Background:
This study evaluated the association of the ankle-brachial index (ABI) and cardiovascular complications after noncardiac surgery.
Methods:
We prospectively evaluated patients referred for ...noncardiac surgery. The ABI was performed before surgery. Patients with abnormal ABI (≤0.9) were included in the peripheral artery disease (PAD) group and the remaining constituted the control group. Cardiac troponin and electrocardiogram were obtained 72 hours after surgery. Patients were followed up to 30 days, and primary end point was the occurrence of any cardiovascular event: cardiovascular death, acute coronary syndrome, isolated troponin elevation (ITE), decompensated heart failure, cardiogenic shock, unstable arrhythmias, nonfatal cardiac arrest, pulmonary edema, stroke, or PAD symptoms increase.
Results:
We evaluated 124 patients (61.3% male; mean age 65.4 years). During the study, 57.9% of patients in the PAD group had an event versus 25.7% in the control group (P = .011). The ITE was the most observed event (24.2%). After logistic regression, the odds ratio for ITE was 7.4 (95% confidence interval 2.2-25.0, P = .001).
Conclusions:
In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event.
Although effective strategies for the prevention of venous thromboembolism (VTE) are widely available, a significant number of patients still develop VTE because appropriate thromboprophylaxis is not ...correctly prescribed. We conducted this study to estimate the risk profile for VTE and the employment of adequate thromboprophylaxis procedures in patients admitted to hospitals in the state of São Paulo, Brazil.
Four hospitals were included in this study. Data on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis were collected from 1454 randomly chosen patients (589 surgical and 865 clinical). Case report forms were filled according to medical and nursing records. Physicians were unaware of the survey. Three risk assessment models were used: American College of Chest Physicians (ACCP) Guidelines, Caprini score, and the International Union of Angiololy Consensus Statement (IUAS). The ACCP score classifies VTE risk in surgical patients and the others classify VTE risk in surgical and clinical patients. Contingency tables were built presenting the joined distribution of the risk score and the prescription of any pharmacological and non-pharmacological thromboprophylaxis (yes or no).
According to the Caprini score, 29% of the patients with the highest risk for VTE were not prescribed any thromboprophylaxis. Considering the patients under moderate, high or highest risk who should be receiving prophylaxis, 37% and 29% were not prescribed thromboprophylaxis according to ACCP (surgical patients) and IUAS risk scores, respectively. In contrast, 27% and 42% of the patients at low risk of VTE, according to Caprini and IUAS scores, respectively, had thromboprophylaxis prescribed.
Despite the existence of several guidelines, this study demonstrates that adequate thromboprophylaxis is not correctly prescribed: high-risk patients are under-treated and low-risk patients are over-treated. This condition must be changed to insure that patients receive adequate treatment for the prevention of thromboembolism.
The relationship between dentistry and medicine has been acknowledged throughout the history of humanity. This relationship was documented in ancient medicine accounts, and has survived until the ...present day, accompanied by the evolution of molecular technologies. Although we have had very important researchers’ contributions in this interdisciplinary area, mainly after the 18th century, the knowledge on oral infections is still ignored by or unknown to the majority of clinical dentists and physicians. These circumstances could be changed through a broader divulgation of this complex relationship, both in the dentistry and in the medicine areas, which in turn would have a significant impact in systemic health worldwide. This movement has already started, as was observed in a World Health Assembly resolution which called for oral health to be integrated into chronic disease prevention programs in 2007. This was a significant indicator of changing perceptions of oral health over the past several decades. This brief review reports the evolution through time of the knowledge on the association between dental infections and systemic diseases, as well as the paths which we could take to consolidate this historical trend.
Abstract Background and aims HDL–cholesterol (HDL–C) and non-HDL–cholesterol (nHDL–C) are involved in atherosclerosis. The aim of this study was to determine the distribution of HDL–C and nHDL–C and ...its association with cardiovascular and socio-cultural variables in a pediatric Brazilian sample. Methods and results Children and adolescents from Florianopolis were randomly selected and a structured questionnaire was administered, a physical examination was performed and a blood sample was collected. Enzymatic and Direct methods in vitro were used to determine the total cholesterol and HDL–cholesterol levels. The associations among HDL–C and nHDL–C and the described variables were tested by odds ratio and logistic regression. A total of 1009 individuals were examined. Based on the Brazilian criteria, 23% were classified with low levels of HDL–C and 25% with high levels of non-HDL–C. After multivariate analysis there were significant associations among low HDL–C and high C-reactive protein (OR, 3.3; 95% CI, 2.1–5.2), paternal tobacco use (OR, 1.5; 95% CI,1.1–2.1), and high triceps-to-subscapular index (OR, 1.5; 95% CI, 1.1–2.2). There were also significant associations among high nHDL–C and high waist circumference (OR, 1.95; 95% CI, 1.16–3.29), black skin color (OR, 1.78; 95% CI, 1.06–3.06), and high income (OR, 1.48; 95% CI, 1.09–2.02). Conclusions In this sample, low levels of HDL–C were associated with other clinical variables such as a centripetal fat pattern and C-reactive protein, and n-HDL–C was associated with abdominal obesity, skin color and economic class.
Abstract
Introduction
Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower ...perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries.
Purpose
Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures.
Methods
Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries.
Results
Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p<0.001). There was no significant difference in the incidence of PMI between groups (p=0.8).
Conclusions
In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE.
Mortality and MACE at one year
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo
PDF
