Infarction

IJCS

Case Report

Multivessel Coronary and Cerebral Vasospasm in a Post-Acute Myocardial Infarction Patient

Mateus Amorim Aboboreira et al. Julio Paiva Maia Vitória Burin Borges Felipe Hideaki Ueda Marcos Franchetti

Introduction

Coronary vasospasm was initially described by Prinzmetal et al. as angina that occurs at rest, without being provoked by an increase in oxygen demand, unlike classic Heberden’s angina, which is induced by physical or emotional stress. The pathophysiology of coronary vasospasm is multifactorial, and various precipitating factors exist.² The present case demonstrates an intriguing scenario that highlights the complexities of clinical management and etiological determination of vasospasm in a post-acute myocardial infarction patient.

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IJCS

Original Article

Chocolate Consumption Does Not Reduce the Risk of Cardiovascular Events and Increases the Risk of Gastrointestinal Bleeding One Year After the First Myocardial Infarction

Daniel Medeiros Moreira et al. Lara Marcon Dandolini Tammuz Fattah Rodrigo de Moura Joaquim Roberto Leo da Silva

Abstract

Background

Coronary artery disease is the leading cause of death worldwide, with high social and financial costs. Although previous studies have demonstrated the potential of chocolate to reduce coronary events, data on its effects in patients who have suffered an acute myocardial infarction (AMI) are lacking.

Objective

To evaluate the impact of chocolate consumption on the incidence of events in patients with AMI followed for one year.

Methods

A subanalysis of the Catarina Heart study, which evaluated patients hospitalized with a diagnosis of the first AMI, was conducted. During hospitalization, patients were asked about their chocolate consumption before the event. The incidence of events was compared between consumers and non-consumers of chocolate before the AMI. The analyzed outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, reinfarction, stroke, in-stent restenosis, acute stent thrombosis, gastrointestinal bleeding, and bleeding requiring transfusion. Cox regression models were applied, and p < 0.05 was considered statistically significant.

Results

A total of 1404 patients were analyzed, of whom 490 (34.9%) consumed chocolate. Chocolate consumption neither reduced the risk of MACE (hazard ratio [HR] = 0.88 [0.57 – 1.37], p = 0.569) nor showed benefits in other outcomes, such as cardiovascular mortality, reinfarction, or stroke. However, its consumption was significantly associated with an increased risk of gastrointestinal bleeding (HR = 2.89 [1.16 – 7.24], p = 0.023) without increasing the risk of bleeding requiring transfusion or acute stent thrombosis.

Conclusion

Chocolate consumption before AMI did not reduce major cardiovascular events and was associated with an increased risk of gastrointestinal bleeding.