REMO HOLANDA DE MENDONCA FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
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- Long-term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction(2023) FURTADO, Remo H. M.; JULIASZ, Marcela G.; CHIU, Felipe Y. J.; BASTOS, Livia B. C.; DALCOQUIO, Talia F.; LIMA, Felipe G.; ROSA, Renato; CAPORRINO, Cesar A.; BERTOLIN, Adriadne; GENESTRETI, Paulo R. R.; RIBEIRO, Andre S.; ANDRADE, Maria Carolina; V, Roberto R. C. Giraldez; BARACIOLI, Luciano M.; ZELNIKER, Thomas A.; NICOLAU, Jose C.Aims Left ventricular ejection fraction (LVEF) <= 40% is a well-established risk factor for mortality after acute coronary syndromes (ACS). However, the long-term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41-49%) after ACS remains less clear. Methods and results This was a retrospective study enrolling patients admitted with ACS included in a single-centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF >= 50%), mildly reduced (LVEF 41-49%), and reduced (LVEF <= 40%). The endpoint of interest was all-cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36-1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05-1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96-1.57; P = 0.095). Conclusions In patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long-term mortality compared with patients with normal EF. These data emphasize the importance of anti-remodelling therapies for ACS patients who have LVEF in the mildly reduced range.
- Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials(2024) FURTADO, Remo H. M.; SILVA, Pedro G. M. Barros e; FONSECA, Henrique A. R.; SERPA-NETO, Ary; CORREA, Thiago D.; GUIMARAES, Helio P.; PEREIRA, Adriano J.; OLIVATO, Guilherme B.; ZAMPIERI, Fernando G.; LISBOA, Thiago; JUNQUEIRA, Debora L. M.; LAPA, Maura G.; MONFARDINI, Frederico; DAMIANI, Lucas P.; ECHENIQUE, Leandro S.; GEBARA, Otavio E.; HOFFMAN FILHO, Conrado R.; POLANCZYK, Carisi A.; ROHDE, Luis E.; AMAZONAS, Roberto; MACHADO, Flavia R.; AVEZUM, Alvaro; AZEVEDO, Luciano C. P.; VEIGA, Viviane C.; ROSA, Regis G.; LOPES, Renato D.; CAVALCANTI, Alexandre B.; BERWANGER, OtavioThe cardiovascular safety from azithromycin in the treatment of several infectious diseases has been challenged. In this prespecified pooled analysis of 2 multicenter randomized clinical trials, we aimed to assess whether the use of azithromycin might lead to corrected QT (QTc) interval prolongation or clinically relevant ventricular arrhythmias. In the COALITION COVID Brazil I trial, 667 patients admitted with moderate COVID-19 were randomly allocated to hydroxychloroquine, hydroxychloroquine plus azithromycin, or standard of care. In the COALITION COVID Brazil II trial, 447 patients with severe COVID-19 were randomly allocated to hydroxychloroquine alone versus hydroxychloroquine plus azithromycin. The principal end point for the present analysis was the composite of death, resuscitated cardiac arrest, or ventricular arrhythmias. The addition of azithromycin to hydroxychloroquine did not result in any prolongation of the QTc interval (425.8 +/- 3.6 ms vs 427.9 +/- 3.9 ms, respectively, mean difference -2.1 ms, 95% confidence interval -12.5 to 8.4 ms, p = 0.70). The combination of azithromycin plus hydroxychloroquine compared with hydroxychloroquine alone did not result in increased risk of the primary end point (proportion of patients with events at 15 days 17.2% vs 16.0%, respectively, hazard ratio 1.08, 95% confidence interval 0.78 to 1.49, p = 0.65). In conclusion, in patients hospitalized with COVID-19 already receiving standardof-care management (including hydroxychloroquine), the addition of azithromycin did not result in the prolongation of the QTc interval or increase in cardiovascular adverse events. Because azithromycin is among the most commonly prescribed antimicrobial agents, our results may inform clinical practice. Clinical Trial Registration: NCT04322123, NCT04321278.
- Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry(2023) NICOLAU, Jose Carlos; OWEN, Ruth; FURTADO, Remo H. M.; GOODMAN, Shaun G.; GRANGER, Christopher B.; COHEN, Mauricio G.; WESTERMANN, Dirk; YASUDA, Satoshi; SIMON, Tabassome; HEDMAN, Katarina; HUNT, Phillip R.; BRIEGER, David B.; POCOCK, Stuart J.Background Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post- acute myocardial infarction (AMI) populations in rural and urban settings are limited.Methods The long- Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged =50 years 1-3 years post -AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all- cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months.Results There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all- cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke.Conclusions Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.
- P2Y12 inhibitor monotherapy versus dual antiplatelet therapy in patients with acute coronary syndromes undergoing coronary stenting: rationale and design of the NEOMINDSET Trial(2023) GUIMARES, Patricia O.; FRANKEN, Marcelo; TAVARES, Caio A. M.; SILVEIRA, Fabio S.; ANTUNES, Murillo O.; BERGO, Ricardo R.; JOAQUIM, Rodrigo M.; HIRAI, Jessica C. S.; ANDRADE, Pedro B.; PITTA, Fabio G.; MARIANI JR., Jose; NASCIMENTO, Bruno R.; SILVEIRA, Marcos S.; COSTA, Tiberio A. O.; DALL'ORTO, Frederico T. C.; SERPA, Renato G.; SAMPAIO, Fernanda B. A.; OHE, Louis N.; MANGIONE, Fernanda M.; FURTADO, Remo H. M.; SARMENTO-LEITE, Rogerio; MONFARDINI, Frederico; ASSIS, Silvia R. L.; NICOLAU, Jose C.; SPOSITO, Andrei C.; LOPES, Renato D.; ONUMA, Yoshinobu; VALGIMIGLI, Marco; ANGIOLILLO, Dominick J.; SERRUYS, Patrick W.; BERWANGER, Otavio; BACAL, Fernando; LEMOS, Pedro A.Dual antiplatelet therapy (DAPT) is currently the standard of care after percutaneous coronary interven-tion (PCI). Recent studies suggest that reducing DAPT to 1-3 months followed by an aspirin-free single antiplatelet therapy (SAPT) strategy with a potent P2Y12 inhibitor is safe and associated with less bleeding. However, to date, no randomised trial has tested the impact of initiating SAPT immediately after PCI, par-ticularly in patients with acute coronary syndromes (ACS). NEOMINDSET is a multicentre, randomised, open-label trial with a blinded outcome assessment designed to compare SAPT versus DAPT in 3,400 ACS patients undergoing PCI with the latest-generation drug-eluting stents (DES). After successful PCI and up to 4 days following hospital admission, patients are randomised to receive SAPT with a potent P2Y12 inhibitor (ticagrelor or prasugrel) or DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months. Aspirin is discontinued immediately after randomisation in the SAPT group. The choice between ticagrelor and prasugrel is at the investigator's discretion. The primary hypothesis is that SAPT will be non-inferior to DAPT with respect to the composite endpoint of all-cause mortality, stroke, myocardial infarction or urgent target vessel revascularisation, but superior to DAPT on rates of bleeding defined by Bleeding Academic Research Consortium 2, 3 or 5 criteria. NEOMINDSET is the first study that is specifically designed to test SAPT versus DAPT immediately following PCI with DES in ACS patients. This trial will provide impor-tant insights on the efficacy and safety of withdrawing aspirin in the early phase of ACS. (ClinicalTrials. gov: NCT04360720)
- COMPARISON BETWEEN TWO DIFFERENT LOCAL HEMOSTATIC METHODS FOR DENTAL EXTRACTIONS IN PATIENTS ON DUAL ANTIPLATELET THERAPY: A WITHIN-PERSON, SINGLE-BLIND, RANDOMIZED STUDY(2023) GUARDIEIRO, Bruno; SANTOS-PAUL, Marcela alves; FURTADO, Remo Holanda de Mendonca; DALCOQUIO, Talia; SALSOSO, Rocio; NEVES, Itamara Lucia Itagiba; NEVES, Ricardo Simoes; CAVALHEIRO FILHO, Cyrillo; BARACIOLI, Luciano Moreira; NICOLAU, Jose CarloBackground Dual antiplatelet therapy (DAPT) provides additional risk reduction of ischemic events compared to aspirin monotherapy, at cost of higher bleeding risk. There are few data comparing new techniques for reducing bleeding after dental ex-tractions in these patients. Purpose This study investigated the effectiveness of the HemCon Dental Dressing (HDD) compared to oxidized cellulose gauze. Materials and methods This randomized study included 60 patients on DAPT who required at least two dental extractions (120 procedures). Each surgical site was randomized to HDD or oxidized regenerated cellulose gauze as the local hemostatic method. Intra-oral bleeding time was measured immediately after the dental extraction and represents our main endpoint for comparison of both hemostatic agents. Pro-longed bleeding, platelet reactivity measured by Multiplate Analyser (ADPtest and ASPItest) and tissue healing comparison after 7 days were also investigated. Results Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes, P =0.001). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%), P =0.03]. There was poor correlation between platelet reactivity and intra-oral bleeding time.Conclusions In patients on DAPT, HDD resulted in a lower intra-oral bleeding time compared to oxidized cellulose gauze after dental extractions. Moreover, HDD also seems to improve healing conditions.
- Exploring modern approaches to address critical care challenges in risk stratification for cardiology(2023) HAMIDI, Fardin; FURTADO, Remo H. M.; JR, Antonio Fagundes; ZELNIKER, Thomas A.
- Effects of exercise on platelet reactivity after myocardial infarction: a randomized clinical trial(2023) DALCOQUIO, Talia Falcao; SANTOS, Mayara Alves dos; ALVES, Leandro Silva; ARANTES, Flavia Bittar Brito; FERREIRA-SANTOS, Larissa; RONDON, Maria Urbana Pinto Brandao; FURTADO, Remo Holanda M.; FERRARI, Aline Gehlen; RIZZO, Paulo Roberto Genestreti; SALSOSO, Rocio; FRANCI, Andre; BARACIOLI, Luciano Moreira; ALVES, Maria Janieire de Nazare Nunes; NEGRAO, Carlos Eduardo; NICOLAU, Jose CarlosExercise training (ET) can lower platelet reactivity in patients with cardiovascular risk factors. However, the effects of ET on platelet reactivity in higher-risk patients is unknown. The aim of this study was to evaluate the effects of ET on platelet reactivity in patients with recent myocardial infarction (MI). Ninety patients were randomly assigned 1 month post-MI to the intervention (patients submitted to a supervised ET program) or control group. All patients were on dual antiplatelet therapy (DAPT). Platelet reactivity by VerifyNow-P2Y(12) (measured by P2Y(12) reaction units - PRU5) test was determined at baseline and at the end of 14 +/- 2 weeks of follow-up at rest (primary endpoint), and multiplate electrode aggregometry (MEA) adenosine diphosphate (ADP) and aspirin (ASPI) tests were performed immediately before and after the maximal cardiopulmonary exercise test (CPET) at the same time points (secondary endpoints). Sixty-five patients (mean age 58.9 +/- 10 years; 73.8% men; 60% ST elevation MI) completed follow-up (control group, n = 31; intervention group, n = 34). At the end of the follow-up, the mean platelet reactivity was 172.8 +/- 68.9 PRU5 and 166.9 +/- 65.1 PRU5 for the control and intervention groups, respectively (p = .72). Platelet reactivity was significantly increased after the CPET compared to rest at the beginning and at the end of the 14-week follow-up (among the intervention groups) by the MEA-ADP and MEA-ASPI tests (p < .01 for all analyses). In post-MI patients on DAPT, 14 weeks of supervised ET did not reduce platelet reactivity.