Unplanned readmissions to the hospital are a problem faced by most health care organizations in the United States; hospitals are penalized for such readmissions. The project site identified high readmission rates for patients who were discharged after acute myocardial infarction (AMI), making careful transition home a necessity for post-AMI patients. The focus of this quality improvement (QI) project was implementation of an early follow-up appointment of AMI patients following discharge. The purpose of this project was to evaluate the effectiveness of changing follow-up appointments for patients with an AMI from 14-30 days to 7-14 days post discharge to reduce unplanned readmission rates. Bandura’s self- efficacy theory provided the theoretical framework for this project. An evaluation of the QI project was completed by comparing patient readmission rates 6 months before and 6 months after implementation of the early follow-up appointments. Data analysis demonstrated that the readmission rate was not improved in the first 6 months post QI project implementation. Using the plan-do-check-act process, a multifactorial approach was recommended to refine the QI project and address the system-wide readmission rates. The implications of this project for positive social change include providing early analysis of the readmission QI project, which allowed the hospital to restructure the QI approach and improve the plan for preventing readmission.

Aims: There are limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. Methods: Using the Nationwide Inpatient Sample (2004-2015), we examined outcomes of AMI patients stratified by severity and sub-types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no-CLD. Results: Of 7 024 723 AMI admissions, 54 283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60-0.63 and 0.59, 95%CI 0.58-0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15-1.23), mortality (1.30, 95%CI 1.25-1.34) and major bleeding (1.74, 95%CI 1.67-1.81). In comparison to the non-severe CLD sub-groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (P <.05). Among severe CLD patients, those with alcohol-related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub-group (P <.05). Conclusions: CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.

Aims: There are limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. Methods: Using the Nationwide Inpatient Sample (2004-2015), we examined outcomes of AMI patients stratified by severity and sub-types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no-CLD. Results: Of 7 024 723 AMI admissions, 54 283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60-0.63 and 0.59, 95%CI 0.58-0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15-1.23), mortality (1.30, 95%CI 1.25-1.34) and major bleeding (1.74, 95%CI 1.67-1.81). In comparison to the non-severe CLD sub-groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (P <.05). Among severe CLD patients, those with alcohol-related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub-group (P <.05). Conclusions: CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / BACKGROUND: In order to improve the quality and efficacy of healthcare while reducing the overall cost to deliver that healthcare, it has become increasingly important to manage utilization of services for populations of patients. Healthcare systems are aggressively working to identify patients at risk for hospital readmissions. Although readmission rates have been studied before, parameters for identifying patients at risk for readmission appear to vary depending the patient population. We will examine existing Electronic Health Record (EHR) data at Banner Health to establish what parameters are clinical indicators for readmission risk. Three conditions were identified by the CMS to have high and costly readmissions rates; heart failure (HF), acute myocardial infarction (AMI), and pneumonia. This study will focus on attempting to determine the primary predictive variables for these three conditions in order to have maximum impact on cost savings. METHODS: A literature review was done and 68 possible risk variables were identified. Of these, 30 of the variables were identifiable within the EHR system. Inclusion criteria for individual patient records are that they had an index admission secondary to AMI, heart failure, or pneumonia and that they had a subsequent readmission within 30 days of the index admission. Pediatric populations were not studied since they have unique factors for readmission that are not generalizable. Logistics regression was applied to all data including data with missing data rows. This allowed all coefficients to be interpreted for significance. This model was termed the full model. Variables that were determined to be insignificant were subsequently removed to create a new reduced model. Chi square testing was then done to compare the reduced model to the full model to determine if any significant differences existed between the two. RESULTS: Several variables were determined to be the significant predictors of readmission. The final reduced model had 19 predictors. When analyzed using ROC analysis, the area under the curve (AUC) was 0.64. CONCLUSION: Several variables were identified that could be significant contributors to readmission risk. The final model had an AUC on it ROC of 0.64 suggesting that it would only have poor to moderate clinical value for predicting readmission.

Orientador: Silméia Garcia Zanati Bazan / Resumo: Introdução: A doença arterial coronariana é a primeira causa isolada de morte e responsável por elevado número de hospitalizações em todo o mundo. O desenvolvimento de remodelação ventricular está associado com pior prognóstico após o infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST), representando fator de risco para a disfunção ventricular e insuficiência cardíaca. Objetivos: Identificar quais variáveis são preditoras da remodelação ventricular após o IAMCST e avaliar as características clínicas, laboratoriais e ecocardiográficas em pacientes na fase aguda do IAMCST de parede anterior submetidos à angioplastia primária e após seis meses do infarto. Metodologia: Foi realizado um estudo prospectivo, observacional e longitudinal, composto por pacientes com diagnóstico de IAMCST de parede anterior admitidos na Unidade Coronariana (UCO) do Hospital das Clínicas da Faculdade de Medicina de Botucatu no período de julho de 2017 a agosto de 2018. Foram incluídos 50 pacientes, sendo que quatro perderam o seguimento em seis meses e cinco evoluíram a óbito no mesmo período. Durante o período da internação na UCO, os pacientes foram avaliados diariamente e submetidos ao primeiro ecocardiograma em 2 a 3 dias após o IAMCST. No sexto mês após o IAMCST, os pacientes foram submetidos à reavaliação clínica e a novo ecocardiograma, conforme protocolo do serviço. A remodelação cardíaca foi considerada como aumento no volume diastólico superior a 15%. Análise estatística... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Coronary arterial disease is the first isolated death cause and is responsible for an elevated number of hospitalizations all over the world. The development of ventricular remodeling is associated with worse prognosis after ST segment elevation myocardial infarction (STEMI), representing a risk factor for ventricular dysfunction and heart failure. Objectives: To identify which variables are predictors of ventricular remodeling after STEMI and to evaluate clinical, laboratorial and echocardiographic characteristics of patients early post anterior STEMI who went through primary percutaneous intervention and six month after infarction. Methods: This was a prospective, observational and longitudinal study, with anterior STEMI patients admitted to the coronary care unit (CCU) of the Botucatu Medical School Clinics Hospital within July 2017 and August 2018. A total of 50 patients were included, four lost follow-up in six months and five died within the same period. During CCU stay, patients were daily evaluated and submitted to an echocardiogram within the first three days after STEMI. After six months, patients were submitted to a new clinical evaluation and a new echocardiogram, according to local protocol. Ventricular remodeling was considered as a raise in diastolic volume greater than 15%. Statistical analysis: continuous variable both normal and non-normal distribution were presented in either average and standard deviation or median and 25 and 75 percentiles, ... (Complete abstract click electronic access below) / Mestre

O presente estudo procurou avaliar, prospectivamente, a segurança do sistema de tele-eletrocardiografia para a liberação de pacientes que se apresentem a postos de saúde com queixa de dor torácica. Avaliamos a incidência de infarto do miocárdio dessa população ao longo de seis meses. Como objetivo secundário, correlacionamos, retrospectivamente, a razão das probabilidades entre diferentes indicadores clínicos e eletrocardiográficos e a ocorrência do infarto do miocárdio. Entre junho e dezembro de 2006, 32444 pacientes foram atendidos em postos de saúde pública, carentes de cardiologistas e tiveram o seu tele-eletrocardiograma transmitido até uma central de telemedicina, através de linha telefônica fixa. Selecionaram-se 1535 pacientes atendidos devido a dor torácica, que tinham mais de 50 anos e apresentavam exame clínico, laboratorial (troponina I ou creatino fosfoquinase fração MB-CKMB) e tele-eletrocardiográfico normais além de consentirem em repetir o tele-eletrocardiograma após um e seis meses. Todos os pacientes foram seguidos durante seis meses. Não houve eventos durante o primeiro mês. No segundo mês houve 12(0,8%) infartos; no terceiro mês, 18(1,2%); no quarto mês, 38(2,4%) e no sexto, 18(1,2%). Ao longo dos seis meses houve 15(1%) óbitos, sendo 9(0,6%) de origem cardíaca; 9 (0,6%)acidentes vasculares encefálicos e 86(5,6%) infartos agudos do miocárdio. Entre as variáveis que se correlacionaram, independentemente, com maior chance de infarto agudo do miocárdio, encontrou-se a obesidade grau I [p=0,009 RC 4,5 IC 95%(1,5-13,8)], a dislipidemia [p< 0,0001 RC 3,4 IC 95%(2,0-5,8)], a baixa amplitude da onda T em V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)] e o sobrepeso [p=0,019 RC 2,6 IC 95%(1,2-5,7)]. Cada 0,5mm de redução na amplitude da onda T aumentou em quase três vezes a chance de ocorrência do infarto agudo do miocárdio durante seis meses. O tabagismo apresentou forte tendência [p=0,057 RC 1,7 IC 95%(1,0-2,8)] à regressão logística binária e foi significante após análise por árvore de decisão. Estes resultados permitiram as seguintes conclusões: o sistema de tele-eletrocardiografia oferece alta segurança ao estratificar o risco de pacientes com exame clínico, laboratorial e tele-eletrocardiográfico normais, queixando-se de dor torácica. Identificou-se, ao longo dos seis meses, a população de maior chance de apresentar o evento através de variáveis clínicas (obesidade, dislipidemia, tabagismo e sobrepeso) e tele-eletrocardiográficas (amplitude da onda T em V2), que determinaram, independentemente, a ocorrência de infarto agudo do miocárdio / The present study aimed at prospectively evaluating the reliability of teleeletrocardiography for the discharge of chest pain patients who present themselves at remote medical centers. The incidence of acute myocardial infarction among this population was evaluated during a period of six months. As a secondary objective, the correlation between different clinical and electrocardiographic features and the occurrence of myocardial infarction was retrospectively checked. Between June and December of 2006, 32.444 patients were treated in public medical centers which lacked the assistance of cardiologists. Those patients had their electrocardiogram transmitted to a telemedicine center over a fixed-wired telephone line. Among them 1535 patients who had been assisted due to chest pain were selected. Those patients were all older than 50 years and showed normal clinical and laboratorial (troponine I or creatine phosphokinase MB-CKMB fraction) exams, as well as normal tele-electrocardiograms. They also agreed to repeat the teleelectrocardiogram in a six-month period. All patients were followed up to the sixth-month. In the second month, there were 12 (0,8%) infarctions; in the third month there were 18 (1,2%) infarctions; in the fourth month there were 38 (2,4%) infarctions, and in the sixth month there were 18 (1,2%) infarctions. Over that six month period, there were 15 (1%) deaths, 9 (0,6%) of which were related to cardiac causes; 9 (0,6%) strokes, and 86 (5,6%) acute myocardial infarctions. Among the variables which independently correlated with greater risk of acute myocardial infarction, we found grade I obesity [p=0,009 RC 4,5 IC95%(1,5-13,8)]; dyslipidemia [p<0,0001 RC 3,4 IC 95%(2,0-5,8)]; low T-wave amplitude in V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)], and overweight [p=0,019 RC 2,6 IC 95%(1,2-5,7)]. Each 0,5mm reduction in the T-wave raised almost three times the chance for the occurrence of acute myocardial infarction in a sixmonth period. Smoking showed a strong tendency [p=0,057 RC 1,7 IC 95%(1,0-2,8)] to binary logistic regression and was significant after decision tree analysis. These results lead to the following conclusions: the teleelectrocardiographic system offers high level of safety and reliability due to its capacity to stratify chest pain patient risk. Over these six months the study identified the population who showed greater chances of presenting the event through clinical (obesity, dyslipidemia, smoking and overweight) and teleelectrocardiography (amplitude of T-wave in V2) variables, which independently, determined the occurrence of acute myocardial infarction

Made available in DSpace on 2017-07-21T14:35:56Z (GMT). No. of bitstreams: 1 Anderson Jose de Melo Silva.pdf: 2395463 bytes, checksum: ffa3d1c0f5669babc3c89ef037bd4833 (MD5) Previous issue date: 2017-10-06 / The Acute Coronary Syndrome (ACS) defines a range of clinical changes that are compatible with myocardial ischemia, resulting in the death of myocardial cells due functional deficit of blood flow, characterizing the acute myocardial infarction (AMI). The AMI is evidenced through clinical data that are reinforced by electrocardiogram (ECG), imaging and even the biochemical markers (biomarkers) evaluation, such as serum creatine phosphokinase (CK), its isoenzyme MB fraction (CK-MB), troponin and new biomarkers not yet included in routine laboratory tests, such as myeloperoxidase (MPO). In addition to new laboratory markers, science allows the development of new technologies for clinical assessment of patients, providing new information and less risk, such as non-invasive evaluation of intracranial pressure (ICP). This study is justified by the need to predict earlier the complications in patients with suspected AMI, as well as evaluate them as to the diagnosis and prognosis of the event in question. Thus, we sought to study patients with suspected ACS/AMI about the cardiovascular risk and possible PIC change through traditional biomarkers, most current markers ( "gold standard") and new biomarkers and new ICP monitoring technology. Therefore, from a population of 20 patients, randomly selected according to gender and age, separated into two groups: CK-MB≥25 IU (n = 6) and CK-MB<25 IU (n = 14), which were submitted to measurement of PIC and PAS, as well as biochemical and hematological measurements, and specific cardiac biomarkers. As a result, there was correlation of clinical significance between the values of creatine kinase MB fraction (CK-MB) and glycated hemoglobin (HGBA1C). From these data, it started to study two cases that were selected two patients. It was observed that even with changes of CK-MB, troponin and myeloperoxidase (compared to laboratory practice reference values for traditional markers and "gold standard" and MPO value considered normal in the literature), it was found not manifestations that have allowed to observe reduction of cerebral compliance, where the waves P2 are larger than P1, and therefore, there were no PIC changes identified for patients under the conditions studied. Thus, it was concluded that, even without demonstration of PIC change in this work, it is not possible to exclude the value of its inclusion in the clinical evaluation, considering that biases, like the sample universe and the time of collection of PIC or the use of medication at the admission time on hospital, may have contributed to the non-registration of changes in ICP, even in cases where patients had an unfavorable evolution of the clinical picture. / A Síndrome Coronariana Aguda (SCA) define uma gama de alterações clinicas que são compatíveis com um quadro de isquemia miocárdica, acarretando na morte de células do tecido miocárdico devido ao déficit funcional do fluxo sanguíneo, caracterizando o Infarto Agudo do Miocárdio (IAM). O IAM pode se revelar através de dados clínicos que são reforçados pelo eletrocardiograma (ECG), exames de imagem e ainda a pesquisa de marcadores bioquímicos (biomarcadores), tais como Creatinafosfoquinase (CK), sua isoenzima fração MB (CK-MB), troponina e novos biomarcadores ainda não inclusos na rotina laboratorial, tais como mieloperoxidase (MPO). Além de novos marcadores laboratoriais a ciência permite o desenvolvimento de novas tecnologias para avaliação clínica dos pacientes, proporcionando novas informações e menor risco, tais como a avaliação não invasiva da pressão intracraniana (PIC). O presente trabalho justifica-se pela necessidade de se prever intercorrências com maior antecedência em pacientes com suspeita de IAM, assim como em avaliá-los quanto ao diagnóstico e prognóstico do evento em questão. Desta forma, buscou-se estudar pacientes com suspeita de SCA/IAM quanto ao risco cardiovascular e possível alteração de PIC por meio biomarcadores tradicionais, marcadores mais atuais ("padrão ouro") e novos biomarcadores e nova tecnologia de acompanhamento da PIC. Para tanto, de uma população de 20 pacientes, escolhidos aleatoriamente quanto ao gênero e idade, separou-se em dois grupos: CK-MB≥25 UI (n=6) e CK-MB˂ 25 UI (n=14), os quais foram submetidos à aferição de PIC e PAS, além de dosagens bioquímicas e hematológicas, bem como biomarcadores cardíacos. Como resultado, observou-se correlação de significância clinica entre os valores de creatinofosfoquinase fração MB (CK-MB) e hemoglobina glicada (HgbA1C). A partir destes dados, passou-se ao estudo de dois casos clínicos em que foram selecionados dois pacientes. Foi observado que, mesmo com alterações de CK-MB, troponinas e Mieloperoxidase (comparando-se a valores de referencia da prática laboratorial para os marcadores tradicionais e "padrão ouro" e valor de MPO considerado normal em literatura especializada), constatou-se não haver manifestações que permitissem observar redução da complacência cerebral, quando as ondas P2 se dão maiores que ondas P1 e, portanto, não foram identificadas alterações de PIC para os pacientes nas condições estudadas. Com isso, concluiu-se que, mesmo não havendo demonstração de alteração de PIC neste trabalho, não se pode excluir o valor de sua inclusão na avaliação clínica, dado que vieses como universo amostral, bem como o momento da coleta da PIC e ou uso de medicação no momento da admissão hospitalar, podem ter contribuído para o não-registro de alterações da PIC, mesmo em casos que os pacientes tiveram uma evolução desfavorável do quadro clínico.

Cardiovascular disease (CVD) is a complex combination of multiple conditions. The majority of deaths within CVD include heart attacks and strokes caused by atherosclerotic disease. The pathophysiological process for atherosclerotic disease occurs within the endothelial lining of the vessels of the body. This prolonged process occurs when cholesterol deposits form irregularity in luminal flow resulting in decreased blood flow and ischaemia. This unstable cholesterol plaque can rupture resulting in clot formation and artery occlusion. Within this thesis I aim to show background to the relevant pathophysiology of ischaemic heart disease (IHD) with the main emphasis on acute myocardial infarction (AMI), the history of its therapy to current therapy. I will discuss the theorised role of stem cell therapy within animal models and previous clinical trials within regenerative medicine and AMI. I will describe and discuss the method and the results of the REGENERATE-AMI trial (Clintrial.gov: NCT00765453), which will include the safety and efficiency of the therapy, and the possible cytokine mechanism by which this therapy may exert it effect. Additionally I will describe the potential for assessing myocardial oedema using 3-slice T2-STIR short axis stack imaging post AMI compared to the conventional 10-slice T2-STIR technique to assess its feasibility and clinical similarity to assess its use as a tool in translational research.

Introdução: A inflamação e o estresse oxidativo estão associados à progressão do infarto agudo do miocárdio (IAM) para a insuficiência cardíaca (IC). Logo, o tratamento com metilprednisolona, um conhecido glicocorticoide com propriedades anti-inflamatórias e antioxidantes, tem o potencial de mitigar a piora da função do ventrículo esquerdo após o IAM. Entretanto, a utilização de glicocorticoides após o IAM tem apresentado resultados contraditórios que podem ser decorrentes da maneira como são aplicados. Objetivo: Verificar a influência do período de administração de acetato de metilprednisolona sobre a função cardíaca de ratos após o infarto agudo do miocárdio. Materiais e Métodos: No experimento 1, foram utilizados 29 ratos Wistar machos divididos em 3 grupos: Sham (n=14), infartado tratado com salina logo após o IAM (IAM0 n=7) e infartado tratado 7 dias pós-IAM (IAM7 n=8). A função cardíaca foi avaliada 2 e 56 dias pós-IAM pelo exame de ecocardiografia. No experimento 2 foram utilizados 45 ratos Wistar machos divididos em 4 grupos: Sham (Sham, n=13); infartado (IAM, n=14); infartado e tratado com metilprednisolona no dia da indução do infarto (IAM+M0, n=7); infartado e tratado com metilprednisolona no 7º dia após a cirurgia (IAM+M7, n=7). A cirurgia do IAM foi realizada pela oclusão da artéria coronária descendente anterior esquerda. Uma dose única de acetato de metilprednisolona (40mg/kg,i.m.) foi aplicada nos animais dos grupos IAM+M. A função cardíaca foi avaliada pela ecocardiografia e pelo cateterismo ventricular 56 dias após a indução do infarto. Dados morfométricos e de estresse oxidativo do coração foram avaliados No experimento 3, foram utilizados 16 ratos Wistar machos, sendo divididos em 2 grupos: grupo controle tratado com salina no dia 0 (C, n=5) e grupo tratado com acetato de metilprednisolona (40mg/kg. i.m.) no dia 0. A coleta de sangue ocorreu uma vez por semana durante oito semanas, para avaliação de parâmetros do soro. A função cardíaca foi avaliada pelo cateterismo ventricular 56 dias o início da administração farmacológica. Dados morfométricos e de estresse oxidativo do coração foram avaliados. Parecer CEUA/UFRGS: 30797. Resultados: Os grupos IAM e IAM+M0 e IAM+M7 apresentaram área de infarto de 50,4%, 54,8% e 55,1%, respectivamente. A fração de encurtamento e a mudança de área fracional do ventrículo esquerdo diminuíram significativamente (37% e 39%) no grupo IAM em relação ao Sham. O tratamento iniciado no 7º dia promoveu um declínio adicional na mudança da área fracional (66%) quando comparado ao IAM. Tais parâmetros foram semelhantes entre os grupos IAM e IAM+M0. Observamos um aumento de 69% na pressão diastólica final do ventrículo esquerdo (PDFVE) no grupo IAM quando comparado ao grupo Sham. O tratamento com acetato de metilprednisolona, independentemente do tempo de administração, foi capaz de atenuar a PDFVE apenas os grupos IAM e IAM+M7 apresentaram congestão pulmonar. Conclusão: Nossos resultados demonstram que o tratamento com metilprednisolona iniciado logo após o infarto agudo do miocárdio impede ou reverte o aumento da PDFVE e a congestão pulmonar. O tratamento realizado no 7º dia após o IAM também foi eficaz em atenuar a PDFVE, porém não reverteu a congestão pulmonar. Portanto, concluímos que o tratamento iniciado precocemente apresenta potencial em mitigar a transição do IAM para a insuficiência cardíaca. / Introduction: Inflammation and oxidative stress are associated with the progression of acute myocardial infarction (AMI) to heart failure (HF). Therefore, treatment with methylprednisolone, a known glucocorticoid with anti-inflammatory and antioxidant properties, has the potential to mitigate the worsening of left ventricular function after AMI. However, the use of glucocorticoids after AMI has presented contradictory results that may be due to the way they are applied. Aim: To verify the influence of the period of administration of methylprednisolone acetate on the cardiac function of rats after acute myocardial infarction. Materials and Methods: In the experiment 1, 29 male Wistar rats were divided into 3 groups: Sham (n = 14), infarcted treated with saline immediately after AMI (AMI0 n = 7) and infarcted treated 7 days after AMI n = 8). Cardiac function was assessed 2 and 56 days post AMI by echocardiography. In the experiment 2, 45 male Wistar rats were divided into 4 groups: Sham (Sham, n = 13); infarcted (AMI, n = 14); infarcted and treated with methylprednisolone on the day of infarction induction (AMI+M0, n = 7); infarcted and treated with methylprednisolone on the 7th day after surgery (AMI+M7, n = 7). The AMI surgery was performed by occlusion of the left anterior descending coronary artery. A single dose of methylprednisolone acetate (40 mg / kg, i.m.) was applied to animals in the AMI-M groups. Cardiac function was assessed by echocardiography and ventricular catheterization 56 days after infarction induction. Morphometric and oxidative stress of the heart were evaluated. In the experiment 3, 16 male Wistar rats were divided into 2 groups: control group treated with saline at day 0 (C, n = 5) and group treated with methylprednisolone acetate (40mg / kg, im) at day 0 Blood collection occurred once a week for eight weeks for evaluation of serum parameters. Cardiac function was assessed by ventricular catheterization 56 days after initiation of pharmacological administration. Morphometric data and oxidative stress of the heart were evaluated. CEUA / UFRGS opinion: 30797. Results: The AMI and AMI+M0 and AMI+M7 groups presented an infarct area of 50.4%, 54.8% and 55.1%, respectively. The fraction of shortening and the change in fractional area of the left ventricle decreased significantly (37% and 39%) in the AMI group in relation to Sham. The treatment started on day 7 promoted an additional decline in the fractional area change (66%) when compared to AMI. These parameters were similar between the AMI and AMI + M0 groups. We observed a 69% increase in left ventricular end-diastolic pressure (LVEDP) in the AMI group when compared to the Sham group. Treatment with methylprednisolone acetate, irrespective of the time of administration, was able to attenuate LVDEP only the AMI and AMI+M7 groups presented pulmonary congestion. Conclusion: Our results demonstrate that treatment with methylprednisolone initiated shortly after acute myocardial infarction prevents or reverses the increase in LVEDP and pulmonary congestion. Treatment on the 7th day after AMI was also effective in attenuating LVEDP, but did not reverse pulmonary congestion. Therefore, we conclude that the treatment started early has the potential to mitigate the transition from AMI to heart failure.

Dans les pays « développés », les syndromes coronariens aigus (SCA) représentent une pathologie fréquente et grave et les maladies cardiovasculaires restent la première cause de mortalité en Europe. Au cours de la dernière décennie, pourtant, plusieurs travaux épidémiologiques ont suggéré une baisse sensible de l'incidence des infarctus et la mortalité cardiovasculaire est dorénavant en recul dans de très nombreux pays, dont la France. La cardiologie est une des disciplines médicales qui a connu les plus grands bouleversements au cours des 25 dernières années et la prise en charge des SCA ainsi que le profil des patients ont considérablement évolué. Dans ce contexte, il nous a paru intéressant d'étudier la manière dont le devenir des patients présentant un infarctus aigu pouvait participer à cette baisse générale de la mortalité cardio-vasculaire. A partir de quatre enquêtes longitudinales successives répertoriant les SCA (USIK 1995, USIC 2000, FAST-MI 2005, FAST-MI 2010) et de l’observatoire national des actes de cardiologie interventionnelle (ONACI), nous avons observé, après standardisation sur les caractéristiques initiales des différentes cohortes, une baisse spectaculaire de la mortalité quel que soit le type de SCA (avec sus-décalage ST [SCA ST+] ou ST-elevation myocardial infarction [STEMI] ; sans sus-décalage ST [SCA ST-] ou non-ST-elevation myocardial infarction [NSTEMI]). Cette évolution peut être expliquée par plusieurs paramètres : amélioration de la prise en charge globale, meilleur suivi des recommandations, changement de profils des patients (pour les STEMI), développement de la stratégie invasive et utilisation de nouvelles thérapeutiques, évolution des techniques de cardiologie interventionnelle… Ainsi, il apparaît que l'amélioration du pronostic des patients atteints d'infarctus est bien un des éléments ayant pu contribuer à la baisse de la mortalité cardiovasculaire. L’enjeu aujourd’hui est de maintenir ces résultats, de renforcer les mesures de prévention et d’améliorer le pronostic à long terme en développant notamment les programmes d’éducation thérapeutique. / In developed countries, acute coronary syndromes (ACS) represent a common and serious disease, and cardiovascular disease remains the leading cause of death in Europe. During the last decade, however, several epidemiological studies have suggested a significant reduction in the incidence of myocardial infarction and cardiovascular mortality in many countries, including France. Over the past 25 years, Cardiology has dramatically evolved and the management of ACS, as well as patient risk profile have substantially changed. In this context, we aimed to evaluate how the outcomes of patients with acute myocardial infarction could participate in the general decline in cardiovascular mortality. From four successive longitudinal surveys including ACS (USIK 1995, USIC 2000, FAST-MI 2005, FAST-MI 2010) and the national observatory of interventional cardiology (ONACI) we observed, after standardization of the cohorts on baseline clinical characteristics, a dramatic decline in mortality regardless of the type of ACS (STEMI, ST-elevation myocardial infarction, NSTEMI, non-ST-elevation myocardial infarction). This evolution can be explained by several factors: overall improvement in organization of care, better implementation of recommendations, substantial change in the patient risk profile (for STEMI), increasing use of invasive strategy and adjunctive therapies, improved technique for Interventional Cardiology ... Therefore, the improved prognosis of patients with myocardial infarction appears to be one of the factors that have contributed to the decline in cardiovascular mortality. For the future, the challenge will be to maintain these results, strengthen preventive measures and improve long-term prognosis in particular by developing the therapeutic education programs.