Stent direto na intervenção coronária primária: avaliação de seu uso na prática clínica contemporânea / Direct stenting in primary percutaneous coronary intervention: an evaluation in current clinical practice

INTRODUÇÃO: Existem poucos estudos contemporâneos avaliando o implante de stent direto em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM). Método: Estudo de coorte prospectivo com pacientes consecutivamente atendidos com IAM em um centro de referêncioa em cardiologia entre dezembro de 2009 e janeiro de 2010. Dados clínicos e laboratoriais, características angiográficas e evolução hospitalar foram avaliados. Foram excluídos pacientes com mais de 12 horas de evolução, com menos de 18 anos de idade ou por recusa em participar do estudo. Os pacientes submetidos a implante de stent direto foram comparados àqueles tratados com pré-dilatação. Os dados foram armazenados em banco de dados dedicado e analisados com SPSS 17.0. Resultados: No período de estudo, 98 pacientes foram submetidos a angioplastia primária, dos quais em 33 (34,7 por cento) foi implantado stent direto e em 65 (65,3 por cento) foi realizada pré-dilatação. A média de idade dos 98 pacientes foi de 58,6 +- 10,6 anos e 63 por cento eram do sexo masculino. Os procedimentos com stent direto foram menos frequentes em lesões calcificadas (9 por cento vs. 30 por cento; P + 0,02) e mais frequentes naqueles com TIMI 3 pré-procedimento (41 por cento vs. 18 por cento; P=0,06), sendo a tromboaspiração...

BACKGROUND: There are few contemporary studies assessing direct stenting in patients with acute ST-segment elevation myocardial infarction (AMI). METHOD: Prospective cohort study in consecutive patients with AMI seen at a reference cardiology center from December 2009 to January 2010. Clinical and laboratory data, angiographic characteristics and hospital outcomes were evaluated. Patients with over 12 hours of symptom onset, with less than 18 years of age and those who denied participating in the study were excluded. Patients undergoing direct stenting were compared to those treated with stent with balloon pre-dilatation. Data were entered in a dedicated database and analyzed by SPSS 17.0. RESULTS: During the study period, 98 patients were submitted to primary angioplasty, of which 33 (34.7%) received direct stenting and 65 (65.3%) underwent stent with balloon pre-dilatation. Mean age was 58.6 ± 10.6 years and 63% were men. Direct stenting was less frequent in calcified lesions (9% vs. 30%; P = 0.02) and more frequent in those with TIMI 3 before the procedure (41% vs. 18%; P = 0.06) and thrombus aspiration was more frequently used in these cases (41% vs. 14%; P = 0.003). There was no statistically significant difference for the clinical outcome in both groups of patients. CONCLUSION: Direct stenting was more frequently used in patients with normal flow prior the procedure and in combination with thrombus aspiration and less used in calcified lesions. It was not associated to significant differences in clinical outcome rates.

Associação entre renda, características clínicas e angiográficas de pacientes submetidos a intervenção coronária percutânea / Association between income, clinical and angiographic characteristics in patients undergoing percutaneous coronary intervention

INTRODUÇÃO: Há grande interesse científico com relação ao status socioeconômico e à saúde populacional, e vários estudos demostraram influência dessas variáveis na evolução clínica dos pacientes. A presente análise avalia a influência da renda do indivíduo na distribuição dos fatores de risco e nas características clínicas e angiográficas em pacientes submetidos a angiografia percutânea. Método: Os pacientes submetidos a intervenção coronária percutânea em um centro terciário, entre dezembro de 2007 e março de 2008, foram incluídos prespectivamente. A informação relativa à renda foi coletada diretamente com o paciente por um dos pesquisadores do estudo. Na presente análise, os indivíduos foram divididos em quartis, de acordo com seus respectivos rendimentos mensais. Resultados: Foram incluídos 400 pacientes com média de idade de 61,6...

BACKGROUND: There is great scientific interest with respect to socioeconomic status and population health, and several studies have shown the influence of these variables on clinical outcome of patients. The present study assesses the influence of income on the distribution of risk factors, clinical and angiographic characteristics in patients undergoing percutaneous coronary intervention. METHOD: Patients undergoing percutaneous coronary intervention in a tertiary center from December 2007 to March 2008 were prospectively included. The information on income was directly collected from the patient by one of the investigators. In this analysis, subjects were divided into quartiles according to their respective monthly income. RESULTS: Four hundred patients with mean age of 61.01 ± 10.36 years, 64.7% males and 24.6% diabetics were included. A majority had stable angina (54.9%), and there were no differences between groups regarding comorbidities. Income was associated with the percentage of male patients (48% in the first quartile vs. 81.3% in the last quartile; P < 0.001), the weight and height (P < 0.05), but there was no association with mean body mass index. We also observed a significant association between income and use of drug-eluting stents with the following rates from first to fourth quartile: 0, 1%, 1.9% and 7.7% (P = 0.003). CONCLUSION: In this study, there was an association between income and gender, anthropometric characteristics and use of drug-eluting stents. There was no association between income and risk factors, medical history and angiographic characteristics of patients.

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do registro IC-FUC / Predictors and incidence of vascular complications after percutaneous coronary interventions: findings from the IC-FUC registry

Introdução: As complicações vasculares (CV) são uma das principais causas de morbidade e mortalidade em pacientes submetidos a intervenções coronárias percutâneas (ICPs), porém estudos anteriores não refletem a prática atual. Objetivos: Avaliar a incidência de CV e seus preditores, em uma população de pacientes tratada com ICP contemporaneamente. Método: Estudo observacional de corte transversal, com implantes de stents coronários, de janeiro de 2000 a dezembro de 2007. As características clínicas e angiográficas e a evolução intra-hospitalar foram avaliadas e registradas em banco de dados informatizados. Foram excluídos aqueles com óbito hospitalar ou cirurgia cardíaca de urgência. CV foram definidas como sangramento maior, cirurgia vascular ou hematoma > 10 cm. Os dados foram analisados com SPSS 11,0, e as características dos pacientes com e sem CV foram comparadas com teste t de Student e teste do qui-quadrado. Os preditores independentes de CV foram identificados por análise de regressão logística múltipla. Resultados: Total de 4.595 pacientes com 5.485 stents implantados, com média de idade de 60,64 + - 10,65 anos e 32 por cento de mulheres. As ICPs foram realizadas pela via femoral...

Background: Vascular complications (VC) following percutaneous coronary intervention (PCI) are an important cause of morbidity and mortality. However, available data do not reflect current interventional cardiology practice. Objective: To determinate the incidence of VC and its predictors in a population treated with PCI in contemporary practice. Methods: Cross-sectional study with coronary stent implantation conducted from January/2000 to December/2007. Clinical and angiographic characteristics, as well as in-hospital evolution, were evaluated and recorded in a database. Exclusion criteria included in-hospital death and urgent heart surgery. VC were defined as major bleeding, vascular surgery or hematoma > 10 cm. Data were analyzed using SPSS 11.0 and the characteristics of patients with and without VC were compared using the Student's t test and chi-square test. Multiple Logistic Regression Analysis was performed to determinate the independent predictors of VC. Results: A total of 4,595 patients with 5,485 stents were included in this analysis. Mean age was 60.64 ± 10.65 years and 32% of the patients were female. The transfemoral approach was used in 95% of the PCIs and the transradial approach in 5%. Six French and 7 French introducers were used in 85% and 15% of the PCIs, respectively. A total of 162 (3.3%) patients experienced VC. The multivariate analysis determined that the only predictor for VC was the use of 7 French introducers (odds ratio = 3.05, 95% confidence interval = 1.2-7.8; p = 0.02)...

Perfil de risco de reestenose em pacientes submetidos a implante de stents coronarianos convencionais / Restenosis risk profile of patients submitted to coronary bare-metal stent implantation

Introdução: O perfil de risco de reestenose de populações tratadas com implante de stents coronarianos em nosso meio não é conhecido. Essa informação tem importância na decisão de incorporar uma estratégia seletiva de implante de stents farmacológicos pelo sistema público de saúde. Objetivos: Avaliar o risco de reestenose antes do procedimento de uma população de pacientes tratados com stents coronarianos convencionais. Método: Estudo observacional de corte transversal, com 4.482 pacientes tratados com 5.336 stents , no período de janeiro de 2000 a dezembro de 2007. O risco de reestenose foi avaliado conforme escore previamente validado, com pontuação de 0 a 5 conforme a presença de diabetes melito (1 ponto), o diâmetro de referência do vaso tratado (menor 3 mm igual 2 pontos, 3-3,5 mm igual 0) e a extensão da lesão (maior 20 mm igual 2 pontos, 10-20 mm igual 1, e menor 10 mm igual 0. Resultados: A média de idade foi de 60,6 mais ou menos 10,6 anos e 32 por cento dos pacientes eram do sexo feminino. O diâmetro de referência do vaso tratado foi de 3,10 maior e menor 0,51 mm, a extensão da lesão foi de 13,2 maior ou menor 5,9 mm e 20 por cento dos pacientes apresentavam diabetes melito. A distribuição dos pacientes conforme os pontos no escore de reestenose...

Background: The restenosis risk of patient populations treated with coronary stent implantation is not well studied. This information has a potential impact on the decision of incorporating a selective strategy of drug-eluting stent implantation by the public health system. Our objective was to evaluate the restenosis risk of a population of patients (pts) treated with bare-metal stents. Methods: Observational study with 4,482 pts treated with 5,336 stents, between January 2000 and December 2007. The restenosis risk was assessed according to a previous validated risk score. Points in the score ranged from 0 to 5 according to diabetes mellitus (1 point), reference vessel diameter (< 3 mm = 2 points, 3-3.5 mm = 1, and > 3.5 mm = 0), and the lesion length (> 20 mm = 2 points, 10-20 mm = 1, and < 10 mm = 0). Results: The mean age was 60.6 ± 10.6 years of age, and 32% were female. The mean reference vessel diameter was 3.10 mm ± 0.51mm, the lesion length was 13.2 mm ± 5.9 mm, and 20% of the pts were diabetics. The distribution of pts according to points in the risk score was the following: score 0 = 4% of the pts; score 1 = 22%; 2 = 34%; 3 = 29%; 4 = 9%; and score 5 = 1% of the pts. Conclusions: The majority of pts presented low or intermediate restenosis risk. The adoption of a selectivestrategy of drug-eluting stent implantation only in those at higher restenosis risk would represent its use in no more than 20% of the procedures.