SUMMARY OBJECTIVES This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults. METHODS A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients. RESULTS After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients – 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies. CONCLUSIONS Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.
Background:The SYNTAX score was developed as an angiographic tool to grade the complexity of coronary artery disease in patients with three-vessel and/or left main disease. The role of this score in predicting clinical outcomes after percutaneous coronary intervention (PCI) in non-selected patients treated in the daily clinical practice of a referral centre was evaluated. Methods: Analysis of patients undergoing PCI from March to September of 2009, and at the 12-month follow-up. Patients were divided into tertiles according to the SYNTAX score. The primary endpoint included major adverse cardiac events (MACE) -death, non-fatal acute myocardial infarction, and target-vessel revascularisation. The ability of the SYNTAX score to predict MACE was assessed by the receiver operator characteristic (ROC) curve. Results: Two hundred and thirty-four patients with a mean SYNTAX score of 11.6 ± 6.2 points were included. Tertile I had a SYNTAX score ≤ 9 (average 5.9); tertile II, > 9 and ≤ 13 (average 10.8); and tertile III, > 13 (average 18.3). During the clinical follow-up of 7.2 ± 4.9 months, the incidence of MACE was greater in tertile III than in tertiles I and II (2.5% vs. 6.4% vs. 14.1%; P = 0.0075). The ROC curve showed an area under the curve of 0.667 (P = 0.012), indicating a moderate ability to anticipate the occurrence of MACE in this population. Conclusions: The SYNTAX score proved to be useful in predicting the occurrence of MACE after PCI in patients treated in clinical practice.
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