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Int. j. cardiovasc. sci. (Impr.) ; 35(2): 184-190, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364983


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.

Humans , Angioplasty, Balloon, Coronary/methods , ST Elevation Myocardial Infarction/surgery , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/epidemiology , Cross-Sectional Studies , Coronary Disease/complications , Hospitalization/statistics & numerical data
Rev. méd. Chile ; 149(5): 672-681, mayo 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1389516


ABSTRACT Background The coronavirus disease (COVID-19) pandemic affected the prompt diagnosis and treatment of Acute myocardial infarction (AMI). Aim: To characterize the clinical profile of patients with AMI during the COVID-19 pandemic, comparing them with a historical cohort. Material and Methods: A case-control study of 96 patients with AMI transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March and July 2020, and a historical cohort of 269 patients transferred during the same period in 2019. Results: When comparing patients transferred during the pandemic with those of the historical cohort, the former were younger (63 ± 12 vs 68 ± 12 years, p 12 hours from the onset of symptoms (44 vs 0%, p < 0.01), a higher median door-to-device time (4 vs 3 hours, p < 0.01), a higher use of primary percutaneous coronary intervention (97 vs 71%, p < 0.01), and higher frequencies of cardiogenic shock (20 vs 4%, p < 0.01) and mechanical complications (10% vs 2%, p < 0.01). Patients during COVID pandemic had a higher thirty-day overall (20 vs 1.4%, p < 0.01) and cardiovascular mortality (13 vs 1%, p < 0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for thirty-day overall mortality (Risk ratio 2.90; 95% confidence intervals 1.14-7.36). Conclusions: During the pandemic patients with AMI exhibited delays in consultations and treatment, higher morbidity, and increased mortality. COVID-19 positivity was associated to worse thirty-day overall survival.

Antecedentes: La pandemia COVID-19 afectó el tratamiento oportuno del infarto agudo de miocardio (IAM). Objetivo: Caracterizar el perfil clínico de pacientes con IAM durante la pandemia COVID-19 y compararlos con una cohorte histórica. Pacientes y Métodos: Estudio caso-control de 96 pacientes con IAM transferidos a un hospital de alto volumen de intervención coronaria percutánea (ICP) entre marzo julio de 2020 y una cohorte histórica de 269 pacientes transferidos en el mismo período de 2019 (n = 269). Resultados: Al comparar los pacientes transferidos durante pandemia y la cohorte histórica, los primeros eran más jóvenes (63 ± 12 y 68 ± 12 años respectivamente, p 12 h desde iniciados síntomas de IAM con elevación ST (44,4 y 0% respectivamente, p < 0,01), una mediana de tiempo puerta-guía mayor (4 y 3 horas respectivamente, p < 0,01), un mayor uso de ICP primaria (97 y 71% respectivamente, p < 0,01), mayor frecuencia de shock cardiogénico (19,8 y 4,1% respectivamente, p < 0.01) y complicaciones mecánicas (10,4 y 1,7% respectivamente, p < 0,01). A treinta días, los primeros tuvieron mayor mortalidad general (19,8 y 1,4% respectivamente p < 0.01) y cardiovascular (12,5 y 1,4% respectivamente, p < 0,01). Durante la pandemia, 40% de los pacientes presentó positividad para COVID-19, siendo un factor predictivo de mortalidad general (razón de riesgo 2,90; intervalos de confianza 95% 1,14-7,36). Conclusiones: Durante la pandemia, hubo retrasos en tiempos de consulta y tratamiento y mayor morbimortalidad del IAM. La positividad de COVID-19 se asoció a peor sobrevida general a treinta días.

Humans , Angioplasty, Balloon, Coronary , Percutaneous Coronary Intervention , COVID-19 , Myocardial Infarction/therapy , Myocardial Infarction/epidemiology , Prognosis , Reperfusion , Case-Control Studies , Treatment Outcome , Electrocardiography , Pandemics , SARS-CoV-2
Int. j. cardiovasc. sci. (Impr.) ; 34(1): 53-59, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154535


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

Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary , Time-to-Treatment/statistics & numerical data , ST Elevation Myocardial Infarction/surgery , Cross-Sectional Studies , Cohort Studies , Quality Indicators, Health Care , Emergency Service, Hospital , ST Elevation Myocardial Infarction/mortality , Length of Stay
Rev. int. sci. méd. (Abidj.) ; 23(1): 86-89, 2021. figures
Article in French | AIM | ID: biblio-1397430


Introduction. L'insuffi sance mitrale ischémique est une complication fréquente et représente un facteur de mauvais pronostic. Sa prise en charge thérapeutique est diffi cile. L'objectif de ce travail est de réévaluer l'intérêt de la revascularisation par angioplastie en cas d'insuffi sance mitrale ischémique importante. Observation et conclusion. Nous rapportons le cas d'un patient âgé de 48 ans ayant comme facteurs de risque cardiovasculaire ; une hypertension artérielle non suivie et un tabagisme actif (20 Paquets/année) qui s'était présentait pour un syndrome coronaire aigu compliqué d'une insuffi sance mitrale sévère et d'une insuffi sance cardiaque gauche avec une altération de la fraction d'éjection ventriculaire gauche à l'échocardiographie. La coronarographie montrait une atteinte tritronculaire. La revascularisation complète par angioplastie a permis une bonne évolution à cinq (5) ans

Humans , Angioplasty , Mitral Valve Insufficiency , Angioplasty, Balloon, Coronary , Myocardial Ischemia
Article in English | WPRIM | ID: wpr-887556


INTRODUCTION@#Early reperfusion of ST-segment elevation myocardial infarction (STEMI) results in better outcomes. Interventions that have resulted in shorter door-to-balloon (DTB) time include prehospital cardiovascular laboratory activation and prehospital electrocardiogram (ECG) transmission, which are only available for patients who arrive via emergency ambulances. We assessed the impact of mode of transport on DTB time in a single tertiary institution and evaluated the factors that affected various components of DTB time.@*METHODS@#We conducted a retrospective cohort study using registry data of patients diagnosed with STEMI in the emergency department (ED) who underwent primary percutaneous coronary intervention. We compared patients who arrived by emergency ambulances with those who came via their own transport. The primary study end point was DTB, defined as the earliest time a patient arrived in the ED to balloon inflation. As deidentified data was used, ethics review was waived.@*RESULTS@#A total of 321 patients were included for analysis after excluding 7 with missing data. The mean age was 61.4±11.4 years old with 49 (15.3%) females. Ninety-nine (30.8%) patients arrived by emergency ambulance. The median DTB time was shorter for patients arriving by ambulance versus own transport (52min, interquartile range [IQR] 45-61 vs 67min, IQR 59-74; @*CONCLUSION@#Arrival via emergency ambulance was associated with a decreased DTB for STEMI patients compared to arriving via own transport. There is a need for public education to increase the usage of emergency ambulances for suspected heart attacks to improve outcomes.

Aged , Ambulances , Angioplasty, Balloon, Coronary , Female , Humans , Middle Aged , Percutaneous Coronary Intervention , Retrospective Studies , Time Factors
Chinese Journal of Cardiology ; (12): 1227-1234, 2021.
Article in Chinese | WPRIM | ID: wpr-941426


Objective: To systematically evaluate the efficacy of drug coated balloon (DCB) versus conventional balloon in the treatment of coronary de novo bifurcation lesions. Methods: The databases of PubMed, Embase, Cochrane Library, Web of science, CNKI (China National Knowledge Infrastructure), Wanfang database, VIP, China Biology Medicine disc, Chinese clinical trial registry, American clinical trial registry and cardiovascular related websites until September 2020 were retrieved for collecting the randomized controlled trials (RCT) comparing DCB versus conventional balloon in the treatment of coronary de novo bifurcation lesions. The risk of bias of included studies was assessed using the Cochrane risk assessment tool. The meta-analysis was performed by using Revman 5.3 and Stata 14.0 software. Results: Seven RCTs with a total of 613 patients were included in this meta-analysis. Among the included studies, 4 articles reached the low risk of bias, and the other 3 articles reached the medium risk of bias. The results of meta-analysis showed that there was no significant difference in the major adverse cardiac events (RR=0.65, 95%CI 0.39-1.08, P=0.10), myocardial infarction (RR=0.68, 95%CI 0.25-1.80, P=0.43), target lesion revascularization (RR=0.94, 95%CI 0.53-1.67, P=0.83) between DCB group and conventional balloon group. Late lumen loss of side branch was less in the DCB group than that in the conventional balloon group (WMD=-0.25, 95%CI -0.41--0.09, P<0.01) and the risk of side branch restenosis was also lower in the DCB group than that in the conventional balloon group (RR=0.47, 95%CI 0.22-0.98, P<0.05). However, subgroup analysis showed that the conclusions of domestic studies and foreign studies on late lumen loss and side branch restenosis were inconsistent. The meta-analysis based on domestic literature showed that the risk of side branch restenosis after DCB treatment was lower compared with conventional balloon group (RR=0.29, 95%CI 0.15-0.57, P<0.05), while this parameter derived from foreign literatures remained unchanged between two groups (P=0.53). The meta-analysis results of domestic literature showed that late lumen loss in DCB group was less than that in conventional balloon group (WMD=-0.32, 95%CI -0.51--0.13, P<0.05), but this phenomenon was not observed in foreign literatures (P=0.30). Conclusions: The use of DCB in the treatment of coronary de novo bifurcation lesions has the potential to reduce the rate of restenosis and late lumen loss of side branch compared with conventional balloon group. However, due to the limitation on quantity, quality and results of published studies, more high-quality and large scale RCTs are still needed to confirm these findings.

Angioplasty, Balloon, Coronary , Coronary Artery Disease , Coronary Restenosis , Humans , Myocardial Infarction , Pharmaceutical Preparations , Treatment Outcome
Rev. méd. Chile ; 148(10)oct. 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389209


Acute myocardial infarction caused by thrombosis of left main coronary artery generate acute cardiac failure, cardiogenic shock and death. Along with the clinical history, the electrocardiogram (EKG) is the most useful tool for its recognition and timely management. Classically the EKG shows ST elevation > 1 mm in aVR or V1 with ST depression in the other leads. Urgent coronary angiography with percutaneous coronary angioplasty using drug eluting stents is recommended when the diagnosis is made. We report two cases to exemplify the clinical presentation, EKG and angiographic findings and therapeutic approach.

Humans , Thrombosis , Angioplasty, Balloon, Coronary , Myocardial Infarction , Treatment Outcome , Coronary Angiography , Coronary Vessels , Myocardial Infarction/etiology , Myocardial Infarction/diagnostic imaging
Rev. chil. cardiol ; 39(1): 34-38, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115447


Recently, intravascular lithoplasty (IVL) has been introduced as a novel technique for treating calcified intracoronary artery lesions. There are no reports of this intervention in Latin America. We report 2 cases in which IVL was successfully used to treat this type of coronary artery lesions.

Humans , Male , Middle Aged , Coronary Artery Disease/therapy , Lithotripsy/methods , Atherectomy, Coronary/methods , Vascular Calcification/therapy , Angioplasty, Balloon, Coronary
Rev. peru. med. exp. salud publica ; 37(1): 74-80, ene.-mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1101796


RESUMEN Con el objetivo de determinar las características clínicas y epidemiológicas de los pacientes con infarto de miocardio agudo (IMA), se realizó un estudio descriptivo en 175 pacientes de un hospital peruano de referencia. La edad promedio de los pacientes fue de 68,7 años y el 74,8% fueron de sexo masculino. La principal estrategia de reperfusión utilizada fue la angioplastia coronaria transluminal percutánea + stent, aunque su uso primario resultó ser bajo; además, el porcentaje de revascularización quirúrgica fue alto. Casi el 60% de los pacientes tuvo una estancia hospitalaria mayor a siete días. La mortalidad intra hospitalaria fue de 3,4%, siendo el shock cardiogénico la causa más frecuente de muerte. Se concluye que el IMA afecta principalmente a varones mayores de 60 años y que la principal estrategia de reperfusión es la angioplastia, además, los tiempos para la realización de la reperfusión son mayores a lo recomendado con porcentajes altos de revascularización quirúrgica.

ABSTRACT To determine the epidemiological and clinical characteristics of patients with acute myocardial infarc tion, a descriptive study was conducted in 175 patients in a referral hospital in Lima. The average age of the patients was 68.7 ± 10.8 years and 74.8% were male. The main reperfusion strategy used was percutaneous transluminal coronary angioplasty + stent, however, the use of primary angioplasty was low (19.5% of patients with ST elevation myocardial infarction). Time to reperfusion therapies (angio plasty or fibrinolysis) were longer than recommended and the percentage of surgical revascularization was high. Almost 60% of the patients had a length of stay longer than seven days. In-hospital mortality was 3.4%, with cardiogenic shock being the most frequent cause of death. Myocardial infarction mainly affects men over 60 years, the clinical and epidemiological variables are like other regional reports. The main reperfusion strategy is angioplasty, although the use of primary angioplasty is low. Time to perfor ming reperfusion is longer than recommended and the percentage of surgical revascularization is high.

Aged , Female , Humans , Male , Middle Aged , Myocardial Infarction , Peru/epidemiology , Referral and Consultation , Angioplasty, Balloon, Coronary , Hospital Mortality , Myocardial Infarction/therapy , Myocardial Infarction/epidemiology
Rev. méd. Minas Gerais ; 30(supl.4): S33-S40, 2020.
Article in Portuguese | LILACS | ID: biblio-1152270


Introdução. O infarto agudo do miocárdio apresenta significativas taxas de morbimortalidade. A reperfusão precoce por angioplastia primária é a intervenção que reduz a mortalidade e as complicações, e deve ser iniciada em até 12 horas, a fim de impedir a perda muscular irreversível. O tempo entre chegada do paciente ao hospital e a abertura da artéria acometida, tempo porta-balão, determina a morbimortalidade do paciente. Objetivo. Esse estudo busca analisar o potencial benefício do tratamento da reperfusão coronariana precoce, os fatores de risco, as possíveis complicações e o Killip em pacientes que sofreram infarto agudo do miocárdio relacionando-os a sua morbimortalidade. Materiais e métodos. Estudo observacional transversal realizado por meio de coleta de dados dos prontuários dos pacientes submetidos a angioplastia primária de um hospital privado. Resultados. A hipertensão arterial sistêmica foi a variável mais prevalente (75%), e que houve predomínio no sexo masculino (71%) e associação com a progressão da idade. 61% dos pacientes apresentaram um tempo porta balão menor que 90 minutos. Houve significância estatística entre o tempo porta balão e a evolução do Killip, evidenciando um tempo porta-balão maior que 90 minutos na maioria dos pacientes que obtiveram aumento da pontuação do Killip. Conclusão. A precocidade da intervenção no paciente com IAM impacta na morbimortalidade, visto que o tempo porta balão está diretamente associado a evolução da do Killip. Logo, deve-se identificar os fatores que interferem no atendimento, a fim de proporcionar uma intervenção otimizada. (AU)

Introduction. Acute myocardial infarction has significant rates of morbidity and mortality. Early reperfusion by primary angioplasty is the intervention that reduces mortality and complications, and should be started within 12 hours in order to prevent irreversible muscle loss. The time between the patient's arrival at the hospital and the opening of the affected artery, door-to-balloon time, determines the patient's morbidity and mortality. Objective. The proposition of this study is to analyze the potential benefits of early coronary reperfusion, associated with the risk factors, possible complications, and the Killip score in patients whit acute myocardial infarction (AMI) and the relation of those factors with the morbidity and mortality. Materials and methods. This is a transversal observational study and uses data collected of medical records of patients subjected to primary angioplasty in a private hospital. Results. Systemic arterial hypertension was the most prevalent one (75%), it was more common in males (71%) and associated with a higher age. In 61% of the patients port-balloon time was less than 90 minutes. There was statistical significance between port-balloon time and Killip score evaluation, that showed a higher score in patient with a port-balloon time that exceeded 90 minutes. Conclusion. Early intervention in patients with AMI impacts morbimortality, once that the port-balloon time is directly associated with the Killip score results. Therefore, all factors that can lead to a delay in their care of those patients should be identified with the objective of optimize the intervention. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Time Factors , Myocardial Reperfusion/instrumentation , Myocardial Infarction , Angioplasty, Balloon, Coronary , Indicators of Morbidity and Mortality , Risk Factors , Myocardial Infarction/therapy
Chinese Journal of Cardiology ; (12): 641-647, 2020.
Article in Chinese | WPRIM | ID: wpr-941152


Objective: To investigate the safety and efficacy of regional transport to percutaneous coronary intervention(PCI) hospitals from non-PCI hospitals after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI) in northwest China. Methods: In this retrospective study, 1 062 STEMI patients who were transferred from non-PCI hospitals within 24 hours from symptom onset, during January 2015 and January 2019 in the First Hospital of Lanzhou University, were included. According to the treatment strategy, they were divided into two groups, namely intravenous thrombolysis combined with PCI group(n=240), and primary PCI group(n=822). Observation endpoint were in-hospital adverse cardiovascular and cerebrovascular events and bleeding events, Including all-cause death, ischemic stroke, malignant arrhythmia, intracranial hemorrhage and hemorrhage with hemoglobin decrease≥50 g/L. Results: A total of 1 062 STEMI patients were included(age was (61±12) years old), with 905 males (85.2%). The proportion of grade 0 TIMI blood flow in the primary PCI group before operation was significantly higher than that in the thrombolysis combined with PCI group(63.0%(518/822) vs. 36.3%(87/240), P<0.001). Compared with primary PCI group, the time from symptom onset to first medical contact(2.11(1.00, 4.00)hours vs.3.00(1.13, 7.07)hours, P<0.001) and reperfusion in thrombolysis combined with PCI group(3.07(1.83, 4.87)hours vs. 6.92(4.07, 11.15) hours, P<0.001) were significantly shorter. The proportion of all-cause death was significantly higher in the primary PCI group than that in the thrombolysis combined with PCI group (1.8%(15/822) vs. 0, P=0.03). There was no significant difference in hemorrhage, ischemic stroke and malignant arrhythmia between the two groups(all P>0.05). Conclusions: For STEMI patients initially hospitalized in non-PCI hospitals, regional transport combined with PCI is feasible and effective. It does not significantly increase the risk of bleeding and cardiovascular and cerebrovascular events, with shorter time from symptom onset to myocardial reperfusion.

Aged , Angioplasty, Balloon, Coronary , China , Humans , Male , Middle Aged , Myocardial Infarction , Percutaneous Coronary Intervention , Retrospective Studies , ST Elevation Myocardial Infarction/therapy , Thrombolytic Therapy , Treatment Outcome
Rev. méd. Chile ; 147(12): 1626-1629, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1094196


The anomalous origin of the coronary arteries is uncommon and the origin of the right coronary artery from the middle third of the anterior descending artery is a finding of extreme rarity. We report two patients with coronary atherosclerotic disease and with an acute coronary syndrome, in whom a single left coronary artery was found. The clinical and angiographic characteristics and the treatment of these patients are described.

Humans , Male , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Coronary Artery Disease/surgery , Coronary Artery Disease/etiology , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/complications
CorSalud ; 11(4): 348-352, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1124635


RESUMEN El ejercicio físico evita las enfermedades cardiovasculares pero cuando es intenso debe tener planificación y dosificación correctas y, de ser posible, es muy útil contar con una prueba ergométrica previa y un especialista orientador; porque también puede producir accidentes cardiovasculares en deportistas de alto rendimiento, entre otras cosas, por no cumplir con una programación bien definida con un basamento científico. La complicación más temida es la muerte súbita cardíaca, habitualmente por arritmias malignas y enfermedad isquémica. Se presenta el caso de un deportista de alto rendimiento, de 34 años de edad, en fase desentrenamiento y sin factores de riesgo cardiovascular u otros antecedentes de interés, que sufrió un infarto agudo de miocardio anterior extenso, con angina postinfarto, debido a una estenosis suboclusiva de la descendente anterior proximal. Se realizó angioplastia de rescate, con implantación de un stent farmacoactivo y el paciente evolucionó favorablemente.

ABSTRACT Physical exercise avoids cardiovascular diseases but when it is intense, it must have correct planning and dosage and, if possible, a previous ergometric test and a guidance specialist could be very useful; because it can also cause cardiovascular events in high performance athletes, among other things, for not complying with a well-defined schedule with a scientific base. The most feared complication is sudden cardiac death, usually due to malignant arrhythmias and ischemic heart disease. Here is presented the case of a 34-year-old high-performance athlete, in the detraining phase and without cardiovascular risk factors or other history of interest, who suffered an extensive acute myocardial infarction, with post-infarction angina, due to a stricture suboclusive of the proximal left anterior descending artery. A rescue angioplasty was performed, with implantation of a drug-eluting stent and the patient evolved favorably.

Angioplasty, Balloon, Coronary , Risk Factors , Myocardial Infarction
Medicina (B.Aires) ; 79(4): 251-256, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040517


Se evaluaron las características clínicas, demoras, resultados y morbimortalidad de 1142 pacientes tratados con angioplastia primaria (AP) dentro de las 36 horas del infarto, incluidos en el registro ARGEN-IAM-ST, de carácter prospectivo, transversal, multicéntrico y de alcance nacional. Edades: 61.2 ± 12 años, 88% varones, 20% diabéticos y 58% hipertensos; 77.6% en Killip y Kimball I y 6.2% en shock cardiogénico. El tiempo desde el inicio del dolor hasta el ingreso fue de 153 (75-316) minutos, y puerta-balón de 91 (60-150) minutos. Los casos derivados (17%) tuvieron mayor demora de ingreso, 200 minutos (195-420; p = 0.0001) y mayor tiempo puerta-balón, 113 minutos (55-207); p = 0.099. En 47.6% de los casos la AP se hizo en arteria descendente anterior, en 36.4% a coronaria derecha, en 14.8% a circunfleja y en 1.2% al tronco de coronaria izquierda; en 95% con stent (29% farmacológico). El 95% fue exitoso. El 1.3% presentó angina post-infarto (APIAM), 1.3% re-infarto, 8.8% shock y 3.2% sangrado. Se asociaron a mayor mortalidad edad > 64 años (OR 6.2 (IC 95%: 3.2-12), p < 0.001), diabetes (OR 2.5, IC 95% 1.6-3.9, p < 0.001), re-infarto o APIAM (OR 3.3, IC 95% 1.3-8.3, p = 0.011) y shock (OR 29.2 (15.6-54.8), p < 0.001). La mortalidad hospitalaria del infarto agudo de miocardio con elevación del segmento ST tratado con AP fue de 7.6%. La derivación se asoció a demora de tratamiento. El shock cardiogénico y la isquemia post-infarto se asociaron a alta mortalidad. No hubo variables del procedimiento asociadas a mortalidad.

Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.

Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/mortality , ST Elevation Myocardial Infarction/therapy , Argentina , Cross-Sectional Studies , Prospective Studies , Treatment Outcome , ST Elevation Myocardial Infarction/mortality
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 297-301, May-June 2019. graf
Article in English | LILACS | ID: biblio-1002228


Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty

Humans , Female , Adult , Uterine Hemorrhage/complications , Women , Stents , Angioplasty , Platelet Aggregation Inhibitors/therapeutic use , Angioplasty, Balloon, Coronary/methods , Embolization, Therapeutic/methods , Leiomyoma
Arq. bras. cardiol ; 112(5): 564-570, May 2019. tab
Article in English | LILACS | ID: biblio-1011185


Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

Resumo Fundamento: A angioplastia primária (AP) com colocação de stent, seja ele convencional ou farmacológico, representa a principal estratégia no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Os pacientes diabéticos, entretanto, representam população especial no IAMCSST, com altas taxas de reestenose e desfechos clínicos desfavoráveis, devendo-se indicar o uso de stents farmacológicos (SF), nível de evidência A e classe de indicação II, para redução destes danos. Objetivo: Avaliar a taxa de uso de SF em pacientes com IAMCSST e no subgrupo dos diabéticos assistidos na rede pública versus privada de saúde em Sergipe. Métodos: Trata-se de um estudo populacional, transversal, com abordagem quantitativa, que utilizou os dados do Registro VICTIM. Estes foram coletados nos quatro únicos hospitais com capacidade para realizar AP em Sergipe, no período de dezembro de 2014 a março de 2017. Em todas as hipóteses testadas, o nível de significância adotado foi de 5% (p < 0,05). Resultados: Foram avaliados 707 pacientes diagnosticados com IAMCSST, dos quais 589 foram atendidos pelo SUS e 118 pela rede privada. O uso de SF na AP foi menor no SUS em comparação com a rede privada, tanto no total da amostra (10,5% vs 82,4%; p < 0,001) quanto no subgrupo dos pacientes diabéticos (8,7% vs 90,6%; p < 0,001), respectivamente. Conclusões: O estudo revela disparidade no uso de SF durante a realização de AP entre a rede pública e privada, tanto na amostra total quanto no subgrupo dos diabéticos, com menores taxas para usuários do SUS, demonstrando os desafios que necessitam ser vencidos para se atingir melhorias na qualidade dos serviços prestados.

Humans , Male , Female , Middle Aged , Angioplasty, Balloon, Coronary/methods , Public Sector/statistics & numerical data , Private Sector/statistics & numerical data , Diabetes Complications/prevention & control , Drug-Eluting Stents/statistics & numerical data , ST Elevation Myocardial Infarction/therapy , Socioeconomic Factors , Time Factors , Cross-Sectional Studies , Treatment Outcome
Arq. bras. cardiol ; 112(4): 432-438, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001287


Abstract Background: The analysis of risk factors for predicting related complications has not been reported to date. Objective: This study aims to investigate the risk factors of related complications of percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) retrospectively. Method: Clinical data, and one-year follow-up results of patients with HOCM, who underwent PTSMA between January 2000 and July 2013 in the Department of Cardiology, Liaoning Province People's Hospital, Liaoning Province, China, were retrospectively analyzed to determine risk factors for operative complications with multiple logistic regression analysis. All p values are two-sided, with values of p < 0.05 being considered statistically significant. Results: Among 319 patients with HOCM, PTSMA was performed in 224 patients (120 males and 104 females, mean age was 48.20 ± 14.34 years old). The incidence of PTSMA procedure-related complications was 36.23% (66/224), which included three cardiac deaths, two cardiac shocks, one ST-segment elevated myocardial infarction, two ventricular fibrillations, 20 third-degree atrioventricular (AV) blocks (four patients were implanted with a permanent pacemaker (PPM)), 32 complete right bundle branch blocks, two complete left bundle branch blocks, and four puncture-related complications. After multivariate logistic regression analysis, it was found that age, gender, coronary artery diseases, diabetes, heart rate, cardiac function on admission, the number of septal ablations, and the volume of alcohol were not independent risk factors correlated to the whole complications, except for hypertension (OR: 4.856; 95% CI: 1.732-13.609). Early experience appears to be associated with the occurrence of complications. Conclusion: Hypertension was an independent risk factor for PTSMA procedure-related complications. It might be much safer and more efficient if PTSMA procedures are restricted to experienced centers, according to the analysis results for the learning curve.

Resumo Fundamento: A análise dos fatores de risco para previsão de complicações relacionadas não foi relatada até o momento. Objetivo: Este estudo tem como objetivo investigar retrospectivamente os fatores de risco de complicações relacionadas da ablação miocárdica septal transluminal percutânea (PTSMA) para cardiomiopatia hipertrófica obstrutiva (CMHO). Método: Dados clínicos e resultados de acompanhamento de um ano de pacientes com CMHO submetidos a PTSMA entre janeiro de 2000 e julho de 2013 no Departamento de Cardiologia do Hospital Popular da Província de Liaoning, província de Liaoning, China, foram analisados retrospectivamente para determinar fatores de risco para complicações operatórias com análise de regressão logística múltipla. Todos os valores de p são bilaterais, com valores de p < 0,05 sendo considerados estatisticamente significativos. Resultados: Entre os 319 pacientes com CMHO, a PTSMA foi realizada em 224 pacientes (120 homens e 104 mulheres, com idade média de 48,20 ± 14,34 anos). A incidência de complicações relacionadas ao procedimento PTSMA foi de 36,23% (66/224), incluindo três mortes cardíacas, dois choques cardíacos, um infarto do miocárdio com supradesnivelamento de ST, duas fibrilações ventriculares e 20 bloqueios atrioventriculares (AV) de terceiro grau (quatro pacientes receberam implantes de marca-passo permanente), 32 bloqueios completos de ramo direito, dois bloqueios completos de ramo esquerdo e quatro complicações relacionadas com a punção. Após análise de regressão logística multivariada, verificou-se que idade, sexo, doenças coronarianas, diabetes, frequência cardíaca, função cardíaca à admissão, número de ablações septais e volume de álcool não foram fatores de risco independentes correlacionados com as complicações totais, exceto para hipertensão (OR: 4,856; IC 95%: 1,732-13,609). A experiência principiante parece estar associada à ocorrência de complicações. Conclusão: A hipertensão arterial foi um fator de risco independente para complicações relacionadas com o procedimento de PTSMA. Pode ser muito mais seguro e eficiente se os procedimentos de PTSMA forem restritos a centros experientes, de acordo com os resultados da análise para a curva de aprendizado.

Humans , Male , Female , Adult , Middle Aged , Cardiomyopathy, Hypertrophic/surgery , Angioplasty, Balloon, Coronary/adverse effects , Catheter Ablation/adverse effects , Intraoperative Complications/etiology , Cardiomyopathy, Hypertrophic/complications , Angioplasty, Balloon, Coronary/methods , Logistic Models , Retrospective Studies , Risk Factors , Treatment Outcome , Catheter Ablation/methods , Statistics, Nonparametric , Risk Assessment , Echocardiography, Stress , Hypertension/etiology , Intraoperative Complications/diagnostic imaging
Arq. bras. cardiol ; 112(1): 40-47, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-973839


Abstract Background: In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS). Objectives: To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS. Methods: Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE. Results: We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%. Conclusion: FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.

Resumo Fundamentos: Em pacientes multiarteriais e lesões moderadas, a reserva de fluxo fracionada (FFR) avalia cada lesão e direciona o tratamento, podendo ser útil no custo-efetividade (CE) de implante de stents não farmacológicos (SNF). Objetivos: Avaliar CE e impacto clínico da angioplastia + FFR versus angioplastia + angiografia (ANGIO), em multiarteriais, utilizando SNF. Métodos: pacientes com doença multiarteriais foram randomizados prospectivamente durante ±5 anos para FFR ou ANGIO, e acompanhados por até 12 meses. Foram avaliados eventos cardíacos maiores (ECAM), reestenose e CE. Resultados: foram incluídos 69 pacientes, 47(68,1%) homens, 34(49,2%) no FFR e 35(50,7%) no ANGIO, idade 62,0 ± 9,0 anos, com angina estável e Síndrome Coronariana Aguda estabilizada. No FFR, havia 26 com doença (76,5%) biarterial e 8 (23,5%) triarterial, e no grupo ANGIO, 24(68,6%) biarteriais e 11(31,4%) triarteriais. Ocorreram 12(17,3%) ECAM - 3(4,3%) óbitos: 2(5,8%) no FFR e 1(2,8%) no ANGIO, 9(13,0%) anginas, 4(11,7%) no FFR e 5(14,2%) no ANGIO, 6 reestenoses: 2(5,8%) no FFR e 4 (11,4%) no ANGIO. Angiografia detectou 87(53,0%) lesões no FFR, 39(23,7%) com ICP e 48(29,3%) com tratamento clínico; e 77(47,0%) lesões no ANGIO, todas submetidas à angioplastia. Quanto aos stents, registrou-se 39(33,3%) (0,45 ± 0,50 stents/lesão) no FFR e 78(66,6%) (1,05 ± 0,22 stents/lesão) no ANGIO (p = 0,0001); ANGIO utilizou 51,4% a mais que o FFR. Análise de CE revelou um custo de R$5045,97 e R$5.430,60 nos grupos ANGIO e FFR, respectivamente. A diferença de efetividade foi 1,82%. Conclusões: FFR diminuiu o número de lesões tratadas e de stents e necessidade de revascularização do vaso-alvo, com CE comparável ao da angiografia.

Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Angiography/methods , Fractional Flow Reserve, Myocardial/physiology , Acute Coronary Syndrome/therapy , Angina, Stable/therapy , Time Factors , Angioplasty, Balloon, Coronary/economics , Stents , Prospective Studies , Treatment Outcome , Coronary Angiography/economics , Cost-Benefit Analysis , Statistics, Nonparametric , Coronary Restenosis/mortality , Coronary Restenosis/therapy , Kaplan-Meier Estimate , Acute Coronary Syndrome/economics , Acute Coronary Syndrome/pathology , Angina, Stable/economics , Angina, Stable/mortality