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Coronavirus disease-2019 and heart: assessment of troponin and cardiovascular comorbidities as prognostic markers in patients hospitalized with coronavirus disease-2019 in a tertiary center in Brazil
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Pinesi, Henrique Trombini

; Giugni, Fernando Rabioglio

; Matuck, Bruna Romanelli Scarpa

; Pitta, Fabio Grusnpun

; Garzillo, Cibele Larrosa

; Lima, Eduardo Gomes

; Kalil Filho, Roberto

; Serrano Junior, Carlos Vicente

Revista da Associação Médica Brasileira

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2023, Volume 69 N. 7 elocation e20230350

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: Our study aimed to evaluate the correlation of cardiac troponin T levels with comorbidities and in-hospital outcomes in patients with coronavirus disease-2019 in Brazil. METHODS: Data from a cohort of 3,596 patients who were admitted with suspected coronavirus disease-2019 in a Brazilian tertiary center, between March and August 2020, were reviewed. A total of 2,441 (68%) patients had cardiac troponin T determined in the first 72 h of admission and were stratified into two groups: elevated cardiac troponin T (cardiac troponin T >0.014 ng/mL) and normal cardiac troponin T. Associations between troponin, comorbidities, biomarkers, and outcomes were assessed. Regression models were built to assess the association of several variables with in-hospital mortality. RESULTS: A total of 2,441 patients were embraced, of which 924 (38%) had normal cardiac troponin T and 1,517 (62%) had elevated cardiac troponin T. Patients with elevated cardiac troponin T were older and had more comorbidities, such as cardiovascular disease, hypertension, diabetes, arrhythmia, renal dysfunction, liver disease, stroke, cancer, and dementia. Patients with abnormal cardiac troponin T also had more altered laboratory parameters on admission (i.e., leukocytes, C-reactive protein, D-dimer, and B-type natriuretic peptide), as well as more need for intensive care unit, vasoactive drugs, mechanical ventilation, dialysis, and blood transfusion. All-cause mortality was markedly higher among patients with increased cardiac troponin T (42 vs. 16%, P<0.001). Multiple regression analysis demonstrated that in-hospital mortality was not independently associated with troponin elevation. CONCLUSION: This study showed that cardiac troponin T elevation at admission was common and associated with several comorbidities, biomarkers, and clinical outcomes in patients hospitalized with coronavirus disease-2019, but it was not an independent marker of in-hospital mortality.

https://doi.org/10.1590/1806-9282.20230350

Acompanhamento de Dois Anos de Pacientes com Cardiopatia Isquêmica Crônica em um Centro Especializado no Brasil
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Moreira, Eduardo Martelli

; Pinesi, Henrique Trombini

; Martins, Eduardo Bello

; Pitta, Fábio Grunspun

; Bolta, Paula Mathias Paulino

; Segre, Carlos Alexandre Wainrober

; Favarato, Desiderio

; Rached, Fabiana Hanna

; Hueb, Whady Armindo

; Lima, Eduardo Gomes

; Kalil Filho, Roberto

; Garzillo, Cibele Larrosa

; Serrano Jr, Carlos Vicente

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 10 elocation e20220440

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records. Objectives This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Methods Patients with CIHD who reported for clinical evaluation at Instituto do Coração (São Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted. Results From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 – 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. Conclusion This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.

Resumo Fundamento A incidência de eventos cardiovasculares em pacientes com doença cardíaca isquêmica crônica (DCIC) pode variar significativamente entre os países. Embora populoso, o Brasil é frequentemente sub-representado nos registros internacionais. Objetivos Este estudo teve como objetivo descrever a qualidade do atendimento e a incidência de eventos cardiovasculares em dois anos, além de fatores prognósticos associados em pacientes com DCIC em um centro terciário de saúde pública no Brasil. Métodos Pacientes com DCIC que compareceram para avaliação clínica no Instituto do Coração (São Paulo, Brasil) foram cadastrados e acompanhados por dois anos. O desfecho primário foi um composto de infarto do miocárdio (IM), acidente vascular encefálico ou morte. Um nível de significância de 0,05 foi adotado. Resultados De janeiro de 2016 a dezembro de 2018, 625 participantes foram incluídos no estudo. As características basais mostram que 33,1% eram mulheres, a idade mediana era de 66,1 [59,6 – 71,9], 48,6% tinham diabetes, 83,1% tinham hipertensão, 62,6% tinham IM prévio e 70,4% passaram por algum procedimento de revascularização. Em um acompanhamento mediano de 881 dias, 37 (7,05%) desfechos primários foram observados. Após ajustes, idade, acidente vascular encefálico prévio e colesterol LDL foram independentemente associados ao desfecho primário. Comparando a linha de base com o acompanhamento, os participantes relataram alívio da angina com base na escala da Sociedade Cardiovascular Canadense (SCC) de acordo com as seguintes porcentagens: 65,7% vs. 81,7% eram assintomáticos e 4,2% vs. 2,9% eram SCC 3 ou 4 (p < 0,001). Eles também relataram melhor qualidade na prescrição de medicamentos: 65,8% vs. 73,6% (p < 0,001). No entanto, não houve melhora no colesterol LDL ou no controle da pressão arterial. Conclusão O presente estudo mostra que pacientes com DCIC apresentaram uma incidência de 7,05% do desfecho primário composto em um período de dois anos, sendo a diminuição do colesterol LDL o único fator de risco modificável associado ao prognóstico.

https://doi.org/10.36660/abc.20220440

Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares
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Soeiro, Alexandre de Matos

; Biselli, Bruno

; Leal, Tatiana C.A.T.

; Bossa, Aline Siqueira

; César, Maria Cristina

; Jallad, Sérgio

; Goldstein, Priscila Gherardi

; Guimarães, Patrícia Oliveira

; Serrano Jr, Carlos Vicente

; Nomura, Cesar Higa

; Nakamura, Débora

; Rochitte, Carlos Eduardo

; Soares, Paulo Rogério

; Oliveira Jr., Múcio Tavares de

Arquivos Brasileiros de Cardiologia

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may 2022, Volume 118 N. 5 Pages 894 - 902

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A angiotomografia coronária (ATC) tem sido usada para avaliação de dor torácica principalmente em pacientes de baixo risco, e poucos dados existem com pacientes em risco intermediário. Objetivo Avaliar o desempenho de medidas seriadas de troponinas sensíveis e de ATC em pacientes de risco intermediário. Métodos Um total de 100 pacientes com dor torácica, TIMI score 3 ou 4 e troponina negativa foram prospectivamente incluídos. Todos os pacientes foram submetidos à ATC, e aqueles com obstruções ≥ 50% foram encaminhados à cineangiocoronariografia. Pacientes com lesões < 50% recebiam alta hospitalar, receberam alta e foram contatados 30 dias depois por telefonema para avaliação dos desfechos clínicos. Os desfechos foram hospitalização, morte, e infarto agudo do miocárdio em 30 dias. A comparação entre os métodos foi realizada pelo teste de concordância kappa. O desempenho das medidas de troponina e da ATC na detecção de lesões coronárias significativas e desfechos clínicos foi calculado. Os resultados foram considerados estatisticamente significativos quando p <0,05. Resultados Estenose coronária ≥ 50% na ATC foi encontrada em 38% dos pacientes e lesões coronárias significativas na angiografia coronária foram encontradas em 31 pacientes. Dois eventos clínicos foram observados. A análise de concordância Kappa mostrou baixa concordância entre as medidas de troponina e ATC na detecção de lesões coronárias significativas (kappa = 0,022, p = 0,78). O desempenho da ATC para detectar lesões coronárias significativas na angiografia coronária ou para prever eventos clínicos em 30 dias foi melhor que as medidas de troponina sensível (acurácia de 91% versus 60%). Conclusão ATC teve melhor desempenho que as medidas seriadas de troponina na detecção de doença coronariana significativa em pacientes com dor torácica e risco intermediário para eventos cardiovasculares.

Abstract Background Coronary tomography angiography (CTA) has been mainly used for chest pain evaluation in low-risk patients, and few data exist regarding patients at intermediate risk. Objective To evaluate the performance of serial measures of sensitive troponin and CTA in intermediate-risk patients. Methods A total of 100 patients with chest pain, TIMI risk scores of 3 or 4, and negative troponin were prospectively included. All patients underwent CTA and those with coronary stenosis ≥ 50% were referred to invasive coronary angiography. Patients with coronary lesions <50% were discharged and contacted 30 days later by a telephone call to assess clinical outcomes. Outcomes were hospitalization, death, and myocardial infarction at 30 days. The comparison between methods was performed by Kappa agreement test. The performance of troponin measures and CTA for detecting significant coronary lesions and clinical outcomes was calculated. Results were considered statistically significant when p < 0.05. Results Coronary stenosis ≥ 50% on CTA was found in 38% of patients and significant coronary lesions on coronary angiography were found in 31 patients. Two clinical events were observed. Kappa agreement analysis showed low agreement between troponin measures and CTA in the detection of significant coronary lesions (kappa = 0.022, p = 0.78). The performance of CTA for detecting significant coronary lesions on coronary angiography or for predicting clinical events at 30 days was better than sensitive troponin measures (accuracy of 91% versus 60%). Conclusion CTA performed better than sensitive troponin measures in the detection of significant coronary disease in patients with chest pain and intermediate risk for cardiovascular events.

https://doi.org/10.36660/abc.20210006

Atualização da Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia: Foco em Manejo dos Pacientes com Intervenção Coronária Percutânea – 2022
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Calderaro, Daniela

; Bichuette, Luciana Dornfeld

; Maciel, Pamela Camara

; Cardozo, Francisco Akira Malta

; Ribeiro, Henrique Barbosa

; Gualandro, Danielle Menosi

; Baracioli, Luciano Moreira

; Soeiro, Alexandre de Matos

; Serrano Jr., Carlos Vicente

; Costa, Ricardo Alves da

; Caramelli, Bruno

Arquivos Brasileiros de Cardiologia

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2022, Volume 118 N. 2 Pages 536 - 547

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20220039

Occurrence of recently diagnosed atrial fibrillation in the immediate postoperative period of myocardial revascularization surgery. Although common, a devalued complication
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Pereira, Marcel de Paula

; Lima, Eduardo Gomes

; Garzillo, Cibele Larrosa

; Barbosa, Camila Talita Machado

; Sampaio, Leon Pablo Cartaxo

; Darrieux, Francisco Carlos da Costa

; Serrano Jr, Carlos Vicente

Revista da Associação Médica Brasileira

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nov 2020, Volume 66 N. 11 Pages 1473 - 1475

Abstract: En | Text: En | PDF: En

SUMMARY Atrial fibrillation (AF) is the most common arrhythmia in the postoperative period of cardiac surgery, with a prevalence between 15-40% after coronary artery bypass surgery (CABG). Several strategies have been tested for the prevention and management of AF postoperatively. Previous studies and analysis of records have shown higher rates of hospitalization and clinical outcomes associated with this entity, including increased mortality in the short- and long-term. This perspective reviews the topic, and offers recommendations for the management of this arrhythmia in the postoperative period of CABG, with a special focus on anticoagulation strategies.

https://doi.org/10.1590/1806-9282.66.11.1473 375 downloads

Pharmacological therapy and cardiovascular risk reduction for type 2 diabetes
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Martins, Eduardo Bello

; Lima, Eduardo Gomes

; Pitta, Fábio Grunspun

; Carvalho, Leticia Neves Solon

; Queiroz, Thiago Dias de

; Serrano Júnior, Carlos Vicente

Revista da Associação Médica Brasileira

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sep 2020, Volume 66 N. 9 Pages 1283 - 1288

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A terapia farmacológica do diabetes mellitus tipo 2 apresentou avanços importantes nos últimos anos, impactando principalmente o tratamento dos pacientes com doença cardiovascular estabelecida ou com alto risco cardiovascular. Nesse cenário, surgiram duas classes de fármacos com claros benefícios clínicos; os inibidores da SGLT-2 e os agonistas do GLP-1. Na presente revisão os autores discutem desde a farmacologia, efeitos adversos e também os estudos clínicos que demonstraram os benefícios dessas medicações na redução de risco cardiovascular.

SUMMARY The pharmacological therapy for type 2 diabetes mellitus has presented important advances in recent years, which has impacted the treatment of patients with established cardiovascular disease or with high cardiovascular risk. In this scenario, two drug classes have emerged and demonstrated clear clinical benefits: SGLT-2 inhibitors and GLP-1 agonists. The present review discusses the pharmacology, adverse effects, and clinical trials that have demonstrated the benefits of these medications in reducing cardiovascular risk.

https://doi.org/10.1590/1806-9282.66.9.1283 1292 downloads

Posicionamento sobre Uso de Antiplaquetários e Anticoagulantes nos Pacientes Infectados pelo Novo Coronavírus (COVID-19) – 2020
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Soeiro, Alexandre de Matos

; Leal, Tatiana de Carvalho Andreucci Torres

; Pereira, Marcel de Paula

; Lima, Eduardo Gomes

; Figueiredo, Ana Cristina Baptista da Silva

; Petriz, João Luiz Fernandes

; Precoma, Dalton Betolim

; Serrano Jr, Carlos Vicente

Arquivos Brasileiros de Cardiologia

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aug 2020, Volume 115 N. 2 Pages 292 - 301

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20200424 16198 downloads

Viral infections and atherothrombosis: Another caution in the wake of COVID-19?
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Pereira, Marcel de Paula

; Lima, Eduardo Gomes

; Serrano Junior, Carlos Vicente

Revista da Associação Médica Brasileira

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mar 2020, Volume 66 N. 3 Pages 366 - 369

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.66.3.366 897 downloads

Extractos de los documentos de posicionamientos y recomendaciones mexicanas en enfermedades cardiovasculares y COVID-19
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Alcocer-Gamba, Marco A.

; Gutiérrez-Fajardo, Pedro

; Cabrera-Rayo, Alfredo

; Sosa-Caballero, Alejandro

; Piña-Reyna, Yigal

; Merino-Rajme, José A.

; Heredia-Delgado, José A.

; Cruz-Alvarado, Jaime E.

; Galindo-Uribe, Jaime

; Rogel-Martínez, Ulises

; González-Hermosillo, Jesús A.

; Ávila-Vanzzini, Nydia

; Sánchez-Carranza, Jesús A.

; Jímenez-Orozco, Jorge H.

; Sahagún-Sánchez, Guillermo

; Fanghänel-Salmón, Guillermo

; Albores-Figueroa, Rosenberg

; Carrillo-Esper, Raúl

; Reyes-Terán, Gustavo

; Cossio-Aranda, Jorge E.

; Borrayo-Sánchez, Gabriela

; Ríos, Manuel Odín de los

; Berni-Betancourt, Ana C.

; Cortés-Lawrenz, Jorge

; Leiva-Pons, José L.

; Ortiz-Fernández, Patricio H.

; López-Cuellar, Julio

; Araiza-Garaygordobil, Diego

; Madrid-Miller, Alejandra

; Saturno-Chiu, Guillermo

; Beltrán-Nevárez, Octavio

; Enciso-Muñoz, José M.

; García-Rincón, Andrés

; Pérez-Soriano, Patricia

; Herrera-Gomar, Magali

; Lozoya del Rosal, José J.

; Fajardo-Juárez, Armando I.

; Olmos-Temois, Sergio G.

; Rodríguez-Reyes, Humberto

; Ortiz-Galván, Fernando

; Márquez-Murillo, Manlio F.

; Celaya-Cota, Manuel de J.

; Cigarroa-López, José A.

; Magaña-Serrano, José A.

; Álvarez-Sangabriel, Amada

; Ruíz-Ruíz, Vicente

; Chávez-Mendoza, Adolfo

; Méndez-Ortíz, Arturo

; León-González, Salvador

; Guízar-Sánchez, Carlos

; Izaguirre-Ávila, Raúl

; Grimaldo-Gómez, Flavio A.

; Preciado-Anaya, Andrés

; Ruiz-Gastélum, Edith

; Fernández-Barros, Carlos L.

; Gordillo, Antonio

; Alonso-Sánchez, Jesús

; Cerón-Enríquez, Norma

; Núñez-Urquiza, Juan P.

; Silva-Torres, Jesús

; Pacheco-Beltrán, Nancy

; García-Saldivia, Marianna A.

; Pérez-Gámez, Juan C.

; Lezama-Urtecho, Carlos

; López-Uribe, Carlos

; López-Mora, Gerardo E.

; Rivera-Reyes, Romina

Archivos de cardiología de México

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2020, Volume 90 Suppl. 1 Pages 100 - 110

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

https://doi.org/10.24875/acm.m20000057 445 downloads

10.

Artificial intelligence in the diagnosis of cardiovascular disease
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Zeron, Rubens Moura Campos

; Serrano Junior, Carlos Vicente

Revista da Associação Médica Brasileira

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dec 2019, Volume 65 N. 12 Pages 1438 - 1441

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A inteligência artificial (IA) é um campo da ciência da computação que tem como objetivo imitar os processos de pensamento humano. Técnicas de IA têm sido aplicadas na medicina cardiovascular para explorar novos genótipos e fenótipos em doenças existentes, melhorar a qualidade do atendimento ao paciente, possibilitar custo-efetividade e reduzir taxas de readmissão e mortalidade. Existe um grande potencial da IA na medicina cardiovascular; no entanto, a ignorância dos desafios pode ofuscar seu impacto clínico. Esse artigo fornece a aplicação da IA no atendimento clínico cardiovascular e discute seu papel potencial na facilitação da medicina cardiovascular de precisão.

SUMMARY Artificial intelligence (AI) is a field of computer science that aims to mimic human thought processes. AI techniques have been applied in cardiovascular medicine to explore novel genotypes and phenotypes in existing diseases, improve the quality of patient care, enabling cost-effectiveness, and reducing readmission and mortality rates. The potential of AI in cardiovascular medicine is tremendous; however, ignorance of the challenges may overshadow its potential clinical impact. This paper gives a glimpse of AI’s application in cardiovascular clinical care and discusses its potential role in facilitating precision cardiovascular medicine.

https://doi.org/10.1590/1806-9282.65.12.1438 1805 downloads

11.

Atualização da Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia - 2019
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Bernoche, Claudia

; Timerman, Sergio

; Polastri, Thatiane Facholi

; Giannetti, Natali Schiavo

; Siqueira, Adailson Wagner da Silva

; Piscopo, Agnaldo

; Soeiro, Alexandre de Matos

; Reis, Amélia Gorete Afonso da Costa

; Tanaka, Ana Cristina Sayuri

; Thomaz, Ana Maria

; Quilici, Ana Paula

; Catarino, Andrei Hilário

; Ribeiro, Anna Christina de Lima

; Barreto, Antonio Carlos Pereira

; Azevedo Filho, Antonio Fernando Barros de

; Pazin Filho, Antonio

; Timerman, Ari

; Scarpa, Bruna Romanelli

; Timerman, Bruno

; Tavares, Caio de Assis Moura

; Martins, Cantidio Soares Lemos

; Serrano Junior, Carlos Vicente

; Malaque, Ceila Maria Sant’Ana

; Pisani, Cristiano Faria

; Batista, Daniel Valente

; Leandro, Daniela Luana Fernandes

; Szpilman, David

; Gonçalves, Diego Manoel

; Paiva, Edison Ferreira de

; Osawa, Eduardo Atsushi

; Lima, Eduardo Gomes

; Adam, Eduardo Leal

; Peixoto, Elaine

; Evaristo, Eli Faria

; Azeka, Estela

; Silva, Fabio Bruno da

; Wen, Fan Hui

; Ferreira, Fatima Gil

; Lima, Felipe Gallego

; Fernandes, Felipe Lourenço

; Ganem, Fernando

; Galas, Filomena Regina Barbosa Gomes

; Tarasoutchi, Flavio

; Souza, Germano Emilio Conceição

; Feitosa Filho, Gilson Soares

; Foronda, Gustavo

; Guimarães, Helio Penna

; Abud, Isabela Cristina Kirnew

; Leite, Ivanhoé Stuart Lima

; Linhares Filho, Jaime Paula Pessoa

; Moraes Junior, João Batista de Moura Xavier

; Falcão, João Luiz Alencar de Araripe

; Ramires, Jose Antônio Franchini

; Cavalini, José Fernando

; Saraiva, José Francisco Kerr

; Abrão, Karen Cristine

; Pinto, Lecio Figueira

; Bianchi, Leonardo Luís Torres

; Lopes, Leonardo Nícolau Geisler Daud

; Piegas, Leopoldo Soares

; Kopel, Liliane

; Godoy, Lucas Colombo

; Tobase, Lucia

; Hajjar, Ludhmila Abrahão

; Dallan, Luís Augusto Palma

; Caneo, Luiz Fernando

; Cardoso, Luiz Francisco

; Canesin, Manoel Fernandes

; Park, Marcelo

; Rabelo, Marcia Maria Noya

; Malachias, Marcus Vinícius Bolívar

; Gonçalves, Maria Aparecida Batistão

; Almeida, Maria Fernanda Branco de

; Souza, Maria Francilene Silva

; Favarato, Maria Helena Sampaio

; Carrion, Maria Julia Machline

; Gonzalez, Maria Margarita

; Bortolotto, Maria Rita de Figueiredo Lemos

; Macatrão-Costa, Milena Frota

; Shimoda, Mônica Satsuki

; Oliveira-Junior, Mucio Tavares de

; Ikari, Nana Miura

; Dutra, Oscar Pereira

; Berwanger, Otávio

; Pinheiro, Patricia Ana Paiva Corrêa

; Reis, Patrícia Feitosa Frota dos

; Cellia, Pedro Henrique Moraes

; Santos Filho, Raul Dias dos

; Gianotto-Oliveira, Renan

; Kalil Filho, Roberto

; Guinsburg, Ruth

; Managini, Sandrigo

; Lage, Silvia Helena Gelas

; Yeu, So Pei

; Franchi, Sonia Meiken

; Shimoda-Sakano, Tania

; Accorsi, Tarso Duenhas

; Leal, Tatiana de Carvalho Andreucci

; Guimarães, Vanessa

; Sallai, Vanessa Santos

; Ávila, Walkiria Samuel

; Sako, Yara Kimiko

Arquivos Brasileiros de Cardiologia

Journal Metrics
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sep 2019, Volume 113 N. 3 Pages 449 - 663

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20190203 54793 downloads

12.

Critical analysis of the classic indications for myocardial revascularization
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Azevedo, Diogo Freitas Cardoso de

; Lima, Eduardo Gomes

; Ribeiro, Matheus de Oliveira Laterza

; Linhares Filho, Jaime Paula Pessoa

; Serrano Júnior, Carlos Vicente

Revista da Associação Médica Brasileira

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mar 2019, Volume 65 N. 3 Pages 319 - 325

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O tratamento da doença arterial coronariana estável (DAC) se baseia na melhora do prognóstico e alívio de sintomas. Diretrizes nacionais e internacionais sobre a DAC respaldam a indicação de revascularização em pacientes com sintomas limitantes e refratários ao tratamento medicamentoso, bem como em situações clínicas nas quais há benefício prognóstico do tratamento intervencionista. Grande parte dos estudos que norteiam as diretrizes de indicação de revascularização data das décadas de 1980 e 1990. Estudos recentes têm revisitado o tema e trazido novo fôlego. A presente revisão faz uma análise crítica das indicações clássicas de revascularização, revisando a evidência desde os estudos da década de 1970 ao recente e polêmico estudo Orbita.

SUMMARY Treatment of stable coronary artery disease (CAD) relies on improved prognosis and relief of symptoms. National and international guidelines on CAD support the indication of revascularization in patients with limiting symptoms and refractory to optimal medical treatment, as well as in clinical situations where there is a prognostic benefit of interventional treatment. Most of the studies that support the guidelines for indication of revascularization date back to the 1980s and1990s of the last century. Recent studies have revisited the theme and brought a new breath. The present review provides a critical analysis of classic indications for revascularization, reviewing evidence from the studies of the 1970s to the recent controversial ORBITA study.

https://doi.org/10.1590/1806-9282.65.3.319 1305 downloads

13.

Dual platelet antiaggregation therapy after myocardial revascularization surgery
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Feitosa, Mateus Paiva Marques

; Soffiatti, Carla David

; Linhares Filho, Jaime Paula Pessoa

; Batista, Daniel Valente

; Lobo Filho, Heraldo Guedis

; Lima, Eduardo Gomes

; Serrano Júnior, Carlos Vicente

Revista da Associação Médica Brasileira

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mar 2019, Volume 65 N. 3 Pages 316 - 318

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A cirurgia de revascularização miocárdica (CRM) é tratamento fundamental em pacientes com doença arterial coronariana (DAC) tanto para controle de sintomas quanto para melhora do prognóstico. A patência dos enxertos venosos ainda hoje é o ponto mais vulnerável do tratamento cirúrgico, por apresentar alta prevalência de oclusão tanto no pós-operatório imediato como no seguimento em longo prazo. A aspirina tem papel bem estabelecido neste cenário e, por muito tempo, o uso do clopidogrel ficou restrito a pacientes alérgicos a aspirina. Recentemente, análises de subgrupos de estudos com diferentes terapias antiplaquetárias demonstraram redução de mortalidade e eventos cardiovasculares em pacientes em uso de dupla antiagregação plaquetária (Dapt) submetidos à CRM, ainda que tais estudos não tenham sido desenhados para avaliar este perfil de pacientes. Contudo, há ainda uma quantidade insuficiente de estudos randomizados com uso de Dapt nesse contexto, resultando em uma discordância entre as diretrizes europeia e americana de cardiologia quanto à sua indicação e gerando dúvidas na prática clínica.

SUMMARY Coronary artery bypass graft (CABG) is a consolidated treatment in patients with coronary artery disease (CAD) for both symptom control and improvement of prognosis. The patency of venous grafts is still the most vulnerable point of the surgical treatment since it presents a high prevalence of occlusion both in the immediate postoperative period and in the long-term follow-up. Aspirin plays a well-established role in this setting, and for a long time, clopidogrel use has been restricted to patients allergic to aspirin. Recently, subgroup analyses of studies with different anti-platelet therapies have shown reduced mortality and cardiovascular events in patients on dual anti-platelet antiplatelet therapy (DAPT) undergoing CABG, although such studies have not been designed to evaluate this patient profile. However, there is still an insufficient number of randomized studies using DAPT in this context, resulting in a disagreement between the European and American cardiology societies guidelines regarding their indication and generating doubts in clinical practice.

https://doi.org/10.1590/1806-9282.65.3.316 1261 downloads

14.

CULPRIT-SHOCK study
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Souza Júnior, Jorge Mangabeira de

; Kulchetscki, Rodrigo Melo

; Linhares Filho, Jaime Paula Pessoa

; Lima, Eduardo Gomes

; Serrano Junior, Carlos Vicente

Revista da Associação Médica Brasileira

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sep 2018, Volume 64 N. 9 Pages 783 - 786

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O tratamento de pacientes com infarto do miocárdio com elevação do segmento ST concomitante à presença de doença multiarterial tem sido estudado em vários estudos recentes com o objetivo de definir a necessidade, bem como o melhor momento, de abordagem das lesões residuais. No entanto, tais estudos incluíam apenas pacientes estáveis. A melhor abordagem terapêutica do choque cardiogênico secundário à síndrome coronariana aguda, no entanto, ainda permanece controversa, havendo porém recomendação de especialistas para uma revascularização que inclua as lesões não relacionadas ao evento. Publicado recentemente, o estudo CULPRIT-SHOCK mostrou benefício da abordagem inicial apenas da lesão culpada pelo evento agudo, perante a intervenção percutânea multiarterial, no contexto do choque cardiogênico. No presente ponto de vista, os autores discutem o trabalho em questão, no que concerne a questões metodológicas, limitações e aplicabilidade clínica.

SUMMARY The treatment of patients with ST-segment elevation myocardial infarction concomitant with the presence of multivessel disease has been studied in several recent studies with the purpose of defining the need, as well as the best moment to approach residual lesions. However, such studies included only stable patients. The best therapeutic approach to cardiogenic shock secondary to acute coronary syndrome, however, remains controversial, but there are recommendations from specialists for revascularization that include non-event related injuries. Recently published, the CULPRIT-SHOCK study showed benefit of the initial approach only of the injury blamed for the acute event, in view of the multivessel percutaneous intervention, in the context of cardiogenic shock. In this perspective, the authors discuss the work in question, regarding methodological questions, limitations and clinical applicability.

https://doi.org/10.1590/1806-9282.64.09.783 1453 downloads

15.

CardioER® - Using smartphone medical applications as an aid to clinical decision-making – are we ready for this?
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Soeiro, Alexandre de Matos

; Leal, Tatiana de Carvalho Andreucci Torres

; Bossa, Aline Siqueira

; Soeiro, Maria Carolina Feres de Almeida

; Serrano Jr, Carlos Vicente

; Oliveira Jr, Múcio Tavares

Revista da Associação Médica Brasileira

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aug 2018, Volume 64 N. 8 Pages 658 - 662

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.64.08.658 777 downloads

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