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1.
Rev. cuba. med ; 60(3): e2579, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347516

ABSTRACT

Introducción: El infarto del miocardio tipo 4a es una complicación del intervencionismo coronario percutáneo, que se asocia a un proceso inflamatorio. El índice neutrófilo linfocitario, como marcador de inflamación, pudiera incluirse en su estratificación del riesgo. Objetivos: Evaluar la sensibilidad, especificidad, los valores predictivos y la variación del índice neutrófilo linfocitario en la predicción del infarto del miocardio tipo 4a. Métodos: Investigación de cohorte prospectiva, en 184 pacientes a los que se les realizó intervencionismo coronario percutáneo. Resultados: Para un valor mayor e igual a 2,74, el índice mostró una sensibilidad de 72,0 por ciento, una especificidad de 74,8 por ciento un valor predictivo negativo de 94,4 por ciento en la predicción de infarto tipo 4a. La variación del índice fue predictor independiente de la complicación p < 0,001. Conclusiones: El índice neutrófilo linfocitario tiene alta sensibilidad, especificidad y valor predictivo negativo en la predicción del infarto tipo 4a. Su elevación a las seis horas del proceder es un predictor independiente para dicha complicación(AU)


Introduction: Type 4a myocardial infarction is a complication of percutaneous coronary intervention, which is associated with an inflammatory process. The lymphocyte neutrophilic index, as a marker of inflammation, could be included in your risk stratification. Objectives: To assess the sensitivity, specificity, predictive values and the variation of the lymphocyte neutrophilic index in the prediction of type 4a myocardial infarction. Methods: A prospective cohort investigation was carried in 184 patients who underwent percutaneous coronary intervention. Results: For a value higher than and equal to 2.74, the index showed 72.0 percent, sensitivity, 74.8 percent specificity and 94.4 percent negative predictive value in the prediction of type 4a infarction. The variation of the index was an independent predictor of the complication p < 0.001. Conclusions: The lymphocyte neutrophil index has high sensitivity, specificity and negative predictive value in the prediction of type 4a infarction. Its elevation six hours after the procedure is an independent predictor for this complication(AU)


Subject(s)
Humans , Percutaneous Coronary Intervention/methods , Forecasting , Myocardial Infarction , Prospective Studies
2.
Arch. cardiol. Méx ; 90(4): 467-474, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152821

ABSTRACT

Resumen Objetivo: Comparar las tasas de recurrencia de revascularización coronaria (cirugía o intervención coronaria percutánea), nuevo evento isquémico o muerte en pacientes con puentes secuenciales y con puentes simples. Método: Cohortes ambispectivas de pacientes sometidos a cirugía de revascularización coronaria secuencial (n = 111) o simple (n = 145) entre el 1 de enero de 2013 y el 31 de diciembre de 2017. Pacientes mayores de 18 años en un primer procedimiento de revascularización, con circulación extracorpórea. Para el seguimiento se realizó revisión del expediente o comunicación telefónica hasta el 9 de febrero de 2019. Se investigaron los siguientes desenlaces: reintervención por isquemia coronaria, nuevo evento isquémico documentado o muerte atribuida a cardiopatía isquémica; también se obtuvieron curvas de sobrevida. Resultados: La proporción de recurrencia según la técnica quirúrgica no fue estadísticamente diferente: secuencial 6.5% (intervalo de confianza del 95% [IC95%]: 2.6-12.6%) contra simple 4.8% (IC95%: 2-9.7%; p = 0.60; análisis bayesiano BF10 = 0.37; evidencia moderada a no diferencia), todos por nuevo evento isquémico y un fallecimiento por grupo. No hubo diferencias en el tiempo de seguimiento: secuencial 59 meses (IC95%: 56-62) y simple 66 meses (IC95%: 64-68). No encontramos diferencia en las tasas de incidencia de recurrencia: secuencial 1.99 eventos/103 meses-paciente contra simple 1.47 (hazard ratio: 1.34; IC95%: 0.47-3.8; p = 0.58). El tiempo promedio de pinzamiento y de circulación extracorpórea por puente fue menor en el grupo de puentes combinados (41.44 minutos de circulación extracorpórea y 24.69 minutos de pinzamiento/puente) que en el de puentes simples (43 minutos en circulación extracorpórea y 26.4 minutos de pinzamiento/puente) cuando se ajusta al promedio de puentes colocados (simples 2.7 y secuencial 3.25; p < 0.001); sin embargo, no se encontró significancia estadística (p = 0.7). Conclusión: Ambos procedimientos tuvieron una baja incidencia de recurrencia de eventos clínicos, sin diferencias entre las técnicas quirúrgicas.


Abstract Objective: To compare the recurrence rates of revascularization (redo CABG or PCI), new ischemic event or death in patients with simple grafts and patients with sequential grafts. Method: Study design is an ambispective cohort of patients that underwent CABG by sequential grafting (n = 111) or simple grafting (n = 145) between January 1st, 2013 and December 31st, 2017. Patients had to be 18 years old at the time of surgery, undergoing their first on-pump CABG. The clinical record of every patient was carefully reviewed and patients who had incomplete follow-up in external consultation were contacted by telephone in order to obtain data about ischemia related reintervention (CABG or PCI), new documented ischemic event or death caused by coronary artery disease, Kaplan-Meier estimators were calculated. Results: The proportion of recurrence depending on technique was not statistically different: sequential (6.5% [CI95% 2.6-12.6%] versus simple 4.8% [CI95% 2-9.7%], p = 0.60, Bayesian analysis BF10 = 0.37; moderate evidence to no difference), each one related to new ischemic event and one death per group. There were no differences in follow-up time (sequential 59m [CI95% 56-62] simple 66m [CI95% 64-68]). No difference was found regarding recurrence incidence rates; sequential 1.99 events x 103 months-patient, versus simple 1.47 (HR=1.34; CI95% 0.47-3.8, p = 0.58). Pump and cross-clamping times were lower for sequential technique (41.44 min; 24.69 min respectively) versus simple technique (43 min; 26.4 min respectively) with a p = 0.7 after adjusting to mean grafts per surgery (2.7 simple; 3.25 sequential, p < 0.001). Conclusions: Both techniques had a low incidence of clinical recurrence, without significant differences between procedures.


Subject(s)
Humans , Middle Aged , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Percutaneous Coronary Intervention/methods , Myocardial Revascularization/methods , Recurrence , Cohort Studies , Follow-Up Studies , Bayes Theorem
3.
Gac. méd. Méx ; 156(6): 569-579, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249969

ABSTRACT

Resumen Introducción: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. Objetivo: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. Método: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología, con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. Resultados: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. Conclusión: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.


Abstract Introduction: Mexico has the highest 30-day acute myocardial infarction (AMI) mortality rate: 28% versus 7.5% on average for the OECD countries, and it constitutes one of the main causes of mortality in the country. Objective: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. Method: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. Results: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. Conclusion: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status.


Subject(s)
Humans , Consensus , ST Elevation Myocardial Infarction/diagnosis , Societies, Medical , Spain , Biomarkers/blood , Myocardial Reperfusion/methods , Thrombolytic Therapy/methods , Cause of Death , Electrocardiography , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/rehabilitation , ST Elevation Myocardial Infarction/blood , Cardiac Rehabilitation , COVID-19/prevention & control , Mexico
4.
Arch. cardiol. Méx ; 90(2): 137-141, Apr.-Jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131022

ABSTRACT

Abstract Objective: The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock. Methods: The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms. The registry is designed to compare the efficacy and safety of primary PCI and pharmacoinvasive strategy. The simple size was calculated in 344 patients divided into two groups, with an estimated loss rate of 10%. Patients included in the PHASE-MX cohort will be followed for up to one year. Conclusion: In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience.


Resumen Objetivo: El objetivo del registro PHASE-MX es validar la eficacia y seguridad de la estrategia farmacoinvasiva en comparación con la angioplastia coronaria transluminal percutánea primaria (ACTPp) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en una región metropolitana de México. El desenlace primario es el compuesto de muerte cardiovascular, reinfarto, accidente vascular cerebral y choque cardiogénico. Métodos: El registro PHASE-MX es una cohorte prospectiva de pacientes con IAMCEST que recibieron tratamiento de reperfusión (mecánico o farmacológico) en las primeras 12 horas desde el inicio de los síntomas, atendidos en el Instituto Nacional de Cardiología Ignacio Chávez. El análisis estadístico se basa en la no inferioridad de la estrategia farmacoinvasiva en comparación con la ACTPp. Se calcula un tamaño de muestra de 344 pacientes divididos en dos grupos (angioplastia primaria y estrategia farmacoinvasiva), considerada una tasa de pérdidas de 10%. Los pacientes incluidos en la cohorte PHASE-MX se seguirán durante un año. Discusión: En México, sólo 5 de cada 10 pacientes con IAMCEST tienen acceso al tratamiento de reperfusión. La estrategia farmacoinvasiva aprovecha la accesibilidad de la fibrinólisis y la efectividad de la ACTPp, por lo que podría resultar el método de elección en el tratamiento del IAMCEST en la mayoría de los casos. El presente protocolo de investigación pretende aportar información que sirva como enlace entre la información derivada de los estudios clínicos controlados y los registros derivados de la experiencia del mundo real.


Subject(s)
Humans , Male , Female , Reperfusion/methods , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/therapy , Research Design , Shock, Cardiogenic/epidemiology , Registries , Prospective Studies , Cohort Studies , Follow-Up Studies , Stroke/epidemiology , Percutaneous Coronary Intervention/adverse effects , Mexico
5.
Arch. cardiol. Méx ; 90(supl.1): 62-66, may. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152846

ABSTRACT

Resumen Las terapias de reperfusión, tales como intervención coronaria y fibrinólisis, son las principales medidas de atención en pacientes con síndromes coronarios agudos. La angioplastia primaria se considera el estándar de oro, sin embargo, en pacientes con infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), la estrategia de reperfusión más recomendada es la terapia fibrinolítica, debido al menor tiempo requerido para realizarla y menor exposición al agente infeccioso. Esta pandemia representa una problemática de contagio en el personal de salud, ya que los casos van en aumento a nivel mundial, por lo cual es importante conocer las medidas que se deben seguir a fin de evitar la enfermedad por coronavirus 2019 (COVID-19).


Abstract Reperfusion therapy is a measure of care in patients with ST-elevation myocardial infarction (STEMI), which should be performed once we have the diagnosis. Percutaneous coronary intervention is considered the gold standard, however in patients with SARS-CoV-2 infection, the reperfusion strategy is more focused on fibrinolytic therapy due to the shorter time required to perform and less exposure. This pandemic represents a contact problem in health personnel, since cases are increasing worldwide, so it is important to know the measures that must be followed to avoid coronavirus disease (COVID-19).


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Myocardial Reperfusion/methods , Health Personnel , Coronavirus Infections/prevention & control , Pandemics/prevention & control , ST Elevation Myocardial Infarction/therapy , Pneumonia, Viral/epidemiology , Thrombolytic Therapy/methods , Coronavirus Infections/epidemiology , Acute Coronary Syndrome/therapy , Percutaneous Coronary Intervention/methods , COVID-19
6.
Arch. cardiol. Méx ; 90(supl.1): 33-35, may. 2020.
Article in Spanish | LILACS | ID: biblio-1152840

ABSTRACT

Resumen Las comunicaciones acumuladas en las últimas semanas dejan claro que no existe un acuerdo para definir la mejor estrategia de tratamiento en los pacientes con un síndrome coronario agudo (SICA). En los pacientes que se presentan con un infarto agudo del miocardio con elevación del segmento ST (IAMCESST) se ha sugerido privilegiar la fibrinólisis (FL) sobre la intervención coronaria percutánea primaria (ICPp), reservando el ICP para los casos de FL fallidar1,2; sin embargo algunas sociedades han mantenido la indicación de la ICPp como el método de repercusión de elecciónr3. En los SICA sin elevación del segmento ST (SICASESST) las recomendaciones son muy similares, favoreciendo el tratamiento medico sobre el intervencionismo coronario percutáneo, en este subgrupo de pacientes1. Varias sociedades consideran el estado de contagio, en particular en los SICASESST, para decidir que estrategia de repercusión seguir3. Anticipando que la curva epidemiológica en México será similar a la observada en la mayoría de los países, recomendamos continuar la atención de los pacientes con SICA, las salas de cateterismo deben mantener su funcionamiento.


Abstract The communications accumulated in the last weeks make it clear that there is no agreement to define the best treatment strategy in patients with acute coronary syndrome (SICA). In patients presenting with an acute myocardial infarction with ST-segment elevation (IAMCESST), it has been suggested to favor fibrinolysis (FL) over primary percutaneous coronary intervention (PCI), reserving ICP for cases of failed FL1,2; however, some societies have maintained the indication of the ICPp as the repercussion method of choice3. In SICAs without ST segment elevation (SICASESST) the recommendations are very similar, favoring medical treatment over percutaneous coronary intervention in this subgroup of patients1. Several companies consider the contagion status, particularly in the SICASESST, to decide which repercussion follow3. Anticipating that the epidemiological curve in Mexico will be similar to that observed in most countries, we recommend continuing the care of patients with SICA, the catheterization rooms must maintain their operation.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Acute Coronary Syndrome/therapy , Pneumonia, Viral/prevention & control , Cardiac Catheterization , Disease Outbreaks , Coronavirus Infections/prevention & control , Acute Coronary Syndrome/physiopathology , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , Non-ST Elevated Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , COVID-19 , Mexico/epidemiology
7.
Acta Paul. Enferm. (Online) ; 33: eAPE20190094, 2020. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1130548

ABSTRACT

Resumo Objetivo: Comparar desfechos clínicos de óbito, reinfarto e Acidente Vascular Encefálico (AVE) em estudos primários que avaliaram o uso da Terapia Fibrinolítica (TF) em relação à Intervenção Coronariana Percutânea Primária (ICPP) para reperfusão miocárdica em pacientes com Infarto Agudo do Miocárdio com supradesnivelamento do segmento ST (IAMCST) no atendimento pré-hospitalar. Método: Revisão sistemática de literatura com busca realizada nas bases de dados CINAHL, MEDLINE, PUBMED, Science Direct, SCOPUS e Web of Science no período de outubro a dezembro de 2017. Foram incluídos Ensaios Clínicos Randomizados, disponíveis na íntegra, em qualquer idioma, sem recorte temporal. A avaliação da elegibilidade foi realizada em duas etapas e aplicada a Escala de Jadad para avaliação metodológica dos estudos encontrados. Resultados: Foram incluídos cinco Ensaios Clínicos Randomizados. A TF pré-hospitalar apresentou taxas de mortalidade em 30 dias após a intervenção semelhantes à ICPP, enquanto que em cinco anos foram encontrados valores menores para a TF. O tratamento instituído em um período menor que duas horas dos sintomas iniciais apresentou associação com a diminuição da mortalidade quando foi utilizada a TF. O reinfarto não-fatal, acidente vascular encefálico e a hemorragia intracraniana foram maiores quando utilizada a TF, enquanto que o choque cardiogênico apresentou menor frequência. Conclusão: A TF foi mais eficaz no tratamento pré-hospitalar para a redução dos óbitos após cinco anos, entretanto, o reinfarto e o AVE ocorreram de forma semelhante na amostra analisada. O fator tempo reduziu os desfechos clínicos, principalmente quando a terapia implementada ocorreu em até duas horas após a ocorrência do IAMCST. Assim, apesar das intervenções terem apresentado desfechos semelhantes, entretanto, a TF pode representar um tratamento viável em locais onde a ICPP não pode ser alcançada em tempo hábil.


Resumen Objetivo: Comparar resultados clínicos de fallecimiento, reinfarto y accidente vascular encefálico (AVE) en estudios primarios que analizaron el uso de la terapia fibrinolítica (TF) respecto a la intervención coronaria percutánea primaria (ICPP) para reperfusión miocárdica en pacientes con infarto agudo de miocardio con supradesnivel del segmento ST (IAMCST) en la atención prehospitalaria. Método: Revisión sistemática de literatura con búsqueda realizada en las bases de datos CINAHL, MEDLINE, PUBMED, Science Direct, SCOPUS y Web of Science en el período de octubre a diciembre de 2017. Se incluyeron ensayos clínicos aleatorizados, con texto completo disponible, en cualquier idioma, sin recorte temporal. El análisis de elegibilidad se realizó en dos etapas y se aplicó la escala de Jadad para una evaluación metodológica de los estudios encontrados. Resultados: Se incluyeron cinco ensayos clínicos aleatorizados. La TF prehospitalaria presentó índices de mortalidad 30 días después de la intervención semejantes a la ICPP, mientras que en cinco años se encontraron valores menores en la TF. El tratamiento aplicado en un período menor a dos horas desde los síntomas iniciales presentó una relación con la reducción de la mortalidad cuando se utilizó la TF. Los reinfartos no fatales, los accidentes vasculares encefálicos y las hemorragias intracerebrales fueron mayores cuando se utilizó la TF, mientras que los choques cardiogénicos presentaron menor frecuencia. Conclusión: La TF fue más eficaz en el tratamiento prehospitalario para reducir los fallecimientos después de cinco años, sin embargo, los reinfartos y los AVE ocurrieron de forma semejante en la muestra analizada. El factor tiempo redujo los resultados clínicos, principalmente cuando la terapia implementada ocurrió hasta dos horas después del episodio del IAMCST. De esta forma, a pesar de que las intervenciones presentaron resultados semejantes, la TF puede representar un tratamiento viable en lugares donde la ICPP no puede realizarse a tiempo.


Abstract Objective: To compare clinical outcomes of death, reinfarction, and stroke in primary studies assessing Fibrinolytic Therapy (FT) use in relation to Primary Percutaneous Coronary Intervention (PPCI) for myocardial reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) in prehospital care. Method: A systematic literature review conducted in the CINAHL, MEDLINE, PUBMED, Science Direct, SCOPUS, and Web of Science databases from October to December 2017. Randomized Clinical Trials, available in full, in any language, without temporal clipping were included. The eligibility assessment was carried out in two stages and applied to the Jadad Scale for methodological assessment of the studies found. Results: Five Randomized Clinical Trials were included. Prehospital FT presented mortality rates at 30 days after the intervention similar to PPCI, while in five years lower values were found for FT. The treatment instituted in a period of less than two hours of the initial symptoms was associated with the decrease in mortality when FT was used. Non-fatal reinfarction, stroke and intracranial hemorrhage were higher when FT was used, while cardiogenic shock showed lower frequency. Conclusion: FT was more effective in prehospital treatment to reduce deaths after five years, however, reinfarction and stroke occurred similarly in the sample analyzed. The time factor reduced clinical outcomes, especially when the implemented therapy occurred within two hours after the occurrence of STEMI. Thus, although the interventions presented similar outcomes. However, FT may represent a viable treatment in places where PPCI cannot be achieved in a timely manner.


Subject(s)
Humans , Myocardial Reperfusion/methods , Myocardial Reperfusion Injury/drug therapy , Thrombolytic Therapy , Emergency Medical Services , Fibrinolytic Agents/therapeutic use , Percutaneous Coronary Intervention/methods , Myocardial Infarction/drug therapy , Outcome Assessment, Health Care
8.
Arch. cardiol. Méx ; 89(4): 330-338, Oct.-Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149091

ABSTRACT

Resumen Antecedentes y objetivo: El interés sobre la influencia del sexo en pacientes con síndrome coronario agudo (SCA) tratados con stent y nuevos antiagregantes inhibidores de P2Y12 en la práctica clínica es creciente. Se analizan las diferencias en función del sexo en el tratamiento con doble antiagregación plaquetaria (DAPT) y los eventos adversos isquémicos y hemorrágicos Materiales y métodos: Estudio prospectivo de pacientes consecutivos con diagnóstico de SCA tratados con stent coronario desde julio de 2015 hasta enero de 2016. Resultados: De un total de 283 pacientes incluidos, 75 (26.5%) correspondió a mujeres y 208 (73.5%) a hombres. La edad media fue de 71 ± 13 y 66.5 ± 13 años, respectivamente. Un 44% de mujeres se presentó como SCA con elevación del segmento ST contra un 52.4 de los hombres, p = 0.21. Las mujeres mostraron un mayor riesgo de sangrado (CRUSADE), sin diferencias en el riesgo isquémico (GRACE y TIMI). Se usaron stents farmacoactivos con más frecuencia en mujeres (88.9 vs. 75.5%, p = 0.04). Se observó una tendencia de menor prescripción del ticagrelor en mujeres (42.6 vs. 50.9%, p = 0.29) en favor de un mayor uso del clopidogrel. No se identificaron diferencias en cuanto a la prescripción del prasugrel. Las mujeres presentaron al año una menor mortalidad (1.4 vs. 6.7%, p = 0.19), aunque mayor sangrado (23.3 vs. 17.4%, p = 0.27). Conclusiones: En este estudio de pacientes consecutivos con SCA tratados con stent se registró una mayor prescripción de clopidogrel en las mujeres que en los hombres. Las mujeres presentaron una menor incidencia anual de mortalidad, pero mayor sangrado en comparación con los hombres, no significativo.


Abstract Aims and objective: Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding. Materials and methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year. Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27). Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Stents , Acute Coronary Syndrome/therapy , Purinergic P2Y Receptor Antagonists/administration & dosage , Percutaneous Coronary Intervention/methods , Prognosis , Practice Patterns, Physicians'/statistics & numerical data , Ticlopidine/administration & dosage , Sex Factors , Prospective Studies , Acute Coronary Syndrome/mortality , Drug-Eluting Stents , Clopidogrel/administration & dosage , Ticagrelor/administration & dosage , Hemorrhage/epidemiology
9.
Arch. cardiol. Méx ; 89(4): 308-314, Oct.-Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149088

ABSTRACT

Resumen Antecedentes: La reserva de flujo fraccional (FFR) es una herramienta con evidencia demostrada para guiar las angioplastias coronarias. El reembolso por los sistemas de cobertura de salud es parcial o nulo a pesar de frecuentemente diferir la angioplastia. Nuestro objetivo fue determinar el beneficio económico de la utilización del FFR en la evaluación de lesiones intermedias, y evaluar asimismo puntos finales clínicos en el seguimiento a un año. Métodos: Estudio observacional prospectivo que incluyó una cohorte de pacientes consecutivos con lesiones coronarias intermedias, evaluadas con FFR, entre abril de 2013 y marzo de 2016. Para el análisis económico se evaluaron los recursos específicos utilizados para la realización del procedimiento. Se analizaron puntos finales clínicos (muerte cardiovascular, revascularización de la arteria objetivo e infarto agudo de miocardio) durante la internación y en el seguimiento a un año Resultados: Se incluyeron 222 lesiones en 151 pacientes consecutivos. Se registró FFR positivo en el 26.1% de las lesiones evaluadas. Se estimó que sin la utilización de FFR, 126 pacientes hubieran sido tratados con angioplastia transluminal coronaria y 25 con cirugía de revascularización miocárdica. El costo estimado con la utilización de FFR fue US$ 891,290.08, mientras que sin el mismo hubiera sido de US$ 1,557,352. Esto implicó un ahorro del 43% de los gastos. Se observaron una muerte de origen cardiovascular y dos reinternaciones en el grupo FFR positivo en el seguimiento a un año. Conclusiones: La revascularización de lesiones intermedias guiada por FFR resultó en un beneficio económico al reducir los costos generales sin resultar clínicamente perjudicial.


Abstract Background: Fractional flow reserve (FFR) is a proven technology for guiding percutaneous coronary intervention, but it is not reimbursed despite the fact that it frequently allows to defer revascularization. Our goal was to determine the economic benefit of FFR on intermediate lesions, as well as the clinical endpoints at 1 year follow up. Methods: Observational prospective study that included consecutive patients with intermediate lesions evaluated with FFR between April 2013 and March 2016. For the economic analysis we evaluated the specific resources used during the procedure. Clinical endpoints including cardiovascular death, target lesion revascularization and acute myocardial infarction, were followed up over a one-year period. Results: FFR was performed on 222 lesions in 151 consecutive patients. FFR was positive in 26.1% of the assessed lesions. The estimated total cost using FFR was US$ 891,290.08 while cost estimate without FFR was US$ 1,557,352, meaning 43% in cost savings. There was one cardiovascular death and two readmissions during follow up in the positive FFR group. Conclusions: FFR guided revascularization on intermediate coronary lesions resulted in an economic benefit by reducing overall costs without harming clinical outcomes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Coronary Disease/therapy , Fractional Flow Reserve, Myocardial , Percutaneous Coronary Intervention/methods , Prospective Studies , Follow-Up Studies , Treatment Outcome , Cost-Benefit Analysis , Percutaneous Coronary Intervention/economics
10.
Arch. cardiol. Méx ; 89(4): 301-307, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1149087

ABSTRACT

Abstract Introduction: Radial access is the gold standard for ST-elevation myocardial infarction; nevertheless, there is scarce information in Mexico. Objectives: The objectives of this study were to describe the differences in radiation exposure, intervention time, fluoroscopy time, complications and temporal trends, and risk factors among radial and femoral access for coronary procedures. Materials and Methods: A total of 493 patients underwent coronary interventions by femoral or radial access. Sociodemographic and procedural data were recorded. A logistic regression model to determine risk factors for complications was performed. Results: The population included 346 men and 147 women, with a median age of 63 years, 159 underwent radial and 334 femoral approaches. Complications occurred in 18 patients (3.6%), 11 in radial and 7 in femoral access, with a higher trend in the first 5 months (n = 14). Vasospasm was the most common (n = 9) complication. Median fluoroscopy time was 12 min for radial and 9 min for femoral groups, with a total radiation dose of 2282 µGm2 and 2848 µGm2, respectively. Temporal trends showed that complications occurred most frequently during the first 6 months of the study. The main predictors for complications were intervention time and one-vessel disease. Conclusions: Radial access had higher frequency of complications than femoral approach and they were more common during the first 6 months. The main risk factor was intervention time longer than 60 min.


Resumen Introducción: El abordaje radial es el de elección para infarto de miocardio con elevación del segmento ST, sin embargo se desconoce información en México. Objetivos: Describir las diferencias en exposición a radiación, tiempo de intervención, tiempo de fluoroscopía, complicaciones y sus variaciones temporales, además de los factores de riesgo entre el abordaje radial y el femoral para procedimientos coronarios. Método: Se incluyeron 493 pacientes que fueron sometidos a estudio angiográfico o intervenciones coronarias por abordaje radial o femoral. Se recabaron datos sociodemográficos, antecedentes y variables del procedimiento. Se realizó un modelo de regresión logística para determinar los factores asociados a complicaciones. Resultados: Se incluyeron 346 hombres y 147 mujeres, con mediana de edad de 63 años. A 159 se les realizó acceso radial y a 334 femoral. Las complicaciones ocurrieron en 18 pacientes (3.65%): 11 en radial y 7 en femoral, teniendo mayor incidencia en los primeros 5 meses (n = 14) y siendo el vasoespasmo el más común (n = 9). La mediana de tiempo de fluoroscopía fue de 12 minutos para el radial y de 9 minutos para el femoral, con una dosis total de radiación de 2,282 µGm2 y 2,848 µGm2, respectivamente. Las tendencias temporales indicaron que las complicaciones fueron más frecuentes durante los primeros 6 meses. Los principales predictores fueron el tiempo de intervención y la enfermedad de 1 vaso. Conclusiones: La vía de acceso radial tuvo más complicaciones que la femoral. Se observaron más complicaciones en los primeros 6 meses del estudio. El principal predictor de complicaciones fue el tiempo de intervención mayor a 60 minutos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Radial Artery , Femoral Artery , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/therapy , Time Factors , Cross-Sectional Studies , Risk Factors , Treatment Outcome , Coronary Angiography/methods , Percutaneous Coronary Intervention/adverse effects , Mexico
11.
Rev. bras. cir. cardiovasc ; 34(6): 645-652, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057499

ABSTRACT

Abstract Objective: To perform a systematic review and meta-analysis of studies comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT) in patients with chronic total occlusions (CTOs). Methods: We identified eligible observational studies published in the China National Knowledge Infrastructure database, PubMed, Excerpta Medica database, Google Scholar, Cochrane Library, Web of Science, and "Clinical trials" registration from 1999 to October 2018. Main outcome measures were all-cause mortality, cardiac death, major adverse cardiac events (MACEs), and myocardial infarction (MI). Results: There were eight observational studies including 6985 patients. Patients' mean age was 64.4 years. Mean follow-up time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients) presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95% confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40, 95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001), and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG (613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI: 0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR: 0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present decreased risk for those outcomes. Conclusions: PCI or CABG was associated with better clinical outcome in patients with CTO than MT. PCI is not better than CABG in decreasing mortality, MI, cardiac death, and MACE in coronary CTO patients.


Subject(s)
Humans , Male , Female , Coronary Occlusion/therapy , Odds Ratio , Coronary Artery Bypass , Risk Factors , Clinical Trials as Topic , Treatment Outcome , Observational Studies as Topic , Coronary Occlusion/surgery , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/mortality
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 356-361, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1047212

ABSTRACT

O desenvolvimento das salas cirúrgicas híbridas permitiu que operações de abordagem cirúrgica convencional pudessem ser realizadas e complementadas com a abordagem percutânea e endovascular, criando uma nova forma de tratar os pacientes por meio de cirurgias híbridas. Os procedimentos híbridos permitem que cirurgiões e cardiologistas intervencionistas possam associar suas expertises para tratar, da melhor forma possível, os pacientes com doenças cada vez mais complexas e avançadas, com melhores resultados, reduzindo a morbidade e mortalidade perioperatória e permitindo recuperação mais rápida


The development of hybrid operating rooms allowed that conventional surgical approach operations could be performed and complemented with the percutaneous and endovascular approach, creating a new way of treating patients through hybrid surgeries. Hybrid procedures allow surgeons and interventional cardiologists to combine their expertise to best treat patients with increasingly complex and advanced diseases, with better outcomes, reducing perioperative morbidity and mortality and allowing faster recovery


Subject(s)
Cardiac Surgical Procedures/methods , Myocardial Revascularization/methods , Operating Rooms , Aorta, Thoracic , Prostheses and Implants , Aortography/methods , Coronary Artery Bypass/methods , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 350-355, out.-dez. 2019. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1047208

ABSTRACT

Cardiologistas intervencionistas são expostos a riscos ocupacionais, que incluem a ocorrência de catarata, malignidades e lesões ortopédicas. A intervenção coronária percutânea (ICP) assistida por robô pode reduzir esses riscos ocupacionais, além de oferecer grande precisão e controle fino da manipulação de dispositivos médicos, podendo conferir benefícios ao paciente. O objetivo desta revisão é descrever as vantagens e as limitações da ICP assistida por robótica, os dados clínicos mais recentes e as futuras aplicações da tecnologia robótica


Interventional cardiologists are exposed to occupational hazards, including cataract, malignancies and orthopedic injuries. Robot-assisted percutaneous coronary intervention (PCI) can reduce these occupational hazards and offer great precision and fine-grained control over the handling of medical devices, potentially benefitting the patients. The aim of this review is to describe the advantages and limitations of robot-assisted PCI, the latest clinical data and future applications of robotic technology


Subject(s)
Robotics/methods , Angioplasty/methods , Percutaneous Coronary Intervention/methods , Technology , Occupational Risks , Cardiology , Stents
15.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 449-456, Sept-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1040108

ABSTRACT

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel


Subject(s)
Humans , Male , Female , Aged , Aged , Treatment Outcome , Acute Coronary Syndrome/complications , /therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Stents , Statistical Analysis , Multivariate Analysis , Retrospective Studies , Risk Factors , Coronary Angiography , Coronary Angiography/methods , Electrocardiography/methods , Percutaneous Coronary Intervention/methods , Hemorrhage/complications
17.
Arq. bras. cardiol ; 112(5): 511-523, May 2019. tab, graf
Article in English | LILACS | ID: biblio-1011194

ABSTRACT

Abstract Background: Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial. Objective: To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials. Methods: Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05. Results: In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI. Conclusion: Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.


Resumo Fundamento: A comparação entre a intervenção coronária percutânea (ICP) utilizando stents e cirurgia de revascularização do miocárdio (CRM) permanece controversa. Objetivo: Realizar uma revisão sistemática com metanálise da ICP utilizando stents vs. CRM em estudos clínicos randomizados. Métodos: Foram pesquisadas bases de dados eletrônicas para identificar estudos randomizados comparando a ICP com stents vs. CRM em multiarteriais e lesão de tronco de coronária esquerda desprotegida (LTCED). Foram encontrados quinze estudos, e seus resultados foram agrupados. As diferenças entre os estudos foram consideradas significativas com valor de p < 0,05. Resultados: Nos dados agrupados (n = 12.781), a mortalidade em 30 dias e o acidente vascular cerebral (AVC) tiveram menor incidência com a ICP (1% versus 1,7%, p = 0,01; 0,6% versus 1,7%, p < 0,0001); não houve diferença na mortalidade em um e dois anos (3,3% versus 3,7%, p = 0,25; 6,3% versus 6,0%, p = 0,5). A mortalidade em longo prazo favoreceu a CRM (10,6% versus 9,4%, p = 0,04), particularmente nos estudos realizados na era do stent farmacológico (SF) (10,1% versus 8,5%, p = 0,01). Nos diabéticos (n = 3.274), a mortalidade em longo prazo favoreceu a CRM (13,7% versus 10,3%; p < 0,0001). Em seis estudos de LTCED (n = 4.700) não houve diferença na mortalidade em 30 dias (0,6% versus 1,1%, p = 0,15), mortalidade em um ano (3% versus 3,7%, p = 0,18) e mortalidade em longo prazo (8,1% versus 8,1%) entre ICP e CRM; a incidência de AVC foi menor com a ICP (0,3% versus 1,5%; p < 0,001). Diabetes e um escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP. Conclusão: Comparada à CRM, a ICP com stent apresentou menor mortalidade em 30 dias, maior mortalidade tardia e menor incidência de AVC. Diabetes e escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP.


Subject(s)
Humans , Coronary Artery Disease/surgery , Coronary Artery Bypass/methods , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods , Randomized Controlled Trials as Topic , Treatment Outcome
18.
Rev. chil. cardiol ; 38(1): 64-67, abr. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1003639

ABSTRACT

Abstracts: Successful treatment following percutaneous angioplasty (PTCA) and percutaneous trans aortic valve aortic valve stenosis and critical obstruction of the main left coronary artery is presented. Due to a very high estimated surgical risk the patient underwent PTCA of the main left trunk followed, a week later, by trans catheter implantation of an aortic valve (TAVI). The procedure was uneventful, and the clinical condition of the patient was excellent at one year (Functional class I).


Subject(s)
Humans , Male , Aged, 80 and over , Aortic Valve Stenosis/therapy , Percutaneous Coronary Intervention/methods , Transcatheter Aortic Valve Replacement , Aortic Valve/transplantation , Heart Valve Prosthesis , Stents , Heart Valve Prosthesis Implantation
20.
Int. j. cardiovasc. sci. (Impr.) ; 32(2): 125-133, mar.-abr. 2019. tab, graf
Article in English | LILACS | ID: biblio-988177

ABSTRACT

Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period .Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend < 0.0001). Moreover, thrombus aspiration decreased significantly from 66.7% in 2011 to less than 3.0% in 2016 (ptrend < 0.0001). In-hospital, short and long-term mortalities remained reasonably stable from 2011 to 2016 (ptrend > 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality


Subject(s)
Humans , Male , Female , Middle Aged , Tertiary Healthcare , Percutaneous Coronary Intervention/methods , Myocardial Infarction/mortality , Shock, Cardiogenic , Coronary Artery Disease/mortality , Statistical Analysis , Prospective Studies , Risk Factors , Treatment Outcome , Stroke , Diabetes Mellitus , Hypertension
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