IJCS | Volume 32, Nº6, November / December 2019

577 Duarte et al. Chocolate consumption and infarction Int J Cardiovasc Sci. 2019;32(6):576-582 Original Article cocoa in the daily diet could reduce cardiovascular outcomes, make them less severe and improving the prognosis of patients after an AMI episode. Chocolate, whose composition is rich in flavonoids, may have an adjuvant effect to ischemic disease therapies, mainly due to the anti-inflammatory action. 5-7 However, although there are indications that chocolatemaydecrease the occurrence of AMI events, there is no evidence that it may be associated with lower complexity of coronary lesions in patients with AMI or that AMI may be less severe. This study analyzes the association between chocolate consumption and the complexity of coronary lesions, as well as the risk factors for cardiovascular outcomes and the severity of first infarction. Methods This study is a subanalysis of the Catarina Heart Study 10 — a prospective cohort study that began in July 2016 that is intended to evaluate 1,426 patients by the year 2020 and proposes a follow-up of thirty days and one year. The patients selectedwere diagnosed as having the first AMI andwere assisted at the Cardiology Institute of Santa Catarina and other hospitals in the State of Santa Catarina. Once the patients’ consent was taken, they answered a questionnaire that included different clinical, laboratory, electrocardiographic, echocardiographic and angiographic variables from July 2016 to July 2018. Inclusion criteria were minimum 18 years of age, presence of precordial pain suggestive of AMI associated with electrocardiogram with new ST-segment elevation at point J in two contiguous leads with ≥ 0.1 mv limits on all leads, in addition to the V2-V3 leads in which the following limits apply: ≥ 0.2 mv in men ≥ 40 years of age; ≥ 0.25 mv in men < 40 years of age, or ≥ 0.15 mV in women or the presence of precordial pain suggestive of AMI associated with elevation of troponin I or CK-MB above the 99 th percentile of the upper reference limit. Exclusion criterion was the presence of previous AMI. The primary endpoint of this study evaluated the association between chocolate consumption with severity, complexity and AMI complications. Secondary outcomes assessed the association between chocolate consumption and prevalence of classic cardiovascular risk factors and the correlation between chocolate consumption and variables associated with the complexity of coronary lesions and severity of infarction in patients who ate chocolate. Measurement of chocolate consumption was done by asking the patients whether they had chocolate or not and the number of chocolate bites eaten per week. 43 grams were used as standard for each bite eaten, and the total consumption per week was divided by the days in order to evaluate the average consumption in grams per day. To assess the severity and complexity of AMI, three variables were used: Syntax, Thrombolysis inMyocardial Infarction (TIMI) frame count and Left Ventricular Ejection Fraction (LVEF). The first variable is a score that considers the location, quantity and the respective repercussion of the lesions in the functioning of the coronary arteries, and the higher the Syntax index, the greater the complexity of coronary lesions. 11 The TIMI frame count evaluates the number of film frames from the beginning of the contrast injection to the range of the coronary artery end. It is an estimate of arterial perfusion performed after therapeutic management. 12 This variable was only applied for patients with AMI with ST- segment elevation. LVEF was estimated by transthoracic echocardiography within 72 hours after AMI. Hypertension, diabetes mellitus and dyslipidemia were self-reported at the time of the study. Chocolate consumption was considered positive in those who ate it regularly, at least once a week. Patients with a positive family history were considered those who had first- degree relatives with coronary artery disease, women ≤ 65 years old and men ≤ 55 years old. Regarding the use of drugs and alcohol, any consumption of these substances was considered positive. As for relevant smoking, consumption of any tobacco at the time of the interview. Statistical analysis The current study samplewas calculatedas 158patients with a power of 90% and alpha = 0.05 for a correlation of 0.35 between the consumption of chocolate per day in grams. Data were organized into a table and analyzed by the software SPSS 13.0. The qualitative variables were expressed using absolute and percentage numbers and evaluated using the chi-square test. Quantitative variables with normal distribution were presented as mean ± standard deviation and were evaluated using Student’s t-test for independent samples, while quantitative variables with non-normal distributionwere presented as median and interquartile range and were evaluated using Mann-Whitney’s U test. Normality was evaluated using the Kolmogorov-Smirnov test. Among patients who consumed chocolate, the amount in grams