Desfechos clínicos tardios de pacientes diabéticos tratados com stents farmacológicos eluidores de sirolimus ou everolimus: uma análise do registro DESIRE / Late clinical outcomes of diabetic patients treated with sirolimus or everolimus drug-eluting stents: an analysis of the DESIRE registry

Stents farmacológicos (SF) de segunda geração demonstraram melhor desempenho clínico que os de primeira geração, sobretudo pela redução nas taxas de trombose, mas ainda não está claro se esse benefício se estende a diabéticos da prática diária. Objetivamos comparar o desempenho de pacientes diabéticos não selecionados tratados com SF eluidores de sirolimus (SES; primeira geração) vs. SF eluidoresde everolimus (SEE; segunda geração).Métodos: Entre 2007 e 2014, 798 diabéticos foram tratados com SES (n = 414) ou SEE (n = 384) e incluídosnesta análise. Seguimento clínico tardio foi obtido em 99,4% da população e os grupos foram comparados quanto à ocorrência de eventos cardíacos adversos maiores (ECAM) e trombose de stent. Resultados: A idade da população foi semelhante, com predomínio do sexo masculino. Em ambas as coortes, a apresentação clínica mais frequente foi a doença coronária estável. Número de vasos tratados (1,50 ± 0,62 vs. 1,52 ± 0,72; p = 0,88) e extensão total de stents (36,1 ± 20,4 mm vs. 37,7 ± 22,2 mm; p = 0,32) foram semelhantes. Os pacientes tratados com SEE apresentaram menores taxas de ECAM (15% vs. 6,8%; p < 0,001), sobretudo à custa de menor mortalidade cardíaca (5,3% vs. 1,3%; p < 0,001). Observou-se também menor ocorrência de trombose de stent definitiva/provável com SF de segunda geração (3,4% vs. 0,5%; p = 0,004).Conclusões: Nesta experiência unicêntrica, o uso de SEE em diabéticos mostrou-se com menor mortalidadecardíaca e trombose da endoprótese. Esse benefício se fez mais evidente no seguimento mais tardio...

Despite the better clinical performance of second-generation drug-eluting stents (DES)when compared to first-generation DES in controlled trials, mainly due to reduction in thrombosis rate, it remains unclear whether this benefit extends to diabetic patients treated in the daily practice. We sought to compare the clinical outcomes of unselected diabetic patients treated with either sirolimus eluting stents - SES (first-generation DES) or everolimus-eluting stents - EES (second-generation DES). Methods: Between January 2007 and October 2014 a total of 798 diabetic patients were treated with SES(n = 414) and EES (n = 384). Long-term clinical follow-up was achieved in 99,4% of the population andthe groups were compared regarding the occurrence of major adverse cardiac events (MACE) and stent thrombosis. Results: In both cohorts age was similar, and most patients were male. Stable coronary disease was the most frequent clinical presentation. The number of treated vessels (1.50 ± 0.62 vs. 1.52 ± 0.72; p = 0.88)and the total stent length (36.1 ± 20.4 vs. 37.7 ± 22.2 mm; p = 0.32) were similar between groups. Patients treated with EES showed lower rates of MACE (15% vs. 6.8%, p < 0.001), mainly due to a lower cardiac death(5.3% vs. 1.3%, p < 0.001). There was also less definitive/ probable thrombosis with the second generation DES (3.4% vs. 0.5%, p = 0.004)...

Evolução tardia de pacientes com lesões coronárias complexas tratados com o novo Stent Metálico MGuardTM / Late clinical follow-up of patients with complex coronary lesions treated with the new MGuardTM Bare-Metal Stent

INTRODUÇÃO: A embolização de fragmentos de ateroma/trombo durante a intervenção coronária percutânea (ICP) ocasiona distúrbios de perfusão da microcirculação. O novo stent MGuardTM, que é revestido com uma rede de polietileno, demonstrou eficácia na prevenção de complicações embólicas durante a ICP primária. No entanto, a evolução clínica tardia de pacientes tratados com o stent MGuardTM permanece desconhecida. MÉTODOS: Uma série de 65 pacientes portadores de lesões coronárias de novo tratados com o stent MGuardTM foi analisada. Os dados clínicos basais, do procedimento e do seguimento clínico tardio (média de tempo, 2,6 ± 1,4 anos) foram coletados retrospectivamente por meio da revisão de prontuários médicos e/ou contato telefônico direto. RESULTADOS: A média de idade foi de 66,1 ± 13,7 anos, 32,3% eram diabéticos, 49,2% tinham infarto agudo do miocárdio (IAM) prévio, e 44,6% apresentaram-se com síndrome coronária aguda. Dois terços das lesões estavam localizados em pontes de safena, quase metade tinha presença de trombo e a maioria foi classificada como tipo B2/C. O stent MGuardTM foi implantado com sucesso em todos os casos. Ao final do procedimento, fluxo TIMI 3 foi alcançado em 93,4% e o sucesso angiográfico foi de 91,8%. No seguimento tardio, as taxas de eventos adversos incluíram óbito cardiovascular em 6,2%, IAM não-fatal em 9,2%, revascularização da lesão-alvo em 9,2% e trombose de stent definitiva/provável em 1,5%. CONCLUSÕES: O seguimento tardio de pacientes com lesões coronárias complexas tratados com o stent MGuardTM demonstrou baixas taxas de revascularização da lesão-alvo e de trombose do stent.

BACKGROUND: The embolization of atheroma/thrombus fragments during percutaneous coronary intervention (PCI) causes microcirculatory perfusion disturbances. The new MGuardTM, a mesh-based bare-metal stent, demonstrated efficacy in the prevention of embolic complications during primary PCI. However, the late clinical outcome of patients treated with the MGuardTM stent remains unknown. METHODS: A series of 65 patients with de novo coronary lesions treated with MGuardTM stent was analyzed. Baseline clinical data, procedure and late clinical follow-up (mean duration, 2.6 ± 1.4 years) data were collected retrospectively by a review of medical records and/or direct telephone contact. RESULTS: Mean age was 66.1 ± 13.7 years, 32.3% of patients were diabetic, 49.2% had a previous acute myocardial infarction (AMI), and 44.6% presented with acute coronary syndrome. Two thirds of the lesions were located in a saphenous vein graft, almost half of the lesions had thrombus and most were classified as type B2/C. The MGuardTM stent was successfully implanted in all cases. At the end of the procedure, TIMI 3 flow was achieved in 93.4% and angiographic success was 91.8%. In the late clinical follow-up, adverse event rates included cardiac death in 6.2%, non-fatal AMI in 9.2%, target lesion revascularization in 9.2% and definite/probable stent thrombosis in 1.5%. CONCLUSIONS: The late follow-up of patients with complex coronary lesions treated with the MGuardTM stent demonstrated low rates of target lesion revascularization and stent thrombosis.

Relationship of left atrial appendage function to left ventricular function.

BACKGROUND: The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm. METHODS AND RESULTS: The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001). CONCLUSIONS: Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.

Antitrombina III en diabetes mellitus no insulinodependiente de pacientes con infarto del miocardio / Antithrombin III in non insulin dependent diabetes mellitus of patients with myocardial infarction

Objetivo: Determinar si existe alguna relación entre los niveles de antitrombina III y el infarto del miocardio por trombosis coronaria en el paciente diabético no insulinodependiente. Material y métodos: Se realizó un estudio descriptivo en 99 pacientes diabéticos no insulinodependientes. Se midieron niveles plasmáticos de ATIII. En el grupo I se incluyeron 67 de ellos con IM a quienes se les realizó angiografía coronaria. El grupo II se formó con 32 pacientes con DMNID sin infarto del miocardio. Resultados: El grupo I lo integraron 42 pacientes masculinos (63 por ciento) y 25 femeninos (37 por ciento). El intervalo de edades de la población estudiada fue de 42 a 82 años. En la determinación de los niveles de ATIII 50 pacientes (75 por ciento) se encontraron en cifras de referencia (88 a 131 por ciento) y 17 (25 por ciento) con disminución. Los que mostraron nivel de obstrucción coronaria mayor o igual a 85 por ciento fueron 45; de éstos, en 34 (50.7 por ciento) el valor de ATIII se encontró en valores de referencia y en II (16.4 por ciento) con disminución (40 a 83 por ciento). De los 22 con grado de obstrucción menor o igual a 84 por ciento, 16 (24 por ciento) presentaron actividad normal y seis (9 por ciento) mostraron disminución; además, el intervalo de evolución del IM fue de 6 a 60 h, observando que a partir de las 36 h el porcentaje de actividad de la ATIII se encuentra disminuido (40 a 83 por ciento). En el grupo II el porcentaje de actividad de ATIII se encontró dentro de los valores de referencia con un rango de 88 a 115 por ciento. Conclusiones: La actividad de la ATIII no se altera dentro de las primeras 24 h del IM. A pesar de que este estudio no fue diseñado para evaluar la evolución de IM se observó una correlación entre la evolución de éste y la disminución de la actividad de la ATIII

relation between creatine kinase, magnesium and fibrinogen in patients with acute myocardial infarction

One of the most important mechanism of myocardial infarction is coronary thrombosis. One of the diagnostic procedures for myocardial infarction [MI] is serological tests to determine the levels of creatine kinase enzyme [CK] and, more effectively, creatine kinase MB isoenzyme [CK-MB]. On the other hand, high serum fibrinogen concentration can be considered as a risk factor for MI or the occurrence of complications after MI. The present study was conducted to find any possible relationship between the serum CK and CK-MB levels with serum magnesium and fibrinogen concentrations in acute MI [AMI], as well as any association between each of the factors mentioned with post-MI complications. The study included 100 MI affected patients [60 men and 40 women, between 30-60 years] hospitalized in the coronary care units [CCUs] of Isfahan hospitals in 1995. A questionnaire was completed for each subject to obtain information on personal characteristics, previous history of cardiovascular disease risk factors, MI type and location, radiological symptoms, prescribed medicines, and., in addition daily electrocardiography was performed for all patients. Also, blood samples were taken from each patient on admission, 6, 24 and 48 hours after MI for serum CK and CKMB measurements; the serum magnesium and fibrinogen concentrations were measured on the first and the second days, respectively. The results show that the peak value for CK enzyme and isoenzyme occurs 24 hours after MI. As regards the correlation between the serum magnesium and fibrinogen levels with the CK enzyme and CK-MB isoenzyme concentrations at different time points after MI, a significant correlation was observed only after 24 hours. The serum fibrinogen concentration was higher in men [366'103.7] than in women [311'105.2] [p=0.05]. On the other hand, the mean value of CK-MB isoenzyme was significantly higher in the Q-wave MI patients than in the non-Q-wave ones 6 and 24 hours after MI. In addition, there was a significant correlation between the CK enzyme and CKMB isoenzyme levels with post-MI complications after 24 hours. No correlation was found between serum magnesium and enzyme or the occurrence of MI complications were observed. It is concluded that only serum fibrinogen concentration can be used as a diagnostic serum marker for complicated MI

Atherosclerosis and acute arterial thrombosis in rabbits: a model using ballon desendothelization without dietary intervention

Acute thrombosis can be induced in rabbits by a triggering protocol using Russell's viper venom and histamine given after 8 months of a 1 per cent cholesterol diet and balloon desendothelization. In the present study, we tested the hypothesis that aortic desendothelization performed 4 months before the triggering protocol without a high cholesterol diet is a highly effective and less expensive way of producing arterial atherosclerosis and thrombosis. Nineteen male New Zealand white rabbits on a normal diet were studied. The control group (N = 9) received no intervention during the 4-month observation period, while the other group (N = 10) was submitted to aortic balloon desendothelization using a 4F Fogarty catheter. At the end of this period, all animals were killed 48 h after receiving the first dose of the triggering treatment. Eight of 10 rabbits (80 per cent) in the balloon-trauma group presented platelet-rich arterial thrombosis while none of the animals in the control group had thrombus formation (P<0.01). Thus, this model, using balloon desendothelization without dietary manipulation, induces arterial atherosclerosis and thrombosis and may provide possibilities to test new therapeutic approaches.