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The Role of Glycoprotein IIb/IIIa Inhibitor on ST Segment Resolution of Patients Submitted to Primary Angioplasty Introduction: Combination of angioplasty PTCA and glycoprotein IIb/IIIa inhibitors (IGpIIb/IIIa) already had conflicting results in treatment of patients (pts) with ST-elevation segment myocardial infarction (STEMI). Objective: Determine if IIb/ IIIa as an adjunctive therapy to the primary PTCA is associated with a better ST segment (STSR) resolution in the electrocardiogram (EKG). Methods: Of 85 patients submitted to a primary PTCA between 2000-2002, 35 used IIb/IIIa as an adjunct therapy and 50 did not use the drug (control group). Baseline characteristics were compared, and clinical, electrocardiographic and angiographic variables were similar between the groups. Outcomes analyzed were STSRs of early (first 6 hours after PTCA) and late EKGs (12 to 40 hours), in-hospital major adverse clinical cardiovascular events (MACE) and serum enzimatic peak. Significance was set at p < 0.05. Results: The IIb/IIIa group showed a trend to a better STSR in early EKGs (73% vs 62%, p = 0.08), not observed when compared late EKGs (72% vs 73%, p = ns). A significant difference was found when the STSR between early vs. late EKGs in the control group (62% vs 73%, p = 0.006), but not in in the IIb/ IIIa group. Diabetes, inferior AMI, onset of symptoms in less then 6 hours and IIb/IIIa were predictors to a complete STSR (p = 0.04; OR = 3.1; IC 95% = 1 to 10). No differences were observed in the presence of in-hospital MACE or enzymatic peak. Conclusion: IIb/IIIa as an adjunctive therapy to the primary PTCA in the treatment of STEMI is associated with a better STSR in early EKG, which may indicate that the drug accelerates myocardial reperfusion in these patients.

ResumoContexto: A população idosa apresenta alta prevalência de hipovitaminose D, sendo provável que, exposta ao uso de anticonvulsivantes, ocorra agravamento dessa condição. Objetivo: Avaliar a interferência do uso crônico de fármacos anticonvulsivantes nos níveis séricos de vitamina D em idosos institucionalizados com idade acima de 65 anos. Métodos: Foram estudados 18 idosos institucionalizados tratados com anticonvulsivantes, por no mínimo 12 meses, comparados a 16 idosos não tratados. Resultados: O estudo demonstrou que os dois grupos cursaram com de ciência de vitamina D, sendo mais pronunciada no grupo tratado com anticonvulsivantes. Embora não houvesse diferença estatisticamente signi cativa nos valores de paratormônio, nos idosos tratados foi observada uma tendência de níveis mais elevados, 53,44 ± 28,92 pg/ml em comparação aos idosos não tratados, 38,5 ± 10,08 pg/ml (P = 0,42). Foi observada diferença estatisticamente signi cativa entre os níveis séricos de 25-hidroxivitamina D nas pacientes do sexo feminino tratadas de 9,22 ± 3,80 ng/ml versus não tratadas, 18,78 ± 7,62 ng/ml (P = 0,03). Conclusão: Nossos achados sugerem que idosos institucionalizados apresentam menores níveis séricos de 25-hidroxivitamina D, con gurando um estado de de ciência, e diferença signi cativa foi detectada nas mulheres tratadas com fármacos anticonvulsivantes. AbstractBackground: Elderly people have a high prevalence of hypovitaminosis D, especially when they are exposed to anticonvulsants. Objective: e present study evaluated the in uence of chronic use of anticonvulsants on serum levels of vitamin D in institutionalized elders aged above 65 years. Methods: Eighteen elderly subjects treated with anticonvulsants were studied for at least 12 months and compared to 16 untreated elders. Results: Vitamin D de ciency was observed in both groups, but the group treated with anticonvulsants showed a more remarkable de ciency. Although there was no statistically signi cant di erence in serum parathyroid hormone levels, elderly patients in treatment had a higher value (53.44 ± 28.92 pg/ml) compared to untreated elders (38.5 ± 10.8 pg/ml: p = 0.42). Statistically signi cant di erence was observed between serum 25-hydroxyvitamin D in treated female patients (9.22 ± 3.80 ng/ml) compared to untreated female patients (18.78 ± 7.62 ng/ml: p = 0.03). Discussion: e observed de ciency in both groups suggests that elderly subjects have lower serum 25-hydroxyvitamin D. Compared to untreated elderly women, elderly women treated with anticonvulsants showed a signi cantly lower serum level of vitamin D.

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