Resumo Fundamento: Existem diferenças relatadas entre pacientes com síndrome coronariana aguda, de acordo com o sexo. A descrição deste achado comparativo em registro brasileiro ainda não foi documentada. Objetivo: Comparar pacientes do sexo masculino vs. feminino quanto a características basais, achados coronarianos, tratamento e prognóstico intra-hospitalar e em longo prazo. Métodos: Trata-se de estudo retrospectivo, multicêntrico e observacional, no qual foram incluídos 3.745 pacientes (2.437 do sexo masculino e 1.308 do sexo feminino) entre maio de 2010 e maio de 2015. O desfecho primário intra-hospitalar foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramento). A comparação entre grupos foi realizada por meio de qui-quadrado e teste t, sendo considerado significativo p < 0,05. Em longo prazo, foram avaliados a mortalidade e os eventos combinados pelo método Kaplan-Meier, com seguimento médio de 8,79 meses. Resultados: A média de idade foi de 60,3 anos no sexo masculino e 64,6 no feminino (p < 0,0001). O fator de risco mais prevalente foi hipertensão arterial sistêmica em 72,9% das mulheres e 67,8% nos homens (p = 0,001). Intervenção coronária percutânea foi realizada em 44,9% no sexo masculino e 35,4% no feminino (p < 0,0001), e revascularização miocárdica cirúrgica em 17% no sexo masculino e 11,8% no feminino (p < 0,0001), com maior prevalência de padrão coronariano triarterial no sexo masculino (27,3% vs. 16,2%; p < 0,0001). Cerca de 79,9% dos pacientes do sexo feminino enquadraram-se no diagnóstico de síndrome coronariana aguda sem supradesnivelamento do segmento ST, enquanto no sexo masculino este número foi de 71,5% (p < 0,0001). Em curto e longo prazos não se observaram diferenças significativas entre os grupos, tanto em mortalidade quanto em eventos combinados. Conclusão: Observaram-se múltiplas diferenças relacionadas ao sexo em pacientes com síndrome coronariana aguda no que se refere a características demográficas, padrão coronariano e tratamento adotado. No entanto, a evolução prognóstica foi semelhante entre os grupos.

Abstract Background: Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented. Objective: To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis. Methods: This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months. Results: The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events. Conclusion: Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Resumo Fundamento: Estudos pequenos têm relacionado níveis mais elevados de hormônio tireoestimulante (TSH) a pior prognóstico em pacientes com síndrome coronariana aguda (SCA). Tal relação, no entanto, permanece incerta. Objetivo: Analisar os desfechos de pacientes com SCA, relacionando-os aos níveis de TSH medidos no setor de emergência. Métodos: Estudo retrospectivo observacional incluindo 505 pacientes com SCA (446 no grupo I: TSH ± 4 mUI/L; 59 no grupo II: TSH > 4 mUI/L) entre maio de 2010 e maio de 2014. Dados sobre comorbidades e medicamentos usados foram obtidos. O desfecho primário foi mortalidade intra-hospitalar por todas as causas. O desfecho secundário incluiu eventos combinados (morte, angina instável não fatal ou infarto do miocárdio, choque cardiogênico, sangramento e acidente vascular encefálico). A comparação entre grupos foi realizada através de ANOVA de uma via e teste do qui-quadrado. A análise multivariada foi realizada por regressão logística, adotando-se o nível de significância de p < 0,05. Resultados: Diferenças significativas foram observadas entre os grupos I e II relacionadas ao uso de enoxaparina (75,2% vs. 57,63%; p = 0,02) e estatinas (84,08% vs. 71,19%; p < 0,0001), acidente vascular encefálico prévio (5,83% vs. 15,25%; p = 0,007), eventos combinados (14,80% vs. 27,12%, OR = 3,05; p = 0,004), choque cardiogênico (4,77% vs. 6,05%, OR = 4,77; p = 0,02) e sangramento (12,09% vs. 15,25%, OR = 3,36; p = 0,012). Conclusão: Em pacientes com SCA e TSH > 4 mUI/L à admissão hospitalar, observou-se pior prognóstico associado à maior incidência de eventos combinados intra-hospitalares, choque cardiogênico e sangramentos.

Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH ≤ 4 mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding.

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05. RESULTS: Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02). CONCLUSIONS: Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.

A colocação percutânea de filtro de veia cava inferior é bem estabelecida em literatura, reduzindo a chance de ocorrência de tromboembolismo pulmonar após um episódio de trombose venosa profunda em pacientes com contraindicações à anticoagulação. O índice de complicações relacionadas ao procedimento é pequeno, sendo embolização evento extremamente raro. Nesse contexto, descrevemos um caso de embolização intracardíaca de filtro de veia cava inferior associada ao tamponamento cardíaco.

Insertion of inferior vena cava filters has been well established in literature, reducing occurrence of pulmonary embolism after an episode of deep venous thrombosis in patients with contraindication to anticoagulation. There are a small number of complications related to procedure and embolization is rare. In this context, we described a case of intracardiac embolization associated with cardiac tamponade.

OBJECTIVES: Acute respiratory failure is present in 5% of patients with acute myocardial infarction and is responsible for 20% to 30% of the fatal post-acute myocardial infarction. The role of inflammation associated with pulmonary edema as a cause of acute respiratory failure post-acute myocardial infarction remains to be determined. We aimed to describe the demographics, etiologic data and histological pulmonary findings obtained through autopsies of patients who died during the period from 1990 to 2008 due to acute respiratory failure with no diagnosis of acute myocardial infarction during life. METHODS: This study considers 4,223 autopsies of patients who died of acute respiratory failure that was not preceded by any particular diagnosis while they were alive. The diagnosis of acute myocardial infarction was given in 218 (4.63%) patients. The age, sex and major associated diseases were recorded for each patient. Pulmonary histopathology was categorized as follows: diffuse alveolar damage, pulmonary edema, alveolar hemorrhage and lymphoplasmacytic interstitial pneumonia. The odds ratio of acute myocardial infarction associated with specific histopathology was determined by logistic regression. RESULTS: In total, 147 men were included in the study. The mean age at the time of death was 64 years. Pulmonary histopathology revealed pulmonary edema as well as the presence of diffuse alveolar damage in 72.9% of patients. Bacterial bronchopneumonia was present in 11.9% of patients, systemic arterial hypertension in 10.1% and dilated cardiomyopathy in 6.9%. A multivariate analysis demonstrated a significant positive association between acute myocardial infarction with diffuse alveolar damage and pulmonary edema. CONCLUSIONS: For the first time, we demonstrated that in autopsies of patients with acute respiratory failure as the cause of death, 5% were diagnosed with acute myocardial infarction. Pulmonary histology revealed a significant inflammatory response, which has not previously been reported.

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.

FUNDAMENTO: Estudos prévios demonstraram que a leucocitose e a hiperglicemia verificadas à admissão de pacientes com IAM (infarto agudo do miocárdio), estão correlacionadas com a mortalidade intra-hospitalar. Entretanto, pouco é sabido sobre o impacto desses marcadores a longo prazo. OBJETIVO: Avaliar a curto e longo prazos, a influência dos níveis de glicose e leucócitos no prognóstico de pacientes com IAM. MÉTODOS: Foram analisados, retrospectivamente, 809 pacientes (idade média 63,2 ± 12,87 anos) com IAM, incluídos de forma prospectiva e consecutiva em banco de dados específico. RESULTADOS: a) Na fase intra-hospitalar os valores médios aferidos foram comparados entre pacientes que morreram ou sobreviveram: Leucocitose 12156±5977 vs 10337±3528 (p=0.004, 95% IC= 976-2663); Glicose 176±105 mg/dl vs 140±72 mg/dl (p<0.001, 95% IC= 19.4 - 52.6), respectivamente. b) No modo ajustado, o mesmo padrão foi verificado [valores de p: 0.002 (t-ratio 3.05), 0.04 (t-ratio 2.06), respectivamente]. c) Seguimento a longo prazo: a análise univariada revelou valores de P de 0.001 (t-ratio 3.3), <0.001 (t-ratio 4.16), respectivamente. Pela análise multivariada; P=0.001 (t-ratio 3,35), 0.08 (t-ratio 1,75), respectivamente. d) Após exclusão das mortes intra-hospitalares, os níveis leucocitários (P=0.989) e a glicemia (P=0.144) não permaneceram correlacionadas significativamente com mortalidade. O mesmo resultado foi verificado na análise multivariada. CONCLUSÃO: Níveis de leucócitos e glicemia à admissão de pacientes com IAM são excelentes preditores de mortalidade intra-hospitalar, e pobres preditores de óbitos a longo prazo.

BACKGROUND: Previous studies have demonstrated that leukocytosis and hyperglycemia verified at the admission of patients with acute myocardial infarction (AMI) are associated with intrahospital mortality. However, little is known on the long-term impact of these markers. OBJECTIVE: To evaluate the short-and long-term influence of the levels of glucose and leukocytes on the prognosis of patients with AMI. METHODS: A total of 809 patients with AMI were retrospectively assessed (mean age: 63.2 ± 12.87 yrs) and prospectively and consecutively included in a specific database. RESULTS: a) At the intrahospital phase, the mean values were compared between patients that died and those who survived: Leukocytosis: 12156±5977 vs 10337±3528 (p=0.004, 95%CI = 976-2663); Glucose 176±105 mg/dl vs 140±72 mg/dl (p<0.001, 95%CI = 19.4 - 52.6), respectively. b) With the adjusted mode, the same pattern was observed [p values: 0.002 (t-ratio 3.05), 0.04 (t-ratio 2.06), respectively]. c) Long-term follow-up: the univariate analysis showed P values of 0.001 (t-ratio 3.3), <0.001 (t-ratio 4.16), respectively. The multivariate analysis showed P=0.001 (t-ratio 3.35), 0.08 (t-ratio 1.75), respectively. (d) After the exclusion of the intrahospital deaths, the leukocyte (P=0.989) and glucose levels (P=0.144) did not remain significantly correlated with mortality. The same result was observed at the multivariate analysis. CONCLUSION: The levels of glucose and leukocytes at the hospital admission of patients with AMI are excellent predictors of intrahospital mortality and poor predictors of long-term death.

FUNDAMENTO: Estudios previos demostraron que tanto la leucocitosis como la hiperglucemia verificadas cuando de la admisión de pacientes con infarto agudo de miocardio (IAM), están correlacionadas con la mortalidad intrahospitalaria. Sin embargo, poco se sabe acerca del impacto de esos marcadores a largo plazo. OBJETIVO: Evaluar, a corto y largo plazos, la influencia de los niveles de glucosa y leucocitos en el pronóstico de pacientes con IAM. MÉTODOS: Se analizaron, retrospectivamente, a 809 pacientes (edad promedio 63,2 ± 12,87 años) con IAM, incluidos de forma prospectiva y consecutiva en banco de datos específico. RESULTADOS: a) En la fase intrahospitalaria se compararon los valores promedio obtenidos entre pacientes que murieron o supervivieron: leucocitosis 12.156±5.977 vs 10.337±3.528 (p=0.004, 95% IC= 976-2663); glucosa 176±105 mg/dl vs 140±72 mg/dl (p<0.001, 95% IC= 19.4 - 52.6), respectivamente. b) En el modo ajustado, se verificó el mismo estándar [valores de p: 0.002 (t-ratio 3.05), 0.04 (t-ratio 2.06), respectivamente]. c) Seguimiento a largo plazo: el análisis univariado reveló valores de P de 0.001 (t-ratio 3.3), <0.001 (t-ratio 4.16), respectivamente. Ya el análisis multivariado: P=0.001 (t-ratio 3,35), 0.08 (t-ratio 1,75), respectivamente. d) Tras la exclusión de las muertes intrahospitalarias, los niveles leucocitarios (P=0.989) y la glucemia (P=0.144) no permanecieron correlacionadas significativamente con la mortalidad. Igual resultado se verificó en el análisis multivariado. CONCLUSIÓN: Los niveles de leucocitos y glucemia al ingreso de pacientes con IAM resultan excelentes predictores de mortalidad intrahospitalaria, y pobres predictores de óbitos a largo plazo.