REMO HOLANDA DE MENDONCA FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
16 resultados
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conferenceObject SAFETY AND EFFICACY OF DPP4 INHIBITORS IN ACUTE MYOCARDIAL INFARCTION: A BIOMARKER DRIVEN DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL(2021) GENESTRETI, Paulo Rizzo; FURTADO, Remo; SALSOSO, Rocio; DALCOQUIO, Talia; NAKASHIMA, Carlos; LIMA, Viviane; COLODETTI, Raiza; FERRARI, Aline; FRANCI, Andre; MENEZES, Fernando; BARACIOLI, Luciano; NICOLAU, JoseconferenceObject INFLUENCE OF HEALTH INSURANCE ON LONG-TERM ADHERENCE TO STATINS AND BETA-BLOCKERS AFTER ACUTE CORONARY SYNDROMES(2021) NICOLAU, Jose Carlos; SALSOSO, Rocio; DALCOQUIO, Talia; GENESTRETI, Paulo; FRANCI, Andre; FERRARI, Aline; BERTOLIN, Adriadne; LARA, Livia; JULIASZ, Marcela; PEREIRA, Cesar; LIMA, Felipe; BARACIOLI, Luciano; GIRALDEZ, Roberto; FURTADO, Remo- Effect of Evolocumab on Complex Coronary Disease Requiring Revascularization(2021) OYAMA, Kazuma; FURTADO, Remo H. M.; FAGUNDES JR., Antonio; ZELNIKER, Thomas A.; TANG, Minao; KUDER, Julia; MURPHY, Sabina A.; HAMER, Andrew; WANG, Huei; KEECH, Anthony C.; GIUGLIANO, Robert P.; SABATINE, Marc S.; BERGMARK, Brian A.OBJECTIVES This study sought to evaluate the ability of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab to reduce the risk of complex coronary atherosclerosis requiring revascularization. BACKGROUND PCSK9 inhibitors induce plaque regression and reduce the risk of coronary revascularization overall. METHODS FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) was a randomized trial of the PCSK9 inhibitor evolocumab versus placebo in 27,564 patients with stable atherosclerotic cardiovascular disease on statin therapy followed for a median of 2.2 years. Clinical documentation of revascularization events was blindly reviewed to assess coronary anatomy and procedural characteristics. Complex revascularization was the composite of complex percutaneous coronary intervention (PCI) (as per previous analyses, >-1 of: multivessel PCI, >-3 stents, >-3 lesions treated, bifurcation PCI, or total stent length >60 mm) or coronary artery bypass grafting surgery (CABG). RESULTS In this study, 1,724 patients underwent coronary revascularization, including 1,482 who underwent PCI, 296 who underwent CABG, and 54 who underwent both. Complex revascularization was performed in 632 (37%) patients. Evolocumab reduced the risk of any coronary revascularization by 22% (hazard ratio [HR]: 0.78; 95% CI: 0.71 to 0.86; p < 0.001), simple PCI by 22% (HR: 0.78; 95% CI: 0.70 to 0.88; p < 0.001), complex PCI by 33% (HR: 0.67; 95% CI: 0.54 to 0.84; p < 0.001), CABG by 24% (HR: 0.76; 95% CI: 0.60 to 0.96; p 1/4 0.019), and complex revascularization by 29% (HR: 0.71; 95% CI: 0.61 to 0.84; p < 0.001). The magnitude of the risk reduction with evolocumab in complex revascularization tended to increase over time (20%, 36%, and 41% risk reductions in the first, second, and beyond second years). CONCLUSIONS Adding evolocumab to statin therapy significantly reduced the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually. (C) 2021 by the American College of Cardiology Foundation.
- Dapagliflozin in patients with cardiometabolic risk factors hospitalised with COVID-19 (DARE-19): a randomised, double-blind, placebo-controlled, phase 3 trial(2021) KOSIBOROD, Mikhail N.; ESTERLINE, Russell; FURTADO, Remo H. M.; OSCARSSON, Jan; GASPARYAN, Samvel B.; KOCH, Gary G.; MARTINEZ, Felipe; MUKHTAR, Omar; VERMA, Subodh; CHOPRA, Vijay; BUENCONSEJO, Joan; LANGKILDE, Anna Maria; AMBERY, Philip; TANG, Fengming; GOSCH, Kensey; WINDSOR, Sheryl L.; AKIN, Emily E.; SOARES, Ronaldo V. P.; MOIA, Diogo D. F.; ABOUDARA, Matthew; HOFFMANN FILHO, Conrado Roberto; FEITOSA, Audes D. M.; FONSECA, Alberto; GARLA, Vishnu; GORDON, Robert A.; JAVAHERI, Ali; JAEGER, Cristiano P.; LEAES, Paulo E.; NASSIF, Michael; PURSLEY, Michael; SILVEIRA, Fabio Serra; BARROSO, Weimar Kunz Sebba; SOTO, Jose Roberto Lazcano; MAIA, Lilia Nigro; BERWANGER, OtavioBackground COVID-19 can lead to multiorgan failure. Dapagliflozin, a SGLT2 inhibitor, has significant protective benefits for the heart and kidney. We aimed to see whether this agent might provide organ protection in patients with COVID-19 by affecting processes dysregulated during acute illness. Methods DARE-19 was a randomised, double-blind, placebo-controlled trial of patients hospitalised with COVID-19 and with at least one cardiometabolic risk factor (ie, hypertension, type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease). Patients critically ill at screening were excluded. Patients were randomly assigned 1:1 to dapagliflozin (10 mg daily orally) or matched placebo for 30 days. Dual primary outcomes were assessed in the intention-to-treat population: the outcome of prevention (time to new or worsened organ dysfunction or death), and the hierarchial composite outcome of recovery (change in clinical status by day 30). Safety outcomes, in patients who received at least one study medication dose, included serious adverse events, adverse events leading to discontinuation, and adverse events of interest. This study is registered with ClinicalTrials.gov, NCT04350593. Findings Between April 22, 2020 and Jan 1, 2021, 1250 patients were randomly assigned with 625 in each group. The primary composite outcome of prevention showed organ dysfunction or death occurred in 70 patients (11middot2%) in the dapagliflozin group, and 86 (13middot8%) in the placebo group (hazard ratio [HR] 0middot80, 95% CI 0middot58-1middot10; p=0middot17). For the primary outcome of recovery, 547 patients (87middot5%) in the dapagliflozin group and 532 (85middot1%) in the placebo group showed clinical status improvement, although this was not statistically significant (win ratio 1middot09, 95% CI 0middot97-1middot22; p=0middot14). There were 41 deaths (6middot6%) in the dapagliflozin group, and 54 (8middot6%) in the placebo group (HR 0middot77, 95% CI 0middot52-1middot16). Serious adverse events were reported in 65 (10middot6%) of 613 patients treated with dapagliflozin and in 82 (13middot3%) of 616 patients given the placebo. Interpretation In patients with cardiometabolic risk factors who were hospitalised with COVID-19, treatment with dapagliflozin did not result in a statistically significant risk reduction in organ dysfunction or death, or improvement in clinical recovery, but was well tolerated. Funding AstraZeneca.
- Platelet Reactivity and Coagulation Markers in Patients with COVID-19(2021) BERTOLIN, Adriadne J.; DALCOQUIO, Talia F.; SALSOSO, Rocio; FURTADO, Remo H. de M.; KALIL-FILHO, Roberto; HAJJAR, Ludhmila A.; SICILIANO, Rinaldo F.; KALLAS, Esper G.; BARACIOLI, Luciano M.; LIMA, Felipe G.; GIRALDEZ, Roberto R.; CAVALHEIRO-FILHO, Cyrillo; VIEIRA, Alexandra; STRUNZ, Celia M. C.; GIUGLIANO, Robert P.; TANTRY, Udaya S.; GURBEL, Paul A.; NICOLAU, Jose C.Introdution COVID-19 is associated with an increased risk of thrombotic events. However, the contribution of platelet reactivity (PR) to the aetiology of the increased thrombotic risk associated with COVID-19 remains unclear. Our aim was to evaluate PR in stable patients diagnosed with COVID-19 and hospitalized with respiratory symptoms (mainly dyspnoea and dry cough), in comparison with a control group comprised of non-hospitalized healthy controls. Methods Observational, case control study that included patients with confirmed COVID-19 (COVID-19 group, n = 60) and healthy individuals matched by age and sex (control group, n = 60). Multiplate electrode aggregometry (MEA) tests were used to assess PR with adenosine diphosphate (MEA-ADP, low PR defined as < 53 AUC), arachidonic acid (MEA-ASPI, low PR < 86 AUC) and thrombin receptor-activating peptide 6 (MEA-TRAP, low PR < 97 AUC) in both groups. Results The rates of low PR with MEA-ADP were 27.5% in the COVID-19 group and 21.7% in the control group (OR = 1.60, p = 0.20); with MEA-ASPI, the rates were, respectively, 37.5% and 22.5% (OR = 3.67, p < 0.001); and with MEA-TRAP, the incidences were 48.5% and 18.8%, respectively (OR = 9.58, p < 0.001). Levels of d-dimer, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) were higher in the COVID-19 group in comparison with the control group (all p < 0.05). Thromboelastometry was utilized in a subgroup of patients and showed a hypercoagulable state in the COVID-19 group. Conclusion Patients hospitalized with non-severe COVID-19 had lower PR compared to healthy controls, despite having higher levels of d-dimer, fibrinogen, and PAI-1, and hypercoagulability by thromboelastometry.
- Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial(2021) LOPES, Renato D.; SILVA, Pedro Gabriel Melo de Barros E; FURTADO, Remo H. M.; MACEDO, Ariane Vieira Scarlatelli; BRONHARA, Bruna; DAMIANI, Lucas Petri; BARBOSA, Lilian Mazza; MORATA, Julia de Aveiro; RAMACCIOTTI, Eduardo; MARTINS, Priscilla de Aquino; OLIVEIRA, Aryadne Lyrio de; NUNES, Vinicius Santana; RITT, Luiz Eduardo Fonteles; ROCHA, Ana Thereza; TRAMUJAS, Lucas; V, Sueli Santos; DIAZ, Dario Rafael Abregu; VIANA, Lorena Souza; MELRO, Livia Maria Garcia; CHAUD, Mariana Silveira de Alcantara; FIGUEIREDO, Estevao Lanna; NEUENSCHWANDER, Fernando Carvalho; DRACOULAKIS, Marianna Deway Andrade; LIMA, Rodolfo Godinho Souza Dourado; DANTAS, Vicente Ces de Souza; FERNANDES, Anne Cristine Silva; GEBARA, Otavio Celso Eluf; HERNANDES, Mauro Esteves; QUEIROZ, Diego Aparecido Rios; VEIGA, Viviane C.; CANESIN, Manoel Fernandes; FARIA, Leonardo Meira de; FEITOSA-FILHO, Gilson Soares; GAZZANA, Marcelo Basso; LIPORACE, Idelzuita Leandro; TWARDOWSKY, Aline de Oliveira; MAIA, Lilia Nigro; MACHADO, Flavia Ribeiro; SOEIRO, Alexandre de Matos; CONCEICAO-SOUZA, Germano Emilio; ARMAGANIJAN, Luciana; GUIMARAES, Patricia O.; ROSA, Regis G.; AZEVEDO, Luciano C. P.; ALEXANDER, John H.; AVEZUM, Alvaro; CAVALCANTI, Alexandre B.; BERWANGER, OtavioBackground COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. Methods We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged >= 18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0.3-0.7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. Findings From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34.8%) wins in the therapeutic group and 34 288 (41.3%) in the prophylactic group (win ratio 0.86 [95% CI 0.59-1.22], p=0 .40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3.64 [95% CI 1. 61-8. 27], p=0.0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. Interpretation In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation.
- Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization(2021) NAKASHIMA, Carlos A. K.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; JATENE, Fabio B.; HAJJAR, Ludhmila A.; SOEIRO, Alexandre M.; FURTADO, Remo H. M.; DALCOQUIO, Talia F.; BARACIOLI, Luciano M.; LIMA, Felipe G.; V, Roberto R. C. Giraldez; SILVA, Bianca A.; COSTA, Mateus S. S.; STRUNZ, Celia M. C.; DALLAN, Luis R. P.; BARBOSA, Carlos J. D. G.; BRITTO, Flavia A. B.; FARKOUH, Michael E.; GURBEL, Paul A.; NICOLAU, Jose C.BACKGROUND Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y(12) receptor inhibitors, were assigned to either control group, P2Y(12) receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (predefined as >= 46 aggregation units). RESULTS Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (C) 2021 by the American College of Cardiology Foundation.
- Factors associated with actively working in the very long-term following acute coronary syndrome(2021) NICOLAU, Jose C.; FURTADO, Remo H. M.; DALCOQUIO, Talia F.; LARA, Livia M.; JULIASZ, Marcela G.; FERRARI, Aline G.; NAKASHIMA, Carlos A. K.; FRANCI, Andre; PEREIRA, Cesar A. C.; LIMA, Felipe G.; GIRALDEZ, Roberto R.; SALSOSO, Rocio; BARACIOLI, Luciano M.; GOODMAN, ShaunOBJECTIVES: Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS. METHODS: We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed. RESULTS: The following variables were significantly and independently associated with actively working at the last contact: age> median (hazard-ratio [HR], 0.76, p <0.001); male sex (HR, 1.52, p <0.001); government health insurance (HR, 1.36, p <0.001); history of angina (HR, 0.69, p <0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p < 0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables. CONCLUSIONS: In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.
conferenceObject HIGH ON-TREATMENT PLATELET REACTIVITY WITH CLOPIDOGREL VS TICAGRELOR IN PATIENTS WITH AND WITHOUT CHRONIC KIDNEY DISEASE - A RANDOMIZED CONTROLLED TRIAL(2021) FRANCI, Andre; BARBOSA, Carlos; DALCOQUIO, Talia; GENESTRETI, Paulo; SALSOSO, Rocio; FERRARI, Aline; LIMA, Viviane; BARACIOLI, Luciano; FURTADO, Remo; NICOLAU, JoseconferenceObject Long-Term Mortality After Acute Coronary Syndromes Among Patients with Normal, Mid-Range or Low Ejection Fraction(2021) FURTADO, Remo; JULIASZ, Marcela G.; CHIU, Felipe Y.; BASTOS, Livia B.; DALCOQUIO, Talia F.; LIMA, Felipe G.; ROSA, Renato; CAPORRINO, Cesar A.; BERTOLIN, Adriadne; SOFFIATTI, Carla; RIBEIRO, Andre S.; ANDRADE, Maria C.; GIRALDEZ, Roberto; BARACIOLI, Luciano; NICOLAU, Jose C.