Browsing by Author "Freitas, M"
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- Abordagem Invasiva versus Conservadora nas Síndromes Coronárias Agudas sem Supradesnivelamento do Segmento ST – Contributo para o Conhecimento e Avaliação da Realidade NacionalPublication . Teixeira, R; Lourenço, C; Baptista, R; Jorge, E; António, N; Monteiro, S; Gonçalves, F; Monteiro, P; Freitas, M; Providência, LABACKGROUND: In addition to medical therapy, revascularization plays an important role in determining prognosis in the acute setting of unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI). OBJECTIVE: To compare in-hospital and medium-term outcome of an invasive versus a conservative strategy in the setting of UA/ NSTEMI. METHODS: We carried out a prospective study of 802 consecutive patients admitted to a single coronary unit between May 2004 and December 2006 with UA/NSTEMI. Patients were divided into two groups: A (n=418)--invasive strategy; B (n=384)--conservative strategy. All-cause mortality and major adverse cardiovascular events (MACE) were assessed at one year. RESULTS: Group B patients were older (73.0 [29-93] vs. 64.0 [27-86] years, p < 0.001), more frequently female and diabetic (35.9 vs. 26.0%, p = 0.002), and were more likely to have a history of myocardial infarction and heart failure. They also presented with worse renal function, lower hemoglobin levels and lower left ventricular ejection fraction (53.0 [45-59] vs. 57.0% [50-60]%, p < 0.001). In hospital mortality was significantly higher for this group (5.7 vs. 1.9%, p = 0.004). Group A had more smokers, more frequent history of percutaneous coronary intervention, higher total and LDL cholesterol, lower Killip class on admission and lower TIMI scores. They were more frequently treated with anti-platelet therapy and at discharge were more often under beta-blocker and dual anti-platelet therapy. Female gender (adjusted OR 0.46; 95% CI 0.27-0.78) and older age (adjusted OR 0.55; 95% CI 0.31-0.99), were independent predictors for a conservative strategy during hospital stay. One-year survival was higher for the invasive strategy patients (95.9% vs. 86.2%, log rank p < 0.001), as was one-year MACE-free survival (88.3% vs. 75.7%, log rank p < 0.001). According to two multivariate Cox regression analyses, opting for an invasive strategy during hospital stay conferred a 57% reduction in relative risk of death (HR 0.43; 95% CI 0.20-0.94), and a 56% reduction in relative risk of MACE (HR 0.44; 95% CI 0.26-0.77) at one year. CONCLUSIONS: Despite some imbalances between the groups, in our population an invasive strategy during hospital stay independently predicted a favorable one-year outcome.
- Can we improve outcomes in patients with previous coronary artery bypass surgery admitted for acute coronary syndrome?Publication . Teixeira, R; Lourenço, C; António, N; Jorge, E; Baptista, R; Saraiva, F; Mendes, P; Monteiro, S; Gonçalves, F; Monteiro, P; Freitas, M; Providência, LAINTRODUCTION AND OBJECTIVES: Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG. METHODS: This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs. RESULTS: Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B patients more frequently had ST-elevation myocardial infarction, and had a higher median ejection fraction (53% [interquartile range, 47%-60%] vs. 50% [42%-55%]; P< .01) and peak troponin-I concentration. There was no difference in the use of invasive techniques. Regarding medication, Group B patients were more likely to receive dual antiplatelet therapy at discharge. No significant difference was observed in in-hospital mortality (9.5% versus 5.9%; P=.2) or mortality at 1 month, 6 months or 1 year (9.8% versus 9.1%; log-rank test, P=.87) and the cumulative major adverse cardiac event rate was equally low in both groups. The presence of a CABG was associated with more readmissions for unstable angina (11.3% vs. 3.1%; P< .01). CONCLUSIONS: In our ACS patients, the presence of a CABG had no significant influence on short- or medium-term outcomes, such as all-cause mortality and adverse cardiac events.
- CYP2C19*2 and prognosis after an acute coronary syndrome: Insights from a Portuguese centerPublication . Teixeira, R; Monteiro, P; Marques, G; Pego, J; Lourenço, M; Tavares, C; Reboredo, A; Monteiro, S; Gonçalves, F; Ferreira, MJ; Freitas, M; Ribeiro, G; Providência, LABACKGROUND: Clopidogrel requires oxidation dependent on the cytochrome P450 enzyme 2C19 (CYP2C19) to form its active metabolite. The importance of loss-of-function alleles (particularly CYP2C19*2, 681G>A) in poor platelet response to clopidogrel is well recognized. OBJECTIVE: To investigate the prevalence and prognostic impact of the CYP2C19*2 allele in a local acute coronary syndrome (ACS) population. METHODS: We performed a prospective, longitudinal study of 95 patients admitted for an ACS between March and October 2009 to a single coronary care unit. Patients aged under 75 who survived hospital stay and for whom clopidogrel was prescribed were included. At discharge, CYP2C19 was genotyped using a commercially available kit. Patients were divided into two groups: Group A (non-carriers, normal metabolizers, CYP2C19*1/*1), n=69; and Group B (carriers, slow metabolizers, CYP2C19*2/*1 or *2/*2), n=26. The primary endpoint was a combined outcome of cardiovascular death, non-fatal myocardial infarction or re-admission for unstable angina; median follow-up was 136.0 (79.0-188.0) days. RESULTS: The median age of the population was 62.0 (51.0-68.0) years, and 83.2% were male. The CYP2C19*2 (A) allele had a frequency of 14.2%. There were no differences between the groups with respect to demographic data or history of cardiovascular disease. Coronary anatomy, left ventricular ejection fraction and renal function were also similar. The groups were also homogenous with respect to GRACE risk score (118.0 (95.0-136.5) vs. 115.0 (96.0-133.0), p=0.68), medical treatment and percutaneous revascularization during hospital stay. Event-free survival was higher for Group A (94.0% vs. 75.0%, log-rank p=0.010). Three readmissions for MI were documented, all in the slow metabolizers group. CONCLUSION: In our ACS population, the CYP2C19*2 allele was a medium-term prognostic marker.
- Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromesPublication . António, N; Soares, F; Lourenço, C; Saraiva, F; Gonçalves, F; Monteiro, P; Gonçalves, L; Freitas, M; Providência, LAImpact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes
- Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudasPublication . Lourenço, C; Teixeira, R; António, N; Monteiro, S; Baptista, R; Jorge, E; Gonçalves, F; Monteiro, P; Gonçalves, L; Freitas, M; Providência, LABACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.
- A Importância de um ECG Normal em Síndromes Coronarianas Agudas sem Supradesnivelamento do SegmentoPublication . Teixeira, R; Lourenço, C; António, N; Monteiro, S; Baptista, R; Jorge, E; Ferreira, MJ; Monteiro, P; Freitas, M; Providência, LABACKGROUND: Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS). OBJECTIVE: To assess the impact of the admission ECG on prognosis over non-ST ACS. Population: prospective, continuous, observational study of 802 non-ST ACS patients from a single center. METHODS: Patients were divided in 2 groups: A (n=538) - Abnormal ECG and B (n=264) - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate. RESULTS: Group A patients were older (68.7+/-11.7 vs. 63.4+/-12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01+/-10.55 vs. 55.34+/- 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97). There were no differences regarding the MACE rate. CONCLUSION: In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.
- Invasive strategy in non-ST elevation acute coronary syndromes: risks and benefits in an elderly populationPublication . Lourenço, C; Teixeira, R; António, N; Saraiva, F; Baptista, R; Jorge, E; Monteiro, S; Gonçalves, F; Monteiro, P; Matos, V; Calisto, J; Faria, H; Gonçalves, L; Freitas, M; Providência, LA
- Left ventricular end diastolic pressure and acute coronary syndromesPublication . Teixeira, R; Lourenço, C; Baptista, R; Jorge, E; Mendes, P; Saraiva, F; Monteiro, S; Monteiro, P; Ferreira, MJ; Freitas, M; Providência, LABACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP > 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence.
- Oxidative Stress Adaptation in Aggressive Prostate Cancer May Be Counteracted by The Reduction of Glutathione ReductasePublication . Freitas, M; Baldeiras, I; Proença, T; Alves, V; Mota-Pinto, A; Sarmento-Ribeiro, AOxidative stress has been associated with prostate cancer development and progression due to an increase of reactive oxygen species (ROS). However, the mechanisms whereby ROS and the antioxidant system participate in cancer progression remain unclear. In order to clarify the influence of oxidative stress in prostate cancer progression, we performed this study in two human prostate cancer cell lines, PC3 and HPV10 (from metastasis and from cancer in situ, respectively) and RWPE1 cells derived from normal prostate epithelium. Cells were treated with hydrogen peroxide (H2O2) and PC3 cells were also treated with diethyl maleate (DEM). The effect on cell growth, viability, mitochondria membrane potential and oxidative stress was analyzed. Oxidative stress was evaluated based on ROS production, oxidative lesion of lipids (MDA) and on determination of antioxidants, including enzyme activity of glutathione peroxidase (Gl-Px), glutathione reductase (Gl-Red) and on the quantification of glutathione (GSH), glutathione-s-transferase (GST) and total antioxidant status (TAS). PC3 shows higher ROS production but also the highest GSH levels and Gl-Red activity, possibly contributing to oxidative stress resistance. This is also associated with higher mitochondrial membrane potential, TAS and lower lipid peroxidation. On the other hand, we identified Gl-Red activity reduction as a new strategy in overcoming oxidative stress resistance, by inducing H2O2 cytotoxicity. Therefore these results suggest Gl-Red activity reduction as a new potential therapeutic approach, in prostate cancer.
- Preditores de prognóstico adverso numa população com diabetes após síndromes coronárias agudasPublication . Lourenço, C; António, N; Teixeira, R; Saraiva, F; Jorge, E; Baptista, R; Monteiro, S; Gonçalves, F; Monteiro, P; Gonçalves, L; Freitas, M; Providência, LA