Abstract Background: Cardiovascular diseases, such as acute myocardial infarction, are the main causes of death in the world. The flavonoids present in chocolate can have benefits for people who have risk factors to the development of cardiovascular diseases and have a coadjuvant effect on known therapies. Objective: To analyze the association between chocolate consumption, severity of coronary lesions, risk factors and severity of the first infarction in patients attended at the Cardiology Institute of Santa Catarina and other hospitals in the State of Santa Catarina. Methods: Subanalysis of the Catarina Heart Study cohort, evaluated 350 patients with first myocardial infarction. We evaluated clinical, echocardiographic, hemodynamic laboratorial variables. We used chi square test to evaluate qualitative variables, t student test in the case of parametric variables and U Mann Whitney test in non-parametric variables. We considered significant p < 0,05. Results: Lower prevalence of hypertension (43.2% % vs. 62.3% p = 0.003), diabetes mellitus (13.5% vs. 25.7%, p = 0.027) and smoking (24.3% vs. 37.7%, p = 0.032) among those who consume chocolate. Higher use of alcohol (40.5% vs. 26.4%, p = 0.018) and drugs (9.5% vs. 3.3%, p = 0.023) among those who consumed chocolate. Among the patients who consumed chocolate, there was a negative correlation between amount consumed and Syntax (r = -0.296, p = 0.019). Conclusion: There was association between chocolate consumption and lower prevalence of hypertension, diabetes and smoking. There was no association between amount of chocolate consumed and post-infarction ventricular function and TIMI frame count. Higher prevalence of alcohol and drug use among those who consume chocolate. Negative correlation between Syntax and the amount of chocolate consumed.

Abstract Background: Smoking is the most important risk factor for coronary heart disease (CHD) and ischemic events; alcohol consumption, on the other hand, appears to have a protective role. Objective: Assess the association between smoking and alcohol consumption with the severity of coronary artery injuries in patients with acute myocardial infarction (AMI). Methods: Cross-sectional study, performed in Santa Catarina. Variables were evaluated using the Chi-squared T/Fisher’s exact test, Kendall’s correlation coefficient, Student’s t test or Mann-Whitney U test. Values of p < 0.05 were considered significant. Results: Between August 2016 to June 2017, 226 patients were evaluated with first episode of AMI. There was a difference in sex distribution, showing that 59.7% of men and 85.4% of women were not alcoholic (p < 0.001). There was a higher prevalence of non-hypertensive patients who consumed alcohol than hypertensive ones (40.7% vs. 24.4% and p = 0.010) and patients without diabetes who had drinking habits than those diabetic (36.4% vs. 12.0% and p = 0.001). There was also a higher prevalence of non-diabetic patients who smoked than diabetic ones (38.1% vs. 22.0% and p = 0.035). A weak and negative correlation was found between the number of cigarettes per day and the pack-year with the TIMI frame count (r = -0.174 and p = 0.041 and r = -0.192 and p = 0.027, respectively). The other associations did not show statistical significance. Conclusion: The study showed that the number of cigarettes consumed per day and the pack-year is related to a smaller TIMI frame count, i.e., to a better coronary flow, which may be related to the Smoker’s Paradox. There was no correlation between the beverage type and quantity with the SYNTAX score, Ejection fraction and TIMI frame count.

Resumo Fundamento: Apesar de sua grande relevância, não existem trabalhos em nosso país que avaliem a aplicação das diretrizes de 2012 para uso apropriado do cateterismo cardíaco diagnóstico. Objetivo: Analisar a apropriação das coronariografias realizadas em dois hospitais da região sul do Brasil. Métodos: Estudo transversal multicêntrico, que analisou as indicações, resultados e propostas de tratamento de 737 coronariografias realizadas em um hospital terciário com múltiplas especialidades (Hospital A) e um hospital cardiológico terciário (Hospital B). Foram incluídas coronariografias eletivas ou de urgência, com exceção dos casos de infarto agudo do miocárdio com elevação do segmento ST. O nível de significância estatística adotado foi de 5% (p < 0,05). Resultados: Do total de 737 coronariografias, 63,9% foram realizadas em pacientes do sexo masculino. A média de idade foi 61,6 anos. A indicação foi síndrome coronariana aguda em 57,1% e investigação de doença arterial coronariana em 42,9% dos casos. Em relação à apropriação, 80,6% foram classificadas como apropriadas, 15,1% ocasionalmente apropriadas e 4,3% raramente apropriadas. O tratamento proposto foi clínico para 62,7%, intervenção coronária percutânea para 24,6% e cirurgia de revascularização miocárdica para 12,7% dos casos. Das coronariografias classificadas como raramente apropriadas, 56,2% foram relacionadas à não realização de provas funcionais prévias e 21,9% apresentaram lesões coronarianas graves. Porém, independentemente do resultado da coronariografia, todos os pacientes nesse grupo foram indicados para tratamento clínico. Conclusão: Observamos baixo número de coronariografias raramente apropriadas em nossa amostra. A recomendação da diretriz nesses casos foi adequada, sendo que nenhum paciente necessitou de tratamento de revascularização. A maior parte desses casos se deve à não realização de provas funcionais.

Abstract Background: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. Objective: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. Methods: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). Results: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. Conclusion: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

Abstract Background: Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital.