PATRICIA OLIVEIRA GUIMARAES
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7 resultados
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- REPLY: Elimination of Aspirin From PCI Pharmacotherapy(2021) LEMOS, Pedro A.; KOGAME, Norihiro; GUIMARAES, Patricia O.; MODOLO, Rodrigo; SERRUYS, Patrick W.
- High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study(2021) GUIMARAES, Patricia O.; SOUZA, Francis R. de; LOPES, Renato D.; BITTAR, Cristina; CARDOZO, Francisco A.; CARAMELLI, Bruno; CALDERARO, Daniela; ALBUQUERQUE, Cicero P.; DRAGER, Luciano F.; FERES, Fausto; BARACIOLI, Luciano; FILHO, Gilson Feitosa; BARBOSA, Roberto R.; RIBEIRO, Henrique B.; RIBEIRO, Expedito; ALVES, Renato J.; SOEIRO, Alexandre; FAILLACE, Bruno; FIGUEIREDO, Estevao; DAMIANI, Lucas P.; VAL, Renata M. do; HUEMER, Natassja; NICOLAI, Lisie G.; HAJJAR, Ludhmila A.; ABIZAID, Alexandre; FILHO, Roberto KalilBackground: Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients. Methods: We included patients with COVID-19 and high risk features according to clinical and/or labo-ratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death. Results: A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality. Conclusions: This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveil-lance and potential subsequent interventional therapies. (c) 2021 Published by Elsevier B.V.
- The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis(2023) SOEIRO, Alexandre M.; BOSSA, Aline S.; CESAR, Maria C.; LEAL, Tatiana C. A. T.; GARCIA, Guilherme; FONSECA, Rafael A.; NAKAMURA, Debora; GUIMARAES, Patricia O.; SOEIRO, Maria C. F. A.; JR, Carlos V. Serrano; SOARES, Paulo R.; MUELLER, Christian; MEBAZAA, Alexandre; FERNANDES, Fabio; NOMURA, Cesar H.; ROCHITTE, Carlos E.; JR, Mucio T. de OliveiraIntroductionThe role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methodsThis was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. ResultsThe mean follow-up was 18.7 & PLUSMN; 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. ConclusionMeasurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
- Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study(2021) ABIZAID, Alexandre; CAMPOS, Carlos M.; GUIMARAES, Patricia O.; JR, Jose de Ribamar Costa; FALCAO, Breno A. A.; MANGIONE, Fernanda; CAIXETA, Adriano; LEMOS, Pedro A.; BRITO, Fabio S. de; CAVALCANTE, Ricardo; BEZERRA, Cristiano Guedes; CORTES, Leandro; RIBEIRO, Henrique B.; SOUZA, Francis R. de; HUEMER, Natassja; VAL, Renata M. do; CARAMELLI, Bruno; CALDERARO, Daniela; LIMA, Felipe G.; HAJJAR, Ludhmila A.; MEHRAN, Roxana; KALIL FILHO, RobertoObjectives We aimed to explore angiographic patterns and in-hospital outcomes of patients with concomitant coronavirus disease-19 (COVID-19) and myocardial infarction (MI). Background Patients with COVID-19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID-19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID-19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1-10) days. A total of 83 (54.6%) patients presented with ST-elevation MI. The median angiographic Syntax score was 16 (9.0-25.3) and 69.0% had multi-vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in-hospital mortality was 23.7%. ST-segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30-5.80 and HR 3.73, 95%CI 1.61-8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID-19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in-hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
conferenceObject A 30-Day Pooled Analysis of Acetyl Salicylic Elimination Trials (ASET) in Brazil and Japan: Synergy Stent with Prasugrel Monotherapy Without Aspirin(2023) ONUMA, Yoshinobu; MASUDA, Shinichiro; MURAMATSU, Takashi; ISHIBASHI, Yuki; KOZUMA, Ken; KAWASHIMA, Hideyuki; NAKAZAWA, Gaku; TAKAHASHI, Kuniaki; TANABE, Kengo; KOGAME, Norihiro; NAKAMURA, Masato; ASANO, Taku; OKAMURA, Takayuki; MIYAZAKI, Yosuke; TATEISHI, Hiroki; OZAKI, Yukio; NAKATANI, Shimpei; KATAGIRI, Yuki; MORINO, Yoshihiro; NINOMIYA, Kai; KAGEYAMA, Shigetaka; KOTOKU, Nozomi; GUIMARAES, Patricia O.; LEMOS, Pedro A.; SERRUYS, Patrick W.- Association between perivascular inflammation and downstream myocardial perfusion in patients with suspected coronary artery disease(2020) NOMURA, Cesar H.; ASSUNCAO-JR, Antonildes N.; GUIMARAES, Patricia O.; LIBERATO, Gabriela; MORAIS, Thamara C.; FAHEL, Mateus G.; GIORGI, Maria C. P.; MENEGHETTI, Jose C.; PARGA, Jose R.; DANTAS-JR, Roberto N.; CERRI, Giovanni G.Aims To investigate the association between pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary computed tomography angiography (CTA) and coronary flow reserve (CFR) by positron emission tomography (PET) in patients with suspected coronary artery disease (CAD). Methods and results PCAT CT attenuation was measured in proximal segments of all major epicardial coronary vessels of 105 patients with suspected CAD. We evaluated the relationship between PCAT CT attenuation and other quantitative/qualitative CT-derived anatomic parameters with CFR by PET. Overall, the mean age was 60 +/- 12 years and 93% had intermediate pre-test probability of obstructive CAD. Obstructive CAD (>= 50% stenosis) was detected in 37 (35.2%) patients and impaired CFR (<2.0) in 32 (30.5%) patients. On a per-vessel analysis (315 vessels), obstructive CAD, non-calcified plaque volume, and PCAT CT attenuation were independently associated with CFR. In patients with coronary calcium score (CCS) <100, those with high-PCAT CT attenuation presented significantly lower CFR values than those with low-PCAT CT attenuation (2.47 +/- 0.95 vs. 3.13 +/- 0.89, P = 0.003). Among those without obstructive CAD, CFR was significantly lower in patients with high-PCAT CT attenuation (2.51 +/- 0.95 vs. 3.02 +/- 0.84, P = 0.021). Conclusion Coronary perivascular inflammation by CTA was independently associated with downstream myocardial perfusion by PET. In patients with low CCS or without obstructive CAD, CFR was lower in the presence of higher perivascular inflammation. PCAT CT attenuation might help identifying myocardial ischaemia particularly among patients who are traditionally considered non-high risk for future cardiovascular events.
- Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD The ASET Pilot Study(2020) KOGAME, Norihiro; GUIMARAES, Patricia O.; MODOLO, Rodrigo; MARTINO, Fernando De; TINOCO, Joao; RIBEIRO, Expedito E.; KAWASHIMA, Hideyuki; ONO, Masafumi; HARA, Hironori; WANG, Rutao; CAVALCANTE, Rafael; MOULIN, Bruno; FALCAO, Breno A. A.; LEITE, Rogerio S.; SAMPAIO, Fernanda Barbosa de Almeida; MORAIS, Gustavo R.; MEIRELES, George C.; CAMPOS, Carlos M.; ONUMA, Yoshinobu; SERRUYS, Patrick W.; LEMOS, Pedro A.OBJECTIVES The aim of this study was to evaluate the hypothesis that prasugrel monotherapy following successful everolimus-eluting stent implantation is feasible and safe in patients with stable coronary artery disease (CAD). BACKGROUND Recent studies have suggested that short dual-antiplatelet therapy strategies may provide an adequate balance between ischemic and bleeding risks. However, the complete omission of aspirin immediately after percutaneous coronary intervention (PCI) has not been tested so far. METHODS The study was a multicenter, single-arm, open-label trial with a stopping rule based on the occurrence of definite stent thrombosis (if >3, trial enrollment would be terminated). Patients undergoing successful everolimus-eluting stent implantation for stable CAD with SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores <23 were included. All participants were on standard dual-antiplatelet therapy at the time of index PCI. Aspirin was discontinued on the day of the index procedure but given prior to the procedure; prasugrel was administered in the catheterization laboratory immediately after the successful procedure, and aspirin-free prasugrel became the therapy regimen from that moment. Patients were treated solely with prasugrel for 3 months. The primary ischemic endpoint was the composite of cardiac death, spontaneous target vessel myocardial infarction, or definite stent thrombosis, and the primary bleeding endpoint was Bleeding Academic Research Consortium types 3 and 5 bleeding up to 3 months. RESULTS From February 22, 2018, to May 7, 2019, 201 patients were enrolled. All patients underwent PCI for stable CAD. Overall, 98.5% of patients were adherent to prasugrel at 3-month follow-up. The primary ischemic and bleeding endpoints occurred in 1 patient (0.5%). No stent thrombosis events occurred. CONCLUSIONS Aspirin-free prasugrel monotherapy following successful everolimus-eluting stent implantation demonstrated feasibility and safety without any stent thrombosis in selected low-risk patients with stable CAD. These findings may help underpin larger randomized controlled studies to evaluate the aspirin-free strategy compared with traditional dual-antiplatelet therapy following PCI. (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.