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Timóteo AT, Ribeiras R, Calé R, Moura B, G Almeida A, Gavina C, Cabral S, António N, Franco F, Ilhão Moreira R, Geraldes F, Machado AP, Palma F, Pires da Silva V, Gonçalves L. Cardiovascular diseases in women - Consensus document of the Sociedade Portuguesa de Cardiologia, Sociedade Portuguesa de Ginecologia, Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal, Sociedade Portuguesa de Contraceção e Associação Portuguesa de Medicina Geral e Familiar. Rev Port Cardiol 2023; 42:1001-1015. [PMID: 36566887 DOI: 10.1016/j.repc.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The main objective of this consensus statement from the Portuguese Society of Cardiology, the Portuguese Society of Gynecology, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Portuguese Society of Contraception, Portuguese Association of General Practice and Family Medicine is to improve cardiovascular care for women. It includes a brief review of the state-of-the-art of cardiovascular diseases in women and of the links to other fields such as Gynaecology, Obstetrics and Endocrinology. It also provides final recommendations to help clinicians working in care of women's health.
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Affiliation(s)
| | | | - Rita Calé
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Brenda Moura
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Ana G Almeida
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | - Sofia Cabral
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | - Fátima Franco
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | | | - Ana Paula Machado
- Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal, Lisboa, Portugal
| | - Fátima Palma
- Sociedade Portuguesa de Contraceção, Lisboa, Portugal
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Oliveira CC, Vilela F, Braga C, Costa J, Marques J. ST-Segment Elevation Myocardial Infarction Differences between Genders - A Single Center Retrospective Analysis. Arq Bras Cardiol 2022; 120:e20211040. [PMID: 36629597 PMCID: PMC9833215 DOI: 10.36660/abc.20211040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, women show higher mortality. OBJECTIVES To assess gender differences in presentation, management and in-hospital mortality, at 30-days, 6-months and 1-year after STEMI. METHODS We retrospectively collected data from 809 consecutive patients treated with primary PCI and compared the females versus males at the local intervention cardiology database. The level of significance used was p<0.05. RESULTS Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p<.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p<.001), diabetes (30,6% vs. 18,5%; p=.001), hypertension (60.5% vs. 45.9%; p=.001), chronic kidney disease (3.4% vs. 0.6%; p=.010) and acute ischemic stroke (6.8% vs. 3.0%; p=.021). At presentation, women had more atypical symptoms, less chest pain (p=.014) and were more frequently in cardiogenic shock (p=.011)). Women had longer time until reperfusion (p=.001) and were less likely to receive optimal medical therapy (p<0.05). In-hospital mortality (p=.001), at 30-days (p<.001), 6-months (p<.001) and 1-year (16.4% vs. p<.001) was higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI[1.67-10.77];p=.002), Killip class II (HR=8.80; 95% CI[2.72-28.41];p<.001), III (HR=5.88; 95% CI [0.99-34.80]; p=.051) and IV (HR=9.60; 95% CI[1.86-48.59];p=.007), Acute Kidney Injury (HR=2.47; 95% CI[1.00-6.13];p=.051) and days of hospitalization (HR=1.04; 95% CI[1.01-1.08];p=.030) but not female gender (HR=0.83; 95% CI[0.33-2.10];p=.690) as independent prognostic factors of mortality. CONCLUSIONS Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Women admitted for STEMI have a worse risk profile, are treated with a higher reperfusion time related with system delays and are less likely to receive the recommended therapy. Female gender was not an independent prognostic factor for mortality in the studied population.
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Affiliation(s)
- Cátia Costa Oliveira
- Serviço de CardiologiaHospital de BragaBragaPortugalServiço de Cardiologia, Hospital de Braga, Braga – Portugal,Escola de MedicinaUniversidade do MinhoBragaPortugalEscola de Medicina da Universidade do Minho, Braga – Portugal
| | - Filipe Vilela
- Escola de MedicinaUniversidade do MinhoBragaPortugalEscola de Medicina da Universidade do Minho, Braga – Portugal
| | - Carlos Braga
- Serviço de CardiologiaHospital de BragaBragaPortugalServiço de Cardiologia, Hospital de Braga, Braga – Portugal
| | - João Costa
- Serviço de CardiologiaHospital de BragaBragaPortugalServiço de Cardiologia, Hospital de Braga, Braga – Portugal
| | - Jorge Marques
- Serviço de CardiologiaHospital de BragaBragaPortugalServiço de Cardiologia, Hospital de Braga, Braga – Portugal
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Nomogram for Predicting In-Hospital Mortality in Patients with Acute ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock after Primary Percutaneous Coronary Intervention. J Interv Cardiol 2022; 2022:8994106. [PMID: 35356419 PMCID: PMC8934239 DOI: 10.1155/2022/8994106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Mortality after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) remains high. However, the real-world risk factors for mortality in these patients are poorly defined. Objective The aim of this study is to establish a clinical prognostic nomogram for predicting in-hospital mortality after primary PCI in STEMI patients with CS. Methods This retrospective, multicenter, observational study included STEMI patients with CS who underwent PCI at 39 hospitals in Hebei Province from January 2018 to December 2019. A multivariate logistic regression model was used to identify the factors associated with in-hospital mortality. These factors were then incorporated into a nomogram and its performance was evaluated by discrimination, calibration, and clinical utility. Results This study included 274 patients, among whom 179 died in hospital. Sex, random blood glucose on admission, ejection fraction after PCI, no-reflow, and intra-aortic balloon pump (IABP) were independently associated with in-hospital mortality (all P < 0.05). In the training set, the nomogram showed a C-index of 0.819, goodness-of-fit of 0.08, and area under the receiver operating characteristic curve (AUC) of 0.819 (95%CI = 0.759–0.879). In the testing set, the C-index was 0.842, goodness-of-fit was 0.585, and AUC was 0.842 (95%CI = 0.715–0.970). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit. Conclusion We established and validated a nomogram that provided individual prediction of in-hospital mortality for STEMI patients with CS after PCI in a Chinese population.
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Oliveira JC, Barros MPS, Barreto IDDC, Silva RC, Andrade VA, Oliveira ADM, Lima TCRM, Oliveira JC, Arcelino LAM, Oliveira LCS, Santana-Santos E, Almeida-Santos MA, Sousa AC, Barreto JAS. Access to Reperfusion Therapy and Mortality in Women with ST-Segment-Elevation Myocardial Infarction: VICTIM Register. Arq Bras Cardiol 2021; 116:695-703. [PMID: 33886713 PMCID: PMC8121383 DOI: 10.36660/abc.20190468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/23/2020] [Accepted: 03/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Myocardial reperfusion is a fundamental part of the treatment for ST elevation myocardial infarction (STEMI) and is responsible for reducing morbidity and mortality in affected patients. However, reperfusion rates are usually lower and mortality rates higher in women compared to men. OBJECTIVES To evaluate the prevalence of the use of reperfusion therapies among women and men with STEMI in hospitals where percutaneous coronary intervention (PCI) is available in the state of Sergipe. METHODS This is a cross-sectional study that used data from the VICTIM Register. Patients diagnosed with STEMI admitted to the four hospitals (one public and three private) where PCI is available in the state of Sergipe were evaluated, from December 2014 to June 2018. A multivariate analysis with adjusted model using mortality as a dependent variable was made. In all analyses, the level of significance adopted was 5% (p < 0.05). RESULTS A total of 878 volunteers with a confirmed diagnosis of STEMI, of which 33.4% were women, were included in the study. Only 53.3% of the patients underwent myocardial reperfusion (134 women versus 334 men). Fibrinolysis was performed only in 2.3% of all patients (1.7% of women versus 2.6% of men; p = 0.422). The rate of primary PCI was lower (44% versus 54.5%; p = 0.003) and hospital mortality was higher (16.1% versus 6.7%; p < 0.001) in women than in men. CONCLUSION Women have significantly lower rates of primary PCI and higher hospital mortality. Reperfusion rates were low in both sexes and there was a clear underutilization of thrombolytic agents.
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Affiliation(s)
- Jussiely Cunha Oliveira
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Universidade Federal de SergipeNúcleo de Pós-graduação em EnfermagemSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-graduação em Enfermagem, São Cristóvão, SE - Brasil.
| | - Mayse Pereira Souza Barros
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
| | - Ikaro Daniel de Carvalho Barreto
- Universidade Federal Rural de PernambucoNúcleo de Pós-graduação em biometria e estatística aplicadaRecifePEBrasilUniversidade Federal Rural de Pernambuco - Núcleo de Pós-graduação em biometria e estatística aplicada, Recife, PE - Brasil.
| | - Rubens Cruz Silva
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
| | - Volfanio Araújo Andrade
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
| | - André de Melo Oliveira
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
| | - Ticiane Clair Remacre Munareto Lima
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
| | - Jeferson Cunha Oliveira
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Hospital PrimaveraAracajuSEBrasilHospital Primavera, Aracaju, SE - Brasil.
| | - Larissa Andreline Maia Arcelino
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Universidade Federal de SergipeHospital UniversitárioAracajuSEBrasilHospital Universitário da Universidade Federal de Sergipe (HU-UFS), Aracaju, SE - Brasil.
| | - Laís Costa Souza Oliveira
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Hospital PrimaveraAracajuSEBrasilHospital Primavera, Aracaju, SE - Brasil.
| | - Eduesley Santana-Santos
- Universidade Federal de SergipeNúcleo de Pós-graduação em EnfermagemSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-graduação em Enfermagem, São Cristóvão, SE - Brasil.
| | - Marcos Antônio Almeida-Santos
- Universidade TiradentesPrograma de Pós-graduação em Saúde e AmbienteAracajuSEBrasilPrograma de Pós-graduação em Saúde e Ambiente da Universidade Tiradentes, Aracaju, SE - Brasil.
| | - Antônio Carlos Sousa
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
- Fundação São LucasCentro de Ensino e PesquisaAracajuSEBrasilFundação São Lucas - Centro de Ensino e Pesquisa, Aracaju, SE - Brasil.
- Universidade Federal de SergipeHospital UniversitárioDivisão de CardiologiaSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Divisão de Cardiologia do Hospital Universitário, São Cristóvão, SE - Brasil.
| | - José Augusto Soares Barreto
- Universidade Federal de SergipeNúcleo de Pós-Graduação em Ciências da SaúdeSão CristóvãoSEBrasilUniversidade Federal de Sergipe - Núcleo de Pós-Graduação em Ciências da Saúde, São Cristóvão, SE - Brasil.
- Universidade Federal de SergipeSão CristóvãoSEBrasilUniversidade Federal de Sergipe – Medicina, São Cristóvão, SE - Brasil.
- Fundação São LucasCentro de Ensino e PesquisaAracajuSEBrasilFundação São Lucas - Centro de Ensino e Pesquisa, Aracaju, SE - Brasil.
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Roque D, Ferreira J, Monteiro S, Costa M, Gil V. Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. Rev Port Cardiol 2020; 39:57-72. [PMID: 32205012 DOI: 10.1016/j.repc.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality. OBJECTIVE The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods. METHODS We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology. RESULTS A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy. CONCLUSION In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.
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Affiliation(s)
- David Roque
- Cardiology Department, Hospital Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Victor Gil
- Cardiovascular Unit, Hospital dos Lusíadas, Lisbon University, Lisbon, Portugal
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Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. Rev Port Cardiol 2019; 38:637-646. [DOI: 10.1016/j.repc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/01/2022] Open
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8
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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9
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Kanic V, Suran D, Krajnc I, Kompara G. ST-elevation myocardial infarction in a real world population - An observational retrospective study with a sex perspective. Eur J Intern Med 2019; 66:81-84. [PMID: 31200997 DOI: 10.1016/j.ejim.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Mortality after myocardial infarction is higher in women than in men. Data on the association between sex and mortality are conflicting and inconclusive. We evaluated whether there is a sex difference in survival and if sex is associated with the outcome in patients with ST-elevation myocardial infarction (STEMI). METHODS We analyzed 3671 STEMI patients. Long-term and 30-day mortality in men and women were compared. RESULTS Unadjusted mortality at day 30 was higher in women [221 (8.7%) men died compared to 147 (13.1%) women; p < 0.0001]. After multivariate adjustments, this became insignificant (OR 1.65; 95% CI; 0.81 to 1.40). The long-term, unadjusted mortality was also higher in women [674 (26.3%) men died compared to 382 (34%) women; p < 0.0001]. After multivariable adjustments, female sex (adjusted HR 0.81; 95% CI 0.71 to 0.93; p = 0.002), bleeding (adjusted HR 1.79; 95% CI 1.52 to 2.10; p < 0.0001), renal dysfunction adjusted HR (1.60; 95% CI 1.40 to 1.84; p < 0.0001), hyperlipidemia (adjusted HR 1.61; 95% CI 1.40 to 1.85; p < 0.0001), arterial hypertension (adjusted HR 1.17; 95% CI 1.03 to 1.33; p = 0.015), diabetes (adjusted HR 1.55; 95% CI 1.35 to 1.78; p < 0.0001), age (adjusted HR 1.05; 95% CI 1.04 to 1.06; p < 0.0001), anemia on admission (adjusted HR 1.38; 95% CI 1.23 to 1.58; p < 0.0001), and heart failure (adjusted HR 2.40; 95% CI 2.09 to 2.75; p < 0.0001) predicted long-term mortality. CONCLUSION Female sex was associated with a lower risk of dying in the long term. However, risk factors, age, and comorbidities associated with female patients affected the worse outcome.
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Affiliation(s)
- Vojko Kanic
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - David Suran
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Igor Krajnc
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Gregor Kompara
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
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Pereira H, Caldeira D, Teles RC, Costa M, da Silva PC, da Gama Ribeiro V, Brandão V, Martins D, Matias F, Pereira-Machado F, Baptista J, Abreu PFE, Santos R, Drummond A, de Carvalho HC, Calisto J, Silva JC, Pipa JL, Marques J, Sousa P, Fernandes R, Ferreira RC, Ramos S, Oliveira EI, de Sousa Almeida M. Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology. BMC Cardiovasc Disord 2018; 18:69. [PMID: 29699478 PMCID: PMC5921398 DOI: 10.1186/s12872-018-0794-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in ‘real-world’ settings. Methods We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006–2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). Results We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54–1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35–0.98; 3500 patients). Conclusions The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.
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Affiliation(s)
- Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Avenida Prof. Torrado da Silva, 2801-951, Almada, Portugal. .,Centro Cardiovascular da Universidade de Lisboa (CCUL), CAML, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.
| | - Daniel Caldeira
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Avenida Prof. Torrado da Silva, 2801-951, Almada, Portugal.,Centro Cardiovascular da Universidade de Lisboa (CCUL), CAML, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.,Unidade de Farmacologia Clínica, Instituto de Medicina Molecular; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.,Registo Nacional de Cardiologia de Intervenção, APIC-CNCDC, Lisboa, Portugal
| | - Marco Costa
- Centro Hospitalar e Universitário de Coimbra - CHC, Coimbra, Portugal
| | - Pedro Canas da Silva
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | - Vasco da Gama Ribeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho - Hospital Eduardo Santos Silva, Porto, Portugal
| | | | - Dinis Martins
- Hospital do Divino Espírito Santo de Ponta Delgada EPE, Açores, Portugal
| | | | | | - José Baptista
- Unidade de Intervenção Cardiovascular - Alvor, Portimão, Portugal
| | | | - Ricardo Santos
- Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | | | | | - João Calisto
- Centro Hospitalar e Universitário de Coimbra - HUC, Coimbra, Portugal
| | | | | | | | - Paulino Sousa
- Hospital de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, Vila Real, Portugal
| | | | - Rui Cruz Ferreira
- Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisboa, Portugal
| | - Sousa Ramos
- Hospital CUF Infante Santo, Lisboa, Portugal
| | - Eduardo Infante Oliveira
- Registo Nacional de Cardiologia de Intervenção, APIC-CNCDC, Lisboa, Portugal.,Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | - Manuel de Sousa Almeida
- Hospital de Santa Cruz. CHLO; Departamento de Fisiopatologia Nova Medical School, Lisboa, Portugal
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Adopting an early invasive strategy for non-ST-elevation myocardial infarction: Analysis of the Portuguese Registry on Acute Coronary Syndromes. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Morgado G, Pereira H, Caldeira D. Adoção da estratégia invasiva precoce no enfarte agudo do miocárdio sem supra desnivelamento de ST: análise dos resultados do Registo Nacional de Síndromas Coronárias Agudas. Rev Port Cardiol 2018; 37:53-61. [DOI: 10.1016/j.repc.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/10/2017] [Accepted: 06/11/2017] [Indexed: 10/18/2022] Open
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13
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Kanic V, Vollrath M, Tapajner A, Sinkovic A. Sex-Related 30-Day and Long-Term Mortality in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention. J Womens Health (Larchmt) 2017; 26:374-379. [DOI: 10.1089/jwh.2016.5957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Alojz Tapajner
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andreja Sinkovic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Seabra Gomes R. Finally, a continuous national multicenter registry: Primary angioplasty in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Seabra Gomes R. Finalmente um Registo Multicêntrico Nacional contínuo: a propósito da angioplastia primária em Portugal. Rev Port Cardiol 2016; 35:405-6. [DOI: 10.1016/j.repc.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Kanic V, Vollrath M, Naji FH, Sinkovic A. Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI. Int J Med Sci 2016; 13:440-4. [PMID: 27279793 PMCID: PMC4893558 DOI: 10.7150/ijms.15214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data about gender as an independent risk factor for death in ST-elevation myocardial infarction (STEMI) patients is still contrasting. Aim was to assess how gender influences in-hospital and long-term all-cause mortality in STEMI patients with primary percutaneous coronary intervention (PCI) in our region. METHODS We analysed data from 2069 STEMI patients undergoing primary PCI in our institution from January 2009-December 2014, of whom 28.9% were women. In-hospital and long-term mortality were observed in women and men. The effect of gender on in-hospital mortality was assessed by binary logistic regression modelling and by Cox regression analysis for long-term mortality. RESULTS Women were older (68.3±61.8 vs 61.8±12.0 years; p<0.0001), with a higher prevalence of diabetes (13.7% vs 9.9%; p=0.013) and tend to be more frequently admitted in cardiogenic shock (8.4% vs 6.3%; p =0.085). They were less frequently treated with bivalirudin (15.9% vs 20.3%; p=0.022). In-hospital mortality was higher among women (14.2% vs 7.8%; p<0.0001). After adjustment, age (adjusted OR: 1.05; 95% CI: 1.03 to 1.08; p < 0.001) and cardiogenic shock at admission (adjusted OR: 24.56; 95% CI: 11.98 to 50.35; p < 0.001), but not sex (adjusted OR: 1.47; 95% CI: 0.80 to 2.71) were identified as prognostic factors of in-hospital mortality. During the median follow-up of 27 months (25th, 75th percentile: 9, 48) the mortality rate (23.6% vs 15.1%; p<0.0001) was significantly higher in women. The multivariate adjusted Cox regression model identified age (HR 1.05; 95% CI 1.04-1.07; p<0.0001), cardiogenic shock at admission (HR 6.09; 95% CI 3.78-9.81; p<0.0001), hypertension (HR 1.49; 95% CI 1.02-2.18; p<0.046), but not sex (HR 1.04; 95% CI 0.74-1.47) as independent prognostic factors of follow-up mortality. CONCLUSION Older age and worse clinical presentation rather than gender may explain the higher mortality rate in women with STEMI undergoing primary PCI.
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Affiliation(s)
- Vojko Kanic
- 1. University Medical Centre Maribor, Maribor, Slovenia
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Luz A, Santos M, Magalhães R, Silveira J, Cabral S, Dias V, Oliveira F, Pereira S, Leite-Moreira A, Carvalho H, Torres S. Lack of Benefit of Ischemic Postconditioning After Routine Thrombus Aspiration During Reperfusion. J Cardiovasc Pharmacol Ther 2015; 20:523-31. [DOI: 10.1177/1074248415578171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/02/2015] [Indexed: 11/16/2022]
Abstract
Objectives: The underutilization of manual thrombus aspiration (MTA) may have reduced the benefits of ischemic postconditioning (PostCon), as it reduces thrombus embolization. We aimed to assess the benefits of PostCon in patients with ST-segment elevation myocardial infarction (STEMI) after the systematic utilization of MTA. Methods: A total of 87 patients were enrolled in a prospective, randomized trial (43 PostCon and 44 controls). After MTA, PostCon was performed on the treatment group by applying 4 cycles of alternate reperfusion and reocclusion (60 seconds each) using the angioplasty balloon. The primary end point was infarct size assessed by the area under the curve (AUC) of troponin T (TnT) activity. The secondary end points were left ventricle ejection fraction (LVEF) and major cardiac events (new myocardial infarction or cardiac death) both at discharge and at follow-up. Results: The AUC for TnT was no different with respect to study arms (median [interquartile range]): PostCon = 8.9 (10.6) versus control = 8.2 (10.6), P = .68. Left ventricle ejection fraction improved from in-hospital to follow-up (9 ± 3 months) for the entire cohort (46.3% ± 7.3% vs 52.2% ± 10.7%, P < .001), with no differences between PostCon and controls (51.6% ± 9.5% vs 52.7% ± 11.9%, P = .89); major cardiac events at 14 ± 4 months of follow-up were also no different (PostCon = 1.0 (2.3%) vs control = 0, P = .49). Conclusion: In patients with STEMI treated with MTA, PostCon offered no benefits to infarct size, LVEF, or major cardiac events.
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Affiliation(s)
- André Luz
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Mário Santos
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Magalhães
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - João Silveira
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - Sofia Cabral
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Vasco Dias
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | | | - Sousa Pereira
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Carvalho
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - Severo Torres
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
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