ABSTRACT
Resumo Fundamento Vários estudos têm mostrado que as mulheres não recebem tratamento adequado e apresentam piores desfechos após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Por isso, é necessário investigar questões relacionadas ao gênero para melhor lidar com esse problema no Brasil. Objetivo Determinar se existe associação entre o sexo feminino e eventos adversos em uma coorte contemporânea de pacientes com IAMCSST submetidos à intervenção coronária percutânea primária (ICPp). Métodos Este foi um estudo prospectivo do tipo coorte de pacientes com IAMCSST submetidos à ICPp em um hospital universitário terciário entre março de 2011 e dezembro de 2021. Os pacientes foram categorizados em grupos de acordo com o sexo ao nascimento. O primeiro desfecho clínico foi ECAM em longo prazo. Os pacientes foram acompanhados por um período máximo de cinco anos. Um nível de significância bilateral de 0,05 foi aplicado em todos os testes de hipóteses. Resultados Entre os 1457 pacientes internados por IAMCSST no período do estudo, 1362 foram incluídos e 468 (34,4%) eram do sexo feminino. As mulheres apresentaram maior prevalência de hipertensão (73% vs. 60%, p<0,001), diabetes (32% vs. 25%, p=0,003) e classe Killip 3-4 na internação (17% vs. 12%, p=0,01); o escore de risco TIMI foi maior nas mulheres [4 (2, 6) vs. 3 (2, 5), p<0.001]. A mortalidade hospitalar não foi diferente entre os grupos (12,8% vs. 10,5%; p=0,20). Os ECAMs foram numericamente maiores nas mulheres que nos homens tanto durante a internação (16,0% vs. 12,6%, p=0,085) como em longo prazo (28,7% vs. 24,4%, p=0,089), com significância limítrofe. Após a análise multivariada, o sexo feminino não foi associado a ECAMs (HR = 1,14; IC95% 0,86 - 1,51; p = 0,36). Conclusão Em uma coorte prospectiva contemporânea de pacientes com IAMCSST submetidos à ICPp, pacientes do sexo feminino apresentaram idade mais avançada e mais comorbidades no basal que os pacientes do sexo masculino, mas não houve diferenças significativas entre os sexos quanto aos desfechos adversos no hospital ou em longo prazo.
Abstract Background Several studies have shown that women are usually undertreated and have worse outcomes after ST-segment elevation myocardial infarction (STEMI), hence the need to investigate questions related to sex in Brazil to better deal with the problem. Objective To determine whether female sex is still associated with adverse events in a contemporary cohort of patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Methods This was a prospective cohort study of STEMI patients submitted to pPCI in a tertiary university hospital between March 2011 and December 2021. Patients were categorized into groups based on their sex at birth. The primary clinical outcome was long-term MACCE. Patients were followed-up for up to five years. All hypothesis tests had a two-sided significance level of 0.05. Results Among 1457 patients admitted with STEMI in the study period, 1362 were included and 468 (34.4%) were women. Female patients had a higher prevalence of hypertension (73% vs. 60%, p <0.001), diabetes (32% vs. 25%, p=0.003) and Killip class 3-4 at hospital admission (17% vs. 12%, p=0.01); TIMI risk score was higher among women (4 [2, 6] vs. 3 [2, 5], p<0.001). In-hospital mortality was not different between groups (12.8% vs. 10.5%, p=0.20). In-hospital MACCE (16.0% vs. 12.6%, p=0.085) and long-term MACCE (28.7% vs. 24.4%, p=0.089) were numerically higher in women, with borderline significance. After multivariate analysis, female sex was not associated with MACCE (HR = 1.14; 95% CI 0.86 - 1.51; p = 0.36). Conclusion In a prospective cohort of STEMI patients submitted to pPCI, female patients were older and had more comorbidities at baseline, but no significant differences were found in terms of long-term adverse outcomes.
ABSTRACT
Background: Around 20% of percutaneous coronary interventions (PCIs) are used to treat coronary bifurcation syndromes. Technical success was defined as successfully bridging the occluded portion with a wire and balloon and reopening the artery with a 40% residual stenosis in all views. Technical success is defined by the absence of a serious adverse cardiac event throughout the hospital stay (MACE). The purpose of this study was to evaluate the procedural and clinical results associated with LM bifurcational intervention. Methods: A controlled study was carried out on 100 patients eligible to Left Main bifurcational intervention were included. the patients were divided into two groups according to the stenting technique used, the provisional group (n=70) who managed with one stent strategy, and the non-provisional group (n=30) who managed with a double kissing crush, culotte, T stenting, or TAP technique. This study recorded the incidence of MACE: death, non-fatal myocardial infarction, or target lesion revascularizations were recorded at 6 and 12 months of follow-up. Results: It is insignificantly different mortality incidence between the 2 groups but non-fatal myocardial infarction, stent thrombosis, re-PTCA, and target lesion revascularizations were significantly increased in the non-provisional group. As regards clinical success in 2 groups, this study found 68 patients in the provisional group and 24 patients in the non-provisional group fulfilled the characteristics of clinical success. Conclusions: In LM-bifurcational intervention, there is a significant increase in the incidence of MACE in the non-provisional group and so the clinical outcome is better in the provisional stenting than the non-provisional stenting.
ABSTRACT
Background:The pathophysiology of an atherosclerotic plaque is mediated by the mechanisms involving thrombus formation and systemic inflammation. While C-reactive protein (CRP) levels are useful in predicting a cardiovascular event in intermediate risk population, the usefulness of routinely measuring fibrinogen in patients with acute coronary syndrome (ACS) is debatable. Also, data on the association of these markers with periprocedural outcomes in patients undergoing percutaneous coronary interventions (PCI) is scarce. Aims: The study aimed to determine whether the levels of fibrinogen and CRP vary across the different spectra of CAD and whether they have any correlation with cardiac Troponin I levels. Materials and Methods: A total of 284 patients with coronary artery disease undergoing percutaneous coronary intervention were included in the study. Complete blood count, serum lipid profile, serum CRP, fibrinogen, and troponin I were measured for all patients. Results: Patients with STEMI had significantly higher levels of CRP as compared to those with unstable angina (USA) and chronic stable angina (CSA). Patients presenting with ACS had significantly higher baseline fibrinogen as compared to those with CSA. A significant positive correlation between CRP and admission Troponin I (r = 0.50; P < 0.05) as well as fibrinogen and admission troponin I (r = 0.30; P < 0.05) was observed. The CRP levels were significantly higher in 15 patients with periprocedural MI as compared to those who did not develop periprocedural MI. Conclusions: The levels of the markers of inflammation and atherothrombosis vary with presentation across varied spectra of CAD with generally higher levels in acute presentation and in those who develop periprocedural MI.
Subject(s)
Humans , Acute Coronary Syndrome , No-Reflow Phenomenon , Risk Factors , Coronary CirculationABSTRACT
Resumo Fundamento São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237)
Abstract Background Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237)
Subject(s)
Humans , Male , Aged , Coronary Artery Disease , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/surgery , Arteries , Brazil/epidemiology , Registries , Prospective Studies , Treatment Outcome , Middle Aged , Myocardial RevascularizationABSTRACT
The primary concern in percutaneous coronary intervention for bifurcation lesions is occlusion of a side branch after stenting of a main branch, especially in high-risk patients. We describe a novel technique, consecutive jailed- and kissing-Corsair technique, using a Corsair microcatheter for protection of side branches in bifurcation lesions.
Subject(s)
Humans , Percutaneous Coronary Intervention , StentsABSTRACT
Objective To investigate the current status of subjective well-being in patients with coronary heart disease (CHD) undergoing Percutaneous Coronary Interventions and its influence factors. Methods Totally 140 cases of coronary heart disease undergoing percutaneous coronary interventions were investigated with the general information questionnaire, General Well-being Scale, Self-rating Anxiety Scale and Self-rating Depression Scale, and analyzed the influence factors of subjective well-being. Results There were patients whose subjective well-being scores were lower than the average of Chinese norm among the 140 CHD patients,which took a proportion of 75.71%(106/140).The subjective well-being score in male patients was 73.33±6.43,which was lower than 75.00±15.00 of the Chinese norm (t=-2.112,P<0.05).The subjective well-being score in female patients was 65.15±8.32,which was lower than 71.00 ± 18.00 of the Chinese norm (t=-5.981, P<0.01); the self-rated health status and anxiety disorder were the main factors of subjective well-being in coronary heart disease undergoing Percutaneous Coronary Interventions patients. Conclusions The subjective well- being of patients with CHD undergoing percutaneous coronary interventions is poor; the society and family should give them much enough care and support, and effective psychological intervention measures should be taken to improve their subjective well-being.
ABSTRACT
Objective:To explore influence of hyperglycemia on hospitalization and follow‐up prognosis in patients with acute ST elevation myocardial infarction (STEMI ) undergoing direct percutaneous coronary intervention (PCI) .Methods :A total of 218 patients ,who were diagnosed as STEMI and received emergency PCI within 12h af‐ter onset from our hospital ,were enrolled .According to blood glucose level at hospitalization and OGTT results , they were divided into normal blood glucose (NBG) group (n= 108) ,hyperglycemia group (n= 60) and diabetes mellitus (DM) group (n=50) .Cardiac function indexes were evaluated ;Logistic regression analysis was used to an‐alyze influencing factors for mortality in these patients .Results:Compared with NBG group , the in‐hospital mortal‐ity was significant rise (1.9% vs .10.0% ) in DM group ;there were significant rise in percentages of ≥double‐vessel coronary disease (41.2% vs .68.8% vs .66.7% ) and ≥2 stents implanted (14.72% vs .50.0% vs .55.6% ) in women in hyperglycemia group and DM group (P<0.05 or <0.01);Multi‐factor Logistic regression analysis indi‐cated that Killip class ,NT‐proBNP ,number of diseased vessels and body mass index were independent risk factors of in‐hospital mortality of these patients (OR=1.012~5.923 ,P<0.05 all) ,and female was a strong independent risk factor for in‐hospital mortality and mortality within one‐year follow‐up (OR=20.376 ,7.227 ,P<0.01 both) .Con‐clusion:The mortality significantly rises in STEMI patients undergoing emergency PCI complicated with hyperglyce‐mia ,especially in female patients .
ABSTRACT
BACKGROUND AND OBJECTIVES: There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade≤2). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. RESULTS: The persistent no reflow group was associated with higher all-cause mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p=0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p=0.002) compared with the normal reflow group. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). CONCLUSION: The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.
Subject(s)
Humans , Follow-Up Studies , Heart Failure , Incidence , Mortality , Myocardial Infarction , No-Reflow Phenomenon , Percutaneous Coronary Intervention , Stents , ThrombosisABSTRACT
Objective To evaluate the effects of clinical pathway combined with transitional care implemented by specialty nurses on patients with coronary heart disease after PCI (percutaneous coronary intervention) therapy. Methods Totally 124 patients after PCI were divided into the experimental group and the control group with random digit table. Patients in the control group received routine education and follow- up during hospitalization and discharge period. The experimental group received clinical pathway combined with transitional care implemented by specialty nurses based on routine education. The level of patients′knowledge, attitude, practice and risk factors were compared between the two groups 6 and 12 months after discharge. Results There were 55 patients in each group completed the research ultimately. The Coronary Heart Disease Knowledge Questionnaire in the experimental group scored (57.61 ±8.77), (81.27±6.88) and (88.47±6.10),while the control group scored (59.71±7.32),(68.61±7.12) and (76.85±7.70), after repeated measurement analysis of variance, F=74.71, 14.52, P<0.01. The scores of General Self- Efficacy Scale (GSES) and Coronary Artery Disease Self- Efficacy Scale (CSMS) between two groups at three time points showed statistical significance, F=5.40, 14.52, P<0.05 or 0.01. The risk factors of coronary heart disease such as total cholesterol, triacylglycerol, hemoglobin A1c, body mass index, systolic pressure and diastolic pressure were statistically different between two groups except for high density lipoprotein cholesterol and low density lipoprotein cholesterol, F=5.82, 20.32, 4.14, 4.15, 4.99, 7.15, P<0.05 or 0.01. Conclusions Clinical pathway combined with transitional care implemented by specialty nurses can improve the knowledge-attitude- practice level of patients, help to control the risk factors of coronary heart disease. It is an effective heart rehabilitation model for patients after PCI.
ABSTRACT
Background: The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective: To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods: From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results: The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions: The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques. .
Fundamentos: O acesso radial promove menor risco de sangramento e complicações vasculares relacionadas ao sítio de punção quando comparado ao acesso femoral. Estudos recentes sugerem redução de mortalidade favorável ao primeiro em pacientes com infarto agudo do miocárdio submetidos à intervenção coronária percutânea. Objetivo: Comparar a ocorrência de eventos cardiovasculares adversos isquêmicos e hemorrágicos em pacientes submetidos à angioplastia primária conforme a via de acesso arterial. Métodos: No período de agosto de 2010 a dezembro de 2011, foram avaliados 588 pacientes que realizaram intervenção coronária percutânea primária na vigência de um infarto agudo do miocárdio com supradesnivelamento de ST, incluídos em 47 centros participantes do registro ACCEPT. Os pacientes foram agrupados e comparados de acordo com a via de acesso arterial utilizada para a efetivação do procedimento. Resultados: A média de idade foi de 61,8 anos, sendo 75% pertencentes ao sexo masculino e 24% portadores de diabetes melito. Não houve diferença entre os grupos na taxa de sucesso do procedimento, bem como na ocorrência de óbito, reinfarto ou acidente vascular encefálico aos seis meses de seguimento. Sangramento grave foi relatado em 1,1% da amostra analisada, sem diferença estatística conforme a via de acesso utilizada. Conclusões: As vias de acesso femoral e radial são igualmente seguras e eficazes para a realização de intervenção coronária percutânea primária. A baixa taxa de eventos cardiovasculares, bem como de complicações hemorrágicas, reflete a qualidade dos centros participantes e a experiência dos operadores com a utilização de ambas as técnicas. .
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Femoral Artery/surgery , Myocardial Infarction/surgery , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Radial Artery/surgery , Registries/statistics & numerical data , Brazil , Follow-Up Studies , Hemorrhage/etiology , Hemorrhage/mortality , Myocardial Infarction/complications , Myocardial Infarction/mortality , Percutaneous Coronary Intervention/mortality , Treatment OutcomeABSTRACT
@#Objective To investigate the effect of long-term cardiac rehabilitation on risk factors with doctor supervision after percutaneous coronary intervention(PCI). Methods One hundred and twelve patients after PCI were divided into the cardiac rehabilitation group(56 cases) and the control group (56 cases). All of the patients were given medication and health education, meanwhile the cardiac rehabilitation group received 4～6 weeks hospitalized cardiac rehabilitation program and one year ambulatory cardiac rehabilitation with doctor supervision. Risk factors were assessed six mouths and twelve mouths after the treatment. Results The risk factors except diastolic blood pressure and body weight index improved more significantly in the cardiac rehabilitation group than in the control group. Clinical event in the cardiac rehabilitation group is lower than in the control group. Conclusion Long-term cardiac rehabilitation with doctor supervision is safe, efficiency and good compliance to improve risk factors of coronary heart disease after PCI except diastolic blood pressure and weight management.