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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
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
Rev. chil. cardiol ; 37(2): 115-119, ago. 2018. ilus
Article in Spanish | LILACS | ID: biblio-959349


Resumen: Las lesiones cutáneas por radiación (LCR) son una complicación infrecuente, con un estimado de 3.600 casos de lesiones mayores reportados en la actualidad. Presentamos un caso de lesión eritematosa mayor por radiación posterior a angioplastía coronaria fallida y en segundo tiempo angioplastía coronaria con rotablación.

Abstract: Cutaneous radiation injuries are an infrequent complication, with an estimated 3.600 cases of major injuries reported up to now. We present a case of a major erythematous lesion induced by radiation after failed coronary angioplasty and consecutive coronary rotablation.

Humans , Male , Middle Aged , Radiodermatitis/etiology , Skin/radiation effects , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/methods , Pigmentation Disorders/etiology , Radiation Injuries/etiology , Radiodermatitis/therapy
Arq. bras. cardiol ; 110(5): 476-483, May 2018. graf
Article in English | LILACS | ID: biblio-950156


Abstract Percutaneous coronary intervention in chronic total occlusion is a rapidly evolving area, being considered the last frontier of interventional cardiology. In recent years, the development of new techniques and equipment, as well as the training of specialized personnel, increased their success rates, making it the most predictable procedure available. Although the number of randomized and controlled studies is still limited, results from large multicentered registries allow us to safely offer this intervention to patients, as another treatment option along with the optimized drug treatment and myocardial revascularization surgery. This review summarizes the last and most relevant publications in the subject in order to provide an overall view of the field's current status.

Resumo A intervenção coronária percutânea em oclusão total crônica é uma área em rápida evolução, sendo considerada a última fronteira da cardiologia intervencionista. Nos últimos anos, o desenvolvimento de novas técnicas e equipamentos, assim como o treinamento de operadores especializados, elevaram sua taxa de sucesso, tornando o procedimento mais previsível. Apesar do número de estudos randomizados e controlados ainda ser limitado, resultados de grandes registros multicêntricos nos permitem oferecer essa intervenção aos pacientes com segurança, como mais uma opção de tratamento junto ao tratamento medicamentoso otimizado e ao lado cirurgia de revascularização miocárdica. Na presente revisão, resumimos as últimas e mais relevantes publicações sobre o assunto a fim de fornecer uma visão geral do atual estado da área.

Humans , Angioplasty, Balloon, Coronary/methods , Coronary Occlusion/therapy , Chronic Disease , Risk Factors , Coronary Angiography
Article in English, Portuguese | LILACS | ID: biblio-909281


A doença arterial coronariana (DAC) é a principal causa de mortalidade e morbidade entre os portadores de diabetes mellitus (DM). O DM aumenta o risco de DAC e é um preditor independente dos piores resultados após qualquer método de revascularização coronária: intervenção coronária percutânea (ICP) ou cirurgia de revascularização miocárdica (CRM). O tratamento da DAC em diabéticos possui características importantes e sua respectiva presença deve ser utilizada na escolha do método de intervenção, especialmente nos pacientes multiarteriais e/ou com lesão de tronco de coronária esquerda. Além da terapia medicamentosa rigorosa ser um dos pilares fundamentais, a decisão sobre a estratégia de revascularização deve ser tomada por uma equipe multiprofissional e multidisciplinar ("Heart Team"), baseando-se em elementos do quadro clínico, da anatomia coronária, carga isquêmica, função ventricular esquerda, risco cirúrgico hospitalar e do próprio paciente.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity among patients with Diabetes Mellitus (DM). DM increases the risk of CAD and is an independent predictor of poorer outcomes after any method of coronary revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The treatment of CAD in diabetics has important characteristics, and its presence should not be used in the choice of intervention method, especially in multiarterial patients and/or patients with unprotected left main stem disease. In addition to rigorous drug therapy being one of the fundamental pillars, the decision on the type of revascularization strategy should be made by a multiprofessional and multidisciplinary team ("Heart Team"), based on the clinical presentation, coronary anatomy, ischemic burden, left ventricular function, in-hospital surgical risk and individual patient risk.

Humans , Coronary Artery Disease/surgery , Coronary Artery Disease/history , Stroke/mortality , Diabetes Mellitus/epidemiology , Myocardial Revascularization/rehabilitation , Angioplasty, Balloon, Coronary/methods , Stents/history
Rev. chil. cardiol ; 36(3): 200-208, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899587


Resumen: Introducción: La terapia antiagregante dual (TAD) con aspirina más clopidogrel o ticagrelor es fundamental para prevenir trombosis de stent y nuevos eventos cardiovasculares (CV) en pacientes sometidos a angioplastía coronaria (AC). Sin embargo, TAD se asocia a un riesgo aumentado de hemorragias, en particular cuando su uso se prolonga. Recientemente se han creado puntajes (DAPT, PRECISE-DAPT) que buscan estimar el riesgo de sangrado en pacientes con TAD por tiempo prolongado, los que quisimos evaluar en nuestra población. Métodos: Se utilizó la base de datos prospectiva de Prevención Cardiovascular del Hospital Clínico U. Católica, seleccionando pacientes sometidos a AC el año 2015. Se realizó una encuesta telefónica estandarizada para identificar episodios de sangrado definidos según clasificación ISTH, tiempo de uso de TAD y nuevos eventos CV. Se calcularon los puntajes DAPT y PRECISE-DAPT. Se usó pruebas de t de Student, test exacto de Fisher y curva ROC, según correspondiese, considerando significativa una p<0,05. Resultados: Se incluyeron 227 pacientes (edad 64,2±12,3 años, 22,5% mujeres), de los cuales el 69,6% eran hipertensos, 28,6% diabéticos, 26,9% fumadores y 5,3% insuficientes renales crónicos. En el 63% de los pacientes la AC fue por síndrome coronario agudo, se implantaron 1,4±0,7 stents/paciente y el 37% de los pacientes recibió sólo stents metálicos. Al momento de la encuesta, el seguimiento fue de 26±3 meses. Se registró un tiempo promedio de duración de TAD de 12,6±7,4 meses, con 99,1% de los pacientes recibiendo aspirina, 93,4% clopidogrel, 6,6% ticagrelor y 9,3% anticoagulantes orales. Hubo 35 (15,4%) nuevos eventos CV (revascularización 14, infarto 12, accidente cerebrovascular 2 y muerte 7) y 31 (13,6%) episodios de sangrados (criterio ISTH). De acuerdo con el criterio TIMI de sangrado se registraron 5 (2,2%) episodios graves, 9 (3,9%) leves y 17 (7,4%) menores. En 10 (4,4%) pacientes se modificó la TAD debido al sangrado. PRECISE-DAPT se asoció de manera significativa a los episodios de sangrado (p<0,01); tener un puntaje de alto riesgo (>25) aumentó más de 3 veces el riesgo de sangrado (OR 3,1 IC 1,4-7,1, p<0,01) y una curva ROC estableció que en la población estudiada el mejor punto de corte fue de 18 puntos (C-statistic 0,69) (Figuras 1A y B). El uso de TACO aumentó el riesgo (OR 3,4 IC 1,2-9,5, p=0,02). Si bien miden distintos parámetros, los puntajes de riesgo DAPT y PRECISE-DAPT se correlacionaron significativamente en nuestra cohorte (p<0,01). Conclusiones: En esta cohorte de la vida real se demuestra que la ocurrencia de sangramientos es un evento frecuente en pacientes con TAD, similar a la tasa de nuevos eventos CV, y por tanto debe ser un factor relevante a considerar al momento de la AC y la selección de la TAD. El puntaje PRECISE-DAPT es una herramienta útil para predecir sangrados, aunque nuestros resultados sugieren que en población chilena los valores de corte pueden ser algo menores que lo previamente publicado .

Abstracts: Background: Dual antiplatelet therapy (DAT) with aspirin plus clopidogrel or ticagrelor is essential for the prevention of stent thrombosis and new cardiovascular events in patients undergoing PCI. However, DAT is associated with an increased risk of bleeding, more so when it is used for prolonged time periods. Scores (DAPT, PRECISE-DAPT) developed to predict bleeding risk were evaluated in this study. Method: The prospective Cardiovascular Prevention database at Catholic University Hospital was used to select patients who underwent PCI followed by DAT during 2015. By phone contact information on bleeding episodes - according to the ISTH classification -, new cardiovascular events and DAT duration were collected. DAPT and PRECISE- DAPT scores were calculated. Student's t test, Fisher exact test and ROC analysis were used. Significance was established at p< 0.05. Results: 277 patients were included (age 64.2±12.3 y-o, 22.5% women). Hypertension was present in 66.9%, diabetes in 28.6%, smoking habit in 26.9% and renal failure in 5.3%. The indication for PCI was acute coronary syndrome in 63%, 1.4±0.7 stents per patient were implanted and 37% of patients received bare metal stents exclusively. Follow-up extended for 26±3 months. DAT was active for 12.6±7.4 months and 9.3% of patients received oral anticoagulant therapy. There were 35 (15.4%) new cardiovascular events (14 revascularizations, 12 myocardial infarctions, 2 CVA and 7 deaths). Conversely, there were 31 (13.6%) bleeding episodes. According to the TIMI classification, bleeding episodes were severe in 2.2%, mild in 3.9% and minor in 7.4%. In 4% of patients DAT was modified due to bleeding. PRECISE-DAPT score was significantly associated to bleeding episodes (p<0.01). A high score (>25) was associated with a 3-fold risk of bleeding (OR 3.1, CI 1.4-7.1 (p<0.01). Through ROC analysis the best PRECISE-DAPT cutting point in this cohort was 18 (C=0.69). The use of oral anticoagulation increased bleeding risk (OR 3.4 CI 1.2 - 9.5, p=0.02). DAPT and PRECISE-DAPT were significantly correlated (p<0.01). Conclusion: Bleeding is a frequent complication of DAT, similar to the risk of new cardiovascular events. PRECISE-DAPT score is useful to estimate the risk of bleeding, although this study suggests that in the studied population the cutting point may be somewhat lower than previously published.

Humans , Male , Female , Middle Aged , Aged , Platelet Aggregation Inhibitors/adverse effects , Angioplasty, Balloon, Coronary/methods , Hemorrhage/chemically induced , Platelet Aggregation Inhibitors/therapeutic use , Cardiovascular Diseases/prevention & control , Aspirin/adverse effects , Prospective Studies , Surveys and Questionnaires , ROC Curve , Follow-Up Studies , Risk Assessment/methods , Clopidogrel/adverse effects , Ticagrelor/adverse effects , Hemorrhage/epidemiology
Arq. bras. cardiol ; 109(4): 277-283, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-887947


Abstract Background: The place of drug-eluting balloons (DEB) in the treatment of in-stent restenosis (ISR) is not well-defined, particularly in a population of all-comers with acute coronary syndromes (ACS). Objective: Compare the clinical outcomes of DEB with second-generation drug-eluting stents (DES) for the treatment of ISR in a real-world population with a high proportion of ACS. Methods: A retrospective analysis of consecutive patients with ISR treated with a DEB compared to patients treated with a second-generation DES was performed. The primary endpoint was a composite of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, and target lesion revascularization). Comparisons were performed using Cox proportional hazards multivariate adjustment and Kaplan-Meier analysis with log-rank. Results: The cohort included 91 patients treated with a DEB and 89 patients treated with a DES (74% ACS). Median follow-up was 26 months. MACE occurred in 33 patients (36%) in the DEB group, compared to 17 patients (19%) in the DES group (p log-rank = 0.02). After multivariate adjustment, there was no significant difference between the groups (HR for DEB = 1.45 [95%CI: 0.75-2.83]; p = 0.27). Mortality rates at 1 year were 11% with DEB, and 3% with DES (p = 0.04; adjusted HR = 2.85 [95%CI: 0.98-8.32]; p = 0.06). Conclusion: In a population with a high proportion of ACS, a non-significant numerical signal towards increased rates of MACE with DEB compared to second-generation DES for the treatment of ISR was observed, mainly driven by a higher mortality rate. An adequately-powered randomized controlled trial is necessary to confirm these findings.

Resumo Fundamento: O papel de balões farmacológicos (BFs) no tratamento de reestenose intra-stent (RIS) não está bem definido, particularmente em na síndrome coronária aguda (SCA). Objetivo: Comparar desfechos clínicos do uso de BF com stents farmacológicos (SFs) de segunda geração no tratamento de RIS em uma população real com alta prevalência de SCA. Métodos: Foi realizada uma análise retrospectiva de pacientes consecutivos com RIS tratados com um BF comparados a pacientes tratados com SF de segunda geração. O desfecho primário incluiu eventos cardiovasculares adversos importantes (morte por todas as causas, infarto do miocárdio não fatal, e revascularização da lesão alvo). As comparações foram realizadas pelo modelo proporcional de riscos de Cox ajustado e análise de Kaplan-Meier com log-rank. Resultados: A coorte incluiu 91 pacientes tratados com BF e 89 pacientes tratados com um SF (75% com SCA). O tempo mediano de acompanhamento foi de 26 meses. Eventos cardiovasculares adversos importantes ocorreram em 33 pacientes (36%) no grupo BF, e em 17 (19%) no grupo SF (p log-rank = 0,02). Após ajuste multivariado, não houve diferença significativa entre os grupos (HR para BF = 1,45 [IC95%: 0,75-2,83]; p = 0,27). As taxas de mortalidade de 1 ano foram 11% com BF, e 3% com SF (p = 0,04; HR ajustado = 2,85 [IC95%: 0,98-8,32; p = 0,06). Conclusão: Em uma população com alta prevalência de SCA, observou-se um aumento não significativo nas taxas de eventos cardiovasculares adversos importantes com o uso de BF comparado ao uso de SF de segunda geração para o tratamento de RIS, principalmente pelo aumento na taxa de mortalidade. É necessário um ensaio clínico controlado, randomizado, com poder estatístico adequado para confirmar esses achados.

Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/instrumentation , Paclitaxel/therapeutic use , Coronary Restenosis/therapy , Acute Coronary Syndrome/therapy , Drug-Eluting Stents/adverse effects , Prosthesis Design , Time Factors , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/methods , Multivariate Analysis , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Risk Assessment , Coated Materials, Biocompatible , Coronary Restenosis/mortality , Kaplan-Meier Estimate , Acute Coronary Syndrome/mortality
Int. j. cardiovasc. sci. (Impr.) ; 30(5): f:380-l:390, set.-out. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-849531


Fundamento: As taxas de mortalidade relacionadas à doença aterosclerótica coronariana (DAC) vêm reduzindo nas últimas décadas devido, em parte, aos avanços nas técnicas de revascularização. Objetivos: O objetivo deste estudo foi apresentar um visão dos últimos 20 anos do tratamento da DAC pelo Sistema Único de Saúde (SUS) no Brasil. Métodos:Os dados foram obtidos através dos sistemas TABNET e SIGTAP do SUS e através do IBGE. Os procedimentos foram agrupados nas categorias de revascularização percutânea, cirúrgica e percutânea primária. Foram analisados o número de autorizações de internação hospitalar (AIH), duração média de permanência hospitalar, mortalidade hospitalar, valor do repasse total por procedimento e valores médios da AIH e dos serviços profissional e hospitalar. Resultados:Entre 1995 e 2015, houve aumento no número de revascularizações cirúrgicas (de 13.198 a 22.559) e percutâneas (de 10.522 a 66.345). De modo semelhante, o número de angioplastias primárias apresentaram aumento entre 2004 e 2015 (de 1.901 a 8.524). Houve uma queda no tempo médio de permanência hospitalar (de 14,4 a 12,8 dias) e da mortalidade hospitalar (de 7,6% a 5,9%) nas revascularizações cirúrgicas e queda da permanência hospitalar (de 5,3 dias a 3,7 dias) mas manutenção da taxa de mortalidade (2,2%) nas revascularizações percutâneas. Nas angioplastias primárias, o tempo médio de permanência hospitalar variou de 5,3 a 5,6 dias e a taxa de mortalidade variou de 7,94% a 7,43% entre 2004 e 2015, respectivamente. O valor médio do repasse total para as revascularização cirúrgicas variou de R$ 4.327,57 para R$ 12.839,13 e para as revascularizações percutâneas de R$ 2.615,81 a R$ 6.187,87 entre 1995 e 2015, respectivamente. Os valores equivalentes para as angioplastias primárias foram de R$ 5.415,58 em 2004 a R$ 6.581,51 em 2015. Conclusões: O número de procedimentos de revascularização aumentou no Brasil nos últimos 20 anos, juntamente com uma melhora nas taxas de mortalidade e redução no tempo de permanência hospitalar. Observou-se importante defasagem de valores financeiros em relação à inflação acumulada neste período

Introduction: The mortality rates associated with coronary atherosclerotic disease (CAD) have been declining over the past decades driven, in part, by advances in revascularization techniques. Objective: The aim of this study was to provide an overview of the past 20 years in the treatment of CAD delivered by the Brazilian Unified Health Care System (SUS). Methods:The data were obtained from SUS's TABNET and SIGTAP systems and IBGE. The procedures were grouped into the categories percutaneous, surgical, and primary percutaneous revascularizations. The analysis included the number of hospital admission authorizations (AIH), mean length of hospital stay, in-hospital mortality, mean total amount paid by procedure, and mean values paid per AIH and for professional and hospital services. Results: Between 1995 and 2015, there were increases in the number of surgical revascularizations (from 13,198 to 22,559) and percutaneous revascularizations (from 10,522 to 66,345). Similarly, the number of primary angioplasties increased between 2004 and 2015 (from 1,901 to 8,524). There was a decrease in the mean length of hospital stay (from 14.4 to 12.8 days) and hospital mortality (from 7.6% to 5.9%) for surgical revascularizations, and decrease in mean length of hospital stay (from 5.3 days to 3.7 days) but maintenance of the mortality rates (2.2%) for percutaneous revascularizations. In primary angioplasties, the mean length of hospital stay varied from 5.3 to 5.6 days and the mortality rate varied from 7.94% to 7.43% between 2004 and 2015, respectively. The mean total amount paid for surgical revascularization varied from R$ 4,327.57 to $12,839.13 and for percutaneous revascularizations from R$ 2,615.81 to $6,187.87 between 1995 and 2015, respectively. Corresponding values for primary angioplasties were R$ 5,415.58 in 2004 to R$ 6,581.51 in 2015. Conclusions: The number of revascularization procedures increased in Brazil over the past 20 years, with an improvement in mortality rates and decrease in length of hospital stay. There was a substantial lag in economic values relative to the inflation accumulated during the period

Humans , Male , Female , Brazil/epidemiology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/therapy , Myocardial Revascularization/methods , Percutaneous Coronary Intervention/methods , Therapeutics , Unified Health System , Angioplasty, Balloon, Coronary/methods , Cardiovascular Diseases/mortality , Health Care Costs , Health Status Indicators , Health Systems , Hospitalization/trends , Surgical Procedures, Operative/methods , Treatment Outcome
Arq. bras. cardiol ; 106(4): 270-278, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-780795


Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

Resumo Fundamento: A estratégia de revascularização na doença do tronco comum é determinante para os resultados clínicos. Objetivo: Procurou-se: 1) validar e comparar o desempenho do SYNTAX Score 1 e 2 na predição de eventos cardiovasculares aos 4 anos, em pacientes submetidos a angioplastia do tronco comum não protegido e 2) avaliar os resultados a longo prazo de acordo com a estratégia de revascularização recomendada pelo SYNTAX Score. Métodos: Estudo retrospectivo de centro único de 132 pacientes consecutivos submetidos a angioplastia do tronco comum não protegido entre março de 1999 e dezembro de 2010. A discriminação e calibração de ambos os modelos foram avaliadas por análise de curva ROC, curvas de calibração e teste de Hosmer-Lemeshow. Resultados: A taxa de eventos aos 4 anos foi de 26,5%. A AUC para o SYNTAX Score 1 e 2 foi de 0,61 (IC 95% 0,49-0,73) e 0,67 (IC 95% 0,57-0,78), respectivamente. Apesar de uma calibração global boa, o SYNTAX Score 2 tende a subestimar o risco. Nos 47 pacientes (36%) que deveriam ter sido submetidos a cirurgia de revascularização de acordo com o SYNTAX Score 2, a taxa de eventos foi numericamente superior (30% vs. 25%; p=0,54) e para os que tinham uma diferença superior entre as estimativas do SYNTAX Score 2 (>5,7%), a taxa de eventos foi quase o dobro (40% vs. 22%; p=0,2). Conclusão: O SYNTAX Score 2 permite uma estratificação de risco individualizada e melhor em pacientes que requerem revascularização do tronco comum não protegido. São necessários estudos prospectivos para validação adicional.

Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/therapy , Angioplasty, Balloon, Coronary/methods , Risk Assessment/methods , Reference Values , Time Factors , Severity of Illness Index , Coronary Artery Disease/mortality , Calibration , Angioplasty, Balloon, Coronary/mortality , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Coronary Angiography , Statistics, Nonparametric , Disease-Free Survival
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.631-654.
Monography in Portuguese | LILACS | ID: biblio-971558
Yonsei Medical Journal ; : 606-613, 2016.
Article in English | WPRIM | ID: wpr-52540


PURPOSE: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). MATERIALS AND METHODS: This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. RESULTS: Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. CONCLUSION: PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.

Aged , Angioplasty, Balloon, Coronary/methods , Coronary Angiography , Coronary Stenosis/diagnosis , Coronary Vessels/pathology , Drug-Eluting Stents/adverse effects , Female , Humans , Male , Middle Aged , Paclitaxel/administration & dosage , Prospective Studies , Tomography, Optical Coherence/methods , Treatment Outcome , Tubulin Modulators/administration & dosage
Int. j. cardiovasc. sci. (Impr.) ; 28(5): 363-369, set.-out. 2015. tab
Article in Portuguese | LILACS | ID: lil-786801


Fundamentos: A doença arterial coronariana (DAC) apresenta alta morbimortalidade. A angioplastia coronariana e antiagregação com ácido acetilsalicílico (AAS) são fundamentais no tratamento desses pacientes. No contexto da angioplastia eletiva, carece estudos referentes aos fatores associados à resistência ao AAS.Objetivo: Avaliar a prevalência e os fatores relacionados à resistência ao AAS em pacientes submetidos àangioplastia eletiva. Métodos: Coorte retrospectiva de 198 pacientes submetidos à angioplastia eletiva, avaliados quanto à resistência ao AAS pela agregometria óptica com ácido araquidônico como agonista.Resultados: Observou-se resistência ao AAS em 6,56% da coorte (13/198). Os níveis de proteína C-reativa (PCR-t)mostraram associação com a resistência ao AAS (p=0,02). Conclusões: A prevalência da resistência ao AAS observada nos pacientes submetidos à angioplastia eletiva é baixa e os níveis elevados de proteína C-reativa relacionaram-se com maior chance de ocorrência dessa resistência.

Background: Coronary artery disease (CAD) has high morbidity and mortality rates. Coronary angioplasty and antiplatelet therapy with acetylsalicylic acid (ASA) are critical in treating CAD patients. Elective angioplasty lacks studies on the factors associatedwith resistance to ASA. Objective: To evaluate the prevalence and ASA resistance related factors in patients undergoing elective angioplasty.Methods: Retrospective cohort study of 198 patients undergoing elective angioplasty, evaluated for resistance to ASA by optical aggregometry with arachidonic acid as agonist. Results: Resistance to ASA in 6.56% of the cohort (13/198). C-reactive protein (CRP) levels indicated association with resistance to ASA (p=0.02).Conclusions: Low prevalence of ASA resistance in patients undergoing elective angioplasty; C-reactive protein high levels are related to greater frequency of this resistance.

Humans , Male , Female , Middle Aged , Angioplasty, Balloon, Coronary/methods , Aspirin/administration & dosage , Coronary Artery Disease/complications , Coronary Artery Disease/therapy , Platelet Aggregation , Brazil/epidemiology , C-Reactive Protein , Cohort Studies , Risk Factors , Treatment Outcome
Rev. chil. cardiol ; 34(2): 93-99, 2015. graf, tab
Article in Spanish | LILACS | ID: lil-762609


Introducción: El uso de adenosina intracoronario durante la angioplastía coronaria ha sido controversial en los últimos años. El beneficio teórico en el flujo epi-cárdico y microcirculatorio (MC) no se ha demostrado categóricamente en estudios clínicos. Objetivo: Evaluar el efecto de protección de la MC y del flujo epicárdico al utilizar adenosina intracoronaria durante la AP. Métodos: Estudio clínico randomizado multicéntrico, caso-control con análisis post hoc ciego, en pacientes portadores de SCA con SDST. Un total de 122 pacientes aleatorizados 1:1, se consideró caso (A(+)) aquel que se administró adenosina en dosis de 120 microgramos intracoronario en bolo y luego infusión periférica de 6mg en 33ml de suero fisiológico a pasar en 2-3 minutos Se evaluaron criterios clínicos, angiográficos y electrocar-diográficos de reperfusión epicárdica y microvascular. Observadores ciegos evaluaron el conteo de cuadros TIMI (cTFC) y "blush" miocárdico (BM). Se compararon las características clínicas, angiográficas basales y los resultados angiográficos finales entre ambos grupos, usando t-Student, prueba de Mann-Whitney, Chi cuadrado y test exacto de Fisher según correspondiera. En todos los pacientes se evaluó la resolución del SDST con el score de ST. Además, se evaluó las posibles complicaciones por uso de adenosina intracoronaria. Resultados: Entre 2012-2014 se reclutaron 122 pacientes. Al comparar las características basales entre el grupo A(+) vs los A(-) no hubo diferencias significativas en la edad (59+/-10 años para A(+) vs 58+/-10 años para A(-), p:0,97), ni en las comorbilidades. Al comparar las características angiográficas basales, no se encontró diferencias en los vasos culpables (ADA 44% en A(+) vs 43% en A(-), p:0.57), en las cargas trombóticas (Alta carga: 69% para A(+) vs 74% para A(-), p:0.53), en el flujo TIMI pre (TIMI 0-1 86% para ambos grupos, p:0,69), cTFC pre (87+/-23 cuadros en A(+) vs 88+/-25 cuadros en A(-), p:0.99), Killip de ingreso (Killip I, 86% para A(+) vs 76% para A(-), p:0,11) y fracción de eyección (51+/-8% para A(+) vs 48+/-9% para (-), p:0,61). Al evaluar los resultados angiográficos finales encontramos diferencias significativas en el flujo TIMI (TIMI 3 96% para grupo A(+) vs 74% para grupo A(-), p:0,002). No encontramos diferencias significativas en el BM (Blush 3 73% para ambos grupos, p:0.74), el cTFC final (24+/-11 cuadros en A(+) vs 26+/-12 cuadros en A(-), p:0,85). Si consideramos cTFC <23cuadros como éxito angiográficos, tampoco encontramos diferencias significativas (56% para A(+) vs 53% para A(-), p:0,45). Por último tampoco hubo diferencias significativas con la resolución del segmento ST (44% para A(+) vs 58% para A(-), p:0,126). Conclusión: De acuerdo a los resultados obtenidos podemos inferir que la adenosina intracoronaria cumple un rol en la conservación óptima del flujo epicárdico coronario, pero sin influir en la microcirculación. Mayores estudios se requieren para determinar si se traduce en algún beneficio clínico.

Background: The effect of Intracoronary adenosine for coronary flow preservation during primary PTCA is debatable. Clinical studies have not established a benefit of adenosine administration upon epicar-dic or microcirculatory flows. Aim: to evaluate micro circulatory flow preservation after administration of intracoronary adenosine during primary PTCA. Method: From 2012 to 2014, 122 patients with ST elevation myocardial infarction randomized to either adenosine of control (2:1) were included in a controlled clinical trial. Adenosine was administered in a 120 mg bolus followed by 6mg solution during 2 to 3 min. Epicardic and micro vascular flows were evaluated through clinical, angiographic, electrocardiographic and reperfusion variables. TIMI (cTFC) and myocardial "blush" were measured by blind observers. Results: Basal characteristics, namely age and co-morbidities were similar between groups. Also, the distribution of coronary vessels involved in MI was similar with a preponderance of the LAD artery. There was an high proportion of patients with an elevated thrombus load (Adenosine 69%, controls 74%) ; TIMI flow 0-1 was 86% in both groups and TIMI cTFC was not different (adenosine: 87±23 , controls 88±25 ). Over 75% of patients were Killip I, and the ejection fraction was slightly decreased (adenosine 51±8% , controls 48±9% , NS). In contrast, TIMI flow was significantly greater for adenosine (TIMI 3 96% for adenosine and 74% for controls, p=0.002). No difference was observed in myocardial blush (B 3 73% in both groups) nor cTFC (24±11 vs. 26±12, respectively). Finally, regression of ST elevation was similar in both groups. Conclusion: Intracoronary adenosine during PTCA in ST elevation MI was associated to a better epicardial but not microvascular flow. Further study is needed to evaluate the eventual clinical benefit of these effects.

Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/methods , Adenosine/administration & dosage , Coronary Circulation/drug effects , Myocardial Infarction/therapy , Chi-Square Distribution , Multicenter Study , Treatment Outcome , Microcirculation/drug effects