Endovascular treatment of ischemic moyamoya disease / 国际脑血管病杂志

Moyamoya disease is a relatively rare cerebrovascular disease. Extracranial and intracranial vascular bypass is the first choice for moyamoya disease. However, due to the risk of complications and symptoms recurrence after surgery, there is still some controversy about surgical treatment. In recent years, with the development of minimally invasive interventional technology, the endovascular treatment of atherosclerotic ischemic cerebrovascular disease has been widely carried out in the world. Some doctors are also beginning to try endovascular treatment of ischemic moyamoya disease, but its efficacy and safety are still unclear. This article reviews the endovascular treatment of ischemic moyamoya disease.

Association between serum high-density lipoprotein subtype 3 cholesterol levels and coronary artery diseases severity and in-stent restenosis / 中华检验医学杂志

Objective:To explore the association between serum high density lipoprotein subtype 3 cholesterol (HDL3-C) levels and the severity and in-stent restenosis of patients with coronary artery disease.Methods:124 patients with coronary artery diseases and 62 healthy controls were included in this clinical case-control retrospective study. Participants were hospitalized from November 2020 to November 2021 at Jinling Hospital, Medical School of Nanjing University were enrolled. Patients with coronary artery disease were as follows: 28 patients with acute coronary syndrome and 96 patients with stable coronary heart disease. Serum HDL3-C levels as well as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined. According to the coronary artery angiography results of all patients at the time of admission, Gensini scores were calculated and patients were divided into in-stent restenosis group ( n=22), no in-stent stenosis group ( n=23) and non-stent implantation group ( n=79). The correlation between HDL3-C levels and other parameters was analyzed by Pearson or Spearman correlation analyses. Multivariate Logistic regression analyses were used to determine the impact of HDL3-C on the in-stent restenosis of coronary artery diseases. Results:Compared with controls, serum levels of HDL3-C and HDL-C were significantly decreased in patients with coronary artery diseases (all P<0.05). There was a significantly negative correlation between HDL3-C levels and Gensini scores ( r=-0.201, P=0.043). Among patients with coronary artery disease, serum levels of HDL3C, TC and TG in the in-stent restenosis group were significantly lower than in no in-stent stenosis group as well as than in the non-stent implantation group (all P<0.05). Multivariate Logistic regression analyses showed that after adjusting for age, sex, lipid-lowering drugs and TC, TG, LDLC parameters, HDL3-C ( OR=0.885, 95% CI 0.791-0.990, P=0.033) and HDL-C ( OR=0.018, 95% CI 0.001-0.426, P=0.013) levels were both independently associated with the occurrence of coronary artery disease; only HDL3-C levels (no in-stent stenosis group as the reference: OR=0.833, 95% CI 0.698-0.994, P=0.042; non-stent implantation group as the reference: OR=0.812, 95% CI 0.685-0.963, P=0.017) were independently associated with the presence of in-stent restenosis ( P<0.05). Conclusions:Serum HDL3-C levels are decreased in patients with coronary artery disease, especially in patients with in-stent restenosis. HDL3-C levels are associated with the severity of coronary artery lesions and the presence of in-stent restenosis of coronary arteries.

Evaluation of the efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension using pulmonary perfusion tomography imaging / 中华核医学与分子影像杂志

Objective:To evaluate the efficacy of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH) using 99Tc m-macroaggregated albumin (MAA) pulmonary perfusion tomography imaging. Methods:Twenty-five patients (4 males, 21 females; age (56.5±12.3) years) with CTEPH who underwent BPA from January 2017 to April 2020 in Beijing Chaoyang Hospital, Capital Medical University were enrolled retrospectively. Effect of BPA on the improvement of pulmonary lobe/pulmonary segment perfusion was analyzed, and the proportions of improved and unimproved pulmonary lobe/pulmonary segment perfusion by BPA were calculated. The percentages of perfusion defect scores (PPDs%) of lung perfusion tomography imaging before BPA and after 4-6 times BPA were compared and analyzed (paired t test). The correlations between PPDs% and mean pulmonary artery pressure (mPAP) before BPA and after BPA were analyzed respectively, and the correlation between decreased percentage of PPDs% and decreased percentage of mPAP after BPA were also analyzed (Pearson correlation analysis). Results:Among 150 lobes of 25 patients, 96.00%(144/150) lobes showed perfusion abnormalities before BPA. After BPA, 11.11%(16/144) showed complete improvement, 57.64%(83/144) showed partial improvement, and 31.25%(45/144) showed no improvement. Among 450 pulmonary segments of 25 patients, 62.44%(281/450) showed perfusion abnormalities before BPA. After BPA, 30.60%(86/281), 37.37%(105/281), 32.03%(90/281) showed complete, partial and no improvement, respectively. The post-BPA PPDs% was significantly lower than that of pre-BPA ((39.08±10.88)% vs (57.88±10.46)%; t=10.40, P<0.001). The post-BPA mPAP was significantly lower than that of pre-BPA ((32.36±10.57) vs (49.08±10.23) mmHg; 1 mmHg=0.133 kPa; t=10.25, P<0.001). There was no significant correlation between PPDs% and mPAP either before BPA ( r=0.01, P=0.953) or after BPA ( r=0.27, P=0.199), but there was a positive correlation between the changes of PPDs% and mPAP ( r=0.40, P=0.045). Conclusions:BPA can significantly improve the pulmonary perfusion and reduce mPAP in CTEPH patients. Pulmonary perfusion tomography imaging can be used to evaluate the efficacy of BPA in CTEPH.

Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center / Segurança e eficácia de angioplastias de fístulas arteriovenosas realizadas por nefrologistas: relato de um centro de nefrologia intervencionista brasileiro

ABSTRACT Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.

RESUMO Introdução: As fístulas arteriovenosas (FAV) são a primeira escolha de acesso vascular para hemodiálise. No entanto, elas apresentam uma alta incidência de estenoses venosas levando à trombose. Embora o treinamento em nefrologia intervencionista possa melhorar a acessibilidade para o tratamento das estenoses venosas, há dados limitados sobre a segurança e a eficácia desta abordagem realizada por nefrologistas treinados em países em desenvolvimento e de baixa renda. Métodos: Este estudo apresenta os resultados retrospectivos de angioplastias de FAV realizadas por nefrologistas treinados em um centro ambulatorial brasileiro de nefrologia intervencionista. O desfecho primário foi a taxa de sucesso técnico (conclusão do procedimento com angioplastia de todas as estenoses) e os desfechos secundários foram taxas de complicação e a patência geral das FAV. Achados: Duzentas e cinquenta e seis angioplastias foram realizadas em 160 FAV. A taxa de sucesso técnico foi de 88,77% e a principal causa de falha técnica foi a oclusão venosa (10%). A incidência de complicações foi de 13,67%, com apenas um paciente necessitando de internação e quatro acessos perdidos devido à presença de hematomas e/ou trombose. Hematomas de grau 1 foram a complicação mais frequente (8,2%). A patência geral encontrada foi de 88,2 e 80,9% a 180 e 360 dias após o procedimento, respectivamente. Conclusão: Nossos achados sugerem que a angioplastia de FAV realizada por nefrologistas treinados tem taxas de sucesso e patência aceitáveis, com uma baixa incidência de complicações maiores, bem como uma baixa necessidade de hospitalização.

Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate?

Abstract Background: ST-segment elevation acute myocardial infarction (STEMI) is a pathological process that involves cardiac muscle tissue death. Intravenous thrombolysis with fibrinolytics or primary percutaneous coronary intervention (PCI), an invasive technique, can be performed for tissue revascularization. PCI has been preferred as compared to non-invasive methods, although few studies have described its use in Brazil. Objectives: The aim of the present study was to analyze data on the use of primary PCI and investigate the relevance of hospitalizations for the treatment of STEMI in the country. Methods: A descriptive, cross-sectional analysis of data from the Brazilian Unified Health system (SUS) Department of Informatics (DATASUS) from 2010 to 2019 was conducted. Results: Hospitalizations for STEMI represented 0.6% of all hospital admissions in Brazil in the analyzed period, 0.9% of hospital costs, and 2.1% of deaths. The number of hospitalizations due to STEMI was 659,811, and 82,793 for PCIs. Length of hospital stay was 36.0% shorter and mortality rate was 53.3% lower in PCI. The mean cost of PCI was 3.5-fold higher than for treatment of STEMI. Conclusions: Data on hospitalizations for STEMI treatment in Brazil revealed high hospitalization and mortality rates, elevated costs, and long hospital stay. Although primary PCI is a more expensive and less used technique than other methods, it can reduce the length of hospital stay and mortality in the treatment of STEMI.

Síndrome de Wellens: o infarto agudo do miocárdio iminente / Wellens Syndrome: impending acute myocardial infarction

A síndrome de Wellens foi descrita em 1982 por Zwaan, Bär e Wellens. No eletrocardiograma, observam-se alterações morfológicas da onda T nas derivações precordiais, sugerindo estenose proximal grave da artéria coronária descendente anterior que representa iminente risco de infarto agudo do miocárdio e/ou morte súbita, com discreta ou nenhuma alteração da troponina sérica. Seu reconhecimento antecipado e a abordagem com reperfusão miocárdica precoce evitam desfechos desfavoráveis. A intervenção coronária percutânea e a revascularização miocárdica cirúrgica são as estratégias mais utilizadas para tratamento. Os autores descrevem dois casos de síndrome de Wellens tipos A e B tratados por diferentes estratégias de reperfusão.

Wellens syndrome was described by Zwaan, Bär and Wellens, in 1982. On the electrocardiogram, T wave morphological alterations are observed in precordial leads, suggesting severe proximal stenosis of the left anterior descending coronary artery and an imminent risk of acute myocardial infarction and/or sudden death, with slight or no alteration in serum troponin. Its early recognition and management with early myocardial reperfusion avoid unfavorable outcomes. Percutaneous coronary intervention and surgical myocardial revascularization are the most used strategies for treatment. The authors describe two cases of types A and B Wellens syndrome treated with different reperfusion strategies.

Effect of Tongxinluo capsule on improvement of cardiac function and expression of myocardial enzyme spectrum in patients with coronary heart disease after percutaneous coronary intervention / 中国医师进修杂志

Objective:To investigate the effects of Tongxinluo capsule on the improvement of cardiac function and the expression of myocardial enzyme spectrum in patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods:One hundred patients with coronary heart disease after PCI who received treatment in Hebei Xianghe County People′s Hospitalfrom April 2018 to April 2020 were enrolled and randomly divided into the observation group and the control group. The control group was given conventional treatment, while the observation group was treated with Tongxinluo capsule on the basis of the control group. Patients in both groups were treated for 3 months. The normal clinical remission after treatment was observed in the two groups. The improvement of cardiac function index left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF) and myocardial enzyme index aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isoenzyme - MB (CK - MB), lactate dehydrogenase (LDH), troponin T (TnT) were compared between the two groups before and after the treatment.Results:After treated for 3 months, the total effective rate in the observation group was higher than that in the control group: 92.0%(46/50) vs. 76.0%(38/50), the difference was statistically significant ( χ2 = 4.76, P<0.05). After treated for 3 months, the levels of LVEDV and LVESV in two groups were decreased, and the level of LVEF in two groups was increased, and the levels of LVEDV and LVESV in the observation group were lower than those in the control group: (153.39 ± 8.35) ml/m 2 vs. (155.57 ± 9.32) ml/m 2, (103.49 ± 9.25) ml/m 2 vs. (109.65 ± 10.46) ml/m 2; the levels of LVEF in the observation group was higher than that in the control group: (58.14 ± 7.41)% vs. (54.59 ± 6.92)%, the differences were statistically significant ( P<0.05). After treated for 3 months, the levels of AST, CK, CK-MB, LDH, TnT in two groups were decreased, and the levels of above index in the observation group were lower than those in the control group: (38.14 ± 7.28) U/L vs. (45.04 ± 8.12) U/L, (637.15 ± 75.25) U/L vs. (756.24 ± 85.24) U/L, (553.28 ± 53.14) U/L vs. (632.17 ± 62.81) U/L, (162.43 ± 15.41) U/L vs. (181.74 ± 19.25) U/L, (0.32 ± 0.15) μg/L vs. (0.39 ± 0.11) μg/L, the differences were statistically significant ( P<0.05). Conclusions:The application of Tongxinluo capsule in patients with coronary heart disease after PCI can effectively alleviate clinical symptoms, improve cardiac function, and regulate the enzyme activity of the body.

Clinical analysis of excimer laser atherectomy in the treatment of diabetic foot with infrapopliteal arteriopathy / 中国医师杂志

Objective:To explore the clinical efficacy of excimer laser atherectomy (ELA) in the treatment of diabetic foot with infrapopliteal arteriopathy.Methods:The clinical data of 36 patients (40 limbs) with diabetic foot complicated with inferior knee artery disease treated by ELA in Xinjiang Uygur Autonomous Region People′s Hospital from December 2019 to May 2021 were analyzed retrospectively. The success rate of ELA in the treatment of diabetic inferior genicular artery disease, ankle-brachial index (ABI), limb salvage rate and Visual Analogue Scale (VAS) score at 3 days and 3 and 6 months after operation was observed.Results:All the 36 patients were operated successfully, including 2 cases of flow-limiting dissection, 2 cases of arterial embolism and 1 case of hematoma at the puncture point. The ABI of patients 3, 6 months after operation was significantly higher than that before operation (all P<0.05), and the VAS score 3, 6 months after operation was significantly lower than that before operation (all P<0.05). The rate of limb (toe) salvage were 92.5%(37/40), 82.5%(33/40) at 3 d, 3 months and 77.5%(31/40) at 6 months after operation. Conclusions:ELA is safe and effective in the treatment of diabetic foot infrapopliteal arteriopathy, and the recent efficacy is fair.

Effect of subpatellar artery balloon molding on diabetic foot ulcer caused by arterial ischemia / 中国医师杂志

Objective:To explore the feasibility and efficacy of subpatellar artery balloon molding in the treatment of diabetic foot ulcer caused by arterial ischemia.Methods:The clinical data of patients with diabetic foot ulcer caused by subpatellar artery disease treated in Xuanwu Hospital of Capital Medical University from December 2020 to April 2022 were retrospectively analyzed. Among them, 29 patients received medical balloon dilatation (drug balloon group) and 30 patients received balloon dilatation alone (simple balloon group). The improvement of lower limb ischemia at 3 and 6 months after surgery was analyzed in the two groups. The observation indicators included case-fatality rate, limb preservation rate, ulcer healing, Rutherford grading and pain score.Results:There was no significant difference in preoperative Rutherford grading between the two groups ( P>0.05). Three and six months after operation, the Rutherford grading in both groups was significantly improved compared with that before surgery (all P<0.05), and there was no statistical significance between the two groups ( P>0.05). There was no significant difference in preoperative pain scores between the two groups ( P>0.05). The pain scores of both groups were significantly decreased 3 and 6 months after surgery ( P<0.05), and there was no statistical significance between the two groups ( P>0.05). Three and six months after surgery, the wound ulcer healing rate in the drug balloon group was higher than that in the simple balloon group [51.7%(15/29) vs 43.3%(13/30), P=0.519; 86.2%(25/29) vs 50.0%(15/30), P=0.002]. There was no death or amputation in the two groups 3 and 6 months after surgery. Conclusions:Balloon dilatation can improve severe limb ischemia of diabetic foot. Compared with balloon dilatation alone, drug balloon dilatation is more beneficial to the healing of ulcer wounds in diabetic limb ischemia patients.

Drug-coated balloon for in-stent restenosis in femoropopliteal segment: 1-year clinical outcomes from a multicenter study in China / 中华普通外科杂志

Objective:To evaluate the safety and efficacy at 1-year follow-up of the use of drug-coated balloon (DCB) for the treatment of femoropopliteal in-stent restenosis (ISR).Methods:This study enrolled 252 patients undergoing Orchid DCB angioplasty for peripheral arterial disease in the femoral-popliteal segment. The clinical data were retrospectively analyzed.Results:Forty-nine patients were eligible, including 29 (59.2%) chronic total occlusions belonging to TransAtlantic Inter-Society Consensus-Ⅱ(TASC Ⅱ) D, 7 (14.3%) thrombosis, and 14 (28.6%) moderate to severe calcifications. The mean lesion length was (215.9±97.1) mm. 69.4% were of occlusive lesions (Tosaka Ⅲ category). Only 1 provisional stent was implanted. 98% patients had severe claudication or even worse. Of these cases, 34 (73.9%) showed improvements in Rutherford category, while 11 (23.9%) did not change and 1 (2.2%) case deteriorated. The average value of ABI was 0.478±0.264 before surgery and 0.907±0.207 at the end of follow-up. The improvement in Rutherford category ( P<0.01) and ABI ( P<0.005) were both significant. The primary patency (PP) was 80.4%, and the freedom from clinically driven TLR was 84.8% at 1 year. During the follow-up period, there was no all-cause death and major limb amputation. Conclusion:This multicenter study demonstrated the effectiveness of DCB as a treatment for complicated and extensive ISR lesions within 12 months.

Effects of low-dose Esketamine on respiration, circulation and pain in elderly patients undergoing surgical treatment for iliac artery stenosis / 中华老年医学杂志

Objective:To examine the effects of low-dose Esketamine on circulatory function, respiratory function and pain in elderly patients undergoing peripheral vascular interventions, and to provide evidence for appropriate and safe use of Esketamine in elderly patients under anesthesia.Methods:Forty elderly patients with iliac artery stenosis at Beijing Anzhen Hospital affiliated to the Capital Medical University were enrolled and treated with balloon percutaneous transluminal angioplasty(PTA)and stent implantation on a selective basis.Among them, 33 were male and 7 were female with American Society of Anesthesiologists(ASA)physical classification of Ⅱ-Ⅲ.The patients were randomly divided into two groups(20 in each group)using the randomized number method, with the control group(Group C)given 2 ml normal saline intravenously and the Esketamine group(Group L)given Esketamine 0.25 mg/kg intravenously(slow intravenous administration within 1 min). Values of arterial blood pressure and heart rate in stabilized condition in the operating room were collected as the baseline(T0). Five minutes before the surgeon dilated the stenosed iliac artery, intravenous anesthetics were given in both groups as required for the trial.The first 5 minutes before dilatation of the stenosed iliac artery was used as T1, the first 4 minutes as T2, and the first 3 minutes as T3.The recording continued until the 25th minute after anesthetic administration as T30, with a collection of 25-minute blood pressure and heart rate values for analysis.Blood gas analysis was made for arterial blood samples drawn at the time patients entered the operating room(M1), 5 minutes after drug administration(M2), and 10 minutes after drug administration(M3). For all patients, the pain level was recorded using a self-reported scale while the iliac artery was dilated.The doses of vasoactive drugs were recorded from the beginning of the dilatation of the iliac artery to the end of the procedure in patients.Results:In Group C, PaO 2 at M2 was elevated compared with at M1( P=0.003); In Group L, PaCO 2 at M2 was elevated compared with at M1( P=0.011). At T4, systolic blood pressure and diastolic blood pressure were elevated in Group L compared with Group C, and the differences were statistically significant( t=2.403, 2.119, all P<0.05); At T3, heart rate was elevated in Group L compared with Group C, with a statistically significant difference( t=0.789, P=0.007); Compared with Group C, systolic blood pressure was lower in Group L from T6 to T15, with statistically significant differences( t=3.143, 2.403, 2.272, 3.460, 2.610, 2.568, 2.453, 2.367, 2.282, and 2.187, all P<0.05). Diastolic blood pressure was lower in Group L from T8 to T16, with statistically significant differences( t=3.880, 6.602, 2.967, 3.243, 2.641, 3.253, 3.114, 4.521, and 2.659, all P<0.05), and from T7 to T13, the heart rate was lower in Group L, and the differences were statistically significant( t=2.246, 3.285, 3.207, 2.752, 2.725, 2.713, and 2.473, all P<0.05). Compared with Group C, the incidence of dilatation pain in patients with iliac artery stenosis in Group L was lower, and the difference was statistically significant( χ2=6.140, P=0.030). Doses of vasoactive drugs in both groups, including raceanisodamine hydrochloride, norepinephrine, esmolol, and nicardipine, were lower in Group L, and the differences were statistically significant( t=3.573, 7.883, 3.889, and 6.665, P=0.039, 0.001, 0.046, and 0.006). Conclusions:Low-dose Esketamine causes mild respiratory depression and low circulatory excitation in elderly patients with iliac artery stenosis undergoing PTA, and also reduces painful irritation during blood vessel dilatation in elderly patients.

Application of imaging evaluation in endovascular recanalization of non-acute symptomatic intracranial large artery occlusion / 国际脑血管病杂志

Many studies have shown that endovascular recanalization is feasible for the treatment of non-acute symptomatic intracranial large artery occlusion. However, its incidence of perioperative complications is relatively high. Appropriate imaging evaluation can better observe the occluded segments of the vessels before procedure, thereby guiding the choice of clinical treatment.

Perfil Aterosclerótico da Artéria Carótida como Preditor de Risco para Reestenose após Implante de Stent Coronário / Carotid Artery Atherosclerotic Profile as Risk Predictor for Restenosis After Coronary Stenting

Resumo Fundamento: A incidência de reestenose da artéria coronária após o implante de um stent não farmacológico é mais baixa que na angioplastia com balão; no entanto, ainda apresenta altas taxas. Objetivo: O objetivo deste estudo foi identificar novos indicadores de risco para reestenose de stent usando ultrassonografia das carótidas que, em conjunto com indicadores já existentes, ajudariam na escolha do stent. Métodos: Realizamos um estudo prospectivo transversal incluindo 121 pacientes consecutivos com doença arterial coronariana que foram submetidos à intervenção coronária percutânea com angiografia nos 12 meses anteriores. Após os casos de reestenose de stent serem identificados, os pacientes foram submetidos à ultrassonografia de carótidas para avaliar a espessura da camada íntima média e placas ateroscleróticas. Os dados foram analisados por regressão múltipla de Cox. O nível de significância foi p<0,05. Resultados: A idade mediana dos pacientes foi de 60 anos (1º quartil = 55, 3º quartil = 68), e 64,5% dos pacientes eram do sexo masculino. A angiografia coronária mostrou que 57 pacientes (47,1%) apresentaram reestenose de stent. Cinquenta e cinco pacientes (45,5%) apresentaram placas ateroscleróticas ecolucentes nas artérias carótidas e 54,5% apresentaram placas ecogênicas ou nenhuma placa. Dos pacientes que apresentaram placas ecolucentes, 90,9% apresentaram reestenose do stent coronário, e daqueles com placas ecogênicas ou nenhuma placa, 10,6% apresentaram reestenose de stent. A presença de placas ecolucentes nas artérias carótidas aumentou o risco de reestenose de stent coronário em 8,21 vezes (RR=8,21;IC95%: 3,58-18,82; p<0,001). Conclusões: A presença de placas ateroscleróticas ecolucentes na artéria carótida constitui um preditor de risco de reestenose de stent coronário e deve ser considerada na escolha do tipo de stenta ser usado na angioplastia coronária.

Abstract Background: The incidence of restenosis of the coronary artery after a bare-metal stent implant has been lower than in simple balloon angioplasty; however, it still shows relatively high rates. Objective: The aim of this study was to find new risk indicators for in-stent restenosis using carotid ultrasonography, that, in addition to the already existing indicators, would help in decision-making for stent selection. Methods: We carried out a cross-sectional prospective study including 121 consecutive patients with chronic coronary artery disease who had undergone percutaneous coronary intervention with repeat angiography in the previous 12 months. After all cases of in-stent restenosis were identified, patients underwent carotid ultrasonography to evaluate carotid intima-media thickness and atherosclerosis plaques. The data were analyzed by Cox multiple regression. The significance level was set a p<0.05. Results: Median age of patients was 60 years (1st quartile = 55, 3rd quartile = 68), and 64.5% of patients were male. Coronary angiography showed that 57 patients (47.1%) presented in-stent restenosis. Fifty-five patients (45.5%) had echolucent atherosclerotic plaques in carotid arteries and 54.5% had echogenic plaques or no plaques. Of patients with who had echolucent plaques, 90.9% presented coronary in-stent restenosis. Of those who had echogenic plaques or no plaques, 10.6% presented in-stent restenosis. The presence of echolucent plaques in carotid arteries increased the risk of coronary in-stent restenosis by 8.21 times (RR=8.21; 95%CI: 3.58-18.82; p<0.001). Conclusions: The presence of echolucent atherosclerotic plaques in carotid artery constitutes a risk predictor of coronary instent restenosis and should be considered in the selection of the type of stent to be used in coronary angioplasty.

Tempos de atendimento e desfechos no infarto agudo do miocárdio com supradesnivelamento ST / Time of care and outcomes in ST-segment elevation myocardial infarction

Objetivo: Comparar os tempos de tratamento dor-porta e porta-balão em indivíduos com infarto agudo do miocárdio com supradesnivelamento ST com os desfechos cardiovasculares em 30 dias. Métodos: Trata-se de uma coorte histórica, realizada por meio da pesquisa de prontuários eletrônicos e dos bancos de dados já existentes dos serviços de hemodinâmica de todos os indivíduos atendidos com diagnóstico de infarto agudo do miocárdio com supradesnivelamento ST e submetidos à angioplastia, no período de março de 2015 a setembro de 2016, em dois hospitais públicos de grande porte de Porto Alegre (RS). Os desfechos foram o óbito intra-hospitalar e em 30 dias e os eventos cardíacos maiores hospitalares e em 30 dias. Resultados: Foram avaliadas as informações de 808 indivíduos, sendo 26,9% provenientes do Hospital de Clínicas de Porto Alegre e 73,1% do Instituto de Cardiologia ­ Fundação Universitária de Cardiologia. Não houve diferença significativa na caracterização da amostra. Um terço dos indivíduos analisados apresentou tempo dor- -porta menor ou igual a 180 minutos, e 72% tiveram tempo porta-balão menor que 90 minutos. A mediana do tempo total de isquemia foi de 338 minutos. Na avaliação dos tempos não houve diferença significativa entre os dois hospitais. Para eventos cardíacos maiores e óbitos intra- -hospitalares, o único tempo que se mostrou significativo, após o ajuste multivariado, foi o porta-balão, em que os indivíduos com tempo maior que 90 minutos apresentaram razão de risco de 1,06 (IC95% 1,02-1,11) e 5,78 (IC95% 1,44-23,2), respectivamente, para eventos cardíacos maiores e óbitos intra-hospitalares. Para eventos cardíacos maiores total e óbito total, nenhum dos três tempos se associou significativamente com o desfecho após ajuste. Contudo, o tempo porta-balão maior ou igual a 90 minutos também foi significativo para razão de risco bruto para ambos, assim como a dor-porta para óbito total. Conclusão: Os dados da pesquisa corroboram as recomendações internacionais para cumprimento dos menores tempos de atendimento, em especial do tempo porta-balão, para o bom prognóstico. Infelizmente, no país, o tempo de isquemia miocárdica ainda está muito aquém do ótimo, necessitando de melhorias na área para melhorar os desfechos nesses indivíduos.

Objective: To compare symptom-onset-to-door and door- -to-balloon times in individuals with ST-segment elevation myocardial infarction to the 30-day cardiovascular outcomes. Methods: This is a historical cohort, using electronic medical records and the existing databases of hemodynamic services of all individuals diagnosed with ST-segment elevation myocardial infarction undergoing angioplasty between March 2015 and September 2016, in two large public hospitals in Porto Alegre. The outcomes were in-hospital death and death in 30 days, and major adverse cardiac events in hospital and in 30 days. Results: The information of 808 patients was evaluated, with 26.9% from Hospital de Clínicas de Porto Alegre, and 73.1% from the Instituto de Cardiologia ­ Fundação Universitária de Cardiologia. There was no significant difference in the characterization of the sample. One-third of the individuals evaluated presented symptom-onset-to-door of 180 minutes or less, and 72% had door-to- -balloon time below 90 minutes. The median total ischemic time was 338 minutes. In the evaluation of the times, there was no significant difference between the two hospitals. For more major cardiac events and intra-hospital deaths, the only time that proved to be significant after the multivariate adjustment was the door-to-balloon time, in which individuals with time higher than 90 minutes had a risk ratio of 1.06 (95% CI 1.02-1.11) for major cardiac events and 5.78 (95% CI 1.44-23.2), for intra-hospital deaths. For total major adverse cardiac events and total death, none of the 3 times was significantly associated with the outcome after adjustment; however, door-to-balloon of 90 minutes or more was also significant for crude risk ratio for both, as well as symptom-onset-to-door for total death. Conclusion: The research data corroborate the international recommendations to meet shorter service times, especially door-to-balloon time, for a good prognosis. Unfortunately, in the country, the time of myocardial ischemia is still far from optimal, requiring improvement in the area to improve the outcomes in these individuals.

Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil

Abstract Background The use of an adequate door-to-balloon time (≤ 90 minutes) is crucial in improving the quality of care provided to patients with ST-segment elevation myocardial infarction (STEMI). Objective To determine the door-to-balloon time in the management of STEMI patients in a cardiovascular emergency department in a hospital of northern Brazil. Methods This was a cross-sectional study based on review of medical records. A total of 109 patients with STEMI admitted to the emergency department of a referral cardiology hospital in Pará State, Brazil, between May 2017 and December 2017. Correlations of the door-to-balloon time with length of hospital stay and mortality rate were assessed, as well as whether the time components of the door-to-balloon time affected the delay in performing primary percutaneous coronary intervention. Quantitative variables were analyzed by Spearman correlation and the G test was used for categorical variables. A p<0.05 was set as statistically significant. Results Median door-to-balloon time was 104 minutes. No significant correlation was found between door-to-balloon time and length of hospital stay or deaths, but significant correlations were found between door-to-balloon time and door-to-ECG time (p<0.001) and ECG-to-activation (of an interventional cardiologist) time (p<0.001). Conclusion The door-to-balloon time was longer the recommended and was not correlated with the length of hospital stay or in-hospital mortality. Door-to-ECG time and ECG-to-activation time contributed to the delay in performing the primary percutaneous coronary intervention. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Prediction of adverse cardiovascular events in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention / 中国基层医药

Objective:To investigate the application value of combined detection of hypoxia-inducible factor-1α (HIF-1α), N-terminal proBNP (NT-proBNP) and thromboxane B 2 (TXB 2) in the prediction of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction. Methods:The clinical data of 136 patients with acute ST-elevation myocardial infarction who received treatment in Jinhua Municipal Central Hospital, China between February 2018 and September 2019 were retrospectively analyzed. These patients were assigned to MACE group ( n = 33) and no MACE group ( n = 103) according to whether MACE occurred. The basic data was compared between the two groups. Serum levels of HIF-1α, NT-proBNP and TXB 2 prior to PCI were analyzed. The receiver operating characteristic (ROC) curve was plotted to investigate the application value of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of acute ST-elevation myocardial infarction after PCI. Results:At 6 months after PCI, MACE occurred in 33 out of 136 patients with acute ST-elevation myocardial infarction, with the incidence of 24.26%. There were no significant differences in age, sex and accompanied diseases between MACE and no MACE groups (all P > 0.05). Serum HIF-1α level in the MACE group was significantly lower than that in the no MACE group [(31.54 ± 5.26) ng/L vs. (37.18 ± 6.94) ng/L, t = 4.286, P < 0.05]. Serum levels of NT-proBNP and TXB 2 in the MACE group were (1 246.83 ± 243.71) μg/L and (125.13 ± 20.16) ng/L, respectively, which were significantly higher than those in the no MACE group [(876.92 ± 173.04) μg/L, (95.73 ± 18.24) ng/L, t = 9.617, 7.835, both P < 0.05]. ROC curve analysis showed that the optimal cutoff values of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 32.67 ng/L, 1 018.27 μg/L and 112.19 ng/L, respectively. The sensitivity and specificity of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 69.70% (23/33) and 98.06% (101/103), respectively. The specificity of the combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was higher than that of detection of serum HIF-1α, NT-proBNP or TXB 2 level alone. The area under the curve (AUC) plotted regarding the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI by combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was 0.901, which was significantly higher than the AUC obtained for detection of serum HIF-1α, NT-proBNP or TXB2 level alone ( Z = 2.007, 1.991 and 2.217, all P < 0.05). Conclusion:Combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels exhibits a higher value in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI than detection of serum HIF-1α, NT-proBNP or TXB 2 level alone.

SCA con elevación del ST: impacto del tiempo al diagnóstico en el tiempo puerta-balón en el mundo real. Datos del registro ARGEN-IAM-ST / ST-Segment Elevation ACS: Impact of Time to Diagnosis on Door-To-Balloon Time in the Real World. Data from the ARGEN-IAM-ST Registry

RESUMEN • Introducción: El tiempo trascurrido desde el inicio de los síntomas de infarto hasta el diagnóstico (TAD) puede influir en lograr un tiempo puerta-balón (TPB) <90 min. Material y métodos: Análisis retrospectivo que incluyó 1518 pacientes ingresados en forma prospectiva y consecutiva al registro ARGEN-IAM-ST. El 37,8% de ellos fue tratado con un TPB <90 min y el TAD (mediana) fue de 120 min (RIC 60-266). Se dividió a la población de acuerdo al TAD en dos grupos: menor de 120 min y mayor o igual que 120 min. Un TPB <90 min se logró más frecuentemente en el primer grupo (TAD <120 min): 44%, vs. 32,2% en el segundo grupo (p <0,001). Resutados: En el 56% de los pacientes con ATC in situ y TAD <120 min se logró un TPB <90 min, vs. en el 37,1% de quienes tuvieron un TAD >120 min (p <0,001). En pacientes derivados, no hubo diferencias en TPB <90 min de acuerdo al TAD: 27,5% vs. 25,7 (p: 0,3). En pacientes ingresados en horario laborable, el TPB <90 min se logró con TAD <120 min en un 49,8% vs. 36,3% con TAD >120 min (p: 0,003); la frecuencia siguió un patrón similar en los pacientes ingresados en horarios no laborables: 41,9% vs. 30,4%, respectivamente (p <0,001). Los predictores independientes de lograr un TPB <90 min en el análisis multivariado fueron la edad <75 años: OR 1,57 (1,1-2,25; p: 0,01), ATC en horario laborable: OR 1,32 (1,04-1,67; p: 0,002), ATC in situ: OR 2,4 (1,9-3,0; p <0,001), tener un ECG prehospitalario: OR 2,22 (1,73-2,86; p <0,001) y un TAD <120 min: OR 1,53 (1,23-1,9; p <0,001). Conclusiones: En los pacientes con un TAD <120 minutos se logra más frecuentemente un TPB <90 min, especialmente en los tratados in situ y en horario laborable. En los pacientes derivados, solo 1 de cada 3 logra un TPB <90 min y no hay relación con el TAD.

ABSTRACT • Background: Time elapsed from the onset of symptoms to diagnosis (TTD) can influence in achieving a door-to-balloon time <90 min (DBT <90 min). Methods: A retrospective analysis was performed on 1,518 patients prospectively and consecutively included in the ARGEN-AMI-ST registry. In 37.8% of cases. patients were treated with DBT <90 min and a median TTD of 120 min (IQR 60-266). The population was divided according to TTD above or below 120 min. A DBT <90 min was achieved more frequently in those with TTD <120 min: 44% vs. 32.2% (p <0.001) respectively. Results: In patients with in situ percutaneous coronary intervention (PCI) and TTD <120 min, DBT <90 min was achieved in 56% vs. 37.1% of cases with TTD >120 min (p <0.001). In referred patients, there were no differences in DBT <90 min according to TTD: 27.5% vs. 25.7% (p: 0.3). In patients admitted during working hours, DBT <90 min was achieved with TTD <120 min in 49.8% vs. 36.3% with TTD >120 min (p: 0.003), as well as in patients admitted during non-working hours: 41.9% vs. 30.4% (p <0.001). The independent predictors of achieving a DBT <90 min in the multivariate analysis were age <75 years: OR 1.57 (1.1-2.25; p: 0.01), PCI during working hours: OR 1.32 (1.04-1.67; p: 0.002), PCI in situ: OR 2.4 (1.9-3.0; p <0.001), having a pre-hospital ECG: OR 2.22 (1.73-2.86; p <0.001) and a TTD <120 min: OR 1.53 (1.23-1.9; p <0.001). Conclusions: In patients with TTD <120 minutes, a DBT <90 minutes is more frequently achieved, especially in those treated in situ and during working hours. In referred patients, only 1 in 3 achieves a DBT<90 min and there is no relationship with TTD.