REMO HOLANDA DE MENDONCA FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
91 resultados
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- The Use of Oral Beta-Blockers and Clinical Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: a Long-Term Follow-Up Study(2018) NICOLAU, Jose C.; FURTADO, Remo H. M.; BARACIOLI, Luciano M.; LARA, Livia M.; DALCOQUIO, Talia F.; SCANAVINI JUNIOR, Marco A.; PEREIRA, Cesar A. C.; LIMA, Viviane M.; GONCALVES, Talita M.; COLODETTI, Raiza; FERRARI, Aline G.; LOPES, Renato D.; GIUGLIANO, Robert P.BackgroundThe role of beta-blockers in patients with acute coronary syndromes is mainly derived from studies including patients with ST-segment elevation myocardial infarction. Little is known about the use of beta-blockers and associated long-term clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS).MethodsWe analyzed short- and long-term clinical outcomes of 2921 patients with NSTEACS using or not oral beta-blockers in the first 24h of the acute coronary syndromes (ACS) presentation. The association between beta-blocker use and mortality was assessed using a propensity score adjusted analysis (N=1378).ResultsPatients starting oral beta-blockers in the first 24h of hospitalization, compared with patients who did not, had lower rates of in-hospital mortality (OR=0.52, 95% CI 0.33 to 0.74, P=0.002) and higher mean survival times in the long-term follow-up (11.860.4years vs. 9.92 +/- 0.39years, P<0.001).Conclusion The use of beta-blockers in the first 24h of patients presenting with NSTEACS was associated with better in-hospital and long-term mortality outcomes.
- Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial(2019) NICOLAU, Jose C.; STEVENS, Susanna R.; AL-KHALIDI, Hussein R.; JATENE, Fabio B.; FURTADO, Remo H. M.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; DESVIGNE-NICKENS, Patrice; HADDAD, Haissam; JOLICOEUR, E. Marc; PETRIE, Mark C.; DOENST, Torsten; MICHLER, Robert E.; OHMAN, E. Magnus; MADDURY, Jyotsna; ALI, Imtiaz; DEJA, Marek A.; ROULEAU, Jean L.; VELAZQUEZ, Eric J.; HILL, James A.Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) <= 35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n=1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI=0.74-1.15) for all-cause mortality, 0.85 (95% CI=0.64-1.11) for CV mortality, and 1.43 (95% CI=1.15-1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI=0.70-0.95) for all-cause mortality, 0.75 (95% CI=0.62-0.90) for CV mortality and 0.67 (95% CI=0.56-0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI=0.50-1.15) for all-cause mortality, 0.81 (95% CI=0.49-1.36) for CV mortality and 0.61 (95% CI=0.41-0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI.
- Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54(2020) FURTADO, Remo H. M.; NICOLAU, Jose C.; MAGNANI, Giulia; IM, Kyungah; BHATT, Deepak L.; STOREY, Robert F.; STEG, P. Gabriel; SPINAR, Jindrich; BUDAJ, Andrzej; KONTNY, Frederic; CORBALAN, Ramon; KISS, Robert G.; ABOLA, Maria Teresa; JOHANSON, Per; JENSEN, Eva C.; BRAUNWALD, Eugene; SABATINE, Marc S.; BONACA, Marc P.Aims PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduced the risk of major adverse cardiovascular events (MACE), with an acceptable increase in bleeding, in patients with prior myocardial infarction (MI). While much of the discussion around prolonged DAPT has been focused on stented patients, patients with prior MI without prior coronary stenting comprise a clinically important subgroup. Methods and results This was a pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162 patients with prior MI (1-3years) and additional high-risk features to ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. A total of 4199 patients had no history of coronary stenting at baseline. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. Patients without history of coronary stenting had higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The relative risk reduction in MACE with ticagrelor (pooled doses) was similar in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting (HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). Conclusion Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. These data highlight the benefits of DAPT in prevention of spontaneous atherothrombotic events and indicate that long-term ticagrelor may be considered in high-risk patients with prior MI even if they have not been treated with stenting.
- Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography(2020) FURTADO, Remo H. M.; NICOLAU, Jose C.; GUO, Jianping; IM, Kyungah; WHITE, Jennifer A.; SABATINE, Marc S.; NEWBY, L. Kristin; GIUGLIANO, Robert P.BACKGROUND Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. OBJECTIVES This study sought to explore the association between morphine and ischemic events in 5,438 patients treated with concomitant clopidogrel presenting with non-ST-segment elevation acute coronary syndromes (NSTEACS) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome) trial. Patients not treated with clopidogrel (n = 3,462) were used as negative controls. METHODS Endpoints were the composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout at 96 h (4-way endpoint) and the composite of death or MI at 30 days. RESULTS In patients treated with clopidogrel, morphine use was associated with higher rates of the 4-way endpoint at 96 h (adjusted odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.04 to 1.87; p = 0.026). There was a trend for higher rates of death or MI at 30 days (adjusted OR: 1.29; 95% CI: 0.98 to 1.70; p = 0.072), driven by events in the first 48 h (adjusted hazard ratio: 1.54; 95% CI: 1.07 to 2.23; p = 0.021). In patients not treated with clopidogrel, morphine was not associated with either the 4-way endpoint at 96 h (adjusted OR: 1.05; 95% CI: 0.74 to 1.49; p = 0.79; p(interaction) = 0.36) or death or MI at 30 days (adjusted OR: 1.07; 95% CI: 0.77 to 1.48; p = 0.70; p(interaction) = 0.46). CONCLUSIONS When used concomitantly with clopidogrel pre-treatment, morphine was associated with higher rates of ischemic events in patients with NSTEACS. (C) 2020 by the American College of Cardiology Foundation.
conferenceObject Is there a Correlation Between Bleeding Risk Score and Platelet Aggregability?(2014) ARANTES, Flavia B.; FURTADO, Remo H.; BARBOSA, Carlos J.; FRANCI, Andre; MENEZES, Fernando R.; FALCAO, Talia D.; NAKASHIMA, Carlos A.; BARACIOLI, Luciano M.; RAMIRES, Jose A.; NICOLAU, Jose C.conferenceObject EFFECT OF EXERCISE TRAINING ON PLATELET AGGREGATION AND ON P2Y12 INHIBITOR RESISTANCE AFTER MYOCARDIAL INFARCTION: A RANDOMIZED CLINICAL TRIAL(2020) DALCOQUIO, Talia; FURTADO, Remo Holanda de Mendonca; ARANTES, Flavia Bittar Britto Britto; SANTOS, Mayara Alves dos; ALVES, Leandro Silva; RONDON, Maria Urbana Pinto Brandao; FERREIRA-SANTOS, Larissa; ALVES, Maria Janieire de Nazare Nunes; FERRARI, Aline Gehlen; GENESTRETI, Paulo Rizzo; BARACIOLI, Luciano Moreira; FRANCI, Andre; SALSOSO, Rocio; NEGRAO, Carlos Eduardo; NICOLAU, Jose CarlosconferenceObject EFFECT OF TICAGRELOR AND CLOPIDOGREL ON CORONARY MICROCIRCULATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION(2019) SCANAVINI FILHO, Marco Antonio; BERWANGER, Otavio; MATHIAS JUNIOR, Wilson; AGUIAR, Miguel Osman; CHIANG, Hsu Po; BARACIOLI, Luciano Moreira; LIMA, Felipe Gallego; MENEZES, Fernando Reis; DALCOQUIO, Talia; FURTADO, Remo Holanda M.; LUCA, Fabio Augusto De; UEZATO, Delcio; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; NICOLAU, Jose Carlos- What Lessons Have We Learned and What Remains to be Clarified for PCSK9 Inhibitors? A Review of FOURIER and ODYSSEY Outcomes Trials(2020) FURTADO, Remo H. M.; GIUGLIANO, Robert P.For more than half a century, low-density lipoprotein cholesterol (LDL-C) has been recognized as a major risk factor for incident atherosclerotic cardiovascular disease. The discovery of proprotein convertase subtilisin-kexin type 9 (PCSK9) in 2003, which prevents LDL-C receptor recycling, identified a new target for drug intervention. Recently, two large-scale randomized clinical outcomes trials involving fully human anti-PCSK9 monoclonal antibodies tested the hypothesis that targeting this pathway would reduce cardiovascular events. Both the FOURIER (Further cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk) and ODYSSEY OUTCOMES trials met their primary efficacy endpoints, confirming findings reported earlier that major adverse cardiovascular events can be reduced by a further lowering of LDL-C beyond that achieved with statin therapy. In both trials, there were incremental reductions in LDL-C of > 50% from baseline, with no major safety concerns, over the trials' median follow-up time (2.2 and 2.8 years, respectively). While there were differences in design, lipid management and overall results, key messages from both studies were similar. However, post-publication, additional questions have arisen, especially regarding drug effects over the long-term, including a potential mortality benefit.
bookPart Indicação e manejo de balão intra-aórtico e suporte cardiocirculatório(2016) MENEZES, Fernando Reis; FURTADO, Remo Holanda de Mendonça; BARACIOLI, Luciano Moreira- Relation of High Lipoprotein (a) Concentrations to Platelet Reactivity in Individuals with and Without Coronary Artery Disease(2020) SALSOSO, Rocio; DALCOQUIO, Talia F.; FURTADO, Remo H. M.; FRANCI, Andre; BARBOSA, Carlos J. D. G.; GENESTRETI, Paulo R. R.; STRUNZ, Celia M. C.; LIMA, Viviane; BARACIOLI, Luciano M.; GIUGLIANO, Robert P.; GOODMAN, Shaun G.; GURBEL, Paul A.; MARANHAO, Raul C.; NICOLAU, Jose C.Introduction Lipoprotein (a) [Lp(a)] is a risk factor for coronary artery disease (CAD). To the best of our knowledge, this is the first study addressing the relationship between Lp(a) and platelet reactivity in primary and secondary prevention. Methods Lp(a) was evaluated in 396 individuals with (82.3%) and without (17.7%) obstructive CAD. The population was divided into two groups according to Lp(a) concentrations with a cutoff value of 50 mg/dL. The primary objective was to evaluate the association between Lp(a) and adenosine diphosphate (ADP)-induced platelet reactivity using the VerifyNow (TM) P2Y(12)assay. Platelet reactivity was also induced by arachidonic acid and collagen-epinephrine (C-EPI) and assessed by Multiplate (TM), platelet function analyzer (TM) 100 (PFA-100), and light transmission aggregometry (LTA) assays. Secondary objectives included the assessment of the primary endpoint in individuals with or without CAD. Results Overall, 294 (74.2%) individuals had Lp(a) < 50 mg/dL [median (IQR) 13.2 (5.8-27.9) mg/dL] and 102 (25.8%) had Lp(a) >= 50 mg/dL [82.5 (67.6-114.5) mg/dL],P < 0.001. Univariate analysis in the entire population revealed no differences in ADP-induced platelet reactivity between individuals with Lp(a) >= 50 mg/dL (249.4 +/- 43.8 PRU) versus Lp(a) < 50 mg/dL (243.1 +/- 52.2 PRU),P = 0.277. Similar findings were present in individuals with (P = 0.228) and without (P = 0.669) CAD, and regardless of the agonist used or method of analysis (allP > 0.05). Finally, multivariable analysis did not show a significant association between ADP-induced platelet reactivity and Lp(a) >= 50 mg/dL [adjusted OR = 1.00 [(95% CI 0.99-1.01),P = 0.590]. Conclusion In individuals with or without CAD, Lp(a) >= 50 mg/dL was not associated with higher platelet reactivity.