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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

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1 result(s) for: Alexandre Schaan de Quadros

Myocardial infarction in the daily practice

Infarto agudo do miocárdio na prática clínica diária

Alexandre Schaan de Quadros; Márcia Moura Schmidt; Cristina do Amaral Gazeta; Karina Pezzi Melleu; Alexandre Damiani Azmus; Júlio Vinícius Teixeira; Cláudio Vasques de Moraes; Henrique Basso Gomes; Rogério Eduardo Gomes Sarmento-Leite; Carlos Antonio Mascia Gottschall

Int J Cardiovasc Sci.2016;29(4):253-261 : Original Article


BACKGROUND: Guideline recommendations for the management of patients with ST-elevation myocardial infarction (STEMI) are mainly based on data from randomized clinical trials.
OBJECTIVES: We sought to assess temporal trends in characteristics, treatment and outcomes of patients with STEMI representative of the daily practice.
METHODS: Prospective cohort study including all patients with STEMI who presented at our institution from 2010 to 2013. Clinical, angiographic, laboratory, treatment aspects and 30-day major cardiovascular events (MACEs) were assessed and compared over the years.
RESULTS: The mean TIMI risk score, and most baseline clinical and angiographic characteristics of the 1973 patients included remained stable from 2010 to 2013, except for diabetes mellitus (whose frequency increased from 21% to 28%; p < 0.01). Primary PCI was performed in 95% of cases, and the door-to-balloon time decreased from 1.27 to 1.11 hours (p < 0.01). Regarding treatment, there were significant increases in the use of 600 mg boluses of clopidogrel (75% in 2010 vs 93% in 2013; p < 0.001), upstream anticoagulant (50% vs 91%; p < 0.001) and the radial approach in pPCI (9% vs 66%; p < 0.001), and lower use of beta-blockers (72% vs 63%; p < 0.001). MACE decreased from 17.4% to 9.5% (p < 0.05). Independent predictors of MACE were baseline characteristics, the radial approach, and use of beta-blockers and upstream anticoagulant.
CONCLUSIONS: The baseline characteristics of patients with STEMI remained stable over a four-year period, except for the incidence of diabetes mellitus, which increased significantly. Medical and interventional treatments significantly changed, and short-term adverse cardiovascular outcomes significantly decreased. Predictors of better outcomes were baseline characteristics, use of beta-blockers and upstream anticoagulant, and the radial approach. (Int J Cardiovasc Sci. 2016;29(4):253-261)