que se leu este artigo
array:25 [ "pii" => "S0870255118307285" "issn" => "08702551" "doi" => "10.1016/j.repc.2018.10.005" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1310" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2018;37:909-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 860 "formatos" => array:3 [ "EPUB" => 95 "HTML" => 540 "PDF" => 225 ] ] "itemSiguiente" => array:19 [ "pii" => "S0870255117308004" "issn" => "08702551" "doi" => "10.1016/j.repc.2018.03.016" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1305" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2018;37:911-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 767 "formatos" => array:3 [ "EPUB" => 86 "HTML" => 445 "PDF" => 236 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "911" "paginaFinal" => "919" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Doença do tronco comum e/ou doença arterial coronária de três vasos em doentes com enfarte agudo do miocárdio sem elevação do segmento ST e <span class="elsevierStyleItalic">Score</span> Grace de baixo risco: prevalência, prognóstico clínico e preditores" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2214 "Ancho" => 2167 "Tamanyo" => 283739 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patient selection. ACS: acute coronary syndrome; GRACE: Global Registry of Acute Coronary Events; LM/3VD: left main and/or three-vessel disease; MI: myocardial infarction; NSTE-ACS: non-ST-segment elevation acute coronary syndrome; NSTEMI: non-ST-segment elevation acute myocardial infarction; STEMI: ST-segment elevation myocardial infarction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João Filipe Carvalho, Adriana Belo, Kisa Congo, David Neves, Ana Rita Santos, Bruno Piçarra, Ana Filipa Damásio, José Aguiar" "autores" => array:9 [ 0 => array:2 [ "nombre" => "João Filipe" "apellidos" => "Carvalho" ] 1 => array:2 [ "nombre" => "Adriana" "apellidos" => "Belo" ] 2 => array:2 [ "nombre" => "Kisa" "apellidos" => "Congo" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Neves" ] 4 => array:2 [ "nombre" => "Ana Rita" "apellidos" => "Santos" ] 5 => array:2 [ "nombre" => "Bruno" "apellidos" => "Piçarra" ] 6 => array:2 [ "nombre" => "Ana Filipa" "apellidos" => "Damásio" ] 7 => array:2 [ "nombre" => "José" "apellidos" => "Aguiar" ] 8 => array:1 [ "colaborador" => "on behalf of the investigators of the Portuguese Registry on Acute Coronary Syndromes (ProACS)" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117308004?idApp=UINPBA00004E" "url" => "/08702551/0000003700000011/v4_201911280953/S0870255117308004/v4_201911280953/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S087025511730776X" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.11.016" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1306" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2018;37:901-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 938 "formatos" => array:3 [ "EPUB" => 100 "HTML" => 531 "PDF" => 307 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "What is the role of beta-blockers in a contemporary treatment cohort of patients with acute coronary syndrome? A propensity-score matching analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "901" "paginaFinal" => "908" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Qual o papel dos bloqueadores-beta numa coorte de tratamento contemporânea de doentes com síndrome coronária aguda? Análise de emparelhamento de <span class="elsevierStyleItalic">score</span> de propensão" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 2500 "Tamanyo" => 147265 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Subgroup analysis. CI: confidence interval; HR: hazard ratio; LVEF: left ventricular ejection fraction; NSTE-ACS: non-ST-elevation acute coronary syndrome; STEMI: ST-elevation myocardial infarction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Teresa Timóteo, Sílvia Aguiar Rosa, Madalena Cruz, Rita Ilhão Moreira, Ramiro Carvalho, Maria Lurdes Ferreira, Rui Cruz Ferreira" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Ana Teresa" "apellidos" => "Timóteo" ] 1 => array:2 [ "nombre" => "Sílvia Aguiar" "apellidos" => "Rosa" ] 2 => array:2 [ "nombre" => "Madalena" "apellidos" => "Cruz" ] 3 => array:2 [ "nombre" => "Rita Ilhão" "apellidos" => "Moreira" ] 4 => array:2 [ "nombre" => "Ramiro" "apellidos" => "Carvalho" ] 5 => array:2 [ "nombre" => "Maria Lurdes" "apellidos" => "Ferreira" ] 6 => array:2 [ "nombre" => "Rui Cruz" "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730776X?idApp=UINPBA00004E" "url" => "/08702551/0000003700000011/v4_201911280953/S087025511730776X/v4_201911280953/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S087025511730776X" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.11.016" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1306" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2018;37:901-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 938 "formatos" => array:3 [ "EPUB" => 100 "HTML" => 531 "PDF" => 307 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "What is the role of beta-blockers in a contemporary treatment cohort of patients with acute coronary syndrome? A propensity-score matching analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "901" "paginaFinal" => "908" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Qual o papel dos bloqueadores-beta numa coorte de tratamento contemporânea de doentes com síndrome coronária aguda? Análise de emparelhamento de <span class="elsevierStyleItalic">score</span> de propensão" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 2500 "Tamanyo" => 147265 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Subgroup analysis. CI: confidence interval; HR: hazard ratio; LVEF: left ventricular ejection fraction; NSTE-ACS: non-ST-elevation acute coronary syndrome; STEMI: ST-elevation myocardial infarction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Teresa Timóteo, Sílvia Aguiar Rosa, Madalena Cruz, Rita Ilhão Moreira, Ramiro Carvalho, Maria Lurdes Ferreira, Rui Cruz Ferreira" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Ana Teresa" "apellidos" => "Timóteo" ] 1 => array:2 [ "nombre" => "Sílvia Aguiar" "apellidos" => "Rosa" ] 2 => array:2 [ "nombre" => "Madalena" "apellidos" => "Cruz" ] 3 => array:2 [ "nombre" => "Rita Ilhão" "apellidos" => "Moreira" ] 4 => array:2 [ "nombre" => "Ramiro" "apellidos" => "Carvalho" ] 5 => array:2 [ "nombre" => "Maria Lurdes" "apellidos" => "Ferreira" ] 6 => array:2 [ "nombre" => "Rui Cruz" "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730776X?idApp=UINPBA00004E" "url" => "/08702551/0000003700000011/v4_201911280953/S087025511730776X/v4_201911280953/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The dilemma of beta-blocker use after acute coronary syndrome: To support the dogma or to embrace the paradigm shift?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "909" "paginaFinal" => "910" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Daniel Ferreira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Daniel" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "dferreira@hospitaldaluz.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O dilema do uso de bloqueadores beta após uma síndroma coronária aguda: manter o dogma ou abraçar a mudança de paradigma?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">The old evidence</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the last quarter of the 20th century, beta-blockers have been considered a cornerstone therapy after acute coronary syndrome (ACS), alongside reperfusion therapy, antiplatelet agents, statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Together, these therapies have led to striking improvements in the outcome of these syndromes, in terms of both mortality and morbidity.</p><p id="par0015" class="elsevierStylePara elsevierViewall">More recent advances in organizational models of response to ACS and in reperfusion therapy, with wider availability of percutaneous coronary intervention (PCI) replacing pharmacological reperfusion therapy, have led to further significant reductions in mortality and morbidity, particularly in terms of heart failure and mechanical complications following myocardial infarction (MI).</p><p id="par0020" class="elsevierStylePara elsevierViewall">With every new advance in this field, researchers should question old dogmas and reassess previous strategies, procedures and drug indications. Current guidelines should be seen as such, as current, and should be periodically revised. This is regularly done by the major cardiological societies, at the national and continental (and even international) level.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the latest updates of the American and European guidelines on MI, beta-blocker use is still a class I or IIa indication for patients after both ST-elevation MI<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,2</span></a> and non-ST-elevation ACS.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">The new evidence</span><p id="par0030" class="elsevierStylePara elsevierViewall">However, several authors have questioned this indication, especially in patients without left ventricular dysfunction, in most cases on the basis of registries<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5–8</span></a> and/or meta-analyses of real-world population-based studies.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9–11</span></a> These authors all suggest that a paradigm shift is needed and that the guidelines’ indication for beta-blocker use after MI should be challenged.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, another piece of evidence is published that keeps this discussion wide open. In their interesting article, Timóteo et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> present a single-center study that again supports the use of beta-blockers after ACS, as this strategy showed a significant reduction in all-cause mortality, irrespective of residual left ventricular function.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The potential limitations of the study being based on a single center were overcome by a robust statistical analysis with the use of propensity-score matching, a large number of patients, and an impressive 99.8% of successful one-year follow-up.</p><p id="par0045" class="elsevierStylePara elsevierViewall">One of the limitations acknowledged by the authors is the lack of information regarding the type and dose of the beta-blockers used, but the same limitation also applies to similar studies and meta-analyses.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">The dilemma</span><p id="par0050" class="elsevierStylePara elsevierViewall">So we are faced with a significant dilemma. Should we support the dogmatic approach and continue to prescribe beta-blockers for our post-ACS patients, based on indications in the current guidelines and on studies like that of Timóteo et al.?<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">12–15</span></a> Or should we follow Thomas Kuhn's view that science is based on paradigm shifts and challenge these indications, as advocated by the above more recent meta-analyses?<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9–11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">I, for one, as a man of science, would like to have as much robust data as possible, which means that I would like to see contemporary randomized clinical trials (RCTs) that study the results of prescribing beta-blockers after ACS alongside the more recent strategies of care (including modern reperfusion therapies) recommended for these syndromes.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The question, of course, is whether the pharmaceutical industry would support RCTs that question the continued use of old and cheap drugs. This is a clear case for investigator-driven studies, supported by their institutions and/or medical societies, such as the recent article by Watanabe et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> which published the results of the CAPITAL-RCT study, showing no benefit from the use of carvedilol in patients with ST-elevation MI treated with primary PCI. Similar studies are needed in order to clarify this important clinical question.</p><p id="par0065" class="elsevierStylePara elsevierViewall">To the quote attributed to W. Edwards Deming, “In God we trust; all others must bring data,” I would add: “… robust data”.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">Daniel Ferreira has received honoraria (advisory board member and/or invited speaker) from Astellas, Astra-Zeneca, Bayer, BMS/Pfizer, Boehringer-Ingelheim, Novartis, and Sanofi-Aventis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "The old evidence" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "The new evidence" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "The dilemma" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.T. 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Ano/Mês | Html | Total | |
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2024 Novembro | 8 | 3 | 11 |
2024 Outubro | 50 | 29 | 79 |
2024 Setembro | 51 | 26 | 77 |
2024 Agosto | 44 | 25 | 69 |
2024 Julho | 44 | 27 | 71 |
2024 Junho | 39 | 20 | 59 |
2024 Maio | 40 | 22 | 62 |
2024 Abril | 37 | 31 | 68 |
2024 Maro | 52 | 25 | 77 |
2024 Fevereiro | 51 | 19 | 70 |
2024 Janeiro | 52 | 30 | 82 |
2023 Dezembro | 43 | 20 | 63 |
2023 Novembro | 59 | 31 | 90 |
2023 Outubro | 39 | 17 | 56 |
2023 Setembro | 32 | 25 | 57 |
2023 Agosto | 32 | 22 | 54 |
2023 Julho | 30 | 11 | 41 |
2023 Junho | 31 | 12 | 43 |
2023 Maio | 42 | 25 | 67 |
2023 Abril | 24 | 7 | 31 |
2023 Maro | 45 | 26 | 71 |
2023 Fevereiro | 42 | 26 | 68 |
2023 Janeiro | 33 | 16 | 49 |
2022 Dezembro | 40 | 29 | 69 |
2022 Novembro | 42 | 22 | 64 |
2022 Outubro | 72 | 30 | 102 |
2022 Setembro | 54 | 34 | 88 |
2022 Agosto | 98 | 38 | 136 |
2022 Julho | 96 | 36 | 132 |
2022 Junho | 44 | 23 | 67 |
2022 Maio | 31 | 30 | 61 |
2022 Abril | 36 | 34 | 70 |
2022 Maro | 38 | 43 | 81 |
2022 Fevereiro | 39 | 23 | 62 |
2022 Janeiro | 37 | 30 | 67 |
2021 Dezembro | 30 | 32 | 62 |
2021 Novembro | 43 | 35 | 78 |
2021 Outubro | 141 | 48 | 189 |
2021 Setembro | 38 | 28 | 66 |
2021 Agosto | 43 | 32 | 75 |
2021 Julho | 27 | 16 | 43 |
2021 Junho | 47 | 25 | 72 |
2021 Maio | 68 | 35 | 103 |
2021 Abril | 118 | 68 | 186 |
2021 Maro | 82 | 31 | 113 |
2021 Fevereiro | 68 | 24 | 92 |
2021 Janeiro | 64 | 17 | 81 |
2020 Dezembro | 46 | 11 | 57 |
2020 Novembro | 60 | 25 | 85 |
2020 Outubro | 43 | 22 | 65 |
2020 Setembro | 33 | 15 | 48 |
2020 Agosto | 38 | 13 | 51 |
2020 Julho | 51 | 13 | 64 |
2020 Junho | 31 | 20 | 51 |
2020 Maio | 36 | 11 | 47 |
2020 Abril | 43 | 9 | 52 |
2020 Maro | 51 | 11 | 62 |
2020 Fevereiro | 98 | 20 | 118 |
2020 Janeiro | 34 | 12 | 46 |
2019 Dezembro | 32 | 5 | 37 |
2019 Novembro | 25 | 11 | 36 |
2019 Outubro | 22 | 9 | 31 |
2019 Setembro | 22 | 11 | 33 |
2019 Agosto | 21 | 4 | 25 |
2019 Julho | 54 | 12 | 66 |
2019 Junho | 91 | 20 | 111 |
2019 Maio | 31 | 13 | 44 |
2019 Abril | 23 | 15 | 38 |
2019 Maro | 12 | 17 | 29 |
2019 Fevereiro | 14 | 9 | 23 |
2019 Janeiro | 22 | 12 | 34 |
2018 Dezembro | 42 | 40 | 82 |
2018 Novembro | 16 | 23 | 39 |