Gaspar, A; Silva, I; Pereira, AC; Salomé, N; Mariz, JA; Brandão, A; Fernandes, F; Simões, A; Salgado, A; Correia, A
INTRODUCTION: Ischemic stroke is the leading cause of mortality in Portugal, with around 30 to 50 % of cases being of cardioembolic etiology. Transesophageal echocardiography (TEE) has assumed growing importance in the detection of cardiac sources of embolism. However, there is controversy regarding the implications of TEE findings for the therapeutic approach to patients with ischemic stroke.
OBJECTIVES: To analyze TEE findings in the diagnostic work-up of patients with ischemic cerebral events and to determine their influence on therapeutic strategy.
METHODS: We retrospectively studied patients with stroke or transient ischemic attack (TIA) before the age of 65, of no apparent cause after...
Gaspar, A; Ribeiro, S; Nabais, S; Rocha, S; Azevedo, P; Pereira, MA; Brandão, A; Salgado, A; Correia, A
Clopidogrel is an antiplatelet agent converted to its active metabolite by cytochrome P-450 isoenzymes. Numerous drugs are known to inhibit P-450 isoenzymes, including proton pump inhibitors (PPIs), which are often associated with aspirin and clopidogrel to prevent adverse gastrointestinal effects. In vitro studies first showed that PPIs reduced the antiplatelet effect of clopidogrel, while recent clinical studies have raised concerns that the addition of a PPI to clopidogrel in acute coronary syndrome (ACS) patients could actually increase the risk of recurrent cardiovascular events.
The aim of this study was to evaluate whether the prescription of a PPI conferred a worse prognosis...
Ribeiro, S; Gaspar, A; Rocha, S; Nabais, S; Azevedo, P; Salgado, A; Pereira, MA; Correia, A
Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis.
We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h.
Of the 797 patients,...