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3. Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Author

António Tralhão, António Miguel Ferreira, Sérgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Rosário, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, and Miguel Mendes

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction and Aim: The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. Methods: We studied 276 consecutive patients (mean age 62±14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤3. Results: The median ZRS was 3 (interquartile range [IQR] 1–4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 [IQR 4–7] vs. 7.0 [5–13] days, p1) com EAMCST submetidos a ICPP durante um período de dois anos. Foram obtidos os SZ, duração de internamento, mortalidade e readmissão aos 30 dias. Foi definido baixo risco como SZ ≤3. Resultados: A mediana do SZ foi de 3 [distância interquartil (IQR) 1-4] e 171 doentes (62%) foram classificados como de baixo risco. A mortalidade aos 30 dias foi de 4,7% (13 doentes). Em comparação com os restantes, os doentes de baixo risco tiveram menor duração de internamento [mediana 5,0 (IQR 4-7) versus 7,0 (IQR 5-13) dias, p

Published
2015
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4. Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores

Author

António Tralhão, Rui Campante Teles, Manuel Sousa Almeida, Sérgio Madeira, Miguel Borges Santos, Maria João Andrade, Miguel Mendes, and José Pedro Neves

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction and Aim: Isolated aortic valve replacement (AVR) in octogenarians is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. We sought to analyze operative mortality and morbidity and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and Society of Thoracic Surgeons (STS) score in this population. Methods: We retrospectively enrolled 106 consecutive octogenarians with symptomatic severe aortic stenosis undergoing isolated AVR in a large-volume single center between January 2003 and December 2010 and calculated surgical risk scores. Results: Mean logistic EuroSCORE I, EuroSCORE II and STS score were 14.6±11, 4.4±3.1 and 4.0±2.4%, respectively. Mean operative mortality was 5.7% (six patients). Two (1.9%) patients suffered an ischemic stroke, three (2.8%) required temporary hemodialysis and five (4.7%) had a permanent pacemaker implanted. Five (4.7%) required rethoracotomy. No myocardial infarction or sternal wound infection was observed. Calibration-in-the-large showed overestimation of operative mortality with logistic EuroSCORE I (p=0.036), whereas EuroSCORE II (p=1.0) and STS (p=1.0) showed good calibration. C-statistic values were 0.877 (95% CI 0.800–0.933) for logistic EuroSCORE I, 0.792 (95% CI 0.702–0.864) for EuroSCORE II and 0.702 (95% CI 0.605–0.787) for STS, without statistically significant differences. Conclusions: These results suggest that AVR can be performed safely in selected octogenarians. EuroSCORE II and STS demonstrated superior calibration and should be the preferred tools for risk assessment, at least for this population. Resumo: Introdução e objetivos: A cirurgia de substituição valvular aórtica (SVA) envolve um risco acrescido em octogenários, pela elevada prevalência de fatores de risco e comorbilidades, tornando essencial a predição de resultados. Pretendemos analisar a mortalidade operatória e comparar as capacidades preditivas do European System for Cardiac Operative Mortality (EuroSCORE) I, EuroSCORE II e o Society of Thoracic Surgeons (STS) score nesta população. Métodos: Analisámos retrospetivamente 106 octogenários com estenose aórtica grave sintomática, submetidos a SVA isolada num centro terciário, entre janeiro de 2003 e dezembro de 2010. Resultados: O EuroSCORE I logístico, o EuroSCORE II e o STS score médios foram 14,6±11, 4,4±3,1 e 4,0±2,4%, respetivamente. A mortalidade operatória foi 5,7% (seis doentes). Registámos como complicações dois (1,9%) acidentes vasculares cerebrais isquémicos, hemodiálise transitória em três doentes (2,8%) e cinco (4,7%) implantes de pacemaker definitivo. Cinco doentes (4,7%) requereram revisão da hemostase. Não se verificaram enfarte agudo do miocárdio ou infeção do esterno. O EuroSCORE I logístico sobreestimou a mortalidade (p=0,036), enquanto o EuroSCORE II (p=1,0) e o STS (p=1,0) score mostraram boa calibração. A area sob a curva foi de 0,877 (CI 95% 0,800-0,933) para o EuroSCORE I logístico, 0,792 (CI 95% 0,702-0,864) para o EuroSCORE II e 0,702 (CI 95% 0,605-0,787) para o STS score (p=ns para comparações). Conclusões: Estes resultados sugerem que a SVA pode ser realizada com morbi-mortalidade aceitável em octogenários selecionados. O EuroSCORE II e o STS score demonstraram melhor calibração e devem ser as métricas preferidas na avaliação do risco operatório desta população. Keywords: Aortic valve surgery, Aortic stenosis, Octogenarians, Risk assessment, EuroSCORE, STS score, Palavras-chave: Cirurgia valvular aórtica, Estenose aórtica, Octogenários, Avaliação do risco, EuroSCORE, STS score

Published
2015
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5. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease—An analysis of the ACROSS registry

Author

Miguel Borges Santos, António Miguel Ferreira, Pedro de Araújo Gonçalves, Luís Raposo, Rui Campante Teles, Manuel Almeida, and Miguel Mendes

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction and Objectives: The purpose of this study was to assess the diagnostic yield of current referral strategies for elective invasive coronary angiography (ICA). Methods: We performed a cross-sectional observational study of consecutive patients without known coronary artery disease (CAD) undergoing elective ICA due to chest pain symptoms. The proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) was determined according to the use of noninvasive testing. Results: The study population consisted of 1892 individuals (60% male, mean age 64±11 years), of whom 1548 (82%) had a positive noninvasive test: exercise stress test (41%), stress myocardial perfusion imaging (36%), stress echocardiogram (3%) or coronary computed tomography angiography (3%). Referral without testing occurred in 18% of patients. The overall prevalence of obstructive CAD was 57%, higher among those with previous testing (58% vs. 51% without previous testing, p=0.026) and when anatomic rather than functional tests were used (81.3% vs. 57.1%, p=0.001). A positive test and conventional risk factors were all independent predictors of obstructive CAD, with adjusted odds ratios (95% confidence interval) of 1.34 (1.03–1.74) for noninvasive testing, 1.05 (1.04–1.06) for age, 3.48 (2.81–4.29) for male gender, 1.86 (1.32–2.62) for current smoking, 1.74 (1.38–2.20) for diabetes, 1.30 (1.04–1.62) for hypercholesterolemia, and 1.39 (1.08–1.80) for hypertension. Conclusions: More than 40% of patients without known CAD undergoing elective ICA did not have obstructive lesions, even though four out of five had a positive noninvasive test. These exams were relatively weak gatekeepers; functional tests were more often used but appeared to be outperformed by the anatomic test. Resumo: Introdução e objetivos: O objetivo do estudo foi avaliar o rendimento das atuais estratégias de referenciação eletiva para coronariografia invasiva. Métodos: Estudo transversal de indivíduos consecutivos sem doença coronária conhecida submetidos a coronariografia por dor torácica. Determinação da prevalência de doença coronária obstrutiva (definida pela presença de pelo menos uma estenose ≥ 50%) de acordo com a utilização de testes não-invasivos para despiste de cardiopatia isquémica. Resultados: Foram avaliados 1892 indivíduos (60% homens, idade média 64 ± 11 anos), dos quais 1548 (82%) tinham um teste não-invasivo positivo: prova de esforço (41%), cintigrafia de perfusão miocárdica (36%), ecocardiograma de stress (3%) e angiografia coronária por tomografia computorizada (3%). Ocorreu referenciação sem teste prévio em 18% dos doentes. A prevalência global de doença obstrutiva foi 57%, sendo mais elevada nos doentes submetidos a testes não-invasivos (58% versus 51% nos doentes sem testes prévios, p = 0,026) e naqueles em que o teste era anatómico versus funcional (81,3% versus 57,1%, p = 0,001). Um teste não-invasivo positivo e fatores de risco convencionais foram preditores independentes de doença obstrutiva, com odds-ratio ajustado (intervalo confiança 95%) de: teste não-invasivo 1,34 (1,03-1,74), idade 1,05 (1,04-1,06), sexo masculino 3,48 (2,81-4,29), tabagismo ativo 1,86 (1,32-2,62), diabetes 1,74 (1,38-2,20), hipercolesterolemia 1,30 (1,04-1,62) e hipertensão 1,39 (1,08-1,80). Conclusões: Mais de 40% dos doentes sem doença coronária conhecida que realizam coronariografia eletiva não têm doença obstrutiva, apesar de quatro em cada cinco ter um teste não-invasivo positivo. Estes testes são gatekeepers relativamente fracos; os funcionais foram utilizados mais frequentemente mas o anatómico pareceu ter melhor desempenho. Keywords: Coronary angiography, Chest pain/diagnosis, Stable angina, Myocardial ischemia, Palavras-chave: Angiografia coronária, Dor torácica/diagnóstico, Angina estável, Isquémia miocárdica

Published
2013
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6. Um caso raro de elevação persistente da troponina em doente com insuficiência cardíaca crónica

Author

Gonçalo Cardoso, Carlos Aguiar, António Ventosa, Maria José Rebocho, Miguel Borges Santos, Hélder Dores, Pedro Adragão, and Miguel Mendes

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Resumo: Mulher com miocardiopatia hipertrófica, que sofre enfarte do miocárdio aos 28 anos, sem doença coronária angiográfica. Dois anos mais tarde inicia manifestações de insuficiência cardíaca e instala-se disfunção sistólica ventricular esquerda com elevação persistente da troponina I cardíaca. A partir daí houve deterioração progressiva da função ventricular. Abstract: We present the case of a woman diagnosed with hypertrophic cardiomyopathy who suffered a myocardial infarction when she was 28 years old, without coronary artery disease on coronary angiography. Two years later, she presented signs of heart failure and left ventricular systolic dysfunction with persistent troponin I elevation, followed by progressive worsening of ventricular dysfunction. Palavras-chave: Miocardiopatia hipertrófica, Troponina, Insuficiência cardíaca, Keywords: Hypertrophic cardiomyopathy, Troponin, Heart failure

Published
2013
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8. Enfarte agudo do miocárdio no YouTube – Is it all fake news?

Author

João Baltazar Ferreira, Hilaryano Ferreira, Daniela Madeira, Carlos Morais, Daniel Faria, Miguel Borges Santos, Marco Beringuilho, David Roque, João B Augusto, Inês Fialho, and Víctor Gil

Subjects
Internet, business.industry, YouTube, Enfarte do Miocárdio, Myocardial Infarction, Myocardial infarction, 03 medical and health sciences, 0302 clinical medicine, Health education, Health communication, 030228 respiratory system, Health information management, RC666-701, Diseases of the circulatory (Cardiovascular) system, Medicine, 030212 general & internal medicine, Fake news, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumo: Introdução e objetivos: A Internet é fundamental na divulgação de informação médica. Contudo, a ausência de controlo de qualidade potencia a “desinformação” da população. Pretendemos caraterizar a relevância e qualidade da informação sobre enfarte agudo do miocárdio em língua portuguesa no site YouTube (www.youtube.com). Métodos: Analisaram‐se 1.000 vídeos correspondentes aos primeiros 100 resultados da pesquisa no YouTube dos termos: “ataque + cardíaco”, “ataque + coração”, “enfarte ‐ cerebral”, “infarto ‐ cerebral”, “enfarte + miocárdio”, “enfarte + agudo + miocárdio”, “infarto + miocárdio”, “infarto + agudo + miocárdio”, “trombose + coração” e “trombose + coronária”. Excluíram‐se vídeos irrelevantes (n = 316), duplicados (n = 345), sem áudio (n = 24) e de língua não portuguesa (n = 106). Os vídeos elegíveis foram analisados quanto a origem, tema, público‐alvo e imprecisões científicas. A qualidade foi avaliada com os scores Health on the Net Code (HONCode, de 0‐8) e DISCERN (0‐5) – quanto maior, melhor a qualidade. Resultados: Incluíram‐se 242 vídeos, a maioria de formadores independentes (n = 95, 39%) e destinados à população‐geral (n = 202, 83,5%). Um terço (n = 79) apresentou imprecisões; vídeos de sociedades científicas e instituições de saúde/governamentais não apresentaram quaisquer imprecisões. A qualidade média foi baixa/moderada; apenas um vídeo apresentou boa qualidade, sem imprecisões. Instituições de saúde/governamentais foram a fonte com melhor qualidade (HONCode 4±1, DISCERN 2±1). Conclusões: A informação sobre enfarte agudo do miocárdio em língua portuguesa é irrelevante em um terço dos casos e um terço dos vídeos relevantes é impreciso. A qualidade média da informação é reduzida, sendo importante definir estratégias de controlo de qualidade da informação médica online. Abstract: Introduction and objectives: The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. Methods: We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): “cardiac + arrest”; “heart + attack”; “heart + thrombosis”; “coronary + thrombosis”; “infarction – brain”, “myocardial + infarction” and “acute + myocardial + infarction”. Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non‐Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores – the higher the score, the better the quality. Results: 242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). Conclusions: One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.

Published
2021
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9. Health status after invasive or conservative care in coronary and advanced kidney disease

Author

Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, 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Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, 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Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic

Subjects
Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of

Published
2020

10. Unusual Submitral Aneurysms

Author

Renata Ribeiro, José Delgado Alves, Daniel Faria, Ana Oliveira Soares, Sância Ramos, Rosa Gouveia, A.L. Ferreira, Miguel Borges Santos, António Freitas, João B Augusto, and Miguel Sousa-Uva

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Heart failure, MEDLINE, Medicine, Radiology, Nuclear Medicine and imaging, IgG4-related disease, Young adult, Cardiology and Cardiovascular Medicine, business, medicine.disease
Published
2020
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11. Temporal trends in referral patterns for invasive coronary angiography - a multicenter 10-year analysis

Author

António Miguel Ferreira, Mariana Gonçalves, Pedro Farto e Abreu, Manuel de Sousa Almeida, Miguel Borges Santos, David Roque, Mariana Faustino, Rui Campante Teles, and Pedro de Araújo Gonçalves

Subjects
Male, medicine.medical_specialty, Referral, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, Revascularization, Coronary Angiography, Coronary artery disease, Angina, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Myocardial Revascularization, Medicine, Humans, In patient, 030212 general & internal medicine, Referral and Consultation, Aged, Tomography, Emission-Computed, Single-Photon, Portugal, business.industry, General Medicine, medicine.disease, Invasive coronary angiography, Stenosis, Cross-Sectional Studies, Multicenter study, Cardiology, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business
Abstract

AIM To assess the temporal trends in the usage pattern of non-invasive testing before invasive coronary angiography (ICA) and its diagnostic yield in patients with suspected coronary artery disease (CAD). METHODS Cross-sectional observational multicenter study of 4805 consecutive patients (60% male, mean age 66 ± 10 years) with suspected CAD undergoing elective ICA due to angina pectoris in two centers, from 2008 to 2017. The use of noninvasive testing and the proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) were assessed. RESULTS There were 4038 (84%) patients referred for ICA with positive noninvasive test, mainly SPECT (38%, n = 1828) and exercise ECG (36%, n = 1731). Obstructive CAD was found in 54.5% (n = 2621) of the patients and 37.9% (n = 1822) underwent revascularization. The prevalence of obstructive CAD was higher in patients with vs. without previous noninvasive testing (55.8% vs. 48.1%, respectively, P < 0.001) and tended to decrease during the study period (P for trend

Published
2020

12. Acute myocardial infarction on YouTube - is it all fake news?

Author

Inês Fialho, Víctor Gil, Daniela Madeira, Hilaryano Ferreira, Daniel Faria, Carlos Morais, Miguel Borges Santos, João Baltazar Ferreira, João B Augusto, Marco Beringuilho, and David Roque

Subjects
media_common.quotation_subject, Gestão de informação médica, Population, Myocardial Infarction, Video Recording, Target audience, Video quality, Enfarte agudo miocárdio, medicine, Code (cryptography), Diseases of the circulatory (Cardiovascular) system, Relevance (law), Humans, Quality (business), Misinformation, Disinformation, education, Comunicação em saúde, General Environmental Science, media_common, education.field_of_study, Information Dissemination, YouTube, Information quality, medicine.disease, Educação em saúde, RC666-701, General Earth and Planetary Sciences, Medical emergency, Psychology, Social Media
Abstract

Introduction and objectives: The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. Methods: We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): “cardiac + arrest”; “heart + attack”; “heart + thrombosis”; “coronary + thrombosis”; “infarction – brain”, “myocardial + infarction” and “acute + myocardial + infarction”. Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non‐Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores – the higher the score, the better the quality. Results: 242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). Conclusions: One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information. Resumo: Introdução e objetivos: A Internet é fundamental na divulgação de informação médica. Contudo, a ausência de controlo de qualidade potencia a “desinformação” da população. Pretendemos caraterizar a relevância e qualidade da informação sobre enfarte agudo do miocárdio em língua portuguesa no site YouTube (www.youtube.com). Métodos: Analisaram‐se 1.000 vídeos correspondentes aos primeiros 100 resultados da pesquisa no YouTube dos termos: “ataque + cardíaco”, “ataque + coração”, “enfarte ‐ cerebral”, “infarto ‐ cerebral”, “enfarte + miocárdio”, “enfarte + agudo + miocárdio”, “infarto + miocárdio”, “infarto + agudo + miocárdio”, “trombose + coração” e “trombose + coronária”. Excluíram‐se vídeos irrelevantes (n = 316), duplicados (n = 345), sem áudio (n = 24) e de língua não portuguesa (n = 106). Os vídeos elegíveis foram analisados quanto a origem, tema, público‐alvo e imprecisões científicas. A qualidade foi avaliada com os scores Health on the Net Code (HONCode, de 0‐8) e DISCERN (0‐5) – quanto maior, melhor a qualidade. Resultados: Incluíram‐se 242 vídeos, a maioria de formadores independentes (n = 95, 39%) e destinados à população‐geral (n = 202, 83,5%). Um terço (n = 79) apresentou imprecisões; vídeos de sociedades científicas e instituições de saúde/governamentais não apresentaram quaisquer imprecisões. A qualidade média foi baixa/moderada; apenas um vídeo apresentou boa qualidade, sem imprecisões. Instituições de saúde/governamentais foram a fonte com melhor qualidade (HONCode 4±1, DISCERN 2±1). Conclusões: A informação sobre enfarte agudo do miocárdio em língua portuguesa é irrelevante em um terço dos casos e um terço dos vídeos relevantes é impreciso. A qualidade média da informação é reduzida, sendo importante definir estratégias de controlo de qualidade da informação médica online.

Published
2020

13. Implantation of a Dual-Chamber Pacemaker in a Patient with Situs Inversus and Dextrocardia using a Novel Ultrasound Technique

Author

Francisco Madeira, Mariana Faustino, Carlos Morais, João B Augusto, Miguel Borges Santos, and Nuno Cabanelas

Subjects
medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, Vascular ultrasound, Prosthesis Implantation, Case Report, Prosthesis implantation, Bubble contrast, vascular ultrasound, Medicine, Radiology, Nuclear Medicine and imaging, dextrocardia, Dextrocardia, Dual Chamber Pacemaker, business.industry, Ultrasound, medicine.disease, Pacemaker, Situs inversus, Congenital heart defects, pacemaker implantation, Radiology, Permanent pacemaker, Cardiology and Cardiovascular Medicine, business, Atrioventricular block, congenital cardiac disease
Abstract

Acesso ao texto integral: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829762/ We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with syncope in the setting of complete atrioventricular block. The complex anatomy poses a considerable challenge to transvenous permanent pacemaker implantation. We employed a novel technique using vascular ultrasound and agitated saline solution to assist with lead positioning. This technique could be useful in pediatric populations or younger patients, in whom the use of ionizing radiation is an important issue. info:eu-repo/semantics/publishedVersion

Published
2019

14. P1659Evolution of level of evidence c recommendations in European Society of Cardiology clinical practice guidelines on heart failure

Author

F Batista, Marco Beringuilho, Daniel Faria, J Augusto, Miguel Borges Santos, M Trindade, and J Serodio

Subjects
Clinical Practice, medicine.medical_specialty, business.industry, Heart failure, medicine, Evidence-based medicine, Cardiology and Cardiovascular Medicine, medicine.disease, Intensive care medicine, business
Abstract

Background Over the past two decades, the European Society of Cardiology (ESC) Clinical Practice Guidelines (CPG) on Heart Failure has increasingly become a familiar part of Cardiology practice and are used worldwide. By creating objective standards, CPG provides a mechanism to assess decision-making and straightforward references for clinicians. Level of Evidence C recommendations are based on expert consensus and/or small retrospective studies and registries with limited and non-representative populations evaluated. The resulting directives need to be proven with better quality data to assess its true benefits. Purpose The purpose of our study was to describe and evaluate the evolution of Level of Evidence C recommendations of ESC CPG on Heart Failure and to provide a quality assessment of its benefits in the following years. Methods In this retrospective observational Case-Control study, we identified and collected all Level of Evidence C recommendations in five consecutive published documents of ESC CPG in the years 2001, 2005, 2008, 2012 and 2016. Each identified recommendation was classified between two major groups: Diagnostic and Complementary Exams (group 1) and Therapeutics and Interventions (group 2) and was followed up in the following documents. Primary outcomes were classified as: (1) Upgrade to Level of Evidence A or B [Upgrade], (2) Elimination or disproven benefit/harm [Downgrade] and (3) Maintenance or minor reformulation with unchanged benefit/harm [Maintenance]. We applied a Kaplan-Meyer survival analysis to estimate the probability of Upgrade or Downgrade in each group. Results A total of 239 different Level of Evidence C recommendations were submitted to the final analysis, 22.6% (n=54) in group 1 and 77.4% (n=185) in group 2. On follow-up, 35.2% (n=76) of recommendations were upgraded, 29.6% (n=64) were downgraded and 35.2% (n=76) were maintained. Regarding outcomes, the downgrade of recommendations occurred predominantly in group 2 (94.4%). Considering all the eliminated recommendations, 60.9% took place on the next following published ESC CPG document. Likewise, 60.5% of upgraded recommendations also occurred on the next following published ESC CPG document. The probability of upgrade or downgrade in the next following document was 52.8%, predominantly in the Therapeutics and Interventions group (37.5% vs 57.9%, p=0.012). Figure 1 Conclusions Level of Evidence C recommendations constitutes an important asset of ESC CPG on Heart Failure as they are usually updated on new treatment options and are developed by experts in the specific topic. However, the probability of elimination due to disproven benefit or potential harm was high (29.6%), particularly regarding therapeutics and interventions (94%). Since a significant fraction of Level of Evidence C recommendations remains unchanged on the following document (35%), the need for high-quality data, specifically regarding therapeutic interventions, is warranted.

Published
2019
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15. Utility of Pacemaker With Sleep Apnea Monitor to Predict Left Ventricular Overload and Acute Decompensated Heart Failure

Author

João Baltazar Ferreira, Susana Antunes, Marco Beringuilho, Francisco Madeira, Daniel Faria, Nuno Cabanelas, Inês Fialho, Ana Rita Ferreira, Miguel Borges Santos, Carlos Morais, Hilaryano Ferreira, David Roque, Hugo Vasconcelos, João B Augusto, Víctor Gil, António Freitas, and Mariana Faustino

Subjects
Male, medicine.medical_specialty, Pacemaker, Artificial, Acute decompensated heart failure, Heart Ventricles, Polysomnography, Heart failure, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Sleep Apnea Syndromes, Internal medicine, Respiratory disturbance index, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Morning, Aged, Heart Failure, Portugal, business.industry, Incidence, Sleep apnea, Stroke Volume, medicine.disease, Prognosis, Obstructive sleep apnea, Confidence interval, Pacemaker, ROC Curve, Echocardiography, Acute Disease, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.

Published
2019

16. Pre-test probability of obstructive coronary stenosis in patients undergoing coronary CT angiography: Comparative performance of the modified diamond-Forrester algorithm versus methods incorporating cardiovascular risk factors

Author

Nuno Cardim, António Miguel Ferreira, Miguel Borges Santos, Pedro de Araújo Gonçalves, Maria Salomé Carvalho, Ana Rita Santos, António Tralhão, Gonçalo Cardoso, Sérgio Madeira, Hélder Dores, Hugo Marques, and Francisco Pereira Machado

Subjects
Male, medicine.medical_specialty, Computed Tomography Angiography, CAD, Coronary stenosis, 030204 cardiovascular system & hematology, Coronary Angiography, Chest pain, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, Computed tomography angiography, medicine.diagnostic_test, business.industry, Coronary Stenosis, Retrospective cohort study, Coronary ct angiography, Middle Aged, medicine.disease, Pre- and post-test probability, Cardiology, Female, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Algorithm, Algorithms
Abstract

Current guidelines recommend the use of the Modified Diamond-Forrester (MDF) method to assess the pre-test likelihood of obstructive coronary artery disease (CAD). We aimed to compare the performance of the MDF method with two contemporary algorithms derived from multicenter trials that additionally incorporate cardiovascular risk factors: the calculator-based 'CAD Consortium 2' method, and the integer-based CONFIRM score.We assessed 1069 consecutive patients without known CAD undergoing coronary CT angiography (CCTA) for stable chest pain. Obstructive CAD was defined as the presence of coronary stenosis ≥50% on 64-slice dual-source CT. The three methods were assessed for calibration, discrimination, net reclassification, and changes in proposed downstream testing based upon calculated pre-test likelihoods.The observed prevalence of obstructive CAD was 13.8% (n=147). Overestimations of the likelihood of obstructive CAD were 140.1%, 9.8%, and 18.8%, respectively, for the MDF, CAD Consortium 2 and CONFIRM methods. The CAD Consortium 2 showed greater discriminative power than the MDF method, with a C-statistic of 0.73 vs. 0.70 (p0.001), while the CONFIRM score did not (C-statistic 0.71, p=0.492). Reclassification of pre-test likelihood using the 'CAD Consortium 2' or CONFIRM scores resulted in a net reclassification improvement of 0.19 and 0.18, respectively, which would change the diagnostic strategy in approximately half of the patients.Newer risk factor-encompassing models allow for a more precise estimation of pre-test probabilities of obstructive CAD than the guideline-recommended MDF method. Adoption of these scores may improve disease prediction and change the diagnostic pathway in a significant proportion of patients.

Published
2016
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17. ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply?

Author

Pedro Freitas, Manuel Almeida, Gustavo Costa Rodrigues, Rui Campante Teles, Mariana Faria, Miguel Mendes, Miguel Borges Santos, and Nélson Vale

Subjects
Male, Pacemaker, Artificial, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Myocardial Infarction, Context (language use), 030204 cardiovascular system & hematology, Sensitivity and Specificity, Cardiac pacemaker, Diagnosis, Differential, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Positive predicative value, medicine, Humans, Diagnosis, Computer-Assisted, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Aged, Aged, 80 and over, medicine.diagnostic_test, Left bundle branch block, business.industry, Coronary Stenosis, Reproducibility of Results, medicine.disease, Coronary occlusion, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Algorithms
Abstract

Background/Purpose In patients with right ventricular pacing, the ECG shows a left bundle branch block (LBBB) pattern. There are several criteria to diagnose ST-elevation myocardial infarction (STEMI) in patients with LBBB. The aim of this study was to validate and compare Sgarbossa's with two new scores – Selvester's and Smith's – in this context. Methods We identified pacemaker patients submitted to coronary angiography due to acute coronary syndrome. ECGs were analyzed by 2 blinded cardiologists. STEMI was defined according to angiographic and biochemical criteria. Sensitivity, specificity, positive and negative predictive values were calculated. Results Forty-three patients with ventricular pacing were included for analysis. STEMI was diagnosed in 26 patients (60%). The most sensitive score was Selvester's (38.5%; 95% CI: 20.2–59.4) while the most specific was Sgarbossa's (100%; 95% CI: 80.5–100). Conclusions The sequential application of these scores proved to be clinically useful in the context of STEMI.

Published
2016
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19. Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores

Author

José Pedro Neves, Sérgio Madeira, Rui Campante Teles, Maria João Andrade, Miguel Borges Santos, Miguel Mendes, Manuel de Sousa Almeida, and António Tralhão

Subjects
Male, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, Population, Single Center, Risk Assessment, Severity of Illness Index, Postoperative Complications, Aortic valve replacement, Internal medicine, medicine, Humans, Myocardial infarction, education, Retrospective Studies, General Environmental Science, Aged, 80 and over, education.field_of_study, business.industry, Age Factors, EuroSCORE, Aortic Valve Stenosis, medicine.disease, Surgery, Stenosis, Treatment Outcome, lcsh:RC666-701, Aortic Valve, Heart Valve Prosthesis, Cardiology, General Earth and Planetary Sciences, Female, Hemodialysis, Cardiology and Cardiovascular Medicine, business, Risk assessment
Abstract

Introduction and Aim: Isolated aortic valve replacement (AVR) in octogenarians is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. We sought to analyze operative mortality and morbidity and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and Society of Thoracic Surgeons (STS) score in this population. Methods: We retrospectively enrolled 106 consecutive octogenarians with symptomatic severe aortic stenosis undergoing isolated AVR in a large-volume single center between January 2003 and December 2010 and calculated surgical risk scores. Results: Mean logistic EuroSCORE I, EuroSCORE II and STS score were 14.6±11, 4.4±3.1 and 4.0±2.4%, respectively. Mean operative mortality was 5.7% (six patients). Two (1.9%) patients suffered an ischemic stroke, three (2.8%) required temporary hemodialysis and five (4.7%) had a permanent pacemaker implanted. Five (4.7%) required rethoracotomy. No myocardial infarction or sternal wound infection was observed. Calibration-in-the-large showed overestimation of operative mortality with logistic EuroSCORE I (p=0.036), whereas EuroSCORE II (p=1.0) and STS (p=1.0) showed good calibration. C-statistic values were 0.877 (95% CI 0.800–0.933) for logistic EuroSCORE I, 0.792 (95% CI 0.702–0.864) for EuroSCORE II and 0.702 (95% CI 0.605–0.787) for STS, without statistically significant differences. Conclusions: These results suggest that AVR can be performed safely in selected octogenarians. EuroSCORE II and STS demonstrated superior calibration and should be the preferred tools for risk assessment, at least for this population. Resumo: Introdução e objetivos: A cirurgia de substituição valvular aórtica (SVA) envolve um risco acrescido em octogenários, pela elevada prevalência de fatores de risco e comorbilidades, tornando essencial a predição de resultados. Pretendemos analisar a mortalidade operatória e comparar as capacidades preditivas do European System for Cardiac Operative Mortality (EuroSCORE) I, EuroSCORE II e o Society of Thoracic Surgeons (STS) score nesta população. Métodos: Analisámos retrospetivamente 106 octogenários com estenose aórtica grave sintomática, submetidos a SVA isolada num centro terciário, entre janeiro de 2003 e dezembro de 2010. Resultados: O EuroSCORE I logístico, o EuroSCORE II e o STS score médios foram 14,6±11, 4,4±3,1 e 4,0±2,4%, respetivamente. A mortalidade operatória foi 5,7% (seis doentes). Registámos como complicações dois (1,9%) acidentes vasculares cerebrais isquémicos, hemodiálise transitória em três doentes (2,8%) e cinco (4,7%) implantes de pacemaker definitivo. Cinco doentes (4,7%) requereram revisão da hemostase. Não se verificaram enfarte agudo do miocárdio ou infeção do esterno. O EuroSCORE I logístico sobreestimou a mortalidade (p=0,036), enquanto o EuroSCORE II (p=1,0) e o STS (p=1,0) score mostraram boa calibração. A area sob a curva foi de 0,877 (CI 95% 0,800-0,933) para o EuroSCORE I logístico, 0,792 (CI 95% 0,702-0,864) para o EuroSCORE II e 0,702 (CI 95% 0,605-0,787) para o STS score (p=ns para comparações). Conclusões: Estes resultados sugerem que a SVA pode ser realizada com morbi-mortalidade aceitável em octogenários selecionados. O EuroSCORE II e o STS score demonstraram melhor calibração e devem ser as métricas preferidas na avaliação do risco operatório desta população. Keywords: Aortic valve surgery, Aortic stenosis, Octogenarians, Risk assessment, EuroSCORE, STS score, Palavras-chave: Cirurgia valvular aórtica, Estenose aórtica, Octogenários, Avaliação do risco, EuroSCORE, STS score

Published
2015

20. Mild troponin elevation in patients admitted to the emergency department with atrial fibrillation: 30-day post-discharge prognostic significance

Author

David Roque, Daniel Faria, Carlos Morais, Miguel Borges Santos, Joana Urzal, João B Augusto, Víctor Gil, and José Morais

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Revascularization, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Statistical significance, Internal medicine, Atrial Fibrillation, Troponin I, Internal Medicine, medicine, Humans, Clinical significance, 030212 general & internal medicine, Aged, Aged, 80 and over, biology, business.industry, Emergency department, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Troponin, Patient Discharge, Emergency Medicine, Cardiology, biology.protein, Female, Emergency Service, Hospital, business, Biomarkers
Abstract

Patients with atrial fibrillation (AF) often undergo troponin (Tn) testing in the emergency department (ED), but the clinical significance of mildly elevated values remains unclear. We evaluated short-term 30-day post-discharge outcomes in AF patients according to troponin levels. Out of 2181 AF patients evaluated in the ED (June 2014 to June 2015), we included consecutive admitted patients. Patients were grouped into those with normal Tn values (≤ 0.05 ng/mL), mild elevations (> 0.05–0.5 ng/mL, 10× URL) and marked elevations (> 0.5 ng/mL). Outcomes included acute coronary syndrome (ACS), revascularization, all-cause mortality and combined end point; the secondary outcome was ischemic stroke. A total of 348 patients (90.9%) had Tn testing, which was associated with longer in-hospital stay (median 2.04 vs. 0.74 days in unmeasured Tn, p = 0.014); 37.1% did not have clinical suspicion of ACS. Mild Tn elevation occurred in 19.0% and 6.3% had markedly elevated values. Compared to normal values, mild elevations had higher absolute incidence, without statistical significance, of ACS (1.5 vs. 0.0%, p = 0.202), revascularization (1.5 vs. 0.0%, p = 0.202), all-cause mortality (12.1 vs. 6.9%, p = 0.200), combined end point (13.3 vs. 6.9%, p = 0.084) or ischemic stroke (4.5 vs. 2.3%, p = 0.394). Tn testing is routine in admitted AF patients, even without suspicion of ACS, and is associated with prolonged stay. Mild Tn elevation is associated with a nonsignificant trend toward higher adverse events. Larger-scale studies are needed to evaluate the cost-effectiveness of Tn testing for prognosis in admitted AF patients, as this prolongs stay and has unclear impact on patient management.

Published
2018

21. Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: Initial results

Author

Vitor Bettencourt, Sergio Silva, Manuel de Sousa Almeida, Duarte Medeiros, Miguel Borges Santos, Jose A. Silva, and Rui Campante Teles

Subjects
medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Ultrasound, General Medicine, Femoral artery, medicine.disease, Thrombosis, Surgery, Aneurysm, Interquartile range, medicine.artery, Angioplasty, Medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Complication
Abstract

Objectives To describe the technique of ultrasound (US)-guided percutaneous thrombin–gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs). Background FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity. We hypothesized that US-guided combined thrombin and gelatin injection (UG-TGI) would also be effective while minimizing the risk of limb thrombosis. Methods Review of the results, complications and length of hospital admission after the injection into the FAP sac of combined human-origin thrombin and bovine-origin gelatin matrix (FloSeal®, Baxter), under direct US-guidance. Results We treated 13 patients (mean age 64 ± 9.46 years, 38% male), who developed a FAP following a percutaneous procedure: isolated coronariography in five (38%); angioplasty in four (31%); other cardiac procedures in four (31%). Immediate success was obtained in all (100%) patients, assessed by US; no allergic reactions, local infection, or embolic events occurred on 30-day follow-up. Median (interquartile range) admission time after the UG-TGI was 2 days (1.25–2.0); median time of total admission was 8 days (6.5–16.25). Conclusions In this small study, UG-TGI for the treatment of FAP was feasible and had short-term effectiveness, without a learning curve effect. Despite the need for further experience, a trial comparing different therapies for FAP should include this procedure. © 2012 Wiley Periodicals, Inc.

Published
2012
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22. Impact of complete revascularization in patients with ST-elevation myocardial infarction: analysis of a 10-year all-comers prospective registry

Author

Henrique Mesquita Gabriel, Sérgio Madeira, João Brito, Luís Raposo, Pedro de Araújo Gonçalves, Rui Campante Teles, Ricardo C. Rodrigues, Manuel Almeida, Miguel Mendes, G Rodrigues, and Miguel Borges Santos

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Population, Myocardial Infarction, 030204 cardiovascular system & hematology, Lower risk, Revascularization, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Recurrence, Risk Factors, Medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, education, Aged, Proportional Hazards Models, Retrospective Studies, education.field_of_study, business.industry, Hazard ratio, Percutaneous coronary intervention, Drug-Eluting Stents, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Cardiovascular Diseases, Conventional PCI, Multivariate Analysis, Female, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Background The benefit of complete revascularization (CR) during a primary percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD) is still not clear. The aim of the present study was to evaluate the impact of CR in a nonselected population from an all-comers prospective registry of patients with ST-elevation myocardial infarction (STEMI) over a long period of time. Methods and results Between 2004 and 2014, 671 noncardiogenic shock STEMI patients with MVD were included in the present study, of whom 522 were subjected to incomplete revascularization and 149 were subjected to CR. Patients in the CR group were younger [61 (SD 12) vs. 64 (SD 12.4) years old, P=0.001], more often subjected to femoral access (79.4 vs. 67.1%, P=0.002), and had a lower number of segments with lesion [2 (2.2) vs. 3 (3.4), P=0.001]. The CR group tended to have a lower 1-year major adverse cardiac event (MACE) rate (17.8 vs. 25.7%; P=0.05) that reached statistical significance at 2 years (19.4 vs. 28.5%, P=0.03). The rates of the individual endpoints were not different between groups. Independent predictors of 2-year MACE were age, femoral access, and previous PCI. Index CR was associated with lower MACE (hazard ratio 0.5, 0.36-0.79). MACE-free survival was higher in the CR group throughout the 2 years of follow-up. Conclusion In patients with STEMI and MVD undergoing culprit lesion PCI, preventive PCI in noninfarct coronary arteries with significant stenosis was associated with a lower risk of MACE compared with incomplete revascularization in this all-comers prospective registry.

Published
2015

23. A rare case of persistent troponin elevation in a patient with chronic heart failure

Author

Hélder Dores, A Ventosa, Pedro Adragão, Gonçalo Cardoso, Miguel Borges Santos, Maria José Rebocho, Carlos Aguiar, and Miguel Mendes

Subjects
Adult, Coronary angiography, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Coronary artery disease, Internal medicine, Troponin I, Rare case, medicine, Humans, cardiovascular diseases, Myocardial infarction, General Environmental Science, Heart Failure, biology, business.industry, Hypertrophic cardiomyopathy, medicine.disease, Troponin, lcsh:RC666-701, Heart failure, Chronic Disease, cardiovascular system, biology.protein, Cardiology, General Earth and Planetary Sciences, Female, business
Abstract

We present the case of a woman diagnosed with hypertrophic cardiomyopathy who suffered a myocardial infarction when she was 28 years old, without coronary artery disease on coronary angiography. Two years later, she presented signs of heart failure and left ventricular systolic dysfunction with persistent troponin I elevation, followed by progressive worsening of ventricular dysfunction. Resumo: Mulher com miocardiopatia hipertrófica, que sofre enfarte do miocárdio aos 28 anos, sem doença coronária angiográfica. Dois anos mais tarde inicia manifestações de insuficiência cardíaca e instala-se disfunção sistólica ventricular esquerda com elevação persistente da troponina I cardíaca. A partir daí houve deterioração progressiva da função ventricular. Keywords: Hypertrophic cardiomyopathy, Troponin, Heart failure, Palavras-chave: Miocardiopatia hipertrófica, Troponina, Insuficiência cardíaca

Published
2013
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25. P1076Validation of a score to predict the need for permanent pacemaker in the emergency department in patients with atrioventricular blocking drugs

Author

Daniel Faria, C. Santos, N. Martins, Mariana Faustino, Carlos Morais, N. Cabanelas, Joana Urzal, D. Roque, Hugo Ferreira, Miguel Borges Santos, Francisco Madeira, and J Augusto

Subjects
medicine.medical_specialty, business.industry, Blocking (radio), Physiology (medical), Emergency medicine, Medicine, In patient, Emergency department, Medical emergency, Permanent pacemaker, Cardiology and Cardiovascular Medicine, business, medicine.disease
Published
2017
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26. P1520Evaluation of a score to predict the need for permanent pacemaker in the emergency department based on atrioventricular blocking drugs and kalemia

Author

Carlos Morais, Joana Urzal, N. Martins, C. Santos, J Augusto, Miguel Borges Santos, Mariana Faustino, D. Roque, Hugo Ferreira, Daniel Faria, N. Faustino, and Francisco Madeira

Subjects
business.industry, Blocking (radio), Physiology (medical), medicine, Emergency department, Medical emergency, Permanent pacemaker, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published
2017
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27. Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Author

Marisa Trabulo, Manuel de Sousa Almeida, António Tralhão, Jorge Ferreira, António Miguel Ferreira, Ingrid Rosário, Miguel Borges Santos, Carlos Aguiar, Miguel Mendes, Mariana Castro, and Sérgio Madeira

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, medicine.medical_treatment, Population, Risk Assessment, Percutaneous Coronary Intervention, Interquartile range, Internal medicine, medicine, ST segment, Humans, Myocardial infarction, education, Killip class, General Environmental Science, Aged, Retrospective Studies, education.field_of_study, Framingham Risk Score, business.industry, Percutaneous coronary intervention, Retrospective cohort study, respiratory system, Length of Stay, Middle Aged, medicine.disease, Patient Discharge, Surgery, lcsh:RC666-701, Cardiology, General Earth and Planetary Sciences, ST Elevation Myocardial Infarction, Female, Patient Safety, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction and Aim: The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. Methods: We studied 276 consecutive patients (mean age 62±14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤3. Results: The median ZRS was 3 (interquartile range [IQR] 1–4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 [IQR 4–7] vs. 7.0 [5–13] days, p1) com EAMCST submetidos a ICPP durante um período de dois anos. Foram obtidos os SZ, duração de internamento, mortalidade e readmissão aos 30 dias. Foi definido baixo risco como SZ ≤3. Resultados: A mediana do SZ foi de 3 [distância interquartil (IQR) 1-4] e 171 doentes (62%) foram classificados como de baixo risco. A mortalidade aos 30 dias foi de 4,7% (13 doentes). Em comparação com os restantes, os doentes de baixo risco tiveram menor duração de internamento [mediana 5,0 (IQR 4-7) versus 7,0 (IQR 5-13) dias, p

Published
2014

28. 16-48: Does drug discontinuation in patients treated with temporary pacemaker reduce permanent pacemaker implantation?

Author

Mariana Faustino, Miguel Borges Santos, Joana Urzal, João B Augusto, Francisco Madeira, and Carlos Morais

Subjects
medicine.medical_specialty, Digoxin, biology, Drug discontinuation, business.industry, Syncope (genus), biology.organism_classification, medicine.disease, Amiodarone, Temporary Pacemaker, Physiology (medical), Internal medicine, medicine, Cardiology, In patient, Permanent pacemaker, Cardiology and Cardiovascular Medicine, business, Atrioventricular block, medicine.drug
Published
2016
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29. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease-an analysis of the ACROSS registry

Author

Luís Raposo, António Miguel Ferreira, Miguel Mendes, Manuel Almeida, Miguel Borges Santos, Pedro de Araújo Gonçalves, and Rui Campante Teles

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Coronary Artery Disease, Chest pain, Coronary Angiography, Coronary artery disease, Myocardial perfusion imaging, Internal medicine, Diabetes mellitus, Medicine, Humans, Prospective Studies, Registries, Referral and Consultation, General Environmental Science, Aged, medicine.diagnostic_test, Portugal, business.industry, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Stenosis, Cross-Sectional Studies, lcsh:RC666-701, Cardiology, General Earth and Planetary Sciences, Population study, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction and Objectives: The purpose of this study was to assess the diagnostic yield of current referral strategies for elective invasive coronary angiography (ICA). Methods: We performed a cross-sectional observational study of consecutive patients without known coronary artery disease (CAD) undergoing elective ICA due to chest pain symptoms. The proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) was determined according to the use of noninvasive testing. Results: The study population consisted of 1892 individuals (60% male, mean age 64±11 years), of whom 1548 (82%) had a positive noninvasive test: exercise stress test (41%), stress myocardial perfusion imaging (36%), stress echocardiogram (3%) or coronary computed tomography angiography (3%). Referral without testing occurred in 18% of patients. The overall prevalence of obstructive CAD was 57%, higher among those with previous testing (58% vs. 51% without previous testing, p=0.026) and when anatomic rather than functional tests were used (81.3% vs. 57.1%, p=0.001). A positive test and conventional risk factors were all independent predictors of obstructive CAD, with adjusted odds ratios (95% confidence interval) of 1.34 (1.03–1.74) for noninvasive testing, 1.05 (1.04–1.06) for age, 3.48 (2.81–4.29) for male gender, 1.86 (1.32–2.62) for current smoking, 1.74 (1.38–2.20) for diabetes, 1.30 (1.04–1.62) for hypercholesterolemia, and 1.39 (1.08–1.80) for hypertension. Conclusions: More than 40% of patients without known CAD undergoing elective ICA did not have obstructive lesions, even though four out of five had a positive noninvasive test. These exams were relatively weak gatekeepers; functional tests were more often used but appeared to be outperformed by the anatomic test. Resumo: Introdução e objetivos: O objetivo do estudo foi avaliar o rendimento das atuais estratégias de referenciação eletiva para coronariografia invasiva. Métodos: Estudo transversal de indivíduos consecutivos sem doença coronária conhecida submetidos a coronariografia por dor torácica. Determinação da prevalência de doença coronária obstrutiva (definida pela presença de pelo menos uma estenose ≥ 50%) de acordo com a utilização de testes não-invasivos para despiste de cardiopatia isquémica. Resultados: Foram avaliados 1892 indivíduos (60% homens, idade média 64 ± 11 anos), dos quais 1548 (82%) tinham um teste não-invasivo positivo: prova de esforço (41%), cintigrafia de perfusão miocárdica (36%), ecocardiograma de stress (3%) e angiografia coronária por tomografia computorizada (3%). Ocorreu referenciação sem teste prévio em 18% dos doentes. A prevalência global de doença obstrutiva foi 57%, sendo mais elevada nos doentes submetidos a testes não-invasivos (58% versus 51% nos doentes sem testes prévios, p = 0,026) e naqueles em que o teste era anatómico versus funcional (81,3% versus 57,1%, p = 0,001). Um teste não-invasivo positivo e fatores de risco convencionais foram preditores independentes de doença obstrutiva, com odds-ratio ajustado (intervalo confiança 95%) de: teste não-invasivo 1,34 (1,03-1,74), idade 1,05 (1,04-1,06), sexo masculino 3,48 (2,81-4,29), tabagismo ativo 1,86 (1,32-2,62), diabetes 1,74 (1,38-2,20), hipercolesterolemia 1,30 (1,04-1,62) e hipertensão 1,39 (1,08-1,80). Conclusões: Mais de 40% dos doentes sem doença coronária conhecida que realizam coronariografia eletiva não têm doença obstrutiva, apesar de quatro em cada cinco ter um teste não-invasivo positivo. Estes testes são gatekeepers relativamente fracos; os funcionais foram utilizados mais frequentemente mas o anatómico pareceu ter melhor desempenho. Keywords: Coronary angiography, Chest pain/diagnosis, Stable angina, Myocardial ischemia, Palavras-chave: Angiografia coronária, Dor torácica/diagnóstico, Angina estável, Isquémia miocárdica

Published
2012

30. Clinical decision-making in a patient with mitral stenosis

Author

Maria João Andrade and Miguel Borges Santos

Subjects
Diagnostic Imaging, medicine.medical_specialty, business.industry, General surgery, Rheumatic Heart Disease, Middle Aged, medicine.disease, Stenosis, Mitral valve stenosis, Clinical decision making, Internal medicine, Antirheumatic Agents, medicine, Cardiology, Humans, Mitral Valve Stenosis, Female, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Referral and Consultation, Valve disease
Abstract

Despite the decreasing prevalence of rheumatic valve disease in Western countries, European cardiologists still need to be prepared to manage patients with chronic …

Published
2012

31. Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: initial results

Author

Miguel Borges, Santos, Sergio, Silva, Vitor, Bettencourt, Rui Campante, Teles, Manuel Sousa, Almeida, Duarte, Medeiros, and Jose Aniceto, Silva

Subjects
Male, Time Factors, Iatrogenic Disease, Thrombin, Punctures, Middle Aged, Gelatin Sponge, Absorbable, Femoral Artery, Treatment Outcome, Injections, Intra-Arterial, Catheterization, Peripheral, Feasibility Studies, Humans, Female, Ultrasonography, Doppler, Color, Aneurysm, False, Ultrasonography, Interventional, Aged
Abstract

To describe the technique of ultrasound (US)-guided percutaneous thrombin-gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs).FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity. We hypothesized that US-guided combined thrombin and gelatin injection (UG-TGI) would also be effective while minimizing the risk of limb thrombosis.Review of the results, complications and length of hospital admission after the injection into the FAP sac of combined human-origin thrombin and bovine-origin gelatin matrix (FloSeal(®), Baxter), under direct US-guidance.We treated 13 patients (mean age 64 ± 9.46 years, 38% male), who developed a FAP following a percutaneous procedure: isolated coronariography in five (38%); angioplasty in four (31%); other cardiac procedures in four (31%). Immediate success was obtained in all (100%) patients, assessed by US; no allergic reactions, local infection, or embolic events occurred on 30-day follow-up. Median (interquartile range) admission time after the UG-TGI was 2 days (1.25-2.0); median time of total admission was 8 days (6.5-16.25).In this small study, UG-TGI for the treatment of FAP was feasible and had short-term effectiveness, without a learning curve effect. Despite the need for further experience, a trial comparing different therapies for FAP should include this procedure.

Published
2011

32. Stereotactic Radiosurgery in the Management of Glomus Jugulare Tumors

Author

Alvaro Almeida, António Gonçalves Ferreira, Maria Begoña Cattoni, Herculano Carvalho, Francisco Mascarenhas, Miguel Borges Santos, and Sara Germano

Subjects
body regions, business.industry, medicine.medical_treatment, fungi, parasitic diseases, medicine, Retrospective cohort study, business, Nuclear medicine, Glomus Jugulare Tumor, humanities, Radiosurgery
Abstract

Purpose: This retrospective study evaluate the efficacy and toxicity of stereotactic radiosurgery (SRS) in the management of the glomus jugulare tumors. Methods: Fifteen patients were submitted to S

Published
2006
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34. Predictors of conversion from radial to femoral access in cardiac catheterization

Author

Rita Calé, Miguel Borges Santos, M Mendes, Marina Santos Carvalho, J Brito, Manuel Almeida, R Teles, P. De Araujo Goncalves, Hélder Pereira, and António Tralhão

Subjects
Body surface area, medicine.medical_specialty, business.industry, Incidence (epidemiology), medicine.medical_treatment, Vascular access, Mean age, Logistic regression, Surgery, Femoral access, Internal medicine, Cardiology, medicine, Cardiology and Cardiovascular Medicine, business, Cardiac catheterization
Abstract

Aims: To study the prevalence of conversion from Radial (RA) to Femoral Access (FA) in cardiac catheterization and identify its clinical and demographic predictors. Methods and results: Prospective multicentre registry, including 7664 consecutive pts undergoing catheterization via RA between Jan/2009 and Out/2012 (66±11 years, 32% female). A total of 2982 procedures (38.9%) were PCIs and the most used route was the right RA (97.6%). We evaluated the incidence of conversion to FA and its predictors by logistic regression analysis. RA failure rate was 6.2%, with conversion to FA in most cases (93.9%). The need for conversion was more frequent in older pts (mean age 69±12 yrs vs 65±11 yrs, p

Published
2013
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