SOLANGE DESIREE AVAKIAN MANSUR
Índice h a partir de 2011
8
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- BNP and Admission Glucose as In-Hospital Mortality Predictors in Non-ST Elevation Myocardial Infarction(2012) TAKADA, Julio Yoshio; RAMOS, Rogerio Bicudo; AVAKIAN, Solange Desiree; SANTOS, Soane Mota dos; RAMIRES, Jose Antonio Franchini; MANSUR, Antonio de PaduaObjectives. Admission hyperglycemia and B-type natriuretic peptide (BNP) are associated with mortality in acute coronary syndromes, but no study compares their prediction in-hospital death. Methods. Patients with non-ST-elevation myocardial infarction (NSTEMI), in-hospital mortality and two-year mortality or readmission were compared for area under the curve (AUC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of glycemia and BNP. Results. Respectively, AUC, SEN, SPE, PPV, NPV, and ACC for prediction of in-hospital mortality were 0.815, 71.4%, 84.3%, 26.3%, 97.4%, and 83.3% for glycemia = 200 mg/dL and 0.748, 71.4%, 68.5%, 15.2%, 96.8% and 68.7% for BNP = 300 pg/mL. AUC of glycemia was similar to BNP (P = 0.411). In multivariate analysis we found glycemia >= 200mg/dL related to in-hospital death (P = 0.004). No difference was found in two-year mortality or readmission in BNP or hyperglycemic subgroups. Conclusion. Hyperglycemia was an independent risk factor for in-hospital mortality in NSTEMI and had a good ROC curve level. Hyperglycemia and BNP, although poor in-hospital predictors of unfavorable events, were independent risk factors for death or length of stay >10 days. No relation was found between hyperglycemia or BNP and long-term events.
- In-hospital death in acute coronary syndrome was related to admission glucose in men but not in women(2012) TAKADA, Julio Yoshio; RAMOS, Rogerio Bicudo; ROZA, Larissa Cardoso; AVAKIAN, Solange Desiree; RAMIRES, Jose Antonio Franchini; MANSUR, Antonio de PaduaBackground: Admission hyperglycaemia is associated with mortality in patients with acute coronary syndrome (ACS), but controversy exists whether hyperglycaemia uniformly affects both genders. We evaluated coronary risk factors, gender, hyperglycaemia and their effect on hospital mortality. Methods: 959 ACS patients (363 women and 596 men) were grouped based on glycaemia >= or < 200 mg/dL and gender: men with glucose < 200 mg/dL (menG-); women with glucose < 200 mg/dL (womenG-); men with glucose >= 200 mg/dL (menG+); and women with glucose >= 200 mg/dL (womenG+). A logistic regression analysis compared the relation between gender and glycaemia groups and death, adjusted for coronary risk factors and laboratory data. Results group: menG- had lower mortality than menG+ (OR = 0.172, IC95% 0.062-0.478), and womenG+ (OR = 0.275, IC95% 0.090-0.841); womenG- mortality was lower than menG+ (OR = 0.230, IC95% 0.074-0.717). No difference was found between menG+ vs womenG+ (p = 0.461), or womenG- vs womenG+ (p = 0.110). Age (OR = 1.067, IC95% 1.031-1.104), EF (OR = 0.942, IC95% 0.915-0.968), and serum creatinine (OR = 1.329, IC95% 1.128-1.566) were other independent factors related to in-hospital death. Conclusions: Death was greater in hyperglycemic men compared to lower blood glucose men and women groups, but there was no differences between women groups in respect to glycaemia after adjustment for coronary risk factors.
conferenceObject Prognosis importance of absence of angina in non-ST elevation myocardial infarction(2012) TAKADA, J. Y.; RAMOS, R. B.; AVAKIAN, S. D.; RAMIRES, J. A. F.; MANSUR, A. P.Purpose: Cardiac troponins increased myocardial infarction diagnosis in patients without specific electrocardiographic changes. Absence of angina has become common and prognostic significance remains unclear. Methods: We followed 204 consecutive patients after myocardial infarction non-ST elevation(NSTEMI) at emergency department. Outcomes were in-hospital death and follow-up death or cardiac readmission. Results: No-angina (NAG) group (n = 27, 13.2%) had more women (p = 0.001), higher blood glucose (p =0.011) and B-type natriuretic factor (p < 0.001). In-hospital (14.8% vs 4.5%,p = 0.035) and 20-months follow-up mortality (43.5% vs 12.9%, p<0.001) were higher in NAG. Combination of death and cardiac read- mission was similar (70.4%vs 53.1%, p = 0.093). Age (HR = 1.038, 95% CI 1.006 to 1.071), absence of angina at admission (HR 2.554, 95% CI 1.037 to 6.289), male gender (HR 2.706, 95% CI 1.099 to 6.667) and dyspnea (HR 3.113, 95% CI 1.417 to 6.842) were independent predictors of long-term mortality. Conclusion: The absence of chest pain in NSTEMI implies in higher in-hospitaland long-term mortality.- Emergency Service Admission Time and In-Hospital Mortality in Acute Coronary Syndrome(2012) TAKADA, Julio Yoshio; ROZA, Larissa Cardoso; RAMOS, Rogerio Bicudo; AVAKIAN, Solange Desiree; RAMIRES, Jose Antonio Franchini; MANSUR, Antonio de PaduaBackground: The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis. Objective: To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM). Methods: The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay >= 5 days were the outcomes analyzed. Results: Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33% vs. 43%; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay >= 5 days were as follows: age [OR 1.042 (95% CI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95% CI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95% CI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95% CI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95% CI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95% CI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95% CI: 1.374 - 10.409), p = 0.01]. Conclusion: Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time. (Arq Bras Cardiol 2012; 98(2): 104-110)
- B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial infarction(2011) RAMOS, Rogerio Bicudo; STRUNZ, Celia M.; AVAKIAN, Solange Desiree; RAMIRES, Jose Antonio; MANSUR, Antonio de PaduaOBJECTIVE: Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory. METHODS: This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed. RESULTS: The mean age was 64.5 +/- 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 - 8.53); P = 0.002] in non-ST-elevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 - 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 - 3.04); P = 0.032]. CONCLUSIONS: B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.