Pedro de Araújo Gonçalves

Bio: Pedro de Araújo Gonçalves is an academic researcher from Unica Corporation. The author has contributed to research in topics: Coronary artery disease & Medicine. The author has an hindex of 15, co-authored 119 publications receiving 1633 citations. Previous affiliations of Pedro de Araújo Gonçalves include Polytechnic Institute of Porto & Universidade Nova de Lisboa.

TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS.

Abstract: Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63±11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672–0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584–0.674), and TIMI RS (AUC: 0.585; CI: 0.539–0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. Conclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

TIMI, PURSUIT, and GRACE Risk Scores: Sustained Prognostic Value and Interaction With Revascularization in NSTE-ACS

Abstract: Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63±11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672–0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584–0.674), and TIMI RS (AUC: 0.585; CI: 0.539–0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. Conclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry

Abstract: AIMS: Symptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS), to predict the presence of obstructive CAD on coronary computed tomography angiography (CCTA). METHODS AND RESULTS: The study screened 35 281 participants enrolled in the CONFIRM registry, who underwent ≥64 detector row CCTA evaluation because of either suspected or previously established CAD. A boosted ensemble algorithm (XGBoost) was used, with data split into a training set (80%) on which 10-fold cross-validation was done and a test set (20%). Performance was assessed of the (1) ML model (using 25 clinical and demographic features), (2) ML + CACS, (3) CAD consortium clinical score, (4) CAD consortium clinical score + CACS, and (5) updated Diamond-Forrester (UDF) score. The study population comprised of 13 054 patients, of whom 2380 (18.2%) had obstructive CAD (≥50% stenosis). Machine learning with CACS produced the best performance [area under the curve (AUC) of 0.881] compared with ML alone (AUC of 0.773), CAD consortium clinical score (AUC of 0.734), and with CACS (AUC of 0.866) and UDF (AUC of 0.682), P < 0.05 for all comparisons. CACS, age, and gender were the highest ranking features. CONCLUSION: A ML model incorporating clinical features in addition to CACS can accurately estimate the pretest likelihood of obstructive CAD on CCTA. In clinical practice, the utilization of such an approach could improve risk stratification and help guide downstream management.

Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score

Abstract: Background— Computed tomography–adapted Leaman score (CT-LeSc) was developed to quantify coronary CT angiography information about atherosclerotic burden (lesion localization, stenosis degree, and plaque composition). The objective of the study is to evaluate CT-LeSc long-term prognostic value in patients with suspected coronary artery disease (CAD). Methods and Results— Single-center prospective registry including 1304 consecutive patients undergoing coronary CT angiography for suspected CAD. High CT-LeSc was defined by upper tertile (score, >5) cutoff. Segment involvement score and segment stenosis score were also evaluated. Hard cardiac events (cardiac death and nonfatal acute coronary syndromes) were considered for analysis. Different Cox regression models were used to identify independent event predictors. Kaplan–Meier event-free survival was evaluated in 4 patient subgroups stratified by obstructive (≥50% stenosis) versus nonobstructive CAD and a high (>5) versus a low (≤5) CT-LeSc. Of 1196 patients included in the final analysis (mean follow-up of 52±22 months), 125 patients experienced 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarction). All atherosclerotic burden scores were independent predictors of cardiac events (hazard ratios of 3.09 for segment involvement score, 4.42 for segment stenosis score, and 5.39 for CT-LeSc). Cumulative event-free survival was 76.8% with a high CT-LeSc and 96.0% with a low CT-LeSc. Event-free survival in nonobstructive CAD with high CT-LeSc (78.6%) was similar to obstructive CAD with high CT-LeSc (76.5%) but lower than obstructive CAD with low CT-LeSc (80.7%). Conclusions— CT-LeSc is an independent long-term predictor of hard cardiac events. Patients with nonobstructive CAD and high CT-LeSc had hard event-free survival similar to patients with obstructive CAD.

Renal denervation for resistant hypertension

Abstract: There is a marked contrast between the high prevalence of hypertension and the low rates of adequate control. A subset of patients with suboptimal blood pressure control have drug-resistant hypertension, in the pathophysiology of which chronic sympathetic hyperactivation is significantly involved. Sympathetic renal denervation has recently emerged as a device-based treatment for resistant hypertension. In this review, the pathophysiological mechanisms linking the sympathetic nervous system and cardiovascular disease are reviewed, focusing on resistant hypertension and the role of sympathetic renal denervation. An update on experimental and clinical results is provided, along with potential future indications for this device-based technique in other cardiovascular diseases.

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Abstract: ABOARD : Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention ACC : American College of Cardiology ACE : angiotensin-converting enzyme ACS : acute coronary syndromes ACT : activated clotting time ACUITY : Acute Catheterization and Urgent Intervention Triage strategY AF : atrial fibrillation AHA : American Heart Association APPRAISE : Apixaban for Prevention of Acute Ischemic Events aPTT : activated partial thromboplastin time ARB : angiotensin receptor blocker ARC : Academic Research Consortium ATLAS : Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Aspirin With or Without Thienopyridine Therapy in Subjects with Acute Coronary Syndrome BARI-2D : Bypass Angioplasty Revascularization Investigation 2 Diabetes BMS : bare-metal stent BNP : brain natriuretic peptide CABG : coronary bypass graft CAD : coronary artery disease CI : confidence interval CK : creatinine kinase CKD : chronic kidney disease CK-MB : creatinine kinase myocardial band COX : cyclo-oxygenase CMR : cardiac magnetic resonance COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CPG : Committee for Practice Guidelines CrCl : creatinine clearance CRP : C-reactive protein CRUSADE : Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines CT : computed tomography CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CURRENT : Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events CYP : cytochrome P450 DAPT : dual (oral) antiplatelet therapy DAVIT : Danish Study Group on Verapamil in Myocardial Infarction Trial DES : drug-eluting stent DTI : direct thrombin inhibitor DIGAMI : Diabetes, Insulin Glucose Infusion in Acute Myocardial Infarction EARLY-ACS : Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome ECG : electrocardiogram eGFR : estimated glomerular filtration rate ELISA : Early or Late Intervention in unStable Angina ESC : European Society of Cardiology Factor Xa : activated factor X FFR : fractional flow reserve FRISC : Fragmin during Instability in Coronary Artery Disease GP IIb/IIIa : glycoprotein IIb/IIIa GRACE : Global Registry of Acute Coronary Events HINT : Holland Interuniversity Nifedipine/Metoprolol Trial HIT : heparin-induced thrombocytopenia HORIZONS : Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction HR : hazard ratio hsCRP : high-sensitivity C-reactive protein ICTUS : Invasive vs. Conservative Treatment in Unstable coronary Syndromes INR : international normalized ratio INTERACT : Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment ISAR-COOL : Intracoronary Stenting With Antithrombotic Regimen Cooling Off ISAR-REACT : Intracoronary stenting and Antithrombotic Regimen- Rapid Early Action for Coronary Treatment i.v. : intravenous LDL-C : low-density lipoprotein cholesterol LMWH : low molecular weight heparin LV : left ventricular LVEF : left ventricular ejection fraction MB : myocardial band MDRD : Modification of Diet in Renal Disease MERLIN : Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes MI : myocardial infarction MINAP : Myocardial Infarction National Audit Project MRI : magnetic resonance imaging NNT : numbers needed to treat NSAID : non-steroidal anti-inflammatory drug NSTE-ACS : non-ST-elevation acute coronary syndromes NSTEMI : non-ST-elevation myocardial infarction NT-proBNP : N-terminal prohormone brain natriuretic peptide OASIS : Organization to Assess Strategies for Ischaemic Syndromes OPTIMA : Optimal Timing of PCI in Unstable Angina OR : odds ratio PCI : percutaneous coronary intervention PENTUA : Pentasaccharide in Unstable Angina PLATO : PLATelet inhibition and patient Outcomes PURSUIT : Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy RCT : randomized controlled trial RE-DEEM : Randomized Dabigatran Etexilate Dose Finding Study In Patients With Acute Coronary Syndromes (ACS) Post Index Event With Additional Risk Factors For Cardiovascular Complications Also Receiving Aspirin And Clopidogrel REPLACE-2 : Randomized Evaluation of PCI Linking Angiomax to reduced Clinical Events RIKS-HIA : Register of Information and Knowledge about Swedish Heart Intensive care Admissions RITA : Research Group in Instability in Coronary Artery Disease trial RR : relative risk RRR : relative risk reduction STE-ACS : ST-elevation acute coronary syndrome STEMI : ST-elevation myocardial infarction SYNERGY : Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trial SYNTAX : SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery TACTICS : Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy TARGET : Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial TIMACS : Timing of Intervention in Patients with Acute Coronary Syndromes TIMI : Thrombolysis In Myocardial Infarction TRITON : TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction UFH : unfractionated heparin VKA : vitamin K antagonist VTE : venous thrombo-embolism Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the European Society of Cardiology (ESC) Core Curriculum topics. Guidelines and recommendations should help the physicians to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible physician(s). A great number of Guidelines have been issued in recent years by the ESC as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management, and/or prevention of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . …

Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes

Abstract: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to the …