FELIPE GALLEGO LIMA
Índice h a partir de 2011
10
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
13 resultados
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conferenceObject Endovascular Therapeutic Hypothermia Is Feasible as an Adjuvant Therapy in Acute ST-Segment Elevation Myocardial Infarction Patients Without Delay in Door-to-Balloon Time(2019) DALLAN, Luis; GIANNETTI, Natali; DAE, Michael; POLASTRI, Thatiane; ROCHITTE, Carlos Eduardo; NOMURA, Cesar Higa; HAJJAR, Ludhmila Abrahao; BERNOCHE, Claudia; LAGE, Silvia; LIMA, Felipe; NICOLAU, Jose Carlos; TAVARES JR., Mucio; RIBEIRO, Expedito; KALIL JR., Roberto; LEMOS, Pedro A.; TIMERMAN, SergioconferenceObject 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- Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?(2014) NICOLAU, Jose Carlos; BARBOSA, Carlos Jose Dornas Goncalves; FRANCI, Andre; BARACIOLI, Luciano Moreira; FRANKEN, Marcelo; LIMA, Felipe Gallego; GIRALDEZ, Roberto Rocha; KALIL FILHO, Roberto; RAMIRES, Jose Antonio Franchini; GIUGLIANO, Robert P.Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.
- Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer(2022) DALLAN, Luis Augusto Palma; DAE, Michael; GIANNETTI, Natali Schiavo; POLASTRI, Tathiane Facholi; LIMA, Marian Keiko Frossard; ROCHITTE, Carlos Eduardo; HAJJAR, Ludhmila Abrahao; MARTIN, Claudia Yanet Bernoche San; LIMA, Felipe Gallego; NICOLAU, Jose Carlos; JR, Mucio Tavares de Oliveira; DALLAN, Luis Alberto Oliveira; SILVA, Expedito Eustaquio Ribeiro da; FILHO, Roberto Kalil; ABIZAID, Alexandre; LEMOS NETO, Pedro Alves; TIMERMAN, SergioBackground: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETU and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. Methods and results: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEN s starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus (R) Endovascular System (loll Circulation Inc (TM), San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewanning during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 +/- 1.0 degrees C or PCI-only. A total of 35 patients underwent FM (85.7% [30/35] in 90 +/- 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). Conclusions: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEM.
conferenceObject 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, RemoconferenceObject Cooling as an Adjunctive Therapy to Percutaneous Intervention in Acute Myocardial Infarction: COOL-MI InCor Trial(2020) DALLAN, Luis Augusto; GIANNETTI, Natali; ROCHITTE, Carlos Eduardo; POLASTRI, Thatiane; BERNOCHE, Claudia; HAJJAR, Ludhmila Abrahao; LIMA, Felipe; NICOLAU, Jose Carlos; TAVARES JR., Mucio; DAE, Michael; RIBEIRO, Expedito; KALIL JR., Roberto; LEMOS, Pedro A.; TIMERMAN, Sergio- Características clínicas, angiográficas e evolução a longo prazo em pacientes com arterite de Takayasu e síndrome coronária aguda(2013) SOEIRO, Alexandre de Matos; ALMEIDA, Maria Carolina Feres de; TORRES, Tatiana Andreucci; FRANKEN, Marcelo; LIMA, Felipe Gallego; GANEM, Fernando; GIRALDEZ, Roberto R.; BARACIOLI, Luciano; TAVARES JR., Mucio Oliveira; SERRANO JR., Carlos V.; NICOLAU, Jose CarlosIntroduction: Monitoring of disease activity and the best therapeutic approach are a challenge in Takayasu arteritis (TA). When associated with acute coronary syndromes (ACS), the best interventional treatment has not been established. The objective of this study was to describe the baseline characteristics, clinical manifestations, treatment and long-term outcome of patients with TA and ACS. Methods: We retrospectively analyzed eight patients between 2004 and 2010. The following data were obtained: age, gender, clinical and electrocardiographic manifestations, Kit lip class, risk factors for ACS, markers of myocardial necrosis (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate [ESR]), medication during hospital stay, angiographic findings, treatment (medical, percutaneous or surgical) and long-term outcome. Statistical data were expressed as percentages and absolute values. Results: All eight patients were women, median age 49 years. Typical chest pain was present in 37.5%. Elevated ESR was observed in 85.7%. Three patients underwent coronary artery bypass grafting, three underwent percutaneous coronary angioplasty (two with bare-metal stents and one with a drug-eluting stent) and two were treated medically. In-hospital mortality was 25%. There were no deaths during a mean follow-up of 30 months. Conclusions: In our study, patients who were discharged home had good outcomes in long-term follow-up with medical, percutaneous or surgical treatment. ESR appears to be associated with ACS in TA.
- Performance of acute coronary syndrome approaches in Brazil: a report from the BRACE (Brazilian Registry in Acute Coronary SyndromEs)(2020) FRANKEN, Marcelo; GIUGLIANO, Robert P.; GOODMAN, Shaun G.; BARACIOLI, Luciano Moreira; GODOY, Lucas Colombo; FURTADO, Remo H. M.; LIMA, Felipe Gallego; NICOLAU, Jose CarlosAims Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). Methods and results The BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified 'cluster sampling' methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. A total of 1150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% +/- 20.1%. Teaching institutions had a significantly higher PS (71.4% +/- 16.9%) compared with non-teaching hospitals (63.4% +/- 21%; P <0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS perpoint increase (OR = 0.97, 95% CI 0.95-0.98, P < 0.001), age-per year (OR= 1.06, 95% CI 1.03-1.09, P < 0.001), chronic kidney disease (OR = 3.12, 95% CI 1.08-9.00, P = 0.036), and prior angioplasty (OR = 0.25, 95% CI 0.07-0.84, P = 0.025). Conclusions In BRACE, the adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.
conferenceObject IN-HOSPITAL MANAGEMENT OF ACUTE CORONARY SYNDROMES IN BRAZIL IN COMPARISON WITH OTHER BRIC COUNTRIES: ANALYSIS OF THE BRAZILIAN REGISTRY OF ACUTE CORONARY SYNDROMES(2013) FRANKEN, Marcelo; LIMA, Felipe G.; BARACIOLI, Luciano M.; MOREIRA, Humberto G.; NICOLAU, Jose CarlosBackground: Little is known about the management of acute coronary syndromes (ACS) in developing countries, including Brazil. Our main purpose was the comparison between the results obtained by the Brazilian Registry of Acute Coronary syndromEs (BRACE) Registry, with data from other “BRIC” countries. Methods: BRACE was a prospective multicenter registry that recruited ACS patients from 71 randomly selected hospitals in Brazil, stratified according to their regional location, complexity, teaching or non-teaching characteristics. For the overall population, the use of acetil salicylic acid (ASA), clopidogrel, ACE inhibitor/AT2 blocker, beta-blocker and statin during hospitalization was analyzed. Additionally, we analyzed the utilization of recanalization therapies (fibrinolytics and primary angioplasty) in the population with ST-elevation myocardial infarction (STEMI). The results were compared to published registries of other emerging countries – Russia (RECORD), India (CREATE) and China (CPACS). The Chi square test was applied for the developed comparisons. Results: 1150 patients were enrolled in the BRACE. The mean age was 63.6 years, 733 (63.7%) were males, 25% had diabetes mellitus, 69.5% arterial hypertension, and 624 (54.2%) had STEMI. The comparisons of BRACE and other emerging countries’ registries are depicted on the table. Conclusions: Despite the similarities among the BRIC countries, the management of ACS is significantly different between them.- Use of Demonstrably Effective Therapies in the Treatment of Acute Coronary Syndromes: Comparison between Different Brazilian Regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE)(2012) NICOLAU, Jose Carlos; FRANKEN, Marcelo; LOTUFO, Paulo Andrade; CARVALHO, Antonio Carlos; MARIN NETO, Jose Antonio; LIMA, Felipe Gallego; DUTRA, Oscar; KNOBEL, Elias; OLIVEIRA, Cesar Cardoso de; TIMERMAN, Sergio; STEFANINI, EdsonBackground: Little is known in our country about regional differences in the treatment of acute coronary disease. Objective: To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. Methods: A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). Results: In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 +/- 22.1) was lower (p < 0.05) than in the Southeast (77.7 +/- 29.5), Midwest (82 +/- 22.1) and South (82.4 +/- 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 +/- 32.9) was lower (p < 0.05) than in the Southeast (69.2 +/- 31.6), Midwest (65.3 +/- 33.6) and South (73.7 +/- 28.1) regions; additionally, the score of the Midwest was lower (p < 0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p < 0.001 compared to the rest of the country). Conclusion: The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.