Papers by Luciano Baracioli
Journal of the American College of Cardiology, 2014
Category: 1. Acute Coronary Syndromes: Clinical background: There are conflicting results regardi... more Category: 1. Acute Coronary Syndromes: Clinical background: There are conflicting results regarding the long-term outcome of patients (pts) with acute myocardial infarction (AMI) and absence of significant coronary obstructions (SCO), in comparison with pts with coronary obstruction.
Arquivos Brasileiros de Cardiologia, 2008
Fundamento: Pouco se sabe, principalmente em nosso meio, sobre a influência dos planos de saúde n... more Fundamento: Pouco se sabe, principalmente em nosso meio, sobre a influência dos planos de saúde na evolução a longo prazo pós-infarto agudo do miocárdio (IAM).
Clinics, 2009
Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of in... more Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of invasive therapies in elderly patients with acute myocardial infarction. Clinics. 2009;64(6):553-60.
Arquivos brasileiros de cardiologia, 2008
Little is known, especially in our country, about the influence of health insurance plans on the ... more Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI). To assess the outcome of patients with AMI who are covered by the National Health System (SUS) or other health insurance plans. We analyzed 1,588 patients with AMI (mean age of 63.3 + 12.9 years, 71.7% male) who were included prospectively into a specific database and followed up for up to 7.55 years. Of this total, 1,003 were placed in the "SUS" group and 585 in the "other insurance plans" group. We applied chi-square, log-rank and Cox (stepwise) to the different statistical analyses. The long term multivariate model with mortality as a dependent variable included 18 independent variables. In-hospital mortality rates in the "other insurance plans" and "SUS" groups were 11.4% and 10.3%, respectively (p = 0.5); in the long term, survival chances in the groups were respectively, 7...
Arquivos Brasileiros de Cardiologia, 2013
It is well known that the occurrence of bleeding increases in-hospital mortality in patients with... more It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p…
Category: 1. Acute Coronary Syndromes: Clinical background: There are few data in the literature ... more Category: 1. Acute Coronary Syndromes: Clinical background: There are few data in the literature analyzing the very old population, especially in comparison with middle age/young population, main objective of the present study.
Atherosclerosis, 2004
In patients with acute myocardial infarction (AMI), little is known about the correlation between... more In patients with acute myocardial infarction (AMI), little is known about the correlation between prognostic variables and aspects of ruptured plaque at the coronary angiography. Five hundred patients with acute myocardial infarction were studied in a consecutive and prospective manner; of these, 264 patients were excluded mainly because of the presence of an occluded culprit coronary artery. The remaining 236 patients were divided according to the presence (113, 52%) or absence (126, 48%) of angiographic aspects suggestive of ruptured plaque, and correlated with 49 clinical, electrocardiographic, in-hospital complications, procedures, and other angiographic prognostic variables. The variables that correlated significantly and independently with angiographic aspects of ruptured plaque were: presence of thrombi and higher degree of residual stenosis at the culprit coronary artery, as well as white ethnic group.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
Coronary artery bypass grafting (CABG) during the acute phase of infarction (AMI) is associated w... more Coronary artery bypass grafting (CABG) during the acute phase of infarction (AMI) is associated with increased operative risk. The aim of this study was to determine predictors of in-hospital mortality in patients undergoing CABG in AMI. During three years, all patients undergoing CABG in AMI were retrospectively analyzed of the institutional database. Sixty variables per patient were evaluated: 49 preoperative variables from the 2000 Bernstein-Parsonnet and EuroSCORE models, 4 preoperative variables not considered in these models (time between AMI and CABG, maximum CKMB, Troponin maximum and ST-segment elevation) and 7 intraoperative variables [(cardiopulmonary bypass (CPB), CPB time, type of cardioplegia, endarterectomy, number of grafts, use of internal thoracic artery and complete revascularization]. Univariate and multivariate analysis for the outcome of in hospital mortality were performed. The mean time between AMI and CABG was 3.8 ± 3 days. The overall mortality was 19%. In ...
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 2003
Orbofiban is a unique antiplatelet agent that inhibits the binding of fibrinogen to gycoprotein (... more Orbofiban is a unique antiplatelet agent that inhibits the binding of fibrinogen to gycoprotein (GP) IIb/IIIa integrin receptors and thus prevents platelet aggregation induced by various agents. However, recent studies indicate that treatment with orbofiban does not reduce the incidence of recurrent ischemic events. The mechanisms underlying the lack of benefit of orbofiban in patients with acute coronary syndromes are not completely clear. The purpose of this study was to characterize the effects of orbofiban on cellular activation (neutrophil superoxide generation) and surface expression of adhesion molecules of circulating neutrophils (CD18, CD11b, and L-selectin) and platelets (P-selectin and GP IIb/IIIa) in patients with acute coronary syndromes. After 5-7 days, orbifiban (50 mg BID) did not reduce PMN adhesion molecule expression and ex vivo-stimulated PMN superoxide generation--as was observed in the placebo group, without orbofiban. In contrast, orbofiban induced marked redu...
Journal of The American College of Cardiology, 2003
Little is known, especially in the elderly, about the role of surgical myocardial revascularizati... more Little is known, especially in the elderly, about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive procedures -IP)
Arquivos Brasileiros de Cardiologia, 2014
Data from over 4 decades have reported a higher incidence of silent infarction among patients wit... more 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). 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. 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. 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). 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.
Revista Portuguesa de Cardiologia, 2013
Journal of the American College of Cardiology, 2011
Background: Diabetes (DM) and hyperglycemia are both powerful risk factors for pts with acute myo... more Background: Diabetes (DM) and hyperglycemia are both powerful risk factors for pts with acute myocardial infarction (AMI). However, the relationship between them and their individual role during the in-hospital phase and in the long-term after hospital discharge are not clearly understood.
Journal of the American College of Cardiology, 2014
Little is known about the management of acute coronary syndromes (ACS) in developing countries, i... more Little is known about the management of acute coronary syndromes (ACS) in developing countries, including Brazil. Our purpose was to evaluate the performance measures for the management of ACS in Brazil according to the results of the Brazilian Registry of Acute Coronary syndromEs (BRACE).
International Journal of Cardiology, 2012
Background: Among patients with acute coronary syndrome (ACS), demographics, procedural character... more Background: Among patients with acute coronary syndrome (ACS), demographics, procedural characteristics and adjunctive medications differ globally. We examined whether there were differential effects of prasugrel compared with clopidogrel in the multinational TRITON-TIMI 38 study. Methods: We divided the enrollment into 5 pre-specified geographic regions. Patients were randomized to prasugrel or clopidogrel without regard to country of enrollment. End points are expressed as Kaplan-Meier failure estimates through 15 months. Heterogeneity was evaluated using Cox proportional hazards model. Additional sensitivity analyses were performed by dividing countries into categories based on the Human Development Index (HDI), which is a composite measure of social and economic development. Results: 13,608 patients were enrolled. Clinical characteristics including age, comorbidities, ACS presentation, stent types, and adjunctive medications differed broadly among regions. Despite these differences, no regional heterogeneity was observed with prasugrel compared to clopidogrel in the reduction of ischemic events (HR range: 0.76-0.87, p interaction N 0.10 for each) and stent thrombosis (HR range: 0.34-0.72, p interaction N 0.10 for each) or in the increased rate of non-CABG TIMI major bleeding (HR range: 1.16-1.76, p interaction N 0.10 for each). There was a consistent trend in net clinical benefit (all cause death/MI/stroke/non-CABG TIMI major bleeding) favoring prasugrel (HR range: 0.81-0.97, p interaction N 0.10 for each). Consistent results were also observed regarding the safety and efficacy of prasugrel compared with clopidogrel in both developed and developing countries. Conclusions: Despite differences in patient demographics, procedural techniques and adjunctive medications, consistent reduction in ischemic events and increased bleeding were seen with prasugrel compared with clopidogrel throughout the world.
Atherosclerosis, 2004
In patients with acute myocardial infarction (AMI), little is known about the correlation between... more In patients with acute myocardial infarction (AMI), little is known about the correlation between prognostic variables and aspects of ruptured plaque at the coronary angiography. Five hundred patients with acute myocardial infarction were studied in a consecutive and prospective manner; of these, 264 patients were excluded mainly because of the presence of an occluded culprit coronary artery. The remaining 236 patients were divided according to the presence (113, 52%) or absence (126, 48%) of angiographic aspects suggestive of ruptured plaque, and correlated with 49 clinical, electrocardiographic, in-hospital complications, procedures, and other angiographic prognostic variables. The variables that correlated significantly and independently with angiographic aspects of ruptured plaque were: presence of thrombi and higher degree of residual stenosis at the culprit coronary artery, as well as white ethnic group.
Arquivos Brasileiros de Cardiologia, 2002
Clinics, 2009
Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of in... more Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of invasive therapies in elderly patients with acute myocardial infarction. Clinics. 2009;64(6):553-60.
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Papers by Luciano Baracioli