Felipe Gallego Lima

Use of demonstrably effective therapies in the treatment of acute coronary syndromes: comparison between different Brazilian regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE).

BACKGROUND: Little is known in our country about regional differences in the treatment of acute coronary disease. OBJECTIVE: To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. METHODS: A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). RESULTS: In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 ± 22.1) was lower (p <0.05) than in the Southeast (77.7 ± 29.5), Midwest (82 ± 22.1) and South (82.4 ± 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 ± 32.9) was lower (p <0.05) than in the Southeast (69.2 ± 31.6), Midwest (65.3 ± 33.6) and South (73.7 ± 28.1) regions; additionally, the score of the Midwest was lower (p <0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p <0.001 compared to the rest of the country). CONCLUSION: The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.BACKGROUND Little is known in our country about regional differences in the treatment of acute coronary disease. OBJECTIVE To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. METHODS A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). RESULTS In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 ± 22.1) was lower (p <0.05) than in the Southeast (77.7 ± 29.5), Midwest (82 ± 22.1) and South (82.4 ± 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 ± 32.9) was lower (p <0.05) than in the Southeast (69.2 ± 31.6), Midwest (65.3 ± 33.6) and South (73.7 ± 28.1) regions; additionally, the score of the Midwest was lower (p <0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p <0.001 compared to the rest of the country). CONCLUSION The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.

In Patients With Acute Myocardial Infarction, the Impact of Hyperglycemia as a Risk Factor for Mortality Is Not Homogeneous Across Age-Groups

OBJECTIVE To assess the impact of hyperglycemia in different age-groups of patients with acute myocardial infarction (AMI). RESEARCH DESIGN AND METHODS A total of 2,027 patients with AMI were categorized into one of five age-groups: <50 years (n = 301), ≥50 and <60 (n = 477), ≥60 and <70 (n = 545), ≥70 and <80 (n = 495), and ≥80 years (n = 209). Hyperglycemia was defined as initial glucose ≥115 mg/dL. RESULTS The adjusted odds ratios for hyperglycemia predicting hospital mortality in groups 1–5 were, respectively, 7.57 (P = 0.004), 3.21 (P = 0.046), 3.50 (P = 0.003), 3.20 (P < 0.001), and 2.16 (P = 0.021). The adjusted P values for correlation between glucose level (as a continuous variable) and mortality were 0.007, <0.001, 0.043, <0.001, and 0.064. The areas under the ROC curves (AUCs) were 0.785, 0.709, 0.657, 0.648, and 0.613. The AUC in group 1 was significantly higher than those in groups 3–5. CONCLUSIONS The impact of hyperglycemia as a risk factor for hospital mortality in AMI is more pronounced in younger patients.

Utilização de terapêuticas comprovadamente úteis no tratamento da coronariopatia aguda: comparação entre diferentes regiões brasileiras. Análise do Registro Brasileiro de Síndromes Coronarianas Agudas (BRACE - Brazilian Registry on Acute Coronary Syndromes)

BACKGROUND: Little is known in our country about regional differences in the treatment of acute coronary disease. OBJECTIVE: To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. METHODS: A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). RESULTS: In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 ± 22.1) was lower (p <0.05) than in the Southeast (77.7 ± 29.5), Midwest (82 ± 22.1) and South (82.4 ± 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 ± 32.9) was lower (p <0.05) than in the Southeast (69.2 ± 31.6), Midwest (65.3 ± 33.6) and South (73.7 ± 28.1) regions; additionally, the score of the Midwest was lower (p <0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p <0.001 compared to the rest of the country). CONCLUSION: The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.BACKGROUND Little is known in our country about regional differences in the treatment of acute coronary disease. OBJECTIVE To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. METHODS A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). RESULTS In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 ± 22.1) was lower (p <0.05) than in the Southeast (77.7 ± 29.5), Midwest (82 ± 22.1) and South (82.4 ± 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 ± 32.9) was lower (p <0.05) than in the Southeast (69.2 ± 31.6), Midwest (65.3 ± 33.6) and South (73.7 ± 28.1) regions; additionally, the score of the Midwest was lower (p <0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p <0.001 compared to the rest of the country). CONCLUSION The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.

IN-HOSPITAL MANAGEMENT OF ACUTE CORONARY SYNDROMES IN BRAZIL IN COMPARISON WITH OTHER BRIC COUNTRIES: ANALYSIS OF THE BRAZILIAN REGISTRY OF ACUTE CORONARY SYNDROMES

Little is known about the management of acute coronary syndromes (ACS) in developing countries, including Brazil. Our main purpose was the comparison between the results obtained by the Brazilian Registry of Acute Coronary syndromEs (BRACE) Registry, with data from other “BRIC” countries. BRACE

Takayasu arteritis: stenosis after bare-metal and drug-eluting stent implantation

Introducao Arterite de Takayasu (AT) e uma arterite inflamatoria cronica de etiologia desconhecida que acomete grandes vasos, principalmente aorta e seus principais ramos, vasos pulmonares e coronarias1. Devido a raridade dos casos a monitoracao da atividade da doenca e o melhor esquema terapeutico ainda tem sido um desafio para todos os que tratam esses pacientes. Especificamente em casos de sindromes coronarias agudas (SCA), a melhor forma de tratamento intervencionista mantem-se indefinido. Algumas series de casos apresentam sua experiencia com angioplastia coronaria (ATC) e/ou cirurgia de revascularizacao miocardica (CRM), porem com pouca consistencia1. Nesse contexto, o relato da evolucao de uma mesma paciente submetida a implante de stent coronario convencional e, posteriormente, farmacologico de forma consecutiva, associado a estenose coronaria intrastent nos dois procedimentos na ausencia de inflamacao, com subsequente realizacao de CRM, e unico e reforca a dificuldade de manejo de SCA nessa doenca.

Perfusão miocárdica dinâmica por tomografia computadorizada de dupla fonte de raio X

We report a dual-source computed tomography study of dynamic and quantitative myocardial perfusion in a 44-year-old patient with previous documented coronary artery disease. Quantitatively, the tomography showed myocardial perfusion deficit in the territories with significant coronary stenosis, confirmed by computed tomography angiography and conventional angiography. Dual-source computed tomography allowed dynamic perfusion and anatomic evaluation in a single study during the follow-up of this patient.We report a dual-source computed tomography study of dynamic and quantitative myocardial perfusion in a 44-year-old patient with previous documented coronary artery disease. Quantitatively, the tomography showed myocardial perfusion deficit in the territories with significant coronary stenosis, confirmed by computed tomography angiography and conventional angiography. Dual-source computed tomography allowed dynamic perfusion and anatomic evaluation in a single study during the follow-up of this patient.

THE PROGNOSTIC VALUE OF DIABETES AND OF ACUTE HYPERGLYCEMIA IS DIFFERENT DURING THE IN-HOSPITAL AND CHRONIC PHASES AFTER MYOCARDIAL INFARCTION

THE PROGNOSTIC VALUE OF DIABETES AND OF ACUTE HYPERGLYCEMIA IS DIFFERENT DURING THE IN-HOSPITAL AND CHRONIC PHASES AFTER MYOCARDIAL INFARCTION José C. Nicolau, Felipe G. Lima, Marcelo Franken, Carlos V. Serrano Jr., Roberto R. Giraldez, Luciano M. Baracioli, Fernando Ganem, Caio F. Fernandes, Karin D. Campos, Thiago F. Pinto, José A.F. Ramires Background: Diabetes (DM) and hyperglycemia are both powerful risk factors for pts with acute myocardial infarction (AMI). However, the relationship between them and their individual role during the in-hospital phase and in the long-term after hospital discharge are not clearly understood. Methods: We analyzed retrospectively 1429 pts with AMI (mean age 64.5 + 0.34 y.o., 72.5% men) treated in a single tertiary institution, included prospectively in a dedicated databank and followed for up to 11.7 years (mean survival time=8.7 years). Correlations with mortality were carried out utilizing the Chi-square/log-rank tests and logistical/Cox stepwise regression models as indicated. Results: (1) In-hospital phase: Death rates for diabetics and nondiabetics were, respectively, 12.7% and 9.6% (P=0.08); by univariate logistic regression, glucose level (as continuous variable) at hospital arrival was highly correlated with mortality (P<0.001); putting together both variables in a multivariate model, the figures were P=0.74 for DM and P<0.001 for glucose level (GL); in the adjusted model with 15 baseline variables included, GL remained correlating significantly with mortality (P<0.001), along with age (P<0.001), ST-elevation AMI (P=0.03), and history of heart failure (P<0.001) and hypertension (P=0.005). (2) Long-term outcome: The mean survival time for nondiabetics and diabetics were, respectively, 9.02 and 7.88 years (P<0.001); GL showed a borderline correlation with mortality (P=0.046); with both variables in the same model, the figures were P= 0.001 for DM and P=0.75 for GL; in the multivariate model with all 15 variables included, history of DM remained correlating significantly with mortality (P=0.022), along with age (P<0.001) and history of previous AMI (P<0.001), heart failure (P=0.01) and stroke (P=0.013). In a multivariate model excluding in-hospital deaths, DM remained correlating significantly with mortality (P=0.041). Conclusions: During the in-hospital phase the glucose level at hospital arrival is a better mortality predictor than DM; on the other hand, DM is a good mortality predictor in the long-term follow up after AMI, contrary to glucose level.

CRT-700.06 Safety of Endovascular Therapeutic Hypothermia as an Adjuvant Therapy in Acute ST Segment Elevation Myocardial Infarction

Therapeutic hypothermia (TH) reduces the damage by ischemia and reperfusion cell syndrome in cardiac arrests, in which its application is already widely established and carried out in centers of excellence. However its role in patients with acute ST segment elevation myocardial infarction (STEMI)

PERFORMANCE MEASURES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROMES IN BRAZIL: ANALYSIS OF THE BRAZILIAN REGISTRY OF ACUTE CORONARY SYNDROMES

Little is known about the management of acute coronary syndromes (ACS) in developing countries, including Brazil. Our purpose was to evaluate the performance measures for the management of ACS in Brazil according to the results of the Brazilian Registry of Acute Coronary syndromEs (BRACE). BRACE,a