Desfechos de curto prazo da cirurgia de carótida: experiência no "mundo real" em um centro único de formação profissional / Short term outcomes of carotid surgery: the real-world experience of a single teaching center

Resumo Contexto A abordagem cirúrgica para estenose carotídea sintomática está consolidada na literatura para a prevenção de eventos neurológicos, devendo seguir padrões ótimos de qualidade. Entretanto, há uma crescente preocupação relacionada à possibilidade ou não de replicar os dados dos trabalhos controlados no mundo real. Objetivos Avaliar a população com estenose carotídea sintomática submetida a cirurgia e seus desfechos de curto prazo em um contexto de mundo real em um centro de formação profissional. Métodos Tratou-se de um estudo observacional realizado por meio de coleta de dados em prontuário de janeiro de 2012 a janeiro de 2023. Foram excluídos pacientes operados por outras etiologias e com cirurgia cardíaca concomitante. Resultados Foram incluídos 70 pacientes submetidos a angioplastia ou endarterectomia carotídea. Os subgrupos populacionais submetidos a angioplastia ou endarterectomia foram semelhantes. Houve diferença estatisticamente relevante quanto à modalidade anestésica e ao tempo cirúrgico maior para o subgrupo de endarterectomia carotídea. Houve quatro casos de acidente vascular encefálico isquêmico, e três deles estavam relacionados à lesão, sendo dois menores e um maior. Dessa forma, a taxa de acidente vascular encefálico maior relacionado à lesão foi de 1,43% e de qualquer acidente vascular encefálico relacionado à lesão, de 4,29%. A taxa total de eventos adversos cardiovasculares maiores foi de 5,71%. Houve um caso de infarto agudo do miocárdio no grupo angioplastia e nenhum óbito. Não houve diferença estatística entre os grupos de endarterectomia e angioplastia quanto aos desfechos principais. Conclusões Os desfechos acidente vascular encefálico isquêmico, infarto agudo do miocárdio, óbito e eventos adversos cardiovasculares maiores neste centro são semelhantes aos encontrados em estudos clínicos randomizados, demonstrando viabilidade da manutenção deste tratamento em centros com programas de ensino.

Abstract Background Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings. Objectives To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center. Methods Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded. Results A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes. Conclusions The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.

Alta temprana en infarto agudo de miocardio con elevación del segmento ST tratado con angioplastia primaria: estudio de intervención no controlado en Argentina / Early Discharge in Acute ST-segment Elevation Myocardial Infarction Treated with Primary Angioplasty: Uncontrolled Intervention Study in Argentina

RESUMEN Introducción y objetivos: El alta hospitalaria temprana (dentro de las primeras 48 horas) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratados con angioplastia coronaria primaria con stent (ATCp) ha sido adoptada en países desarrollados. Sin embargo, su implementación en Sudamérica ha sido dispar. Material y métodos: Estudio piloto de intervención no controlado, argentino, de pacientes con IAMCEST de bajo riesgo tratados con ATCp, para evaluar tasa de alta temprana y comparar la incidencia de eventos cardiovasculares adversos mayores (MACE) con la que ocurre en pacientes externados en forma no temprana. Resultados: Desde 2013 hasta 2021 se trataron con ATCp 320 pacientes con IAMCEST, de los que 158 fueron de bajo riesgo. Alta temprana en 63,9% (IC 95% 55,9-71,4%). La diabetes (OR 0,31; IC 95% 0,12-0,83) y el IAMCEST anterior (OR 0,34; IC 95% 0,16-0,69) se asociaron en forma independiente con menor probabilidad de alta temprana. Durante una mediana de seguimiento de 27,2 meses, la razón de tasas de incidencia de MACE entre los grupos de alta temprana y no temprana fue de 0,77 (IC 95 % 0,25-2,58; p = 0,61). Las variables asociadas de forma independiente con MACE fueron la revascularización completa (HR 0,18; IC 95% 0,03-0,95) y el tiempo de fluoroscopía (HR 1,02; IC 95% 1,01-1,05). No hubo diferencias significativas en las complicaciones del acceso vascular, las tasas de reingreso a 30 días y sobrevida global entre los grupos. Conclusiones: El alta temprana en pacientes con IAMCEST de bajo riesgo tratados con ATCp puede ser factible incluso en países en desarrollo, sin aumento significativo de la morbimortalidad.

ABSTRACT Background and objectives: Early discharge (within the first 48 hours) in patients with ST-segment elevation myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (PCI) with stenting is a strategy that has been adopted in developed countries. However, its implementation in South America has been uneven. Methods: We conducted an uncontrolled intervention pilot study on low-risk STEMI patients managed with primary PCI to evaluate the early discharge rate and compare the incidence of major adverse cardiovascular events (MACE) with those occurring in patients discharged later. Results: Of 320 STEMI patients managed with primary PCI from 2013 to 2021, 158 were low-risk patients and 63.9% (95% CI 55.9-71,4%) of them were discharged early. Diabetes (OR 0.31, 95% CI 0.12-0.83), and anterior wall STEMI (OR 0.34, 95% CI 0.16-0.69) were independently associated with lower probability of early discharge. During a median follow-up period of 27.2 months, the incidence rate ratio of MACE between the early discharge and non-early discharge groups was 0.77 (95% CI 0.25-2.58; p = 0.61). The variables independently associated with MACE were complete revascularization (HR 0.18, 95% CI 0.03-0.95) and fluoroscopy time (HR 1.02, 95% CI 1.01-1.05). There were no significant differences in vascular access complications, 30-day readmission rate and overall survival between groups. Conclusions: Early discharge in low-risk STEMI patients managed with primary PCI may be feasible even in developing countries, without significantly increasing morbidity and mortality.

Herramientas para la toma de decisiones en pacientes con enfermedad de múltiples vasos / Tools for Decision Making in Patients with Multivessel Disease

RESUMEN La decisión sobre la mejor estrategia de revascularización para los pacientes con enfermedad de múltiples vasos se ha tornado una tarea compleja a medida que la angioplastia coronaria ha mejorado sus resultados. En la siguiente revisión nos propusimos evaluar las variables que en nuestra experiencia definen el beneficio de una técnica sobre la otra, entendiendo que de esta manera la decisión del médico tratante se hace más sencilla y objetiva. Por otro lado, y festejando el saludable protagonismo que se le da al paciente, creemos que esta evaluación permite ofrecer argumentos sólidos para ayudarlo en la toma de la decisión.

ABSTRACT The decision on the best revascularization strategy for patients with multivessel disease has become a complex task as coronary angioplasty has improved its results. In the following review, we set out to evaluate the variables that, in our experience, define the benefit of one technique over the other, understanding that in this way the treating physician's decision will become simpler and more objective. On the other hand, and celebrating the healthy prominence given to patients, we believe that this evaluation allows solid arguments to help them in decision making.

Utilización de la estrategia farmacoinvasiva en Argentina. Análisis del registro ARGEN-IAM ST / Use of the Pharmacoinvasive Strategy in Argentina. ARGEN-IAM ST Registry Analysis

RESUMEN Introducción : La angioplastia primaria (ATCp) es el tratamiento de elección para el infarto agudo de miocardio con elevación del segmento ST (IAMCEST). En nuestro país, de tanta extensión territorial y con tiempos a la reperfusión subóptimos, la estrategia farmacoinvasiva (Finv) podría considerarse. Material y métodos : El ARGEN-IAM-ST es un registro prospectivo, multicéntrico, nacional y observacional. Se incluyen pacien tes con IAMCEST dentro de las 36 horas de evolución. Se definió en el mismo la utilización de Finv y las variables asociadas. Resultados : Se analizaron 4788 pacientes de los cuales en el 88,56 % se realizó ATCp, en el 8,46 % trombolíticos con reperfusión positiva (TL+), y solo en un 2,98% Finv. La mediana y rango intercuartílico (RIC) del tiempo total de isquemia fueron menores en aquellos que recibieron TL+ (165 min, RIC 100-269) y los que fueron a Finv (191 min, RIC 100-330) que en aquellos que fueron a ATCp (280 min, RIC 179- 520), p <0,001. No existieron diferencias en mortalidad intrahospitalaria, en el grupo Finv 4,9%, 5,2% en el grupo TL + y en el grupo ATCp 7,8% (p = 0,081). No hubo diferencias en término de sangrados mayores. Se observó que un 57% de los pacientes con TL+ reunían características de alto riesgo, y no recibieron Finv acorde a lo recomendado Conclusiones : Solo 3 de cada 100 pacientes con IAMCEST que se reperfunden reciben Finv. Su implementación no está ligada en forma sistemática al alto riesgo de eventos. Pese a esta subutilización, por presentar un menor tiempo total de isquemia que la ATCp, sin aumento en los sangrados clínicamente relevantes persiste como una opción a considerar en nuestra realidad.

ABSTRACT Background : Primary percutaneous coronary intervention (PPCI) is the treatment of choice for acute ST-elevation myocardial infarction (STEMI). In Argentina, a country with a large area and suboptimal reperfusion times, the pharmacoinvasive (PI) strategy might be considered. Methods : ARGEN-IAM-ST is a national prospective, multicenter, and observational registry that includes STEMI patients with less than 36 hours of progression. The PI strategy usage and its associated variables were defined. Results : In this registry, 4788 patients were analyzed, of which 88.56% underwent PPCI, 8.46% received thrombolytics with positive reperfusion (TL+), and only 2.98% received PI strategy. Median and interquartile range (IQR) of total ischemia time were lower in patients receiving TL+ (165 min, IQR 100-269) and PI (191 min, IQR 100-330) than in patients undergoing PPCI (280 min, IQR 179-520), p <0.001. No differences in intra-hospital mortality were observed: 4.9% in the PI strategy group, 5.2% in the TL+ group and 7.8% in the PPCI group (p = 0.081). No differences in major bleeding events were observed. It was observed that 57% of the TL+ patients met the criteria for high cardiovascular risk, but they did not receive PI strategy, as recommended. Conclusions : Only 3 out of 100 reperfused STEMI patients received PI strategy. Its administration is not systematically associated to high cardiovascular risk. Despite the under-usage, it remains an option to be considered due to its total ischemia time lower than in the PPCI, with no increase in clinically significant bleedings.

Optimización del tiempo puerta-balón mediante la implementación de un programa de mejora de procesos. Resultados a 5 años de funcionamiento / Optimization of Door-to-Balloon Time Implementing a Process Improvement Program. Results after 5 Years

RESUMEN Introducción : de estar disponible, la angioplastia primaria (ATCp), en tiempos adecuados y en centros con experiencia, es la mejor estrategia de reperfusión para el infarto agudo de miocardio con supradesnivel del segmento ST (IAMCEST). El tiempo puerta-balón (TPB) es una expresión de eficiencia operativa de la institución que realiza la ATCp, con impacto en la evolución del paciente. El objetivo de este trabajo fue analizar los resultados a largo plazo de un programa de mejora continua del proceso TPB. Material y métodos : se incluyeron en forma prospectiva y consecutiva pacientes con diagnóstico de IAMCEST sometidos a ATCp desde enero de 2015 a mayo de 2022. La población se dividió en dos períodos: período de implementación inmediata y período de seguimiento a largo plazo. Resultados : se ingresaron 671 pacientes en forma prospectiva y consecutiva. En el primer período, de implementación, (P1), se incluyeron 91 pacientes, y en el segundo período, de seguimiento del programa, (P2), 580 pacientes. La mediana (rango intercuartilo, RIC) de TPB fue de 46 min (29-59) en P1 vs 42 min(25-52) en el P2, p = 0,055. En el segundo período se evi denció una reducción de las preactivaciones (P1 54,1% vs P2 30%,p = 0,02) y los procedimientos on hours (42% en p1 vs 30% en P2, p = 0,029). Conclusión : el registro mostró el mantenimiento de los buenos resultados a largo plazo a pesar de una reducción de las preactivaciones y los procedimientos on hours.

ABSTRACT Background : If available, primary transluminal coronary angioplasty (PTCA), performed timely and in experienced sites, is the best reperfusion strategy for ST elevation myocardial infarction (STEMI). The door-to-balloon (DTB) time expresses operational efficiency of the site in charge of the PTCA, with an impact on patient's progress. The aim of this study was to analyze the long-term results of a continuous improvement program for the DTB time process. Methods : Patients diagnosed with STEMI who had undergone PTCA from January 2015 to May 2022 were prospectively and consecutively enrolled. The population was divided in two periods: an immediate implementation period and a long-term follow-up period. Results : 671 patients were prospectively and consecutively enrolled. During the implementation period (P1) 91 patients were enrolled, and 580 during the program follow-up (P2). The median (interquartile range, IQR) DTB time was 46 min (29-59) for P1 vs 42 min(25-52) for P2, p=0.055). The second period showed a reduction in pre-activations (P1 54,1% vs P2 30% p=0.02) and on-hour procedures (42% for P1 versus 30% for P2, p=0.029). Conclusion : The registry showed long-term maintenance of good results, despite reduced reactivations and on-hour procedures.

Impacto de la rehabilitación cardiaca de 8 vs 12 semanas sobre la calidad de vida de personas con angioplastia. Ensayo clínico aleatorizado / Impact of an 8 and 12-week Cardiac Rehabilitation Program on the Perception of Quality of Life in Patients with Coronary Angioplasty. A Randomized Controlled Trial

Introducción. La evaluación de la calidad de vida es un resultado de salud que comúnmente se asocia con la eficacia de los tratamientos derivados a los pacientes con enfermedad de las arterias coronarias. Específicamente, la literatura no es clara con respecto al papel de la rehabilitación cardíaca sobre la calidad de vida en población sometida a revascularización coronaria. Objetivo. Determinar si existen diferencias en la percepción de calidad de vida relacionada con la salud, después de asistir a un programa de rehabilitación cardiaca de 8 semanas comparado con uno de 12 semanas en personas post revascularización percutánea. Métodos. Ensayo clínico controlado aleatorizado, conformado por personas que asisten a rehabilitación cardíaca, divididas en dos grupos de estudio (8 y 12 semanas), quienes se evaluaron a través del Cuestionario SF-36.Resultados. La muestra estuvo conformada por 17 personas, con edad promedio de 63.1±6.9 años. Al comparar la evaluación pre y posttratamiento en cada grupo, se encontraron diferencias significativas en los dominios función física y rol físico en el grupo de 8 semanas; al realizar la comparación entre grupos hubo diferencias en el dominio emocional. Conclusión. Los resultados del estudio no evidenciaron diferencias en cuanto a la calidad de vida relacionada con la salud entre los grupos de estudio en el resultado global del cuestionario SF-36. Sin embargo, al comparar las dos intervenciones, el grupo de 8 semanas demostró mejores valores sobre el rol emocional

Introduction. The evaluation of quality of life is a health outcome that is commonly associated with the efficacy of treatments derived from patients with coronary artery disease. The literature is unclear regarding the role of cardiac rehabilitation on quality of life in the population undergoing coronary revascularization.Aim. To determine if there are differences in perception of health-related quality of life after attending an 8-week cardiac rehabilitation program compared to a 12-week program in people after coronary angioplasty. Methods. Randomized controlled clinical trial that included people with coronary angioplasty, who attended a cardiac rehabilitation program, divided in two groups (8 and 12 weeks), who were evaluated through the 8 domains of Short Form-36 Health Survey (SF-36). Results. The sample was made up of 17 people, with an average age of 63.1 ± 6.9 years. When comparing the evaluation before and after treatment in each group, sta-tistical differences were found in the physical-functioning and role-physical in 8 weeks group. Comparation between group show differences in role-emotional. Conclusion. The results of the present study did not show differences between the global score on health-related quality of life. However, when comparing the two in-terventions, the 8-week group showed better values on the role-emotional.

Eficácia da Hidratação Oral na Prevenção da Nefropatia Induzida por Contraste em Indivíduos Submetidos a Intervenções Coronárias Eletivas / Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions

Resumo Fundamento A nefropatia induzida por contraste (NIC) é definida como deterioração da função renal, representada por um aumento da creatinina sérica ≥25% ou ≥0,5 mg/dL até 72 horas após a exposição ao meio de contraste iodado (MCI). A medida preventiva mais eficaz até o momento é a hidratação venosa (HV). Pouco se sabe sobre a eficácia da hidratação oral (HO) ambulatorial. Objetivo Investigar se a HO ambulatorial com água é tão eficaz quanto a HV com solução salina a 0,9% na prevenção de NIC em procedimentos coronarianos eletivos. Métodos Neste estudo observacional retrospectivo, foram analisados prontuários médicos e dados laboratoriais para coletar dados de indivíduos submetidos a procedimentos coronarianos percutâneos com MCI. Os dados coletados entre 2012 e 2015 avaliaram indivíduos que foram submetidos à HV e entre 2016 e 2020 (após a implementação de um protocolo de HO), os indivíduos que foram submetidos à HO em casa antes e depois de procedimentos coronarianos, conforme orientação da equipe de enfermagem. A significância estatística adotada foi de α=0,05. Resultados No total, 116 pacientes foram incluídos neste estudo, 58 no grupo HV e 58 no grupo HO. Observou-se incidência de NIC de 15% (9/58) no grupo que recebeu HV e 12% (7/58) no grupo que recebeu HO (p=0,68). Conclusão O protocolo de HO realizado pelo paciente parece ser tão eficaz quanto o protocolo de HV hospitalar na proteção renal de indivíduos suscetíveis a desenvolver NIC em intervenções coronarianas eletivas. Essas descobertas devem ser testadas em ensaios mais abrangentes.

Abstract Background Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). Objetive To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. Methods In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. Results In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). Conclusion The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.

Prognóstico Relacionado à Terapia de Reperfusão Pós-Síndrome Coronariana Aguda na Atenção Secundária: Análise de Sobrevida em Longo Prazo na Estratégia ERICO / Prognosis Related to Reperfusion Therapy Post-Acute Coronary Syndrome in Secondary Care: Long-Term Survival Analysis in the ERICO Study

Resumo Fundamento A relação entre terapia de reperfusão após a síndrome coronariana aguda (SCA) e mortalidade na atenção secundária não é bem conhecida. Objetivos Avaliar o impacto de três estratégias terapêuticas: (1) terapia medicamentosa exclusiva, (2) Angioplastia Transluminal percutânea coronaria (ATPC) e (3) revascularização do miocárdio (RM) na sobrevida em longo prazo de participantes da Estratégia de Registro de Insuficiência Coronariana Aguda (ERICO). Métodos Análises de sobrevida para mortalidade por todas as causas, mortalidade por doença cardiovascular (DCV) e mortalidade por doença arterial coronariana (DAC) foram realizadas de acordo com três estratégias terapêuticas (tratamento clínico exclusivo, ATPC ou RM). Modelos de regressão de Cox foram usados para estimar o hazard ratio (HR) com intervalo de confiança de 95% (IC95%) de 180 dias a quatro anos de acompanhamento após a SCA. Os modelos são apresentados como modelo sem ajuste ou ajustado quanto à idade, sexo e DAC prévia, tipo de SCA, tabagismo, hipertensão, dislipidemia, fração de ejeção do ventrículo esquerdo e de acordo com o número de artérias coronárias principais obstruídas (≥50%). Resultados Entre os 800 participantes, as piores taxas de sobrevida (mortalidade por todas as causas e DCV) foram detectadas entre os indivíduos que se submeteram a RM. Houve correlação entre RM e DAC [HR: 2,19 (IC95% 1,05-4,55)], mas o risco perdeu significância no modelo multivariado. A ATPC foi associada a uma menor probabilidade de eventos fatais durante os quatro anos de acompanhamento: mortalidade por todas as causas [HR, análise multivariada: 0,42 (IC95% 0,26-0,70)], por DCV [HR: 0,39 (95% CI: 0,20-0,73)] e DAC [HR, análise multivariada: 0,24 (IC95% 0,09-0,63)] em comparação aos submetidos ao tratamento clínico exclusivo. Conclusão No ERICO, a ATPC após a SCA foi associada a um melhor prognóstico, principalmente sobrevida por DAC.

Abstract Background Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known. Objectives To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries. Results Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy. Conclusion In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.

Avaliação no Mundo Real de um Stent Eluidor de Sirolimus de Hastes Ultrafinas em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST Submetidos à Intervenção Coronária Percutânea Primária (Registro INSTEMI) / Real-World Assessment of an Ultrathin Strut, Sirolimus-Eluting Stent in Patients with ST-Elevation Myocardial Infarction Submitted to Primary Percutaneous Coronary Intervention (INSTEMI Registry)

Resumo Fundamento O padrão-ouro atual dos stents farmacológicos (SF) coronários consiste em ligas metálicas com hastes mais finas e polímeros bioabsorvíveis. Objetivos Nosso objetivo foi comparar um stent eluidor de sirolimus de hastes ultrafinas (Inspiron®) com outras plataformas de SF de terceira geração em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) submetidos à intervenção coronária percutânea (ICP) primária. Métodos Analisamos dados de um registro multicêntrico de IAMCSST de centros de referência da Região Sul do Brasil. Todos os pacientes foram submetidos à ICP primária, seja com Inspiron® ou outro SF de segunda ou terceira geração. Foi calculado pareamento por escore de propensão (PEP) para gerar grupos semelhantes (Inspiron® versus outros stents) em relação às características clínicas e do procedimento. Todos os testes de hipótese tiveram um nível de significância bilateral de 0,05. Resultados De janeiro de 2017 a janeiro de 2021, 1.711 pacientes foram submetidos à ICP primária, e 1.417 pacientes preencheram nossos critérios de inclusão (709 pacientes no grupo Inspiron® e 708 pacientes no grupo dos outros SF de segunda ou terceira geração). Após PEP, a amostra do estudo foi composta por 706 pacientes (353 pacientes no grupo Inspiron® e 353 pacientes no grupo dos demais SF de segunda ou terceira geração). As taxas de revascularização do vaso alvo (odds ratio [OR] 0,52; intervalo de confiança [IC] 0,21 a 1,34; p = 0,173), trombose de stent (OR 1,00; IC 0,29 a 3,48;p = 1,000), mortalidade (hazard ratio 0,724; IC 0,41 a 1,27; p = 0,257) e os desfechos cardiovasculares maiores (OR 1,170; IC 0,77 a 1,77; p = 0,526) foram semelhantes entre os grupos após um acompanhamento mediano de 17 meses. Conclusão Nossos achados mostram que o stent Inspiron® foi eficaz e seguro quando comparado a outros SF de segunda ou terceira geração em uma coorte contemporânea do mundo real de pacientes com IAMCSST submetidos à ICP primária.

Abstract Background The current gold standard of coronary drug-eluting stents (DES) consists of metal alloys with thinner struts and bioresorbable polymers. Objectives Our aim was to compare an ultrathin strut, sirolimus-eluting stent (Inspiron®) with other third-generation DES platforms in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI). Methods We analyzed data from a STEMI multicenter registry from reference centers in the South Region of Brazil. All patients were submitted to primary PCI, either with Inspiron® or other second- or third-generation DES. Propensity score matching (PSM) was computed to generate similar groups (Inspiron® versus other stents) in relation to clinical and procedural characteristics. All hypothesis tests had a two-sided significance level of 0.05. Results From January 2017 to January 2021, 1711 patients underwent primary PCI, and 1417 patients met our entry criteria (709 patients in the Inspiron® group and 708 patients in the other second- or third-generation DES group). After PSM, the study sample was comprised of 706 patients (353 patients in the Inspiron® group and 353 patients in the other the other second- or third-generation DES group). The rates of target vessel revascularization (OR 0.52, CI 0.21 - 1.34, p = 0.173), stent thrombosis (OR 1.00, CI 0.29 - 3.48, p = 1.000), mortality (HR 0.724, CI 0.41 - 1.27, p = 0.257), and major cardiovascular outcomes (OR 1.170, CI 0.77 - 1.77, p = 0.526) were similar between groups after a median follow-up of 17 months. Conclusion Our findings show that Inspiron® was effective and safe when compared to other second- or third-generation DES in a contemporary cohort of real-world STEMI patients submitted to primary PCI.

Trombose venosa profunda de veia ilíaca contralateral após stent venoso posicionado na confluência ilíaco-cava: um desafio terapêutico / Deep venous thrombosis of the contralateral iliac vein after stenting of the iliocaval confluence: a therapeutic challenge

Resumo O tratamento de escolha para pacientes com síndrome de compressão venosa sintomática é o implante de stent venoso. Entretanto, esse tratamento possui complicações bem documentadas e, embora rara, trombose venosa profunda contralateral é uma dessas complicações. Nosso objetivo é apresentar um caso de trombose venosa profunda da veia ilíaca contralateral como resultado do posicionamento do stent além do preconizado e o desafio terapêutico que é a recanalização da veia com reconstrução da confluência ilíaco-cava.

Abstract The treatment of choice for patients with symptomatic venous compression syndrome is venous stenting. However, this treatment has well-documented complications and, although rare, contralateral deep venous thrombosis is one of these complications. Our objective is to present a case of deep venous thrombosis of the contralateral iliac vein resulting from placement of the stent beyond the recommended position and the therapeutic challenge is to recanalize the vein with reconstruction of the iliocaval confluence.

Complicações locais e sistêmicas em pacientes pós-angioplastia coronariana transluminal percutânea primária / Complicaciones locales y sistémicas en pacientes tras angioplastia coronaria transluminal percutánea primaria / Local and systemic complications in patients after primary percutaneous transluminal coronary angioplasty

Objetivo: descrever as principais complicações pós-angioplastia primária em um hospital universitário. Método: pesquisa descritiva, com análise documental de registros de 78 pacientes submetidos à angioplastia primária. A coleta de dados ocorreu de setembro a novembro de 2020, em prontuários impressos, através de instrumento previamente elaborado. A análise foi por estatística descritiva. Resultados: predomínio de idosos, com média de 60,7 anos, do sexo masculino (76%), hipertensos (67,9%) e tabagistas (35,9%). As principais complicações encontradas foram hematoma (17,9%), nefropatia induzida por contraste (12,8%) e retenção urinária (5,1%). Os eventos cardíacos adversos maiores mais prevalentes foram reestenose coronariana (7,7%), óbito cardíaco (3,8%), infarto agudo do miocárdio (1,3%) e cirurgia de revascularização do miocárdio de urgência (1,3%). Conclusões: a identificação das complicações pós-angioplastia primária pode ofertar subsídios para qualificar o cuidado através da criação de protocolos de prevenção e intervenção precoce aos eventos adversos aos pacientes submetidos ao procedimento.(AU)

Objective: to describe the main complications after primary percutaneous transluminal coronary angioplasty in a university hospital. Method: descriptive, research with documentary analysis with data of 78 patients submitted to primary angioplasty. Data collection took place from September to November 2020, in printed medical records, using a previously prepared instrument. The analysis was by descriptive statistics. Results: predominance of elderly, with an average of 60.7 years, male (76%), hypertensive (67.9%) and smokers (35.9%). The main complications found were hematoma (17.9%), contrast-induced nephropathy (12.8%) and urinary retention (5.1%). The most prevalent major adverse cardiac events were coronary restenosis (7.7%), cardiac death (3.8%), acute myocardial infarction (1.3%) and urgent myocardial revascularization surgery (1.3%). Conclusions: the identification of complications after primary angioplasty can offer subsidies to qualify care through the creation of prevention and early intervention protocols for adverse events in patients undergoing the procedure.(AU)

Objetivo: describir las principales complicaciones posteriores a la angioplastia coronaria transluminal percutánea primaria en un hospital universitario. Método: investigación por análisis documental de registros de 78 pacientes sometidos a angioplastia primario. La recolección de datos fue en septiembre a diciembre de 2020, en historias clínicas impresas, por instrumento preparado previamente. El análisis fue descriptivo. Resultados: predominio de ancianos, con una media de 60,7 años, varones (76%), hipertensos (67,9%) y fumadores (35,9%). Las principales complicaciones encontradas fueron hematoma (17,9%), nefropatía por contraste (12,8%) y retención urinaria (5,1%). Los eventos cardíacos adversos mayores más prevalentes fueron la reestenosis coronaria (7,7%), muerte cardíaca (3,8%), infarto agudo de miocardio (1,3%) y cirugía urgente de revascularización del miocardio (1,3%). Conclusiones: la identificación de las complicaciones después de la angioplastia primaria puede ofrecer subsidios para calificar la atención mediante la creación de protocolos de prevención e intervención temprana de eventos adversos en pacientes sometidos al procedimiento.(AU)

Tiempos de reperfusión de un programa guiado por telemedicina para la atención del infarto agudo de miocardio con elevación del ST en la Provincia de La Pampa / Reperfusion Times in a Telemedicine-guided Program for the Management of ST-segment Elevation Myocardial Infarction in the Province of La Pampa

RESUMEN Introducción: Los tiempos de atención médica son un factor relevante para la mortalidad por infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Objetivos: Evaluar los tiempos de reperfusión en pacientes con IAMCEST participantes de un programa de atención médica cardiológica basada en telemedicina en la provincia de La Pampa durante el período transcurrido entre agosto de 2018 y diciembre de 2021. Material y Métodos: Este programa consiste en la protocolización de la atención de los pacientes que cursan un síndrome coronario agudo (SCA) en las diferentes localidades de la provincia, con asistencia cardiológica remota las 24 horas del día, que incluye tanto la asistencia diagnóstica como la coordinación de las medidas terapéuticas, incluyendo la posibilidad de administrar trombolíticos a nivel local, con asistencia remota. Resultados: De un total de 72 IAMCEST evaluados, 44 recibieron como terapia de reperfusión trombolisis, 25 angioplastia primaria, y 3 trombolisis seguida de angioplastia de rescate. De los 47 sujetos que recibieron trombolisis, sólo 5 requirieron de traslado al centro de referencia para realizar este procedimiento. La mediana de tiempo puerta-aguja fue de 24 minutos y el tiempo puerta-balón fue de 105 minutos. El 28% de los sujetos con angioplastia primaria tuvieron un tiempo puerta-balón inferior a los 90 minutos y el 53,2% de los tratados con trombolíticos cumplieron con un tiempo puerta-aguja menor a 30 minutos. Conclusiones: La implementación de un programa de atención descentralizada guiada por telemedicina se asoció a un elevado porcentaje de cumplimento de las metas de implementación de la terapia de reperfusión basada en fibrinolíticos.

ABSTRACT Background: Timing of medical care is a relevant factor for ST-segment elevation myocardial infarction (STEMI) mortality. Objectives: The aim of the present study is to evaluate reperfusion times in STEMI patients participating in a telemedicinebased cardiology care program in the province of La Pampa during the period between August 2018 and December 2021. Methods: This program consists of a protocol for the management of patients with acute coronary syndrome (ACS) in the different locations of the province, with 24-hour remote assistance provided by cardiologists including both diagnostic support and coordination of on-site thrombolysis. Results: Of a total of 72 STEMI patients evaluated, 44 received thrombolysis as reperfusion therapy, 25 received primary percutaneous coronary intervention, and 3 received thrombolysis followed by rescue percutaneous coronary intervention. Of the 47 subjects who received thrombolysis, only 5 required to be transferred to the referral center for this procedure. Median door-to-needle time was 24 minutes and door-to balloon-time was 105 minutes. Twenty-five percent of the subjects had a door-to-balloon time <90 minutes and 53.2% fulfilled a door-to-needle time <30 minutes. Conclusions: The implementation of a telemedicine-guided program for decentralized management of STEMI patients was associated with a high percentage of compliance with the goals of implementing fibrinolytic-based reperfusion therapy.

Preditores de Mortalidade Hospitalar nos Pacientes Tratados por Angioplastia Primária: Um Estudo de Caso-Controle Multicêntrico / Predictors of Hospital Mortality Based on Primary Angioplasty Treatment: A Multicenter Case-Control Study

Resumo Fundamento A estratificação do risco de morte dos pacientes no contexto da angioplastia primária (ATC) é fundamental. Objetivo Identificar os fatores relacionados ao desfecho morte em pacientes submetidos a ATC. Métodos Estudo de caso-controle, utilizando como fonte de dados um registro brasileiro. A associação entre cada variável e o desfecho óbito foi avaliada via modelo de regressão logística binária. Consideramos significativo p<0,05. Resultados Foram analisados 26.990 registros, sendo 18.834 (69,8%) do sexo masculino, com idade mediana de 61 (17) anos. Na análise multivariada, as principais variáveis relacionadas ao desfecho óbito com seus respectivos odds ratio e intervalos de confiança (IC) com nível de significância de 95% foram a idade avançada 70 - 79 anos (2,46; 1,64 - 3,79) e ≥ 80 anos (3,68; 2,38 - 5,81), p<0,001, classificação de Killip II (2,71; 1,92 - 3,83), Killip III (8,14; 5,67 - 11,64), Killip IV (19,83; 14,85 - 26,69), p<0,001, disfunção global acentuada do ventrículo esquerdo (VE) (3,63; 2,39 - 5,68), p<0,001 e ocorrência de infarto após a intervenção (5,01; 2,57- 9,46), p<0,001. O principal fator protetor foi o fluxo TIMI III pós-intervenção (0,18; 0,13 - 0,24), p<0,001, seguido do TIMI II (0,59; 0,41 - 0,86), p=0,005, sexo masculino (0,79; 0,64 - 0,98), p= 0,032, dislipidemia (0,69; 0,59 - 0,85), p<0,001 e número de lesões tratadas (0,86; 0,9 - 0,94), p<0,001. Conclusão Os preditores de mortalidade nos pacientes submetidos a ATC foram: classificação de Killip, reinfarto, idade, disfunção global acentuada do VE, sexo feminino e fluxo TIMI 0/I pós-intervenção.

Abstract Background Identification of high-risk patients undergoing primary angioplasty (PCI) is essential. Objective Identify factors related to the causes of death in PCI patients. Methods This work consisted of a multicenter case-control study using a Brazilian registry of cardiovascular interventions as the data source. The association between each variable and death was assessed using a binary logistic regression model, p <0.05 was considered significant. Results A total of 26,990 records were analyzed, of which 18,834 (69.8%) were male patients, with a median age of 61 (±17) years. In the multivariate analysis, the main variables related to the causes of death with their respective odds ratios and 95%confidence intervals (CI) were advanced age, 70-79 years (2.46; 1.64-3.79) and ≥ 80 years (3.69; 2.38-5.81), p<0.001; the classification of Killip II (2.71; 1.92-3.83), Killip III (8.14; 5.67-11.64), and Killip IV (19.83; 14.85-26.69), p<0.001; accentuated global dysfunction (3.63; 2,39-5.68), p<0.001; and the occurrence of infarction after intervention (5.01; 2.57-9.46), p<0.001. The main protective factor was the post-intervention thrombolysis in myocardial infarction (TIMI) III flow (0.18; 0.13-0.24), p<0.001, followed by TIMI II (0.59; 0.41 -0.86), p=0.005, and male (0.79; 0.64-0.98), p = 0.032; dyslipidemia (0.69; 0.59-0.85), p<0.001; and number of lesions treated (0.86; 0.9-0.94), p<0.001. Conclusion The predictors of mortality in patients undergoing PCI were Killip's classification, reinfarction, advanced age, severe left ventricular dysfunction, female gender, and post-intervention TIMI 0 / I flow.

Angioplastia simple de arteria tibial posterior en paciente diabético para el salvamento de la extremidad / Posterior tibial artery simple angioplasty in diabetic patient for limb salvage

Introducción: La diabetes mellitus constituye un factor de riesgo distintivo en la enfermedad arterial periférica. Esta produce típicamente la afectación de los vasos infrageniculares, asociada con mayor predisposición a ulceración y amputación que en pacientes no diabéticos. Debido al desenlace sombrío de estos pacientes es necesario revascularizar con el fin de salvar la extremidad. Objetivo: Presentar un caso en el que se utilizó la angioplastia simple de la arteria tibial posterior para salvar la extremidad de un paciente diabético. Presentación del caso: Se presenta un caso con diagnóstico de pie diabético isquémico infectado en la extremidad inferior izquierda. Al examen físico se constató lesión isquémica infectada en el quinto y cuarto dedos con extensión al dorso y planta del pie, y patrón esteno-oclusivo distal. Se detectó disminución de los índices de presiones distales. En la arteriografía se apreció oclusión de las arterias tibial anterior y peronea desde su origen, y lesiones esteno-oclusivas en la tibial posterior en el tercio inferior de la pierna. Se realizó angioplastia transluminal percutánea de la tibial posterior y el paciente recuperó pulso en tibial posterior con mejoría hemodinámica. Evolucionó satisfactoriamente y egresó con tratamiento médico. A los cinco meses de operado mantenía su pulso tibial posterior presente y la lesión cicatrizada. Conclusiones: La angioplastia simple de una de las arterias de la pierna puede resultar beneficiosa para la cicatrización de lesiones en el pie, aun siendo estas extensas(AU)

Introduction: Diabetes mellitus is a distinctive risk factor in peripheral artery disease. This typically produces the involvement of the infragenicular vessels, associated with a greater predisposition to ulceration and amputation than in non-diabetic patients. Due to the bleak outcome of these patients it is necessary to revascularize in order to save the limb. Objective: To present a case in which simple angioplasty of the posterior tibial artery was used to save the limb of a diabetic patient. Case Presentation: It is presented a case with a diagnosis of infected ischemic diabetic foot in the left lower extremity. On physical examination, infected ischemic lesion was found in the fifth and fourth toes with extension to the back and soles of the foot, and distal steno-occlusive pattern. Decreases in distal pressure indices were detected. Arteriography showed occlusion of the anterior tibial and peroneal arteries from their origin, and steno-occlusive lesions in the posterior tibial in the lower third of the leg. Percutaneous transluminal angioplasty of the posterior tibial was performed and the patient recovered pulse in the posterior tibial with hemodynamic improvement. The patient progressed satisfactorily and was discharged with medical treatment. Five months after surgery, the kept posterior tibial pulse present and the injury healed. Conclusions: Simple angioplasty of one of the arteries of the leg can be beneficial for the healing of foot injuries, even if these are extensive(AU)

Estudio AHORA 6: Angioplastia coronaria con alta HOspitalaria RÁpida en 6 horas / Early Hospital Discharge (Within Six Hours) for Patients Undergoing Coronary Angioplasty

RESUMEN Introducción: Es de práctica habitual la internación durante 24 h en los pacientes (P) intervenidos con una angioplastia coronaria (ATC) programada. Experiencias previas proponen el alta post ATC en el mismo día en P seleccionados. Material y métodos: Estudio prospectivo, aleatorizado, controlado, simple ciego. Se incluyeron P de 18 a 75 años candidatos a una ATC programada por acceso radial, con posibilidad de acceder al sistema de emergencias en menos de 40 minutos. Se excluyeron los P con fracción de eyección ventricular izquierda < 30%, Creatinina > 1,5 mg/dL, insuficiencia cardíaca, enfermedad pulmonar obstructiva crónica, diabetes descompensada, o anatomía coronaria muy compleja. Se dividió a la población en dos grupos (G). G 1: alta en 6 horas. G2: alta al día siguiente. Punto final primario: muerte o necesidad de rehospitalización dentro de las 24 h de realizado el procedimiento. Se realizó seguimiento telefónico la noche del procedimiento y a la mañana siguiente, presencial a las 48 h, y telefónico al mes, seis meses y un año. Resultados: Se adjudicaron aleatoriamente 80 P. Seis P (7,5%) presentaron criterios de exclusión durante el procedimiento. No se produjo ninguna muerte ni evento cardiovascular mayor en ninguno de ambos grupos. Al año de seguimiento se detectó 3,75% de reestenosis intra stent. Se detectó elevación de troponina en 20 P (25%) de los cuales 4 habían sido excluidos por complicaciones durante la ATC. En los restantes 16, la elevación de la troponina no tuvo repercusión clínica. Conclusión: En una población de pacientes entre 55 y 75 años, en su mayoría de género masculino, con alta prevalencia de infarto de miocardio previo, y depresión de la función ventricular, pudo realizarse una angioplastia programada por acceso radial con alta en 6 horas, con un adecuado margen de seguridad.

ABSTRACT Background: 24-hour hospitalization is common practice in patients (P) who underwent scheduled coronary angioplasty (PCI). Previous experiences propose same-day discharge in selected P. Methods: Prospective, comparative, randomized, single-blind study. P aged 18 to 75 years were included as candidates for a scheduled radial-access PCI with the possibility of accessing the emergency system in less than 40 minutes. P with left ventricular ejection fraction <30%, creatinine >1.5 mg/dL, heart failure, chronic obstructive pulmonary disease, decompensated diabetes or very complex coronary anatomy were excluded. The population was divided in two groups (G). G 1: same-day discharge in 6 hours. G2: discharge the next day. Primary endpoint: death or need for rehospitalization within 24 hours of the procedure. Follow-up was carried out by phone the night of the procedure and the next morning, in person at 48 hours, and by telephone after a month, six months and a year. Continuous variables were expressed as median and their respective interquartile range, and qualitative variables as percentages. Results: 80 P were randomized. Six P (7.5%) presented exclusion criteria during the procedure. There were no deaths or major cardiovascular events in either groups. At one year of follow-up, 3.75% of in-stent restenosis was detected. Troponin elevation was detected in 20 P (25%); 4 were P excluded due to complications during PCI, in the remaining 16 it had no clinical repercussion. Conclusion: In a population of patients between 55 and 75 years old, mostly male, with a high prevalence of previous myocardial infarction, and ventricular function depression, a scheduled radial-access PCI could be performed with same day discharge in 6 hours, with an adequate safety margin.

Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty / Efecto de la implementación de la planificación interdisciplinaria del alta en la adherencia al tratamiento y el reingreso en pacientes sometidos a angioplastia de la arteria coronaria / Efeito da implantação do planejamento de alta interdisciplinar na adesão ao tratamento e readmissão em pacientes submetidos à angioplastia coronariana

Objective. To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020. Methods. This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups. Results. Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Conclusion. The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning

Objetivo. Determinar el efecto de la planificación interdisciplinaria del alta en la adherencia al tratamiento y el reingreso en los pacientes sometidos a angioplastia de la arteria coronaria en el sur de Irán en 2020. Métodos. Este estudio experimental contó con un grupo de intervención y un grupo de control con evaluación pre-test y post-test. Participaron en el estudio 70 pacientes que se dividieron aleatoriamente en los grupos. En el grupo de intervención, la planificación del alta se realizó sobre la base de un enfoque interdisciplinario. En ambos grupos se examinó la adherencia al tratamiento antes, inmediatamente y un mes después de la intervención con una encuesta de 10 preguntas puntuadas de 1 a 5 (máximo puntaje = 50), así como el reingreso hasta tres meses después del alta. Resultados. Antes de la intervención, no hubo diferencias estadísticamente significativas entre el grupo de intervención y el de control en la puntuación de la adherencia al tratamiento (18.22 versus 17.37; p=0.84), pero inmediatamente y un mes después de la intervención los grupos mostraron una diferencia estadísticamente significativa (21.51 versus 46.14 y 23.28 versus. 43.12, respectivamente; p<0.001). A los tres meses del alta, la tasa de reingreso fue del 11.4% en el grupo de control, mientras que no se registró ningún reingreso en el grupo de intervención. Conclusión. La aplicación de la planificación interdisciplinaria del alta tuvo efectos positivos la adherencia del tratamiento y la tasa de reingreso en los pacientes sometidos a angioplastia de las arterias coronarias; por lo tanto, se sugiere que los gestores del sistema sanitario hagan los planes necesarios para institucionalizar este nuevo enfoque educativo para la planificación del alta de otros pacientes

Objetivo. Determinar o efeito do planejamento de alta interdisciplinar na adesão ao tratamento e readmissão em pacientes submetidos à angioplastia de artéria coronária no sul do Irã em 2020. Métodos. Este estudo experimental contou com um grupo intervenção e um grupo controle com avaliação pré-teste e pós-teste. Participaram do estudo 70 pacientes que foram divididos aleatoriamente em grupos. No grupo intervenção, o planejamento da alta foi realizado com base na abordagem interdisciplinar. Em ambos os grupos, a adesão ao tratamento foi examinada antes, imediatamente e um mês após a intervenção com um questionário de 10 questões pontuadas de 1 a 5 (pontuação máxima = 50), bem como a readmissão até três meses após a alta. Resultados. Antes da intervenção, não houve diferenças estatisticamente significativas entre os grupos intervenção e controle na pontuação de adesão ao tratamento (18.22 vr. 17.37; p = 0.84), mas imediatamente e um mês após a intervenção os grupos apresentaram diferença estatisticamente significativa (21.51 vr. 46.14 e 23.28 vr. 43.12, respectivamente; p <0.001). Aos três meses após a alta, a taxa de readmissão foi de 11.4% no grupo de controle, enquanto nenhuma readmissão foi registrada no grupo de intervenção. Conclusão. A aplicação do planejamento de alta interdisciplinar teve efeitos positivos na adesão ao tratamento e na taxa de readmissão em pacientes submetidos à angioplastia de artéria coronária; portanto, sugere-se que os gestores do sistema de saúde façam os planos necessários para institucionalizar essa nova abordagem educativa para o planejamento da alta de outros pacientes