quarta-feira, 2 de maio de 2007

A cardiologia avança no tratamento do infarto do miocárdio

JAMA dessa semana divulga o artigo "Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006" dos investigadores do Global Registry of Acute Coronary Events (GRACE) cujo resumo pode ser visto clicando o título do post. Trata-se de demonstração da ação dos tratamentos preconizados no tratamento da insuficiência coronariana aguda com melhoras impressionantes com redução da mortalidade e aparecimento de insuficiência cardíaca. O estudo foi realizado em 113 hospitais em 14 países, incluindo Brasil. Abaixo, um excelente resumo feito pela Associated Press. Antes, um comentário: trata-se de estudo mostrando o mundo real e do poder transformador da medicina e da...Big Pharma. O uso de medicamentos baratos como aspirina e beta-bloqueadores e, outros agora também baratos como inibidores da enzima de conversão ( o nosso captopril) ao lado de procedimentos mais custosos como angioplastia (utilizado em excesso, segundo o próprio estudo) e trombólise propiciaram redução na letalidade e na principal complicação, a insuficiência cardíaca. No Brasil, temos todas as condições para aplicar a maioria dessas propostas, mas como na maioria dos países ainda temos sérios problemas no atendimento pré-hospitalar e de emergência. Nunca é tarde lembrar que esse blogueiro participou e participa de ensaios clínicos com agentes antiplaquetários.
Heart-Attack Death Rates DropAs Treatment Options Improve Associated PressMay 1, 2007 4:00 p.m. CHICAGO -- In just six years, death rates and heart failure in hospitalized heart attack patients have fallen sharply, most likely because of better treatment, the largest international study of its kind suggests. The promising trend parallels the growing use of cholesterol-lowering drugs, powerful blood thinners, and angioplasty, the procedure that opens clogged arteries, the researchers said. "These results are really dramatic, because, in fact, they're the first time anybody has demonstrated a reduction in the development of new heart failure," said lead author Keith Fox, a cardiology professor at the University of Edinburgh. The six-year study involved nearly 45,000 patients in 14 countries who had major heart attacks or dangerous partial artery blockages. The percentage of patients who died in the hospital or who developed heart failure was nearly cut in half from 1999 to 2005. And the heart-attack patients treated most recently were far less likely to have another attack within six months of being hospitalized when compared to the patients treated six years earlier -- a sign that the more aggressive efforts of doctors in the last few years are working. There have been other signs that better treatment of heart patients has been saving lives, but not on a scale as large as this international study, the researchers said. "It's much more dramatic than we expected, in the course of six years," Dr. Fox said. The new study follows landmark research results in March that showed angioplasty is being overused on people who have chest pain but are not in immediate danger of a heart attack. But this popular procedure, which typically uses stents to keep an unclogged vessel open, is still a powerful tool for saving those who are having a heart attack or are at high risk of one. Patients for the study enrolled between July 1999 through December 2005 and were followed for up to six months after hospitalization. Besides the U.S., they were in hospitals in Argentina, Australia, Austria, Belgium, Brazil, Canada, France, Germany, Italy, New Zealand, Poland, Spain and the United Kingdom. The research showed that in 2005, 4.6% of the heart attack patients died in the hospital, compared with 8.4% in 1999. Heart failure developed in 11% of heart attack patients in 2005, versus nearly 20% in 1999. And just 2% had subsequent heart attacks in 2005, compared to 4.8% previously. Improved outcomes also were found in those with partial blockages, which include less-severe heart attacks. The researchers said these marked improvements are probably a "direct consequence" of new practices that followed updated guidelines from key organizations of heart doctors in the U.S. and Europe. The study "is the first report of what's actually going on in the real world," said Joel Gore, a co-author and cardiologist at the University of Massachusetts Medical Center. Recommendations in those guidelines include quick use of aspirin or more potent blood thinners; beta blockers to reduce the damaged heart's oxygen needs, statins to lower cholesterol; ACE inhibitors to relax blood vessels; and angioplasty to open blocked vessels soon after hospital arrival. Use of each of these treatments climbed during the study and in some cases more than doubled. For example, 85% of heart patients studied got holesterol drugs in 2005 versus just 37% in 1999; 78% got potent blood thinners including Bristol-Myers Squibb Co. and Sanofi-Aventis's Plavix versus 30% in 1999; and 53% had quick angioplasty, compared to just 16% six years earlier. The study appears in Wednesday's Journal of the American Medical Association. It was funded by a grant from Sanofi, which makes several other heart drugs as well as ACE inhibitors. Dr. Fox and several other authors reported getting fees and grants from Sanofi and other drug makers. Steven Nissen, former president of the American College of Cardiology and a Cleveland Clinic heart specialist, said the study doesn't prove the recommended treatments were saving lives but he suspects that is the case. "I really am encouraged that those things that appear in our guidelines are being used by physicians around the world," Dr. Nissen said. American Heart Association spokesman Sidney Smith said the results are "exactly what we would hope would happen from the major efforts in this area over the past decade. "The tragedy is that too many patients delay before coming to the hospital," Dr. Smith sai

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