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Chacón-Diaz M, Hernández-Vásquez A, Custodio-Sánchez P. [One-year survival among patients with ST-elevation myocardial infarction in Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:53-59. [PMID: 37351306 PMCID: PMC10284578 DOI: 10.47487/apcyccv.v3i2.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/30/2022] [Indexed: 06/24/2023]
Abstract
Objectives To determine one-year survival and factors associated with mortality in patients with ST-segment elevation myocardial infarction in Peru. Methods An analysis was made of the cohort of patients included in the PERSTEMI-II registry during the year 2020, in whom survival at one year after the event and its risk factors were evaluated using Kaplan-Meier survival analysis and Cox regression. Results Of 374 patients in the PERSTEMI-II study, 366 (97.9%) completed follow-up up to one year after the event with a survival rate of 85%. Successful reperfusion was related to better survival at 1 year (hazard ratio [HR]=0.30, 95% CI: 0.14-0.62, p=0.001). Age (HR=1.04, 95% CI: 1.01-1.07, p=0.003), chronic kidney disease (HR=2.15, 95% CI: 1.04-4.39, p=0.037) and cardiogenic shock (HR=6.67, 95% CI: 3.72-11.97, p<0.001) were factors of higher mortality at 1-year follow-up. Conclusion The PERSTEMI-II registry is the first Peruvian registry that provides data on survival after ST-segment elevation myocardial infarction, which is 85% at one year. Successful reperfusion improves survival at one-year post infarction.
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Affiliation(s)
- Manuel Chacón-Diaz
- Universidad Científica del Sur. Lima, Perú.Universidad Científica del SurUniversidad Científica del SurLimaPeru
- Instituto Nacional Cardiovascular INCOR. Lima, Perú.Instituto Nacional Cardiovascular INCORLimaPerú
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola. Lima, Perú.Universidad San Ignacio de LoyolaCentro de Excelencia en Investigaciones Económicas y Sociales en SaludVicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
| | - Piero Custodio-Sánchez
- Hospital Nacional Almanzor Aguinaga Asenjo, Essalud. Chiclayo, Perú.Hospital Nacional Almanzor Aguinaga Asenjo, EssaludChiclayoPerú
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Abstract
Compared with the general population, myocardial infarction (MI) survivors have a higher risk of mortality in the first year after the index event.The aim of this study was to determine the associations between variables obtained during the index admission and 1-year all-cause mortality on follow-up.A cohort of 296 patients was enrolled in the study, with a median age of 63.8 ± 12.68 years. All patients received a coronary angiography and stent implantation by percutaneous coronary intervention. Each variable was tested for association with all-cause mortality, using chi-square tests for categorical and binary variables and t tests for continuous variables. The relative prognostic power of each significant variable was further evaluated by logistic regression before and after adjustment for differences in baseline characteristics.Patients who were deceased after 1-year of MI had significantly higher mean age, increased prevalence of diabetes, and elevated heart rate as compared to those who were surviving. Univariate analysis indicated that patient mortality within 1-year of MI was strongly correlated with higher rates of pump failure on admission (P < .0001), bleeding complications (P = .02), the severity of coronary artery disease measured by Gensini score (P = .04), and decreased left ventricular ejection fraction (LVEF) (P < .0001). After adjustment of baseline variables, only pump failure (P = .006) and reduced LVEF (P < .0001) were independently associated with 1-year mortality.Our study shows that LVEF dysfunction and pump failure are independent predictors of 1-year all-cause post-MI mortality, while the severity of coronary artery disease and bleeding did not qualify as independent predictors. Also, age, history of diabetes, and elevated heart rate may be used as markers for increased mortality rates.
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Cascabulho CM, Meuser-Batista M, Moura KCGD, Pinto MDC, Duque TLA, Demarque KC, Guimarães ACR, Manso PPDA, Pelajo-Machado M, Oliveira GM, Castro SLD, Menna-Barreto RF. Antiparasitic and anti-inflammatory activities of ß-lapachone-derived naphthoimidazoles in experimental acute Trypanosoma cruzi infection. Mem Inst Oswaldo Cruz 2020; 115:e190389. [PMID: 32074167 PMCID: PMC7029714 DOI: 10.1590/0074-02760190389] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/22/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chagas disease, which is caused by the protozoan Trypanosoma
cruzi, is endemic to Latin America and mainly affects
low-income populations. Chemotherapy is based on two nitrocompounds, but
their reduced efficacy encourages the continuous search for alternative
drugs. Our group has characterised the trypanocidal effect of
naphthoquinones and their derivatives, with naphthoimidazoles derived from
β-lapachone (N1, N2 and N3) being the most active in
vitro. OBJECTIVES In the present work, the effects of N1, N2 and N3 on acutely infected mice
were investigated. METHODS in vivo activity of the compounds was assessed by
parasitological, biochemical, histopathological, immunophenotypical,
electrocardiographic (ECG) and behavioral analyses. FINDINGS Naphthoimidazoles led to a decrease in parasitaemia (8 dpi) by reducing the
number of bloodstream trypomastigotes by 25-50% but not by reducing
mortality. N1 protected mice from heart injury (15 dpi) by decreasing
inflammation. Bradycardia was also partially reversed after treatment with
N1 and N2. Furthermore, the three compounds did not reverse hepatic and
renal lesions or promote the improvement of other evaluated parameters. MAIN CONCLUSION N1 showed moderate trypanocidal and promising immunomodulatory activities,
and its use in combination with benznidazole and/or anti-arrhythmic drugs as
well as the efficacy of its alternative formulations must be investigated in
the near future.
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Affiliation(s)
- Cynthia M Cascabulho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Rio de Janeiro, RJ, Brasil
| | - Marcelo Meuser-Batista
- Fundação Oswaldo Cruz-Fiocruz, Instituto Fernandes Figueira, Departamento de Anatomia Patológica e Citopatologia, Laboratório de Patologia Molecular, Rio de Janeiro, RJ, Brasil
| | - Kelly Cristina G de Moura
- Universidade Federal do Rio de Janeiro, Instituto de Pesquisa em Produtos Naturais, Rio de Janeiro, RJ, Brasil
| | - Maria do Carmo Pinto
- Universidade Federal do Rio de Janeiro, Instituto de Pesquisa em Produtos Naturais, Rio de Janeiro, RJ, Brasil
| | - Thabata Lopes Alberto Duque
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Celular, Rio de Janeiro, RJ, Brasil
| | - Kelly C Demarque
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Celular, Rio de Janeiro, RJ, Brasil
| | - Ana Carolina Ramos Guimarães
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil
| | - Pedro Paulo de Abreu Manso
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Patologia, Rio de Janeiro, RJ, Brasil
| | - Marcelo Pelajo-Machado
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Patologia, Rio de Janeiro, RJ, Brasil
| | - Gabriel M Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Celular, Rio de Janeiro, RJ, Brasil
| | - Solange L De Castro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Celular, Rio de Janeiro, RJ, Brasil
| | - Rubem Fs Menna-Barreto
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Celular, Rio de Janeiro, RJ, Brasil
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Abstract
We reviewed clinical evidence for the use of ivabradine in systolic heart failure (HF), in which it appears to improve symptoms, improve quality of life, prevent hospitalization, and prolong survival, thereby addressing unmet needs in the management of HF. Ivabradine provides symptomatic benefits in HF on top of standard therapies, in terms of functional parameters and exercise capacity, and there is some evidence that this leads to improvements in quality of life in symptomatic HF patients, who may have dyspnea, altered exercise capacity, and fatigue. The SHIFT trial demonstrated that ivabradine has significant beneficial effects on major outcomes in HF. Ivabradine had a significant effect on pump failure death, which was reduced by 26 % (p = 0.014), with no effect on sudden cardiac death. This is an important result since pump failure death is currently the main cause of death in HF, and also because the reductions in mortality obtained with beta-blockers and spironolactone in the last 20 years appear to be mainly due to reduction in sudden death rather than reduction in pump failure death. Ivabradine also has a beneficial effect on hospital admissions (-26 %, p < 0.0001), which is clinically relevant since a quarter of HF patients can expect to be readmitted to hospital for HF within 1 month of discharge. Ivabradine-treated patients are also at significantly lower risk of experiencing a second or third hospitalization for worsening HF. Ivabradine clearly has a key role to play in the management of HF by covering the main therapeutic objectives of symptoms, quality of life, and outcomes.
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Affiliation(s)
- Antonio Carlos Pereira-Barretto
- Prevention and Rehabilitation Service, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, São Paulo, SP, CEP 05403-900, Brazil.
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Pereira-Barretto AC. Cardiac and Hemodynamic Benefits: Mode of Action of Ivabradine in Heart Failure. Adv Ther 2015; 32:906-19. [PMID: 26521191 DOI: 10.1007/s12325-015-0257-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 01/19/2023]
Abstract
Heart failure has seen a number of therapeutic advances in recent years. Despite this, heart failure is still related to increasing rates of morbidity, repeated hospitalizations, and mortality. Ivabradine is a recent treatment option for heart failure. It has a mode of action that includes reduction in heart rate, and leads to improvement in outcomes related to heart failure mortality and morbidity, as demonstrated by the results of the SHIFT trial in patients with systolic heart failure, functional classes II and III on the New York Heart Association classification, and left ventricular ejection fraction ≤ 35%. These results are intriguing since many heart failure drugs reduce heart rate without such benefits, or with quite different effects, making it more difficult to understand the novelty of ivabradine in this setting. Many of the drugs used in heart failure modify heart rate, but most have other pathophysiological effects beyond their chronotropic action, which affect their efficacy in preventing morbidity and mortality outcomes. For instance, heart rate reduction at rest or exercise with ivabradine prolongs diastolic perfusion time, improves coronary blood flow, and increases exercise capacity. Another major difference is the increase in stroke volume observed with ivabradine, which may underlie its beneficial cardiac effects. Finally, there is mounting evidence from both preclinical and clinical studies that ivabradine has an anti-remodeling effect, improving left ventricular structures and functions. All together, these mechanisms have a positive impact on the prognosis of ivabradine-treated patients with heart failure, making a compelling argument for use of ivabradine in combination with other treatments.
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