Efeito da nitroglicerina no espasmo e na oclusão da artéria radial em cateterismos transradiais realizados em mulheres / Effect of nitroglycerin on radial artery spasm and occlusion in transradial catheterizations performed in women

Introdução: O benefício do cateterismo transradial já foi confirmado em pacientes do sexo feminino. Mulheres submetidas a exames por cateterismo transradial apresentam desafios únicos. A ocorrência de espasmo e oclusão da artéria radial após o procedimento é maior em mulheres. Objetivamos avaliar o benefício da nitroglicerina na redução de espasmo e oclusão da artéria radial em mulheres submetidas a cateterismo transradial. Métodos: Estudo multicêntrico, prospectivo, randomizado 2x2 fatorial, duplo-cego. Participantes foram randomizados para nitroglicerina 500mcg ou placebo em dois momentos: após colocação do introdutor hemostático e antes da retirada. A avaliação de espasmo da artéria radial foi clínica, por meio de escala dor. A avaliação da oclusão da artéria radial foi realizada com Doppler, nas primeiras 12 horas. Resultados: Foram incluídos 2.040 pacientes, sendo 774 (37,5%) mulheres. A média de idade foi similar entre os sexos (62,2 anos versus 61,5 anos; p=0,27). A incidência de espasmo da artéria radial foi maior nas mulheres (21,2% versus 6,6%; p<0,01), bem como a incidência de oclusão da artéria radial (3,4% versus 1,8%; p=0,03). O uso da nitroglicerina no início do procedimento não reduziu a incidência de espasmo da artéria radial em mulheres quando comparado com o placebo (19,7% versus 22,6%; p=0,34), tampouco as taxas de oclusão da artéria radial (4,3% versus 2,5%; p=0,17). O uso da nitroglicerina ao fim do procedimento não reduziu a incidência de oclusão da artéria em mulheres (2,8% versus 3,9%; p=0,37). Conclusões: O espasmo e a oclusão da artéria radial são mais frequentes em mulheres submetidas a cateterismo transradial quando comparadas aos homens. O uso da nitroglicerina não apresenta efeito benéfico na redução dessas incidências.

Background: The benefit of transradial catheterization is well established in female patients. Women undergoing transradial catheterization exams present with unique challenges. The occurrence of radial artery spasm and occlusion after the procedure is higher in women. The objective of this study was to evaluate the benefit of nitroglycerin in reducing radial artery spasm and occlusion in women undergoing transradial catheterization. Methods: This was a 2x2 factorial randomized, multicenter, prospective, double-blinded study. Participants were randomized to nitroglycerin 500mcg or placebo at two time points: after placement of the hemostatic introducer and before its removal. The evaluation of the radial artery spasm was clinical, using a pain scale The evaluation of the radial artery occlusion was performed with Doppler, in the first 12 hours. Results: A total of 2,040 patients were included, of which 774 (37.5%) were female. Mean age was similar between sexes (62.2 years versus 61.5 years; p=0.27). The incidence of radial artery spasm was higher in women (21.2% versus 6.6%; p<0.01), as well as the incidence of radial artery occlusion (3.4% versus 1.8%; p=0.03). The use of nitroglycerin at the beginning of the procedure did not reduce the incidence of radial artery spasm in women when compared with placebo (19.7% versus 22.6%; p=0.34), nor did the rates of radial artery occlusion (4.3% versus 2.5%; p=0.17). The use of nitroglycerin at the end of the procedure did not reduce the incidence of artery occlusion in women (2.8% versus 3.9%; p=0.37). Conclusions: Radial artery spasm and occlusion are more frequent in women undergoing transradial catheterization when compared to men. The use of nitroglycerin does not have a beneficial effect in reducing these incidences.

Evaluation of Ventricular Remodeling and Prognosis in Patients with Aortic Stenosis Who Underwent Surgical or Percutaneous Transcatheter Aortic Valve Replacement

ABSTRACT Introduction: Aortic stenosis is the most common heart valve disease in the world, and patients that present with symptoms have a high mortality rate. Aortic valve replacement has the objective of promote left ventricular remodeling, reduce symptoms, and increase overall survival. The objective of this study is to evaluate reverse remodeling of the left ventricle in patients with severe and symptomatic aortic stenosis who underwent surgical or percutaneous transcatheter aortic valve replacement. Methods: This is a longitudinal, prospective, non-concurrent, non-randomized unicentric study with patients who underwent aortic valve replacement. Echocardiogram was performed before and after replacement procedure to evaluate several remodeling indexes. Results: Of 91 patients, 77 (84.6%) underwent surgical aortic valve replacement, and 14 (15.4%) underwent percutaneous transcatheter aortic valve replacement. Mean age was 68,96±11,98 years, and most patients were male. Remodeling evaluation revealed that patients who decreased left ventricular index mass (53% vs. 38.9%; P=0,019) and those who reduced the mass/volume ratio (30.4% vs. 68.9%; P<0,001) presented with positive left ventricular remodeling. No endpoint difference was found in those with positive remodeling. Conclusion: Regarding the left ventricular remodeling in patients with severe and symptomatic aortic valve stenosis who underwent percutaneous transcatheter or surgical valve replacement, there is a positive increment in remodeling, however it remains in concentric hypertrophic shape. Implication of these findings remains uncertain and to be studied in large dedicated trials with clinical endpoints.

Intervenção coronariana percutânea em multiarteriais com syntax score baixo e intermediário / Percutaneous coronary intervention in patients with multivessel coronary disease and low to medium syntax scores

Fundamentos: A doença arterial coronariana é importante causa de morte, com elevada prevalência. A cirurgia de revascularização do miocárdio é considerada o padrão-ouro para o tratamento em pacientes com lesões arteriais complexas, porém a intervenção coronariana percutânea também pode ser utilizada, e os pacientes devem ser estratificados para avaliar qual o melhor benefício terapêutico. Uma das formas de estratificar o risco nesses pacientes é através de escores como o Syntax score.Objetivos: Avaliar pacientes multiarteriais com Syntax score baixo e intermediário e suas características clínicas em relação a eventos cardiovasculares, infarto do miocárdio, necessidade de nova intervenção ou morte cardiovascular.Métodos: Estudo transversal, incluindo 76 pacientes de um único centro de cardiologia em Florianópolis, no período de janeiro 2007 a novembro 2009, para avaliar suas características clínicas e angiográficas em relação a eventos cardiovasculares. Para análise estatística utilizou-se o teste exato de Fisher. Resultados: Os pacientes com Syntax score baixo tiveram menor ocorrência de eventos cardiovasculares quando comparados àqueles com escore intermediário (p=0,0296). Outras variáveis clínicas estudadas, hipertensão arterial sistêmica, diabetes mellitus, dislipidemia, tabagismo, doença renal crônica e infarto do miocárdio prévio não mostraram associação com eventos cardiovasculares.Conclusões: A intervenção coronariana percutânea deve ser reservada para pacientes multiarteriais com Syntax score baixo.

Background: Coronary artery disease is a major and highly prevalent cause of death. Although coronary artery bypass grafts are rated as the gold standard treatment for patients with complex arterial lesions, percutaneous coronary intervention may also be used. Patients must be risk-rated in order to evaluate which offers the best therapeutic benefits. One way of ranking risks is through stratifying systems like the Syntax score.Objectives: Evaluate patients with multivessel coronary disease with low to medium Syntax scores and their clinical characteristics in terms of cardiovascular events, myocardial infarction, cardiovascular death or needing further intervention. Methods: Cross sectional study of 76 patients seen at a cardiology unit in Florianópolis between January 2007 and November 2009, in order to evaluate their clinical and angiographic characteristics with relation to cardiovascular events. The Fisher’s exact test was used for the statistical analysis.Results: Patients with low Syntax scores had fewer cardiovascular events compared to those with medium Syntax scores (p=0.0296). Other clinical variables studied, including hypertension, diabetes mellitus, dyslipidemia, smoking, chronic kidney diseases and prior myocardial infarctions, showed no association with cardiovascular events.Conclusions: Percutaneous coronary intervention should be reserved for patients with multivessel coronary disease and low Syntax scores.