Kontext a cíle: Cílem této studie bylo určit vliv charakteristik pacienta z hlediska jejich klinického stavu, životosprávy a chování na závažnost onemocnění podle pohlaví. Metody: Provedli jsme průřezovou deskriptivní studii. Výsledky: Počáteční vzorek zahrnoval 1 219 pacientů přijatých pro akutní koronární syndrom (AKS) na kardiologické oddělení fakultní nemocnice v alžírském Oranu. Podle EKG vyšetření prodělalo 34 % pacientů infarkt myokardu s elevacemi úseku ST (STEMI) a 66 % infarkt myokardu bez elevací úseku ST (NSTEMI). Průměrný věk 413 pacientů se STEMI byl 60,87 ± 12,20 roku; tato skupina zahrnovala 324 mužů průměrného věku 59,92 ± 11,78 roku a 89 žen průměrného věku 64,36 ± 13,13 roku (tzn. mužů bylo ve skupině se STEMI 3,6× více). Z pacientů se STEMI jich 34,8 % mělo hypertenzi; tato diagnóza byla statisticky významně častější u žen než u mužů (65,6 %, vs. 26,5 %; p < 0,05). Diabetes byl přítomen u 31,7 % celého vzorku; přitom byl častější u žen než u mužů (50,6 % vs. 26,5 %; p < 0,05). Ze 413 pacientů se STEMI jich 63,9 % mělo dyslipidemii; tato diagnóza byla stanovena statisticky významně častěji u mužů než u žen (76,5 % vs. 13,5 %; p < 0,05); kuřáků mezi muži bylo 64,5 %. Z 324 pacientů se STEMI byly ve 46,5 % zjištěny tři rizikové faktory, zatímco z 89 pacientek se STEMI byly ve 34,8 % přítomny čtyři rizikové faktory. Závěr: Naše výsledky prokázaly vyšší prevalenci AKS v hodnoceném vzorku. U pacientů se STEMI bylo nalezeno několik rizikových faktorů kardiovaskulárních onemocnění. Byly pozorovány i rozdíly mezi pohlavími v projevech AKS a výskytu rizikových faktorů.

Background and aims: The aim of this study is to determine the role of clinical, lifestyle, and behavioral characteristics on the severity of the disease according to the gender. Methods: We conducted a cross-sectional descriptive study. Results: An initial sample of 1219 patients was admitted for ACS in the cardiology service of Oran-University-Hospital-Center. The electrocardiographic results revealed that 34% of the patients had ST-segment elevation myocardial infarction (STEMI) while 66% had non-ST-segment elevation myocardial infarction (NSTEMI). In STEMI patients, the mean age was 60.87±12.20 years. STEMI patients sample included 413 patients with 324 men with a mean age of 59.92±11.78 years and 89 women with a mean age of 64.36±13.13 years. A male predominance observed with a sex-ratio of 3.6. Among STEMI patients, 34.8% of patients had hypertension where it was significantly higher in women than in men (65.6% vs 26.5% respectively, p < 0.05). Diabetes was observed in 31.7% of the whole sample where it was also more common in women compared to men (50.6% vs 26.5%, respectively, p <0.05). Out of the 413 STEMI patients 63.9% had dyslipidemia which was significantly higher in men compared to women (76.5% vs 13.5% respectively, p <0.05), 64.5% of men were current smokers. Out of the 324 STEMI men patients, 46.5% had three risk factors while in the 89 STEMI women patients, 34.8% had four risk factors. Conclusion: Our results demonstrated a higher prevalence of ACS among the studied sample. STEMI patients presented with several cardiovascular risk factors. Sex differences in the ACS presentation and risk factors was also noticed.

• MeSH
• akutní koronární syndrom * diagnóza   epidemiologie   etiologie   MeSH
• infarkt myokardu epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pohlavní dimorfismus * MeSH
• průřezové studie MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• senioři MeSH
• statistika jako téma MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Alžírsko MeSH

BACKGROUND: Many patients with acute coronary syndrome have concurrent metabolic risk factors that affect risk of major adverse cardiovascular events (MACE). We aimed to assess the effects of the PCSK9 inhibitor alirocumab compared with placebo on MACE according to baseline metabolic risk factors. METHODS: We performed a post-hoc analysis of the ODYSSEY OUTCOMES trial, which was a multicentre, double-blind, randomised controlled trial done in 1315 hospitals and outpatient clinics in 57 countries. Patients aged 40 years or older with recent acute coronary syndrome (ie, in the past 1-12 months) and elevated concentrations of atherogenic lipoproteins, despite high-intensity or maximum-tolerated statin treatment, were eligible for enrolment. Between Nov 2, 2012, and Feb 9, 2017, patients were randomly assigned (1:1) to 75 mg alirocumab by subcutaneous injection every 2 weeks or matching placebo, beginning 1-12 months after acute coronary syndrome and were followed up for a median of 2·8 years (IQR 2·3-3·4). Patients and investigators were masked to group assignment and treatment dose adjustment. The primary outcome was a composite of death from coronary artery disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke, or unstable angina requiring hospital admission. Analysis of MACE according to an ordinal number of metabolic risk factors was done post hoc. Metabolic risk factors were defined as blood pressure of at least 130/85 mm Hg or treatment with antihypertensive medication, triglyceride concentration of at least 150 mg/dL, HDL cholesterol concentration less than 40 mg/dL for men and 50 mg/dL women, fasting plasma glucose concentration of at least 100 mg/dL or treatment with glucose-lowering medication, and BMI of at least 30 kg/m2. Risk of MACE and effect of alirocumab were assessed according to the number of metabolic risk factors. ODYSSEY OUTCOMES is registered with ClinicalTrials.gov, number NCT01663402. FINDINGS: Of 18 924 patients, 3882 (41%) of 9462 in the alirocumab group and 3859 (41%) of 9462 in the placebo group had three or more metabolic risk factors. In the placebo group, MACE incidence increased monotonically with each metabolic risk factor from 7·8% (no risk factors) to 19·6% (five risk factors; HR 1·18, 95% CI 1·13-1·24 per metabolic risk factor). Alirocumab decreased relative risk of MACE consistently across categories defined by the number of metabolic risk factors (pinteraction=0·77), but absolute risk reduction (aRR) increased with the number of metabolic risk factors (no risk factors aRR 0·7%, -1·81 to 3·29 vs five risk factors aRR 3·9%, -1·45 to 9·25; pinteraction<0·001). Similarly, when patients with diabetes were excluded, the incidence of MACE in the placebo group increased from 7·7% in patients with no metabolic risk factors to 14·6% in those with five metabolic risk factors and aRR with alirocumab increased from 0·91% in patients with no metabolic risk factors to 3·82% in those with five factors. Alirocumab was well tolerated in all subgroups defined by the presence of metabolic risk factors. INTERPRETATION: Accumulation of metabolic risk factors was associated with higher risk of MACE in patients with recent acute coronary syndrome. Alirocumab reduced MACE consistently, but aRR increased with number of metabolic risk factors. FUNDING: Sanofi and Regeneron Pharmaceuticals.

• MeSH
• akutní koronární syndrom * komplikace   farmakoterapie   epidemiologie   MeSH
• cévní mozková příhoda * MeSH
• dvojitá slepá metoda MeSH
• humanizované monoklonální protilátky * terapeutické užití   MeSH
• ischemie mozku * MeSH
• lidé MeSH
• PCSK9 inhibitory terapeutické užití   MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk. METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated. RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups. CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).

• MeSH
• akutní koronární syndrom epidemiologie   MeSH
• antiarytmika škodlivé účinky   terapeutické užití   MeSH
• délka pobytu MeSH
• fibrilace síní komplikace   farmakoterapie   chirurgie   MeSH
• funkce levé komory srdeční účinky léků   MeSH
• hospitalizace statistika a číselné údaje   MeSH
• incidence MeSH
• jednoduchá slepá metoda MeSH
• kardiovaskulární nemoci mortalita   prevence a kontrola   MeSH
• katetrizační ablace * MeSH
• lidé MeSH
• následné studie MeSH
• riziko MeSH
• sekundární prevence MeSH
• senioři MeSH
• srdeční selhání epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

AIMS: The Acute Cardiac Care Association (ACCA)-European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. METHODS AND RESULTS: Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients' outcomes. Patients will be followed for 1 year after admission. CONCLUSION: The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

• MeSH
• akutní koronární syndrom diagnóza   epidemiologie   terapie   MeSH
• infarkt myokardu s elevacemi ST úseků diagnóza   epidemiologie   terapie   MeSH
• kardiologie * MeSH
• kvalita zdravotní péče * MeSH
• lidé MeSH
• management nemoci * MeSH
• registrace * MeSH
• retrospektivní studie MeSH
• společnosti lékařské * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015. Acute coronary syndrome with ongoing myocardial ischaemia was defined by the presence of persistent/recurrent chest pain/dyspnoea and at least one of the following: persistent ST-segment elevation or depression, bundle branch block, haemodynamic or electric instability due to suspected ischaemia. Major adverse cardiac events (death, reinfarction, stroke, unexpected revascularisation, stent thrombosis) and severe bleeding according to Bleeding Academic Research Consortium criteria were evaluated at 30 days. RESULTS: Acute coronary syndrome was ruled out during the hospital stay in 434 (24.7%) patients. Out of 1280 patients with confirmed acute coronary syndrome, 732 (57%) had clinical signs of ongoing myocardial ischaemia at first medical contact. Coronary angiography was performed in 94.7% of patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 89% of patients with confirmed acute coronary syndrome without ongoing myocardial ischaemia (P<0.001). The major adverse cardiac event rate was 9.8% for patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 5.5% for patients without ongoing myocardial ischaemia (P=0.005), the 30-day severe bleeding rate was 1.6% and 1.5% (P=1.0). Patients with ongoing myocardial ischaemia admitted to regional hospitals had higher major adverse cardiac event rates compared with patients admitted directly to cardiocentres with percutaneous coronary intervention capability (13.3% vs. 8.2%, P=0.034). CONCLUSIONS: Ongoing myocardial ischaemia was present in more than half of patients hospitalised with acute coronary syndrome. These very high-risk patients may benefit from direct admission to percutaneous coronary intervention-capable centres.

• MeSH
• akutní koronární syndrom komplikace   epidemiologie   patofyziologie   MeSH
• bolesti na hrudi diagnóza   etiologie   patofyziologie   MeSH
• cévní mozková příhoda epidemiologie   MeSH
• hospitalizace MeSH
• incidence MeSH
• ischemická choroba srdeční diagnostické zobrazování   mortalita   patofyziologie   terapie   MeSH
• koronární angiografie statistika a číselné údaje   MeSH
• koronární angioplastika metody   MeSH
• krvácení epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• recidiva MeSH
• registrace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty škodlivé účinky   MeSH
• trombóza epidemiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika MeSH

• Klíčová slova
• apixaban,
• MeSH
• akutní koronární syndrom epidemiologie   farmakoterapie   mortalita   MeSH
• antikoagulancia terapeutické užití   MeSH
• Aspirin aplikace a dávkování   MeSH
• cévní mozková příhoda epidemiologie   MeSH
• fibrilace síní farmakoterapie   MeSH
• fibrinolytika terapeutické užití   MeSH
• hospitalizace statistika a číselné údaje   MeSH
• klopidogrel aplikace a dávkování   MeSH
• koronární trombóza epidemiologie   MeSH
• krvácení chemicky indukované   epidemiologie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• purinergní receptory P2Y - antagonisté aplikace a dávkování   MeSH
• pyridiny aplikace a dávkování   MeSH
• pyridony aplikace a dávkování   MeSH
• senioři MeSH
• vitamin K antagonisté a inhibitory   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• multicentrická studie MeSH
• novinové články MeSH
• randomizované kontrolované studie MeSH

Coronary heart disease, sometimes also referred to as ischemic heart disease, remains the leading condition causing most deaths and disability-adjusted life years worldwide. Acute coronary syndrome (ACS) represents a subset that is defined by sudden reduction of blood supply in the coronary arteries. ACS consists of unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).The current short communication aims to provide current ACS prevalence and incidence data analysis to inform development of clinical practice guidelines in the Czech Republic.The Institute of Health Information and Statistics of the Czech Republic has provided the data that are collected by the National Health Information System with the National Register of Reimbursed Health Services as a primary source providing data for the period from 2015 to 2017.There has been a slight decrease in the number of hospitalized patients for ACS in the Czech Republic from 2015 to 2017. Sex difference remains large, with majority (two thirds) of those hospitalized for unstable angina, NSTEMI, or STEMI being men. Hospitalization with STEMI is reported in younger age with no sex difference compared with NSTEMI and unstable angina.

• MeSH
• akutní koronární syndrom epidemiologie   MeSH
• hospitalizace statistika a číselné údaje   MeSH
• incidence MeSH
• infarkt myokardu epidemiologie   MeSH
• lidé MeSH
• nestabilní angina pectoris epidemiologie   MeSH
• prevalence MeSH
• sexuální faktory MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Úvod: Počet starších nemocných (≥ 75 let) hospitalizovaných pro akutní koronární syndrom (AKS) narůstá. Chybí dostatek informací o tom, jak se v průběhu času změnila adherence k doporučeným léčebným strategiím u těchto pacientů. Cíl: Analyzovat trendy v léčbě a osudu starších (≥ 75 let) pacientů s AKS na základě údajů získaných ze dvou českých registrů provedených v odstupu deseti let. Metody a výsledky: V této studii byly použity údaje z registrů CZECH-1 a CZECH-3. V uvedených registrech byla shromažďována data na podzim roku 2005, resp. na podzim roku 2015, o 1 952, resp. 1 754 neselektovaných pacientech. Všichni pacienti byli hospitalizováni se vstupní diagnózou AKS. Do registru CZECH-1 bylo zařazeno 490 (25,7 %) starších pacientů, do registru CZECH-3 pak 484 (28,1 %) starších pacientů (p = 0,045) průměrného věku 80,6 ± 4 roky, resp. 82,1 ± 5 let (p < 0,001). Diagnóza AKS byla potvrzena u 345 (72 %), resp. u 352 (73,6 %) starších pacientů (p = 0,781). V registru CZECH-3 bylo ve srovnání s registrem CZECH-1 zaznamenáno více provedených perkutánních koronárních intervencí (65,2 %, resp. 54,8 %; p < 0,001), častější podávání duální protidestičkové léčby, inhibitorů angiotensin konvertujícího enzymu (ACE) a statinů v průběhu léčby. Co se týče nemocniční mortality starších pacientů s potvrzeným AKS, nebyly mezi registry zaznamenány žádné rozdíly (8,2 %, resp. 10,4 %; p = 0,790). Závěr: Podíl starších pacientů s AKS a jejich průměrný věk narůstá. I když bylo v adherenci k léčbě podle doporučených postupů u této podskupiny pacientů v průběhu času zaznamenáno zlepšení, ke změně v nemocniční mortalitě nedošlo.

Background: The number of elderly patients in the population is rapidly increasing, and little is known about how adherence to recommended treatment strategies in elderly patients with acute coronary syndrome (ACS) has changed over time. Aim: To analyze trends in the treatment and outcomes of elderly patients with ACS from two registries conducted in the Czech Republic over 10 years. Methods and results: Data from the CZECH-1 and CZECH-3 registries were used in this study. These registries collected data in autumn 2005 and autumn 2015, and contain data from 1952 and 1754 unselected patients, respectively. All patients had been hospitalized with an initial diagnosis of ACS. There were 490 (25.7%) elderly patients in the CZECH-1 registry and 484 (28.1%) elderly patients in the CZECH-3 registry (p = 0.045) with an average age of 80.6 ± 4 and 82.1 ± 5 years (p < 0.001), respectively. ACS was confirmed in 345 (72%) and 352 (73.6%) elderly patients (p = 0.781), respectively. There was higher use of percutaneous coronary intervention (65.2% and 54.8%; p < 0.001), dual antiplatelet treatment, ACE inhibitors, and statins during treatment in the CZECH-3 compared to the CZECH-1 registry. No differences in hospital mortality of elderly patients with confirmed ACS were observed between registries (8.2% vs. 10.4%; p = 0.790). Conclusion: The proportion of patients with ACS that are elderly is increasing along with their increasing average age. Adherence to guideline-recommended therapy in this sub-group of patients has improved over time, but hospital mortality remains unchanged.

• Klíčová slova
• registr CZECH,
• MeSH
• adherence pacienta * MeSH
• akutní koronární syndrom * diagnostické zobrazování   epidemiologie   farmakoterapie   chirurgie   MeSH
• lidé MeSH
• registrace statistika a číselné údaje   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie * MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH

• Klíčová slova
• Lixisenatid,
• MeSH
• akutní koronární syndrom epidemiologie   farmakoterapie   mortalita   MeSH
• albuminurie prevence a kontrola   MeSH
• diabetes mellitus 2. typu * farmakoterapie   komplikace   MeSH
• lidé MeSH
• receptor pro glukagonu podobný peptid 1 agonisté   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

• MeSH
• akutní koronární syndrom epidemiologie   MeSH
• cévní mozková příhoda epidemiologie   MeSH
• diabetes mellitus 2. typu epidemiologie   farmakoterapie   MeSH
• hodnocení léčiv MeSH
• hodnocení rizik MeSH
• hypoglykemika MeSH
• incidence MeSH
• infarkt myokardu epidemiologie   MeSH
• inhibitory dipeptidylpeptidasy 4 * aplikace a dávkování   škodlivé účinky   MeSH
• kohortové studie MeSH
• lidé MeSH
• srdeční selhání epidemiologie   MeSH
• vildagliptin MeSH
• Check Tag
• lidé MeSH