Complete revascularization versus treatment of the culprit artery only in ST elevation myocardial infarction : a multicenter registry

Fundamento: São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo: Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos: Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados: Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão: Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta.Background: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated. Objective: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy

Adoption de l'article 6 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Champagny de Cadore Jean-Baptiste, Lanjuinais Jean-Denis. Adoption de l'article 6 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 103

Adoption de l'article 6 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Champagny de Cadore Jean-Baptiste, Lanjuinais Jean Denis. Adoption de l'article 6 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 103

Motion de M. Lanjuinais sur l'article 9 du titre III du décret, présenté par M. de Champagny, sur les écoles de mathématiques et d'hydrographie de la marine, lors de la séance du 21 juillet 1791

Champagny de Cadore Jean-Baptiste, Lanjuinais Jean Denis. Motion de M. Lanjuinais sur l'article 9 du titre III du décret, présenté par M. de Champagny, sur les écoles de mathématiques et d'hydrographie de la marine, lors de la séance du 21 juillet 1791. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XXVIII - Du 6 juillet au 28 juillet 1791. Paris : Librairie Administrative P. Dupont, 1887. p. 480

Discussion de l'article 5 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Champagny de Cadore Jean-Baptiste, Lanjuinais Jean-Denis. Discussion de l'article 5 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 102

Discussion de l'article 5 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Champagny de Cadore Jean-Baptiste, Lanjuinais Jean Denis. Discussion de l'article 5 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 102

Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial

Abstract Background Obstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility. Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults. Aging is characterized by motor-unit loss. Force training may affect the whole body muscle tone. We hypothesize that interventions increasing muscle strength might propagate to motor units at the abductor pharyngeal muscles, reducing collapsibility and, hence, sleep apnea severity in elderly patients with obstructive sleep apnea. Methods/design This is a randomized clinical trial including patients between 65 and 80 years of age, with obstructive sleep apnea, and an apnea-hypopnea index (AHI) between 20 and 50 events/hour, diagnosed by out-of-center in-home type III polysomnography. Forty subjects will be included and randomly assigned to two equal sized groups. The participants allocated to the intervention group will attend two sessions per week of one-hour strength training for the legs, arms, chest, back, and abdomen and the controls will receive advice on lifestyle change. The primary outcome measure of the study will be the change in apnea-hypopnea index and the secondary outcomes will be the body composition, evaluated by anthropometric and bioelectrical impedance variables; maximum dynamic force, appraised by one-repetition maximum strength test; muscle quality and thickness by ultrasound; physical function assessed by sit-to-stand test, timed up and go test, handgrip strength test. The study duration will be 12 weeks. Intention-to-treat and per-protocol analyses will be performed. Discussion The high prevalence of obstructive sleep apnea in elderly people is a public health issue. OSA is a recognized cause of cardiovascular disease and reduces quality of life due to sleepiness and fatigue. Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea. Home-based strength exercises may represent a more practical approach than aerobic exercise for elderly patients. If the results confirm our hypothesis, further research on the clinical application of our findings will be warranted. Trial registration ClinicalTrials.gov, NCT02742792 . Registered on 1 April 2016

Discussion de l'article 2 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Champagny de Cadore Jean-Baptiste, Martineau Louis Simon, Lanjuinais Jean Denis. Discussion de l'article 2 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 101

Discussion de l'article 3 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790

Ménonville François-Louis Thibault de, Champagny de Cadore Jean-Baptiste, Lanjuinais Jean-Denis, Aubergeon de Murinais Guy-Joseph d'. Discussion de l'article 3 du décret sur les peines à infliger dans l'armée navale, lors de la séance du 16 aout 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVIII - Du 12 aout au 15 septembre 1790. Paris : Librairie Administrative P. Dupont, 1884. pp. 101-102