Infarction – ABC CARDIOL

ABC

Original Article

Comparison of Coronary Computed Tomography Angiography and Invasive Coronary Angiography in Nonobstructive Coronary Artery Disease: The Brazilian Coronary ARtery Disease (BARD) Study

Protásio Lemos Da Luz et al. Desiderio Favarato Alexandre A. Abizaid Luiz Antonio Machado César … Carlos Vicente Serrano Antônio Carlos Palandri Chagas Carlos E. Rochitte Marco A. Gutierrez

Abstract

Background

The prognosis of nonobstructive coronary artery disease (CAD) is not well established. Comparative data between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are limited.

Objectives

To compare CCTA- and ICA-derived information in nonobstructive CAD regarding detection and clinical outcomes.

Methods

We followed 4,004 adult patients who underwent either ICA (n = 2,355) or CCTA (n = 1,649) for a median of 9 years. The primary endpoint was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Propensity score matching was performed to compare outcomes between groups. The significance level was set at 5%.

Results

The overall event rate was 6.9%. ICA was associated with worse outcomes than CCTA (hazard ratio [HR] 0.54; 95% CI 0.42-0.68; p < 0.001). Patients with nonobstructive CAD had worse outcomes than those without CAD (HR 1.73; 95% CI 1.32-2.27; p < 0.001). Normal coronary findings on CCTA were associated with better outcomes than normal findings on ICA (HR 0.39; 95% CI 0.24-0.62; p < 0.001). Event rates increased proportionally with plaque burden. In 1,187 matched pairs, CCTA was associated with improved survival (HR 0.57; 95% CI 0.42-0.78; p < 0.001).

Conclusion

CCTA more closely reflects clinical outcomes than ICA. Nonobstructive CAD carries a substantial risk regardless of imaging modality.

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ABC

Editorial

Middle-Aged Women — A High-Risk Group for Post-Myocardial Infarction Mortality

Maria Antonieta Albanez A. de Medeiros Lopes et al. Mayara Viana Júlia Nóbrega Heitor N. Albanez A. de Medeiros Gláucia Maria Moraes de Oliveira

Cardiovascular diseases (CVD) remain the leading cause of death worldwide, with acute myocardial infarction (MI) accounting for significant morbidity and mortality. Despite substantial reductions in overall cardiovascular mortality, gender disparities persist, particularly affecting women in different demographic contexts. In this mini-editorial, we highlight recent evidence from an original study conducted in the Brazilian Unified Health System (SUS) in Curitiba, Brazil, which followed 4,896 patients hospitalized for acute MI between 2008 and 2015. This pioneering study demonstrated that middle-aged women (45 to 54.9 years) have a significantly higher risk of post-infarction mortality compared to men of the same age group, regardless of adjusted clinical factors. These data provide a critical warning about the need for differentiated, specific clinical approaches for this group (). The analysis of the Brazilian public cohort strengthens international evidence on the gender paradox in CVD. It reinforces the critical role of hormonal changes and psychosocial determinants in worsening the prognosis for women after MI. This contradicts the common assumption that women in this age group maintain natural cardiovascular protection, raising critical questions about the attention given to cardiovascular health at this vital stage of life.

The so-called “gender paradox” in CVD is well established, especially among younger women. Studies show that women under 50 have almost three times higher mortality after MI than men of the same age group, regardless of previous medical history, disease severity, or type of treatment.^, This paradox is remarkable, given that middle-aged women often have fewer traditional cardiovascular risk factors and tend to have better outcomes after percutaneous coronary intervention. The study findings are aligned with global and national data that indicate that women develop MI approximately 5 years later than men (mean age 65.1 vs. 60.3 years). Still, the protective effect of the female sex diminishes and reverses in the 45-54.9 age range. This period coincides with perimenopause and the onset of menopause, highlighting the importance of hormonal changes in increasing cardiovascular susceptibility.

[…]

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ABC

Original Article

Middle-Aged Women and Post-Myocardial Infarction Mortality: A Vulnerable Group? Real-World Evidence from a Brazilian Public Health System Cohort

Edson Marcos Campos Lessa Júnior et al. Carolina Perin Maia da Silva Tatiana Lorena da Luz Kaestner Cecília Rubini Rocha … Gabriela Redivo Stroher Gabriele da Silva Giovanni Augusto de Oliveira Baccin Marcia Olandoski Andre Bernardi José Rocha Faria Neto

Abstract

Background

Cardiovascular diseases are the leading cause of death in Brazil, with acute myocardial infarction (MI) accounting for a significant share of these fatalities. Women tend to experience MI at older ages and in the presence of more comorbidities — factors that may negatively impact prognosis. Locally generated evidence is essential to guide targeted strategies within the public health care system.

Objective

To assess the influence of age and sex on post-MI mortality among patients treated within the Brazilian Unified Health System.

Methods

This retrospective cohort study included patients residing in Curitiba who were hospitalized for MI (International Classification of Diseases, 10th Revision code I21) between 2008 and 2015. Mortality data were obtained from the Brazilian Mortality Information System. In-hospital mortality, as well as mortality at 6 and 12 months and at the end of follow-up, were analyzed. Age (both as a continuous and categorical variable) and sex, as well as their interaction, were included in the analysis. Statistical significance was set at 5% (p < 0.05).

Results

The sample included 4,896 patients (mean age 62 ± 12.4 years; 34.1% women), with an average follow-up of 50.9 months. Overall mortality was 29.5%. On average, women experienced MI 5 years later than men (65.1 vs. 60.3 years; p < 0.001) and had higher follow-up mortality (p < 0.001). However, in the multivariate analysis, only age remained significantly associated with mortality. Age-stratified analysis revealed a higher risk of death among women aged 45-54.9 years (p = 0.004).

Conclusion

Older age contributes to the worse post-MI prognosis observed among women compared to men. However, women in early middle age showed an increased risk of death, representing a potentially vulnerable group requiring specific attention.

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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.