Browsing by Author "Mimoso, Jorge"
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- Cardiogenic shock: Inotropes and vasopressorsPublication . Amado, José; Gago, Paula; Santos, Walter; Mimoso, Jorge; de Jesus, IlidioCardiogenic shock is characterized by a decrease in myocardial contractility, and presents a high mortality rate. Inotropic and vasopressor agents have been recommended and used for several years in the treatment of patients in shock, but they remain controversial. Despite its beneficial effect on myocardial contractility, the side effects of inotropic therapy (arrhythmias and increased myocardial oxygen consumption) may be associated with increased mortality.The pharmacodynamics of different inotropic agents suggest benefits in specific situations, but these differences have not been reflected in reduced mortality in most studies, making it difficult to formulate recommendations.This review integrates data from different studies on the use of inotropes and vasopressors in patients with cardiogenic shock, proposing a therapeutic scheme for the pharmacological treatment of patients in cardiogenic shock according to the patient's hemodynamic profile. (C) 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
- Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitusPublication . Costa, Hugo; Espírito-Santo, Miguel; Bispo, João; Guedes, João; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and Objectives: Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. Methods: A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all -cause mortality. Results: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65 +/- 11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62 - 2.98). Myocardial infarction and all -cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all -cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85 - 0.99 and p=0.013, HR 0.96, 95% CI 0.93 - 0.99, respectively). Conclusions: T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.
- Clinical results of percutaneous coronary intervention in chronic total occlusions of the right coronary arteryPublication . Costa, Hugo; Espirito-Santo, Miguel; Bispo, João; Guedes, João; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and Objectives: Coronary chronic total occlusions (CTOs) of the right coronary artery (RCA) are a relatively common finding in the context of coronary angiography. However, the benefit of revascularization remains controversial. Methods: A single -center retrospective cohort analysis prospectively collected outcomes of CTO patients undergoing percutaneous coronary intervention (PCI) in 2019 and 2020. Patients were divided into two groups according to the CTO vessel treated (left coronary artery [LCA]-CTO or RCA-CTO). The primary outcome was defined as the recurrence of angina and/or heart failure (HF) symptoms and secondary outcomes were myocardial infarction (MI) and all -cause mortality. Results: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65 +/- 11 years. The primary outcome occurred in 28 (16.6%) patients and was significantly more frequent in RCA-CTO patients (19, 24.7%, p=0.010) in a mean follow-up of 18 months. This was mainly driven by recurrence of HF symptoms (12, 15.6%, p=0.013). Treated RCA-CTO was an independent predictor of the primary outcome (p=0.019, HR 2.66, 95% CI 1.17-6.05). MI and mortality rates were no different between groups (RCA-CTO with 1.3%, p=0.361 and 2.6%, p=0.673, respectively, on survival analysis). Left ventricular ejection fraction was an independent predictor of mortality (p=0.041, HR 0.93, 95% CI 0.87-0.99). Conclusions: Revascularization of CTO lesions by PCI was associated with low rates of symptom recurrence, and clinical outcomes showed no differences regardless of which artery was treated. Recanalization of RCA-CTO was less beneficial in reducing the recurrence of HF symptoms.
- Fibrilhação auricular - uma abordagem pré-hospitalar “descomplicada”Publication . da Mota, Teresa Faria; Candeias, Rui; Mimoso, Jorge; de Jesus, IlidioA Fibrilhação Auricular (FA) é a arritmia crónica mais comum a nível mundial, com uma prevalência que poderá duplicar nas próximas décadas. O seu diagnóstico baseia-se na análise do ECG de 12 derivações e caracteriza-se habitualmente pela ausência de ondas p e pela irregularidade dos intervalos R-R, embora possam existir exceções. Uma das principais e mais nefastas complicações da FA são os eventos tromboembólicos cerebrais ou periféricos, o que sustenta a pertinência de estabelecer o risco trombótico individual de cada doente e iniciar anticoagulação de acordo com o mesmo.
- The impact of delays in inter-hospital transfers on ST-elevation myocardial infarctionPublication . Mimoso, JorgeThe guidelines for ST-elevation myocardial infarction (STEMI) care provide an overview of therapies and strategies that improve prognosis and reduce mortality in patients presenting with STEMI.
- Initial experience with orbital atherectomy in a non-surgical center in PortugalPublication . Faria, Daniel; Vinhas, Hugo; Bispo, João; Guedes, João; Marto, Sandrine; Palmeiro, Hugo; Franco, Patrícia; Mimoso, JorgeIntroduction and objectives: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a higher risk of procedural complications, suboptimal stent expansion, and in-stent restenosis. Lesion preparation with orbital atherectomy (OA) in severely calcified lesions has been shown to increase procedural success and decrease reintervention rates. In this study, we sought to report the procedural safety and efficacy of our initial experience with OA in a non-surgical center in Portugal. Methods: Patients with severely calcified coronary lesions who were treated with intended intravascular ultrasound (IVUS) guided OA were included in a prospective single-center registry. We evaluated several endpoints, including: debulking success, defined <50% residual stenosis severity after OA; procedural success, defined as stent implantation according to OptimalIVUS PCI criteria; use of additional calcium debulking strategies; and procedural complications, including coronary no-reflow, dissection, perforation or side branch occlusion. Patients were followed up for 30 days to assess early cardiovascular or procedure-related death, myocardial infarction, myocardial injury and reintervention. Results: Between January 2023 and September 2023, 37 patients and 53 coronary arteries underwent OA. IVUS imaging was used in all cases. Debulking and procedural success were achieved in 90.5% and 97.3% of cases, respectively. In 26 (49.1%) lesions, additional calcium debulking techniques were needed. Procedural complications occurred in three cases and one patient died during hospitalization. Conclusion: Our initial experience with OA for heavily calcified coronary lesions demonstrated high procedural success and overall favorable clinical outcomes. (c) 2024 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
- Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratoryPublication . Costa, Hugo; Espírito-Santo, Miguel; Bispo, João; Guedes, João; Paulo, Graciano; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and objectives: Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). Methods: This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (P-KA) and cumulative air kerma (K-a,K-r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (K-a,K-r). Results: A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9 +/- 11.2 years and mostly male (81.4%). DRLs were set in K-a,K-r (3012 mGy) and P-KA (162 Gy cm(2)) for complex PCI. ADs were also set in K-a,K-r (1917 mGy) and P-KA (101 Gy cm(2)). Independent predictors of K-a,K-r with a positive correlation were P-KA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). Conclusions: This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in K-a,K-r (3012 mGy) and P-KA (162 Gy cm(2)). ADs, values to be achieved in future assessment, were set to K-a,K-r (1917 mGy) and P-KA (101 Gy cm(2)).
- Long-term recurrent events in ST-elevation myocardial infarction and multivessel disease: the impact of different revascularization strategiesPublication . Mimoso, JorgeThis study makes an important contribution to responding to issues in the field. Significant non-culprit lesions should undergo revascularization because it can reduce recurrent cardiovascular events compared to the culprit-vessel-only PCI strategy. Second, there are no significant differences in clinical endpoint between it being conducted at index hospital admission or after discharge. They observed a reduction of up to two days in hospital stay in the delayed CR group when compared with the in-hospital CR group; in-hospital CR was an independent predictor of a longer hospital stay. Thus, in view of the recurrent lack of hospital beds in cardiology services, reducing the length of hospital stay in a safe way for patients and postponing revascularization of non-culprit patients after discharge could improve service management and cardiovascular care.
- Regional myocardial infarction networks: How to improve qualityPublication . Mimoso, JorgeThis work highlights the need for treatment delays to be systematically recorded and audited, in order to detect avoidable systematic delays and to implement measures at community, hospital, and EMS levels to improve the effectiveness of the healthcare pathway and the quality of care.
- Sindrome coronária aguda sem supradesnivelamento do segmento ST – abordagem pré hospitalarPublication . Fernandes, Raquel Menezes; Bento, Dina; Mimoso, Jorge; Jesus, IlídioO eletrocardiograma (ECG) de 12 derivações é o exame complementar de diagnóstico inicial de maior relevância num doente que se apresenta com dor torácica aguda e persistente. Se se documentar elevação persistente do segmento-ST, cumprindo critérios diagnósticos de Enfarte Agudo do Miocárdio com supradesnivelamento do segmento-ST, está indicada a terapêutica de reperfusão imediata. Já o diagnóstico de Síndrome coronária aguda sem supradesnivelamento do segmento-ST (SCA-SST) requer um elevado nível de suspeição, com base na apresentação clínica do doente, na presença de fatores de risco e de alterações eletrocardiográficas. Se suspeita clínica de SCA-SST, deverá administrar-se 300 mg de ácido acetilsalicílico, iniciar terapêutica antianginosa e transportar o doente monitorizado até ao Serviço de Urgência para ser submetido a avaliação adicional. Não está recomendada a administração de inibidor P2Y12 ou de anticoagulação em contexto pré-hospitalar, devendo ser reservados para o momento do diagnóstico definitivo de SCA-SST. Caso o doente mantenha dor torácica recorrente ou sinais de instabilidade clínica apesar da terapêutica instituída, deverá repetir-se ECG e, na presença de alterações dinâmicas do segmento-ST, contactar-se o Serviço de Cardiologia da área para internamento e eventual realização de coronariografia emergente.