Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Abstract The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.

Comparison of one-catheter strategy versus conventional two-catheter strategy on the volume of radiological contrast and diagnostic coronary catheterization performance by transradial access: A systematic review and meta-analysis of randomized clinical trials / Comparación de la estrategia de catéter único versus la estrategia convencional de dos catéteres sobre el volumen de contraste radiológico y el rendimiento del cateterismo coronario diagnóstico por acceso transradial: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

Abstract Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; −3.831 mL [−6.165 mL to −1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], −72.471 s [−99.694 s to −45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.

Resumen Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.

Impact of One-Catheter Strategy with TIG I Catheter on Coronary Catheterization Performance and Economic Costs / Impacto da Estratégia de um Cateter com Cateter TIG I no Desempenho da Coronariografia por Cateterismo e Custos Econômicos

Abstract Background: Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. Objective: The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. Methods: Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. Results: From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. Conclusions: One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.

Resumo Fundamento: A cineangiocoronariografia com dois cateteres é a estratégia tradicional para procedimentos coronarianos de diagnóstico. O cateter TIG I permite canular ambas as artérias coronárias, evitando a troca de cateteres durante a cineangiocoronariografia por acesso transradial. Objetivo: O objetivo deste estudo é avaliar o impacto da estratégia de um cateter, evitando a troca de cateter, no desempenho da coronariografia por cateterismo e nos seus custos econômicos. Métodos: Foram coletados os procedimentos diagnósticos coronarianos transradiais realizados entre janeiro de 2013 e junho de 2017. A estratégia de um cateter (cateter TIG I) e a estratégia de dois cateteres (cateteres coronários direito e esquerdo de Judkins) foram comparadas. O volume de contraste iodado administrado foi o endpoint primário. Os endpoints secundários eram espasmo radial, duração do procedimento (tempo de fluoroscopia) e exposição a radiações ionizantes (produto dose-área e kerma no ar). Os custos econômicos diretos também foram avaliados. Para as análises estatísticas, valores de p < 0,05 bicaudais foram considerados estatisticamente significativos. Resultados: De um total de 1.953 procedimentos em 1.829 pacientes, 252 procedimentos foram atribuídos à estratégia de um cateter e 1.701 procedimentos à estratégia de dois cateteres. Não houve diferenças nas características basais entre os grupos. A estratégia de um cateter exigiu menos contraste iodado [endpoint primário; (60-105) -mL vs. 92 (64-120) -mL; p < 0,001] em comparação com a estratégia de dois cateteres. Além disso, o grupo da estratégia de um cateter apresentou menos espasmo radial (5,2% vs. 9,3%, p = 0,022) e menor tempo de fluoroscopia [3,9 (2,2-8,0) -min vs. 4,8 (2,9-8,3) -min, p = 0,001] e economia de custos [149 (140-160)-€/procedimento vs. 171 (160-183) -€/procedimento; p < 0,001]. Não foram detectadas diferenças no produto dose-área e kerma no ar entre os grupos. Conclusões: A estratégia de um cateter, com cateter TIG I, melhora o desempenho da coronariografia por cateterismo e reduz os custos econômicos em comparação com a estratégia tradicional de dois cateteres em pacientes encaminhados para cineangiocoronariografia.

Electrocardiographic analysis of V1-V4 leads in infarction by proximal right coronary artery occlusion / Análisis electrocardiográfico de derivaciones V1-V4 en infarto por oclusión de la arteria coronaria derecha proximal

Abstract: Introduction: In some cases, ST segment elevation in right precordial leads in conjunction with inferior leads can be originated by an obstruction of the right coronary artery in its proximal portion, generating an inferior myocardial infarction which involves the right ventricle. Case presentation: We present the case of a 57-year-old male, which presents symptoms of acute coronary syndrome. The electrocardiogram shows subepicardial injury in anteroseptal leads (V1-V3) and elevation of ST segment in inferior leads (DIII, AVF). A coronariography is performed finding a complete obstruction of right coronary artery in the proximal portion, left coronary artery without lesions. Analysis: In right ventricular infarction or anteroseptal infarction, the ST segment vector always has a posterior- anterior direction in horizontal plane, the direction of this vector will produce an elevation of ST segment in leads V1 to V3 (even V4). Conclusion: It is necessary to do a correct analysis of the electrocardiogram for understanding the mentioned changes and to not assume that the electrocardiographic manifestations are a consequence of multivessel disease.(AU)

Resumen: Introducción: En algunos casos, la elevación del segmento ST en derivaciones precordiales derechas en conjunción con derivaciones inferiores, puede originarse por una obstrucción de la arteria coronaria derecha en su porción proximal, generando así un infarto de miocardio inferior que involucra al ventrículo derecho. Presentación del caso: Presentamos el caso de un paciente varón de 57 años, que presenta síntomas de síndrome coronario agudo, el electrocardiograma muestra lesión subepicárdica en derivaciones anteroseptales (V1-V3) y elevación del segmento ST en derivaciones inferiores (DIII, AVF). Una coronariografía se realiza encontrando una obstrucción completa de la arteria coronaria derecha en la porción proximal, arteria coronaria izquierda sin lesiones. Análisis: En el infarto ventricular derecho o infarto anteroseptal, el vector del segmento ST siempre tiene una dirección posterior-anterior en el plano horizontal, la dirección de este vector producirá una elevación del segmento ST en las derivaciones V1 a V3 (incluso V4). Conclusión: Es necesario hacer un análisis correcto del electrocardiograma para comprender los cambios mencionados y no asumir que las manifestaciones electrocardiográficas son consecuencia de la enfermedad multivaso.(AU)

Impacto de la longitud del introductor en procedimientos coronarios transradiales: estudio clínico randomizado analítico / Impact of introducer length in transradial coronary interventions: a clinical randomized study

Objetivos: El objetivo principal del estudio fue conocer el impacto de la longitud del introductor en la aparición de vasoespasmo radial en pacientes sometidos a cateterización coronaria. Los objetivos secundarios fueron conocer la relación entre la longitud y dolor al retirarlo, tiempo de procedimiento, radiación y analizar los factores de riesgo sugeridos para espasmo radial. Material y Métodos: Se realizó un estudio clínico randomizado analítico de 99 pacientes con indicación de cateterización coronaria. Se randomizaron a dos grupos y se les realizó el procedimiento con diferentes longitudes de introductor (25cm y 10cm), ambos con cubierta hidrofílica. Se registró el tiempo de procedimiento, dosis de radiación, radioscopia, dolor al retirar el introductor y vasoespasmo radial. Resultados: En el total de pacientes el procedimiento fue exitoso. Del total de pacientes, en 12 se observó espasmo radial, encontrándose una menor incidencia de vasoespasmo (18,75 por ciento vs 5,88 por ciento, p = 0,005) y menor dolor al retirar el introductor (43,75 por ciento vs 21,57 por ciento, p = 0,018) en pacientes con introductor corto. No se observaron diferencias entre ambos grupos en relación a los otros factores. Diabetes y género femenino se mostraron como predictores independientes de vasoespasmo radial en pacientes sometidos a procedimientos coronarios transradiales. Conclusiones: El uso de un introductor corto disminuye la incidencia de vasoespasmo radial y dolor al retirar el introductor durante procedimientos coronarios transradiales.

Aim: Radial artery spasm producing severe pain is the most common complication of trans-radial approach for coronary artery catheterization. It remains unclear whether the length of the introducer is related to this complication. The aim of this study was to assess the impact of introducer length on radial artery spasm and, also, to identify variables associated to this complication. Methods and results: 99 patients were randomized to receive either a long (25 cm) or a short (10 cm) introducer for coronary catheterization. Both types of introducer were hydrophilic coated. The procedure was successful in all subjects. Radial artery spasm developed in 12 patients, 18.8 percent of those receiving a long introducer vs 5.9 percent of those receiving the short one (p=0.005). Corresponding values for sheath retrieval pain were 21.6 per cent and 43.8 per cent, respectively (p=0.018). No between-group difference was observed in radiation dose, radioscopy time and total procedure time. Diabetes and female gender were predictors of radial artery spasm. Conclusion: Use of a shorter hydrophilic coated introducer resulted in a lesser incidence of radial artery spasm and associated pain, during coronary catheterization.

Software livre e de código aberto para avaliação de imagens de angiotomografia de coronárias / Free and open-source software application for the evaluation of coronary computed tomography angiography images

FUNDAMENTO: A estandardização do padrão de imagens utilizada dentro da medicina foi realizada em 1993 por meio do padrão DICOM (Digital Imaging and Communications in Medicine). Diversos exames utilizam esse padrão e cada vez mais são necessários softwares capazes de manipular esse tipo de imagem, porém esses softwares geralmente não têm o formato livre e de código aberto, e isso dificulta o seu ajuste para os mais diferentes interesses. OBJETIVO: Desenvolver e validar um software livre e de código aberto capaz de manipular imagens DICOM de exames de angiotomografia de coronárias. MÉTODOS: Desenvolvemos e testamos o software intitulado ImageLab na avaliação de 100 exames selecionados de forma randômica por meio de um banco de dados. Foram realizadas 600 análises divididas por dois observadores utilizando o ImageLab e um outro software comercializado junto a aparelhos de tomografia computadorizada Philips Brilliance, na avaliação da presença de lesões e placas coronarianas nos territórios do Tronco da Coronária Esquerda (TCE) e na Artéria Descendente Anterior (ADA). Para avaliar as concordâncias intraobservador, interobservadores e intersoftware, utilizamos concordância simples e estatística Kappa. RESULTADOS: As concordâncias observadas entre os softwares foram em geral classificadas como substancial ou quase perfeitas na maioria das comparações. CONCLUSÃO: O software ImageLab concordou com o software Philips na avaliação de exames de angiotomografia de coronárias especialmente em pacientes sem lesões, com lesões inferiores a 50% no TCE e inferiores a 70% na ADA. A concordância para lesão >70% na ADA foi menor, porém isso também é observado quando se utiliza o padrão de referência anatômico.

BACKGROUND: The standardization of images used in Medicine in 1993 was performed using the DICOM (Digital Imaging and Communications in Medicine) standard. Several tests use this standard and it is increasingly necessary to design software applications capable of handling this type of image; however, these software applications are not usually free and open-source, and this fact hinders their adjustment to most diverse interests. OBJECTIVE: To develop and validate a free and open-source software application capable of handling DICOM coronary computed tomography angiography images. METHODS: We developed and tested the ImageLab software in the evaluation of 100 tests randomly selected from a database. We carried out 600 tests divided between two observers using ImageLab and another software sold with Philips Brilliance computed tomography appliances in the evaluation of coronary lesions and plaques around the left main coronary artery (LMCA) and the anterior descending artery (ADA). To evaluate intraobserver, interobserver and intersoftware agreements, we used simple and kappa statistics agreements. RESULTS: The agreements observed between software applications were generally classified as substantial or almost perfect in most comparisons. CONCLUSION: The ImageLab software agreed with the Philips software in the evaluation of coronary computed tomography angiography tests, especially in patients without lesions, with lesions < 50% in the LMCA and < 70% in the ADA. The agreement for lesions > 70% in the ADA was lower, but this is also observed when the anatomical reference standard is used.

Validação do reprocessamento de cateteres cardíacos angiográficos: uma avaliação da funcionalidade e da integridade / Reprocessing validation of angiographic cardiac catheters: an evaluation of the functionality and integrity / Validación del reprocesamiento de catéteres cardíacos angiográficos: una evaluación de la funcionalidad e integridad

Objetivou-se validar o reprocessamento de cateteres cardíacos angiográficos quanto às suas características de funcionalidade mecânica e à integridade molecular e micro-estrutural da cadeia polimérica. Pesquisa experimental, aplicada, comparativa e controlada. Construiu-se uma bancada de simulação de uma arteriografia de coronária esquerda para simular um estresse mecânico e biológico em cateteres. Testou-se a funcionalidade por ensaio de tração e a integridade por Espectroscopia na Região do Infravermelho e Microscopia Eletrônica de Varredura. Evidenciou-se uma tendência ao aumento da rigidez a cada acréscimo do número de reprocessamento (p<0,05). As modificações das propriedades mecânicas e das estruturas moleculares dos polímeros foram mais evidentes a partir do quinto reprocessamento. As micrografias revelaram o aumento de rugosidade a partir do quarto reprocessamento. Os resultados deste estudo poderão contribuir para a elaboração de protocolos de reprocessamento e vigilância sistemática da reutilização de materiais de uso único, não apenas por sua relevância econômica, mas sobretudo do ponto de vista ético, legal, biológico, funcional e assistencial.

The objective of this study was to validate the reprocessing of angiographic cardiac catheters regarding their characteristics of mechanical functionality and the molecular and micro-structural integrity of the polymeric chain. This is an experimental, applied, comparative and controlled study. A simulation set was built for a left coronary angiography in order to simulate mechanical and biological stress in the catheters. Traction tests were performed for the functionality and the integrity was tested through Infrared Spectrometry and Scanning Electronic Microscopy. The study evidenced a tendency to an increase in rigidity at every increment of the reprocessing number (p<0.05). The changes in the mechanical properties and molecular structures of the polymers were more evident as of the fifth reprocessing. Micrographies revealed an increase in rugosity as of the forth reprocessing. The results of this study may contribute to the elaboration of reprocessing protocols and a systematic surveillance of the reutilization of single use materials, not only due to their economical relevance, but especially from the ethical, legal, biological, functional and care point of view.

El objetivo del trabajo fue validar el reprocesamiento de catéteres cardíacos angiográficos en cuanto a sus características de funcionalidad mecánica e integridad molecular y microestructural de la cadena de polímeros. Investigación experimental, aplicada, comparativa y controlada. Se construyó un banco de simulación de una arteriografía de coronaria izquierda para simular un estrés mecánico y biológico en catéteres. Se testeó la funcionalidad por ensayo de tracción y la integridad por Espectroscopía Local Infrarroja y Microscopía Electrónica de Barrido. Se evidenció una tendencia al aumento de la rigidez en cada incremento del número de reprocesamientos (p<0,05). Las modificaciones de las propiedades mecánicas y de las estructuras moleculares de los polímeros fueron más evidentes a partir del quinto reprocesamiento. Las micrografías revelaron un aumento de rugosidad a partir del cuarto reprocesamiento. Los resultados de este estudio podrán contribuir en la elaboración de protocolos de reprocesamiento y vigilancia sistemática de la reutilización de materiales de uso único, no sólo por su relevancia económica, sino también, y sobre todo, respecto del punto de vista ético, legal, biológico, funcional y asistencial.

Influence of heart rate on image quality to identify the best cardiac phase in 16-slice coronary CT angiography.

OBJECTIVE: To identify the best cardiac phase in different patient's heart rate on 16-slice coronary CT angiography. MATERIAL AND METHOD: The patients who had undergone coronary CT angiography with 16 multi-detector rows CT at Siriraj Hospital between September 2003 and August 2004. For each patient, the image reconstruction based on relative timing was performed placed at center of 35% to 85% of the R-R interval with step increments 10%. The authors created six data sets (35%, 45%, 55%, 65%, 75%, and 85% of R-R interval) throughout the cardiac cycle. The coronary arteries were reviewed based on cross-sectional images and reformat images. The authors inspected all data sets and selected the cardiac phase that contained the best image quality for each coronary artery. RESULTS: Five hundred sixty four vessels were evaluated in the 141 patients (83 men, 58 women). The mean patient age was 63.3 +/- 16.7 years (range 4-89 years). Mean patient heart rate was 65.7 +/- 16.5 beats per minute (bpm), range 46-104 bpm. The most coronary arteries were well demonstrated at center of 75% of R-R interval (66.8%). Ninety-eight patients (69.5%) required one phase that provided best overall image quality and motion free delineation for four coronary arteries. Forty-three patients (30.5%) required combination of data from each phase to achieve motion free images. CONCLUSION: The best cardiac phase of evaluate coronary artery in 16 slices coronary CT angiography in the patient's heart rate below 70 bpm is 75% of cardiac cycle (mid to late diastole). In patients with a heart rate 71-80 bpm, the authors required a combination of images from 45% and 75% of cardiac cycle to completely evaluate all coronary arteries. In patients with a heart rate above 80 bpm, 45% of cardiac cycle (end-systole) is the best phase.

Comparison of image quality of coronary CT angiography between 16 and 64 slices MDCT.

OBJECTIVE: To compare the image quality and visibility of coronary arteries that were performed by 16 slices and 64 slices multidetector row CT (MDCT). STUDY DESIGN: Descriptive analysis. MATERIAL AND METHOD: Twenty-eight patients suspected of hearing coronary artery disease had noninvasive coronary CT angiography performed by 16 slices MDCT and 64 slices MDCT Data were retrospectively analyzed and reviewed by two radiologists. Image quality was assessed by using a grading scale from excellent (4) to non-assessable (0) and the rate of displayed coronary branches was calculated. RESULTS: Four hundred twenty coronary CT angiography segments in 28 patients were evaluated. CONCLUSION: Coronary CT angiography using 64 slices multi-detector row CT provides a significantly higher image quality of coronary arteries and their branches compared with 16 slices multi-detector row CT.

Effect of concentration of contrast medium on coronary CT angiography.

OBJECTIVE: To compare concentration of contrast medium for vascular opacification at ascending aorta using retrospective reconstruction of coronary CT angiography. STUDY DESIGN: Retrospective study. MATERIAL AND METHOD: Eighty-four patients undergoing coronary CT angiography with 16 multi-detector rows at Siriraj Hospital between September 2003 and July 2004 were included in this study. The patients were categorized into two groups. The first group was administrated with 350 mgl/ml contrast medium and the second group was administrated with 370 mgl/ml contrast medium. The total amount of contrast medium was about 140 ml (20 ml for timing bolus and 120 ml for CT angiography) in both groups. The CT density on peak contrast administration at ascending aorta was measured and compared between the two groups. RESULTS: The mean density at ascending aorta in 350 mgl/ml and 370 mgl/ml were 362.96 HU (SD 67.53) and 354.44 (SD 59.39), respectively. There was no statistically significant difference in mean density at the ascending aorta between the two groups. CONCLUSION: Administration of contrast medium with different concentrations of 350 or 370 mgl/ml showed no statistical difference on enhancement of the ascending aorta in coronary CT angiography (p < 0.05).

Reutilización de catéteres de angiografía en una Unidad de Hemodinamia de un hospital del sector público-Chile / Angiographic catheter reuse at the Hemodynamic Department of a public hospital in Chile

Se presentan los resultados de un estudio realizado en 421 pacientes que se sometieron a procedimientos invasores utilizando catéteres con fines diagnósticos y terapéuticos en la Unidad de Hemodinamia de un hospital público en el período julio-diciembre del año 2003. El objetivo de la investigación fue conocer si existen riesgos en la re-utilización de catéteres de angiografía empleados en dicha unidad y que son catalogados como de uso único. Para este fin se seleccionó como metodología de investigación la de estudio epidemiológico de tipo analítico observacional de cohortes prospectivas. De la población estudiada, 63,4 por ciento correspondió a población masculina con edad promedio de 64 años. Del total de los pacientes 27 por ciento presentaban diabetes mellitus y 24 por ciento obesidad. El 82 por ciento de los procedimientos tenía fines diagnósticos y 74 por ciento fueron realizados con catéteres reutilizados. Se encontró 4,3 por ciento de complicaciones infecciosas locales o reacciones a pirógenos; sin embargo, no se encontró diferencia significativa entre el grupo que fue intervenido con catéteres de primer uso respecto a los que utilizaron catéteres antes usados (p < 0,05) en ninguna de las variables estudiadas.

Síndrome de Tako-Tsubo: relato de caso e revisão da literatura / Tako-Tsubo syndrome: case report and review

A síndrome de Tako-Tsubo, descrita em 1990, é ainda subdiagnosticada. Descreve-se o caso de uma mulher de 77 anos apresentando sinais e sintomas da doença após estresse físico, evoluindo com disfunção sistólica ventricular esquerda apical e com recuperação completa alguns dias após. É apresentado um breve resumo da literatura, sendo descritos os achados característicos aos exames complementares

Coronary angiography using 4 French catheters with power injection: a randomized comparison with 6 French catheters.

BACKGROUND: Coronary angiography using 4 F catheters may reduce access-site complications and enable early ambulation, although earlier studies suggested that the quality of images may be an issue of concern. METHODS AND RESULTS: To ascertain the quality of angiographic images and safety of early ambulation, 500 patients were randomized to coronary angiography with either 4 F or 6 F catheters. Procedural characteristics, angiographic quality scores and results of ambulation were analyzed in the two groups. Patients in the 4 F group were mobilized at 2 hours post-procedure while those in the 6 F group were ambulated at 6 hours. There was no procedure-related complication in either group. The procedure was successfully completed in 250 of 252 patients randomized to the 4 F group. In two patients in the 4 F group, sheaths were upgraded to 6 F to complete the procedure, as difficulty was encountered in hooking the coronary ostium with a 4 F Judkin's catheter. Coronary angiographic quality scores in these two groups were comparable. Angiographic scores for the 4 F and 6 F groups for the left coronary artery averaged 4.45+/-0.5 and 4.58+/-0.3 (p>0.1), respectively. The right coronary artery scores averaged 4.30+/-0.4 and 4.35+/-0.2 (p>0.1) in the 4 F and 6 F groups. Angiographic scores for the left ventricular angiogram averaged 4.22+/-0.1 and 4.44+/-0.3 (p>0.1) in the 4 F and 6 F groups, respectively. None of the angiograms were assigned a score of <3.0 (not diagnostic). The total contrast volume consumed in the two groups was also equivalent. There were no groin-related complications in the 4 F group although these patients were ambulated 2 hours after the procedure. CONCLUSIONS: Coronary angiography performed with a 4 F catheter is a safe and reliable procedure. The quality of image obtained with a 4 F catheter is equivalent to that obtained with a 6 F catheter. Early ambulation at 2 hours is feasible without compromising safety.

Limitações na utilizaçäo dos meios de contraste radiológico / Restrictions to the employmente of contrast media

Os autores revisam as limitações atuais ao emprego de meios de contraste na realizaçäo de angiografias cardiovasculares.Estudos em larga escala demonstraram que a incidência de reações adversas discretas, após exames contratados cardiológicos, é inferior a 5 por cento; eventos graves näo-fatais ocorrem em um paciente para 14.000 injeções e óbitos, em um paciente para 40.000 injeções.No Brasil, em quatro anos de análise, mais de 40.000 pacientes submeteram-se a angioplastia coronária e estima-se que mais de 150.000 cinecoronariografias sejam realizadas anualmente.Os agentes de contraste atuais säo classificados em três grupos distintos: iônicos de alta osmolaridade (ioxitalamato de meglumina) e näo iônicos (iopamidol e outros).A incidência de reações adversas é baixa e está relacionada ao tipo de agente utilizado.As reações leves, que näo necessitam de intervençäo farmacológica, säo inferiores a 5 por cento e as moderadas, revertidas sem sequelas, inferiores a 0,1 por cento.Choque anafilático e óbito, muito raros, säo inferiores a 0,006 por cento.As reações alérgicas guardam relaçäo direta com maior osmolaridade e conteúdo de iodo; a nefrotoxidade é previnida com hidrataçäo prévia adequada e näo guarda relaçäo com tipo de contraste, ocorrendo em menos de 1 por cento dos pacientes; distúrbios elétricos graves (bradicardia acentuada e fibrilaçäo ventricular) säo raros com os agentes atuais...

Validación de un método para realizar angiografía cuantitativa a bajo costo / Validation of a low cost method for quantitative angiography

La angiografía cuantitativa es el método de elección para la medición de la severidad de las lesiones coronarias en cardiología intervencional. Sin embargo, su aplicabilidad está restringida por los elevados costos de los programas comerciales que permiten realizar estas mediciones. En el presente trabajo hemos estudiado la posibilidad de desarrollar un sistema de angiografía cuantitativa a un costo más razonable, abordable por distintos laboratorios en el país. Diversos moldes de polietileno (PE,n=14) de diámetro interno conocido (entre 0, 58 y 1,67 mm) fueron llenados con medio de contraste y filmados con un cineangiógrafo General Electric a 25 cuadros por segundo. Los films fueron escaneados (Microteck) y las imágenes digitales fueron transferidas a un programa computacional de libre distribución (Image-NIH), con el cual se realizaron las mediciones en un computador Quadra, con una relación de 14 bit/pixel. También se realizaron aortografías de ratas Sprague Dawley anestesiadas (n=5), y los films fueron procesados de idéntica manera. Inmediatamente después de la aortografía, las ratas fueron perfundidas in vivo con formalina a 100 mm Hg, para mediciones histológicas posteriores. Se encontró una correlación de 0,95 (p<0,001) al comparar los valores reales de los diámetros de los moldes de PE versus los medidos digitalmente, y de 0,91 (p<0, 0001) para las áreas. La exactitud de la medición fue de 0,046 mm. Al comparar los diámetros de la aotiografía versus los diámetros histológicos, se encontró una correlación de 0,92 (p<0,02). Los díámetros reales fueron 1,06 ñ 0,1 mm y los medidos 1,09 ñ 0,07mm, lo cual representa una diferencia de 3,5 por ciento (NS). En conclusión, se logró validar un método de angiografía cuantitativa que requiere de elementos tecnológicos mínimos y de bajo costo. Este método puede ser de utilidad en laboratorios de hemodinamia que estén interesados en comenzar a realizar anaioarafía cuantitativa