Cell Engineering Technology Research Center of Ministry of Health, Department of Cardiac Center, Third Central Hospital of Tianjin, Tianjin 300170, China.
[Ti] Título:[Effect of the ischemic post-conditioning on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention].
[So] Source:Zhonghua Xin Xue Guan Bing Za Zhi;45(4):277-282, 2017 Apr 24.
[Is] ISSN:0253-3758
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the effect of the ischemic post-conditioning (IPC) on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). A total of 251 consecutive STEMI patients underwent PPCI in the heart center of Tianjin Third Central Hospital from January 2012 to June 2014 were enrolled in this prospective, randomized, control, single-blinded, clinical registry study. Patients were randomly divided into IPC group (123 cases) and control group (128 cases) with random number table. Patients in IPC group underwent three times of inflation/deflation with low inflation pressure using a balloon catheter within one minute after culprit vessel blood recovery, and then treated by PPCI. Patients in control group received PPCI procedure directly. The basic clinical characteristics, incidence of reperfusion arrhythmia during the procedure, the rate of electrocardiogram ST-segment decline, peak value of myocardial necrosis markers, incidence of contrast induced acute kidney injury(CI-AKI), and one-year major adverse cardiovascular events(MACE) which including myocardial infarction again, malignant arrhythmia, rehospitalization for heart failure, repeat revascularization, stroke, and death after the procedure were analyzed between the two groups. The age of IPC group and control group were comparable((61.2±12.6) vs. (64.2±12.1) years old, =0.768). The incidence of reperfusion arrhythmia during the procedure was significantly lower in the IPC group than in the control group(42.28% (52/123) vs. 57.03% (73/128), =0.023). The rate of electrocardiogram ST-segment decline immediately after the procedure was significantly higher in the IPC group than in the control group (77.24% (95/123) vs. 64.84% (83/128), =0.037). The peak value of myocardial necrosis markers after the procedure were significantly lower in the IPC group than in the control group(creatine kinase: 1 257 (682, 2 202) U/L vs. 1 737(794, 2 816)U/L, =0.029; creatine kinase-MB: 123(75, 218)U/L vs.165(95, 288)U/L, =0.010). The rate of CI-AKI after the procedure was significantly lower in the IPC group than in the control group(5.69%(7/123) vs. 14.06%(18/128), =0.034). The rate of the one-year MACE was significantly lower in the IPC group than in the control group(7.32%(9/123) vs. 15.63% (20/128), =0.040). The IPC strategy performed eight before PPCI can reduce myocardial ischemia- reperfusion injury, decline the rates of CI-AKI and one-year MACE significantly in STEMI patients, thus has a significant protective effect on heart and kidney in STEMI patients. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-ICR-15006590.
[Mh] Termos MeSH primário: Lesão Renal Aguda/prevenção & controle
Infarto Miocárdico de Parede Anterior
Pós-Condicionamento Isquêmico
Traumatismo por Reperfusão Miocárdica/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Biomarcadores
Creatina Quinase Forma MB
Eletrocardiografia
Feminino
Seres Humanos
Masculino
Meia-Idade
Intervenção Coronária Percutânea
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Biomarkers); EC 2.7.3.2 (Creatine Kinase, MB Form)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0253-3758.2017.04.005


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[PMID]:28492790
[Au] Autor:Pan Y; Lu Z; Hang J; Ma S; Ma J; Wei M
[Ad] Endereço:Heart Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
[Ti] Título:Effects of Low-Dose Recombinant Human Brain Natriuretic Peptide on Anterior Myocardial Infarction Complicated by Cardiogenic Shock.
[So] Source:Braz J Cardiovasc Surg;32(2):96-103, 2017 Mar-Apr.
[Is] ISSN:1678-9741
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION:: The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Infusion of low dose recombinant human brain natriuretic peptide (rhBNP) at the time of AMI is well tolerated and could improve cardiac function. OBJECTIVE:: The objective of this study was to evaluate the hemodynamic effects of rhBNP in AMI patients revascularized by emergency percutaneous coronary intervention (PCI) who developed cardiogenic shock. METHODS:: A total of 48 patients with acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and whose hemodynamic status was improved following emergency PCI were enrolled. Patients were randomly assigned to rhBNP (n=25) and control (n=23) groups. In addition to standard therapy, study group individuals received rhBNP by continuous infusion at 0.005 µg kg-1 min-1 for 72 hours. RESULTS:: Baseline characteristics, medications, and peak of cardiac troponin I (cTnI) were similar between both groups. rhBNP treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group. Respectively, 7 and 9 patients died in experimental and control groups. No drug-related serious adverse events occurred in either group. CONCLUSION:: When added to standard care in stable patients with cardiogenic shock complicating anterior STEMI, low dose rhBNP improves PCWP and is well tolerated.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/tratamento farmacológico
Peptídeo Natriurético Encefálico/administração & dosagem
Intervenção Coronária Percutânea/mortalidade
Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Análise de Variância
Infarto Miocárdico de Parede Anterior/complicações
Infarto Miocárdico de Parede Anterior/mortalidade
Pressão Sanguínea/efeitos dos fármacos
Feminino
Frequência Cardíaca/efeitos dos fármacos
Seres Humanos
Balão Intra-Aórtico/métodos
Masculino
Meia-Idade
Peptídeo Natriurético Encefálico/farmacologia
Peptídeo Natriurético Encefálico/uso terapêutico
Pressão Propulsora Pulmonar/efeitos dos fármacos
Proteínas Recombinantes/administração & dosagem
Proteínas Recombinantes/farmacologia
Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
Choque Cardiogênico/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Recombinant Proteins); 114471-18-0 (Natriuretic Peptide, Brain)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE


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[PMID]:28403033
[Au] Autor:Soeda T
[Ad] Endereço:First Department of Medicine, Nara Medical University, Kashihara, Nara Prefecture, Japan.
[Ti] Título:The mechanism of microvascular obstruction in patients with acute ST-segment elevation myocardial infarction: new light from optical coherence tomography.
[So] Source:Coron Artery Dis;28(3):188-189, 2017 05.
[Is] ISSN:1473-5830
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Intervenção Coronária Percutânea
Tomografia de Coerência Óptica
[Mh] Termos MeSH secundário: Infarto Miocárdico de Parede Anterior
Eletrocardiografia
Seres Humanos
Infarto do Miocárdio
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE
[do] DOI:10.1097/MCA.0000000000000466


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[PMID]:28302642
[Au] Autor:Havakuk O; Goland S; Mehra A; Elkayam U
[Ad] Endereço:From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
[Ti] Título:Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases.
[So] Source:Circ Cardiovasc Interv;10(3), 2017 Mar.
[Is] ISSN:1941-7632
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. METHODS AND RESULTS: A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation. CONCLUSIONS: Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and life-threatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior
Anomalias dos Vasos Coronários
Complicações Cardiovasculares na Gravidez
Infarto do Miocárdio com Supradesnível do Segmento ST
Doenças Vasculares/congênito
[Mh] Termos MeSH secundário: Adulto
Infarto Miocárdico de Parede Anterior/diagnóstico
Infarto Miocárdico de Parede Anterior/mortalidade
Infarto Miocárdico de Parede Anterior/fisiopatologia
Infarto Miocárdico de Parede Anterior/terapia
Ponte de Artéria Coronária
Anomalias dos Vasos Coronários/diagnóstico
Anomalias dos Vasos Coronários/mortalidade
Anomalias dos Vasos Coronários/fisiopatologia
Anomalias dos Vasos Coronários/terapia
Feminino
Transplante de Coração
Coração Auxiliar
Hemodinâmica
Seres Humanos
Meia-Idade
Intervenção Coronária Percutânea
Gravidez
Complicações Cardiovasculares na Gravidez/diagnóstico
Complicações Cardiovasculares na Gravidez/mortalidade
Complicações Cardiovasculares na Gravidez/fisiopatologia
Complicações Cardiovasculares na Gravidez/terapia
Resultado da Gravidez
Recidiva
Fatores de Risco
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
Resultado do Tratamento
Doenças Vasculares/diagnóstico
Doenças Vasculares/mortalidade
Doenças Vasculares/fisiopatologia
Doenças Vasculares/terapia
Função Ventricular Esquerda
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170318
[St] Status:MEDLINE


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[PMID]:28132793
[Au] Autor:Qian G; Jin RJ; Fu ZH; Yang YQ; Su HL; Dong W; Guo J; Jing J; Guo YL; Chen YD
[Ad] Endereço:Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
[Ti] Título:Development and validation of clinical risk score to predict the cardiac rupture in patients with STEMI.
[So] Source:Am J Emerg Med;35(4):589-593, 2017 Apr.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with poor prognosis. The aim of this study was to develop and validate practical risk score to predict the CR after STEMI. METHODS: A total of 11,234 STEMI patients from 7 centers in China were enrolled in our study, we firstly developed a simplified fast-track CR risk model from 7455 STEMI patients, and then prospectively validated the CR risk model using receiver-operating characteristic (ROC) curves by the other 3779 consecutive STEMI patients. This trial is registered with ClinicalTrials.gov, number NCT02484326. RESULTS: The incidence of CR was 2.12% (238/11,234), and the thirty-day mortality in CR patients was 86%. We developed a risk model which had 7 independent baseline clinical predictors (female sex, advanced age, anterior myocardial infarction, delayed admission, heart rate, elevated white blood cell count and anemia). The CR risk score system differentiated STEMI patients with incidence of CR ranging from 0.2% to 13%. The risk score system demonstrated good predictive value with area under the ROC of 0.78 (95% CI 0.73-0.84) in validation cohort. Primary percutaneous coronary intervention decreased the incidence of CR in high risk group (3.9% vs. 6.2%, p<0.05) and very high risk group (8.0% vs. 15.2%, p<0.05). CONCLUSIONS: A simple risk score system based on 7 baseline clinical variables could identify patients with high risk of CR, for whom appropriate treatment strategies can be implemented.
[Mh] Termos MeSH primário: Anemia/epidemiologia
Infarto Miocárdico de Parede Anterior/epidemiologia
Ruptura Cardíaca Pós-Infarto/epidemiologia
Leucocitose/epidemiologia
Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Infarto Miocárdico de Parede Anterior/fisiopatologia
Infarto Miocárdico de Parede Anterior/terapia
China/epidemiologia
Feminino
Frequência Cardíaca
Ruptura Cardíaca Pós-Infarto/mortalidade
Hospitalização
Seres Humanos
Incidência
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Intervenção Coronária Percutânea
Estudos Prospectivos
Curva ROC
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
Fatores Sexuais
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170131
[St] Status:MEDLINE


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[PMID]:28044983
[Au] Autor:Watanabe H; Morimoto T; Shiomi H; Furukawa Y; Nakagawa Y; Ando K; Kadota K; Kimura T
[Ad] Endereço:Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
[Ti] Título:Chronic total occlusion in a non-infarct-related artery is closely associated with increased five-year mortality in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (from the CREDO-Kyoto AMI registry).
[So] Source:EuroIntervention;12(15):e1874-e1882, 2017 Feb 03.
[Is] ISSN:1969-6213
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:AIMS: We sought to investigate the clinical impact of chronic total occlusion (CTO) in a non-infarct-related artery (IRA) on long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: Among 5,429 patients enrolled in the CREDO-Kyoto AMI registry, the current study population consisted of 2,045 STEMI patients with multivessel disease (MVD) who underwent primary PCI within 24 hours after symptom onset. The cumulative five-year, 30-day and 30-day to five-year incidences of all-cause death were all significantly higher in the CTO group than in the non-CTO group (37.0% versus 22.0%, log-rank p<0.0001, 12.8% versus 6.3%, log-rank p<0.0001, and 28.2% versus 16.8%, log-rank p<0.0001, respectively). The adjusted risk for all-cause death in the CTO group was significantly higher during the entire five years, during the initial 30 days, and beyond 30 days and up to five years (hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.18-1.84, p=0.0009; HR: 1.49, 95% CI: 1.04-2.13, p=0.03; and HR: 1.61, 95% CI: 1.23-2.07, p=0.0006, respectively). CONCLUSIONS: CTO in a non-IRA was associated with increased five-year mortality in STEMI patients with MVD. This was consistently seen even after excluding early deaths within 30 days of the index STEMI event.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/mortalidade
Oclusão Coronária/mortalidade
Oclusão Coronária/cirurgia
Infarto do Miocárdio/epidemiologia
Infarto do Miocárdio/mortalidade
Intervenção Coronária Percutânea
[Mh] Termos MeSH secundário: Idoso
Infarto Miocárdico de Parede Anterior/complicações
Oclusão Coronária/complicações
Feminino
Seguimentos
Seres Humanos
Incidência
Masculino
Meia-Idade
Infarto do Miocárdio/cirurgia
Intervenção Coronária Percutânea/métodos
Intervenção Coronária Percutânea/mortalidade
Sistema de Registros
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170104
[St] Status:MEDLINE


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[PMID]:27927700
[Au] Autor:Jenkins WS; Vesey AT; Stirrat C; Connell M; Lucatelli C; Neale A; Moles C; Vickers A; Fletcher A; Pawade T; Wilson I; Rudd JH; van Beek EJ; Mirsadraee S; Dweck MR; Newby DE
[Ad] Endereço:British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
[Ti] Título:Cardiac α ß integrin expression following acute myocardial infarction in humans.
[So] Source:Heart;103(8):607-615, 2017 Apr.
[Is] ISSN:1468-201X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Maladaptive repair contributes towards the development of heart failure following myocardial infarction (MI). The α ß integrin receptor is a key mediator and determinant of cardiac repair. We aimed to establish whether α ß integrin expression determines myocardial recovery following MI. METHODS: F-Fluciclatide (a novel α ß -selective radiotracer) positron emission tomography (PET) and CT imaging and gadolinium-enhanced MRI (CMR) were performed in 21 patients 2 weeks after ST-segment elevation MI (anterior, n=16; lateral, n=4; inferior, n=1). CMR was repeated 9 months after MI. 7 stable patients with chronic total occlusion (CTO) of a major coronary vessel and nine healthy volunteers underwent a single PET/CT and CMR. RESULTS: F-Fluciclatide uptake was increased at sites of acute infarction compared with remote myocardium (tissue-to-background ratio (TBR ) 1.34±0.22 vs 0.85±0.17; p<0.001) and myocardium of healthy volunteers (TBR 1.34±0.22 vs 0.70±0.03; p<0.001). There was no F-fluciclatide uptake at sites of established prior infarction in patients with CTO, with activity similar to the myocardium of healthy volunteers (TBR 0.71±0.06 vs 0.70±0.03, p=0.83). F-Fluciclatide uptake occurred at sites of regional wall hypokinesia (wall motion index≥1 vs 0; TBR 0.93±0.31 vs 0.80±0.26 respectively, p<0.001) and subendocardial infarction. Importantly, although there was no correlation with infarct size (r=0.03, p=0.90) or inflammation (C reactive protein, r=-0.20, p=0.38), F-fluciclatide uptake was increased in segments displaying functional recovery (TBR 0.95±0.33 vs 0.81±0.27, p=0.002) and associated with increase in probability of regional recovery. CONCLUSION: F-Fluciclatide uptake is increased at sites of recent MI acting as a biomarker of cardiac repair and predicting regions of recovery. TRIAL REGISTRATION NUMBER: NCT01813045; Post-results.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/metabolismo
Infarto Miocárdico de Parede Inferior/metabolismo
Integrina alfaVbeta3/metabolismo
Miocárdio/metabolismo
Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo
[Mh] Termos MeSH secundário: Idoso
Infarto Miocárdico de Parede Anterior/diagnóstico por imagem
Infarto Miocárdico de Parede Anterior/patologia
Infarto Miocárdico de Parede Anterior/fisiopatologia
Biomarcadores/metabolismo
Estudos de Casos e Controles
Meios de Contraste/administração & dosagem
Feminino
Seres Humanos
Infarto Miocárdico de Parede Inferior/diagnóstico por imagem
Infarto Miocárdico de Parede Inferior/patologia
Infarto Miocárdico de Parede Inferior/fisiopatologia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Miocárdio/patologia
Peptídeos
Polietilenoglicóis
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Recuperação de Função Fisiológica
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem
Infarto do Miocárdio com Supradesnível do Segmento ST/patologia
Fatores de Tempo
Função Ventricular Esquerda
Remodelação Ventricular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (AH 111585); 0 (Biomarkers); 0 (Contrast Media); 0 (Integrin alphaVbeta3); 0 (Peptides); 30IQX730WE (Polyethylene Glycols)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161209
[St] Status:MEDLINE
[do] DOI:10.1136/heartjnl-2016-310115



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