Antônio Carlos Sobral Sousa

Desfechos clínicos aos 30 dias do registro brasileiro das síndromes coronárias agudas (ACCEPT)

BACKGROUNDnThere are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome.nnnOBJECTIVESnDemography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome.nnnMETHODSnThe ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up.nnnRESULTSnBetween August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively.nnnCONCLUSIONSnThe prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.

Parâmetros clínicos e ecocardiográficos associados a baixo índice cronotrópico em pacientes não idosos

BACKGROUNDnDespite abundant evidence of increased morbidity and mortality, chronotropic incompetence (CI) is not a routine diagnosis well defined in protocols of cardiac evaluation and its clinical importance is still underestimated.nnnOBJECTIVEnTo evaluate the clinical and echocardiographic parameters associated with HF in non-elderly patients submitted to stress echocardiography (SE).nnnMETHODSnOne thousand seven hundred ninety-eight patients with a mean age of 48.4 ± 7.5 years, who underwent SE between January/2000 and August/2009 were evaluated. Patients with chronotropic index smaller than 0.8 were considered chronotropic incompetent as compared to competent patients as to clinical and echocardiographic characteristics.nnnRESULTSnThe duration of the exercise was 9.3 ± 2.4 minutes on average. Two hundred and seventy (15%) patients were chronotropic incompetent. The chronotropic index of this group was 0.7 ± 0.1 vs. 1.0 ± 0.1 for competent patients. Multivariate logistic regression analysis identified the following parameters as independently associated with HF: dyspnea on examination [odds ratio (OR) = 4.27, p <0.0001], previous chest pain on medical history (OR = 1.51; p = 0.0111), higher left ventricular mass rate in incompetent patients (LVMI) (OR = 1.16, p = 0.0001), metabolic equivalents (METs) (OR = 0.70, p = 0 , 0001), ST segment depression (OR = 0.58, p = 0.0003) and high systolic blood pressure (ΔSBP) (OR = 0.87, p = 0.0011). Myocardial ischemia was not associated with HF.nnnCONCLUSIONnHF is associated with functional parameters, such as dyspnea on exertion, history of chest pain and lower METS. It is also associated with structural benchmark index of left ventricular mass. In addition, chronotropic incompetence does not appear to increase the chance of myocardial ischemia in non-elderly patients.

Stress echocardiography in coronary artery disease

Doppler echocardiography is a simple, fast and non-invasive method to identify abnormal regional and global left ventricular function. One could consider this non-invasive method to be the best approach within imaging techniques. Stress echocardiography techniques are used for the diagnosis, risk stratification, prognosis and the study of myocardial viability in the ischemic heart disease. There are many ways to subject the heart to stress for echocardiographic studies. For physically fit patients exercise stress testing using a treadmill or bicycle is unemployed and patients who are unable to exercise undergo pharmacological tests. Although accurate diagnosis and a high prognosis value are achivied with both methods, there are new techniques under study, including the utilization of echocardiographic contrast with microbubbles for endocardial edge evaluation and for myocardial perfusion studies.

DIET QUALITY OF PATIENTS WITH ACUTE CORONARY SYNDROME RECEIVING PUBLIC AND PRIVATE HEALTH CARE

OBJECTIVEnThe aim of this study was to investigate the quality of the diets consumed by patients with acute coronary syndrome (ACS) who received public and private health care.nnnMETHODSnThis observational, prospective, longitudinal cohort study evaluated patients with ACS who attended three private and one public cardiology reference hospitals. Information about dietary parameters during the 6 mo before the acute ACS event was collected at admission and 180 d later using a semiquantitative food frequency questionnaire. Diet quality was assessed using the Alternative Healthy Eating Index (2010), and a multilinear regression model was developed to evaluate the associated variables.nnnRESULTSnThe 581 volunteers included in this study comprised 325 (55.9%) and 256 (44.1%) patients treated at private and public hospitals, respectively. Although the dietary index increased significantly after ACS (P < 0001), diet quality remained unsatisfactory, particularly in terms of reductions in the consumption of cardioprotective components (vegetables, fruits, and eicosapentaenoic and docosahexaenoic fatty acids). Compared with patients receiving private health care, those attending a public hospital reported lower dietary quality (P < 0.001). The best diet quality was found to correlate with female sex (P < 0.001), receipt of dietary guidance at hospital discharge (P < 0.001), private health care (P < 0.001), a stable relationship status (P, 0.016), and older age (P < 0.001).nnnCONCLUSIONnThe overall post-ACS diet quality remained unsatisfactory, especially in terms of cardioprotective components and among patients receiving public health care. Sociodemographic factors and the assistance model/quality were determinants of the observed differences in dietary quality.

Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I–III) and suspected or confirmed coronary arterial disease

Background Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.

Disparities in Acute Myocardial Infarction Treatment Between Users of the Public and Private Healthcare System in Sergipe

Mailing Address: José Augusto Barreto-Filho Avenida Gonçalo Prado Rollemberg, 211, sala 202. Postal Code: 49010-410, Aracaju, SE Brazil. E-mail: joseaugusto.se@gmail.com, jasbf@cardiol.br Disparities in Acute Myocardial Infarction Treatment Between Users of the Public and Private Healthcare System in Sergipe Jussiely Cunha Oliveira1,2, Laís Costa Souza Oliveira1,3, Jeferson Cunha Oliveira3,4, Ikaro Daniel de Carvalho Barreto5, Marcos Antonio Almeida-Santos2,6, Ticiane Clair Remacre Munareto Lima1, Larissa Andreline Maia Arcelino1,7, Luiz Flávio Andrade Prado2,8, Fábio Serra Silveira8, Thiago Augusto Nascimento6,9, Eduardo José Pereira Ferreira6,8,10, Rafael Vasconcelos Barreto8, Enilson Vieira Moraes3, José Teles de Mendonça8,9,11, Antonio Carlos Sobral Sousa1,6,10,11, José Augusto Barreto-Filho1,6,10,11, em nome do grupo de pesquisadores do Registro VICTIM Núcleo de Pós-Graduação em Ciências da Saúde da Universidade Federal de Sergipe (UFS)1, São Cristóvão, SE Brazil Universidade Tiradentes (UNIT)2, Aracaju, SE Brazil Hospital Primavera3, Aracaju, SE Brazil Departamento de Farmácia da Universidade Federal de Sergipe (UFS)4, Lagarto, SE Brazil Departamento de Estatística da Universidade Federal de Sergipe (UFS)5, Aracaju, SE Brazil Centro de Ensino e Pesquisa da Fundação São Lucas6, Aracaju, SE Brazil Faculdade Estácio de Sá7, Aracaju, SE Brazil Fundação Beneficência Hospital de Cirurgia8, Aracaju, SE Brazil Hospital do Coração9, Aracaju, SE Brazil Departamento de Medicina da Universidade Federal de Sergipe (UFS)10, São Cristóvão, SE Brazil Divisão de Cardiologia do Hospital Universitário da UFS11, São Cristóvão, SE Brazil

Low to Moderate Alcohol Consumption and Myocardial Ischemia on Exercise Stress Echocardiography

Background: The impact of alcohol consumption on the development of myocardial ischemia remains uncertain. Studies diverge whether low to moderate alcohol consumption provides cardioprotection or whether it is a risk factor for myocardial ischemia. Objective: To study the relationship between low to moderate alcohol consumption and myocardial ischemia on exercise stress echocardiography (ESE). Methods: Cross-sectional study with 6632 patients with known or suspected coronary artery disease undergoing ESE between January/2000 and December/2015. The patients were divided into two groups: G1, composed of 2130 (32.1%) patients whose report showed maximal consumption of 1 drink per day on average for women or of 2 drinks per day for men; G2, composed of individuals denying any alcohol consumption. For comparing between the groups, Student t test was used for quantitative variables, and chi-square test or Fisher exact test, for categorical variables. The significance level adopted was p < 0.05. Logistic regression was also used to evaluate independent risk factors for myocardial ischemia. Results: G1 had a higher number of men (77.1%; p < 0.001), lower mean age (54.8 ± 10.3 years old; p < 0.001) and higher frequency of myocardial ischemia on ESE (p = 0.014). Age, male sex, dyslipidemia, systemic arterial hypertension, diabetes mellitus, smoking and family history were independently associated with myocardial ischemia on ESE. Independent association between low to moderate alcohol consumption and myocardial ischemia on ESE (OR 0.96; 95%CI: 0.83 to 1.11) was not observed. However, age, male sex, smoking and dyslipidemia were associated with alcohol consumption. Conclusion: Low to moderate alcohol consumption was not an independent predictor of myocardial ischemia on ESE. Nevertheless, we observed a predominance of the male sex, dyslipidemia and smoking habit, important predictors of myocardial ischemia, in the group of alcohol consumers. (Int J Cardiovasc Sci. 2018;31(3)235-243)

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries

Background The current guidelines dispose recommendations to manage antiplatelet agents in the perioperative period; however, the daily medical practices lack standardization. Objectives To asses factors associated with inadequate management of antiplatelet agents in the perioperative period of non-cardiac surgeries. Methods Cross-sectional Study conducted in hospital from October 2014 to October 2016. The study dependent variable was a therapy that did not comply with the recommendations in the Brazilian Association of Cardiology (SBC) guidelines. The independent variables included some characteristics, the people in charge of the management and causes of lack of adherence to those guidelines. Variables were included in the multivariate model. Analysis was based on the odds ratio (OR) value and its respective 95% confidence interval (CI) estimated by means of logistic regression with 5% significance level. Results The sample was composed of adult patients submitted to non-cardiac surgeries and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161). The management failed to comply with the recommendations in the guidelines in 80.75% of the sample. Surgeons had the highest number of noncomplying orientations (n = 63). After multivariate analysis it was observed that patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and those with a previous episode of acute myocardial infarction (AMI) (OR = 0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying with the guidelines. Conclusion Positive association between patients’ schooling level, or those with a history of previous AMI, with management of the use of aspirin and clopidogrel in the perioperative period of non-cardiac surgeries. However, diverging conducts stress the need of having internal protocol defined.

The First Brazilian Registry of Hypertension

&NA; A systematic, nationwide assessment of care of patients with hypertension in Brazil is needed. The objective of the First National Registry of Patients with Hypertension in Brazil is to evaluate the clinical profile, treatment patterns, and outcomes of diagnosed hypertensive patients in the country.

Predictors of Atherosclerotic Plaque in Individuals with Asymptomatic Ischemia on Physical Stress Echocardiography

Coronary artery disease (CAD) is currently the leading cause of mortality in Brazil and worldwide. Therefore, one of the most frequent challenges of everyday cardiology practice is the evaluation of patients with symptoms indicating myocardial ischemia.1 The greater the number or severity of independent risk factors (hypertension, diabetes mellitus [DM], dyslipidemia, family history of CAD, smoking, obesity, and sedentary lifestyle), the greater the chance of an individual presenting cardiovascular events or early death.2-11