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Furtado RHDM, Genestreti PR, Dalçóquio TF, Baracioli LM, Lima FG, Franci A, Giraldez RRCV, Menezes FR, Ferrari AG, Lima VM, Pereira CAC, Nakashima CAK, Salsoso R, Godoy LC, Nicolau JC. Association between Statin Therapy and Lower Incidence of Hyperglycemia in Patients Hospitalized with Acute Coronary Syndromes. Arq Bras Cardiol 2021; 116:285-294. [PMID: 33656078 PMCID: PMC7909967 DOI: 10.36660/abc.20200128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Fundamento O maior risco de se desenvolver diabetes com o uso de estatinas é um desafio para a segurança do uso dessa classe de medicamentos em longo prazo. No entanto, poucos estudos analisaram essa questão durante síndromes coronarianas agudas (SCA). Objetivos Investigar a associação entre início precoce da terapia com estatina e níveis de glicemia em pacientes admitidos com SCA. Métodos Este foi um estudo retrospectivo de pacientes hospitalizados por SCA. Pacientes que nunca haviam usado estatinas foram incluídos e divididos segundo uso ou não de estatina nas primeiras 24 horas de internação. O desfecho primário foi a incidência de hiperglicemia na internação (definida como pico de glicemia > 200mg/dL). Modelos de regressão logística e modelos lineares multivariados foram usados para ajuste quanto a fatores de confusão e um modelo de pareamento por escore de propensão foi desenvolvido para comparações entre os dois grupos de interesses. Um valor de p menor que 0,05 foi considerado estatisticamente significativo. Resultados Um total de 2357 pacientes foram incluídos, 1704 deles alocados no grupo que receberam estatinas e 653 no grupo que não receberam estatinas nas primeiras 24 horas de internação. Após os ajustes, uso de estatina nas primeiras 24 horas foi associado com uma menor incidência de hiperglicemia durante a internação (OR ajustado = 0,61, IC95% 0,46-0,80; p < 0,001) e menor necessidade de uso de insulina (OR ajustado = 0,56, IC 95% 0,41-0,76; p < 0,001). Essas associações mantiveram-se similares nos modelos de pareamento por escore de propensão, bem como após análises de sensibilidade, como exclusão de pacientes que desenvolveram choque cardiogênico, infecção grave ou pacientes que foram a óbito durante a internação hospitalar. Conclusões Entre os pacientes internados com SCA que não receberam estatinas previamente, a terapia precoce com estatina associou-se independentemente com menor incidência de hiperglicemia durante a internação. (Arq Bras Cardiol. 2021; 116(2):285-294)
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Affiliation(s)
- Remo Holanda de Mendonça Furtado
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Paulo Rizzo Genestreti
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Talia F Dalçóquio
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Felipe Galego Lima
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - André Franci
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Roberto R C V Giraldez
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fernando R Menezes
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Aline Gehlen Ferrari
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Viviane Moreira Lima
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Cesar A C Pereira
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Carlos Alberto Kenji Nakashima
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Rocio Salsoso
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Lucas Colombo Godoy
- University of Toronto Ringgold standard institution - Peter Munk Cardiac Centre Toronto, Ontario - Canadá
| | - José C Nicolau
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
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Nakashima CAK, Dallan LAO, Lisboa LAF, Jatene FB, Hajjar LA, Soeiro AM, Furtado RHM, Dalçoquio TF, Baracioli LM, Lima FG, Giraldez RRCV, Silva BA, Costa MSS, Strunz CMC, Dallan LRP, Barbosa CJDG, Britto FAB, Farkouh ME, Gurbel PA, Nicolau JC. Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization. J Am Coll Cardiol 2021; 77:1277-1286. [PMID: 33706868 DOI: 10.1016/j.jacc.2021.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y12 receptor inhibitors, were assigned to either control group, P2Y12 receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (pre-defined as ≥46 aggregation units). RESULTS Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (Evaluation of Platelet Aggregability in the Release of CABG in Patients With ACS With DAPT; NCT02516267).
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Affiliation(s)
- Carlos A K Nakashima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luis A O Dallan
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luiz A F Lisboa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabio B Jatene
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre M Soeiro
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Remo H M Furtado
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Talia F Dalçoquio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciano M Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Felipe G Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roberto R C V Giraldez
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bianca A Silva
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mateus S S Costa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Celia M C Strunz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luis R P Dallan
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Flavia A B Britto
- Hospital das Clinicas, Faculdade de Medicina, Universidade Federal de Uberlandia, Minas Gerais, Brazil; Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Hospital das Clinicas, Faculdade de Medicina, Universidade Federal de Uberlandia, Minas Gerais, Brazil; Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Paolino BS, Pomerantzeff PM, Dallan LAO, Gaiotto FA, Preite NZ, Latrônico AC, Nicolau JC, Bianco AC, Giraldez RRCV. Myocardial Inactivation of Thyroid Hormones in Patients with Aortic Stenosis. Thyroid 2017; 27:738-745. [PMID: 28095748 PMCID: PMC5749598 DOI: 10.1089/thy.2016.0514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The human heart expresses the type 2 deiodinase (D2) that activates thyroxine (T4) to triiodothyronine (T3). At the same time, the inactivating type 3 deiodinase (D3) has been found in a rat model of right ventricular hypertrophy. It is not known whether the human myocardium metabolizes thyroid hormone. This study examined myocardial thyroid hormone metabolism in patients with aortic valve stenosis (AS) undergoing aortic valve replacement and in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting surgery. METHODS Myocardial thyroid hormone metabolism was assessed by analyzing the difference in serum thyroid hormone levels between the aortic root (incoming blood) and the coronary sinus (outgoing blood) of patients undergoing cardiac surgery. A total of 23 patients with AS and 35 patients with CAD were included. Patients received a pre-surgical echocardiogram, and pre-, during and post-surgical thyroid hormone serum levels were collected in the myocardial and peripheral circulations. RESULTS Patients with AS exhibited the expected left ventricle (LV) hypertrophy (i.e., 20-30% increase in LV posterior wall and interventricular septum thickness and ∼10% increase in AS in LV diastolic diameter). Immediately before cardiopulmonary bypass, blood flowing through the AS myocardium exhibited a 4.6% reduction in T3 and 6.9% increase in rT3 levels, decreasing the serum T3/rT3 ratio by 9.6%. T4 and thyrotropin serum levels remained similar between the aortic root and coronary sinus. In contrast, no myocardial thyroid hormone metabolism was observed in CAD patients. Notably, the AS myocardium lost the ability to inactivate thyroid hormone after cardiopulmonary bypass, possibly due to myocardial stunning. CONCLUSIONS There is accelerated thyroid hormone inactivation in the AS myocardium, which is likely the result of D3 expression. No evidence to suggest thyroid hormone activation in the myocardium was obtained in the present study.
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Affiliation(s)
- Bruno S. Paolino
- Heart Institute of the University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Fabio A. Gaiotto
- Heart Institute of the University of São Paulo Medical School, Sao Paulo, Brazil
| | - Nailliw Z. Preite
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | | | - José Carlos Nicolau
- Heart Institute of the University of São Paulo Medical School, Sao Paulo, Brazil
| | - Antonio C. Bianco
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
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Sousa MRD, Feitosa GS, Paola AAVD, Schneider JC, Feitosa-Filho GS, Nicolau JC, Ferreira JFM, Carvalho RCMD, Chalela WA, Malachias MVB, Pena JLB, Somaio-Neto F, Montera MW, Barbosa GV, Bacal F, Jatene IB, Santos RD, Miranda RD, Peixoto JM, Barbosa MR, Fenelon G, Assef AH, Naccarato AFP, Rodrigues Sobrinho CRM, Kohler I, Vasconcelos JNGD, Magalhães MJG, Morais NSD, Rocha RM, Giraldez RRCV, Silva GCD. [First guidelines of the Brazilian Society of Cardiology on processes and skills for education in cardiology in Brazil]. Arq Bras Cardiol 2014; 96:4-24. [PMID: 24043332 DOI: 10.5935/abc.2013s008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum Junior A, Marques AC, Franci A, Manica ALL, Volschan A, De Paola AAV, Greco AIL, ACN F, Sousa ACS, Pesaro AEP, Simão AF, Lopes ASSA, Timerman A, Ramos AIO, Alves BR, Caramelli B, Mendes BA, Polanczyk CA, Montenegro CEL, Barbosa CJDG, Serrano Junior CV, Melo CCL, Pinho C, Moreira DAR, Calderaro D, Gualandro DM, Armaganijan D, Machado Neto EA, Bocchi EA, Paiva EF, Stefanini E, D’Amico E, Evaristo EF, Silva EER, Fernandes F, Brito Junior FS, Bacal F, Ganem F, Gomes FLT, Mattos FR, Moraes Neto FR, Tarasoutchi F, Darrieux FCC, Feitosa GS, Fenelon G, Morais GR, Correa Filho H, Castro I, Gonçalves Junior I, Atié J, Souza Neto JD, Ferreira JFM, Nicolau JC, Faria Neto JR, Annichino-Bizzacchi JM, Zimerman LI, Piegas LS, Pires LJT, Baracioli LM, Silva LB, Mattos LAP, Lisboa LAF, Magalhães LPM, Lopes MACQ, Montera MW, Figueiredo MJO, Malachias MVB, Gaz MVB, Andrade MD, Bacellar MSC, Barbosa MR, Clausell NO, Dutra OP, Coelho OR, Yu PC, Lavítola PL, Lemos Neto PA, Andrade PB, Farsky PS, Franco RA, Kalil RAK, Lopes RD, Esporcatte R, Heinisch RH, Kalil Filho R, Giraldez RRCV, Alves RC, Leite REGS, Gagliardi RJ, Ramos RF, Montenegro ST, Accorsi TAD, Jardim TSV, Scudeler TL, Moisés VA, Portal VL. Diretrizes Brasileiras de Antiagregantes Plaquetários e Anticoagulantes em Cardiologia. Arq Bras Cardiol 2013; 101:1-95. [DOI: 10.5935/abc.2013s009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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