The Impact of the COVID-19 Pandemic on ST Elevation Myocardial Infarction Care Indicators at a Public Hospital in Brazil

Abstract Background International publications have shown that the COVID-19 pandemic has negatively impacted the indicators of care for ST-segment elevation acute myocardial infarction (STEMI), with a potential increase in morbidity and mortality. Objectives To compare mortality, time from symptom onset to primary angioplasty (total delay [TD]), time from symptom onset to initial medical contact (patient delay [PD]), and time from initial medical contact to guidewire insertion in the hemodynamics laboratory (system delay [SD]) among patients admitted for STEMI at the Hemodynamics Service of Santa Casa de Passos, Minas Gerais, Brazil before and after the declaration of the COVID-19 pandemic by the World Health Organization, assessing the impact of the COVID-19 pandemic on STEMI care indicators. Methods This is a before-and-after study involving patients hospitalized with STEMI undergoing primary angioplasty. Data were collected retrospectively through medical record review. Clinical and demographic profiles and outcomes between the pre-pandemic and pandemic groups were compared using the chi-square test for categorical variables or Student's t-test for continuous variables. A significance level of p < 0.05 was adopted. Results There were no differences in TD (pre-pandemic: 300 min [± 159 min], 95% CI 277.1 to 322.6; pandemic: 300 min [± 148 min], 95% CI 274.3 to 326.6, p = 0.97). However, there was an increase in SD (pre-pandemic: 145 min [± 97 min], 95% CI 122.7 to 167.9; pandemic: 178 min [± 96 min], 95% CI 157.4 to 197.9, p = 0.037). There was no increase in PD (pre-pandemic: 145 min ± 133 min; pandemic: 130 min ± 117 min, p = 0.44), and no differences in mortality were observed (pre-pandemic: 9.7%; pandemic: 12%, p = 0.49). Conclusion The COVID-19 pandemic increased SD in the management of STEMI in the region of Passos, Minas Gerais. There were no differences in PD, TD, and in-hospital mortality.

Carotid Subclavian Bypass for the Treatment of Coronary Subclavian Steal Syndrome

Abstract Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.

Comparação entre os tempos de procedimento e fluoroscopia e o volume de contraste das vias de acesso radial e femoral em pacientes submetidos a cateterismo cardíaco / Comparison of procedural and fluoroscopy times and contrast volume between radial and femoral access for cardiac catheterization

Introdução: Há controvérsias na literatura quanto às vantagens da via radial para cateterismos diagnósticos comparadas às da via femoral. O objetivo deste estudo foi comparar o acesso pelas vias radial e femoral quanto aos tempos de procedimento e de fluoroscopia, e ao volume de contraste utilizado. Métodos: Estudo observacional, retrospectivo, realizado por meio de análise documental de registros de pacientes submetidos consecutivamente ao cateterismo cardíaco, nos meses de julho de 2012 a dezembro de 2013. Resultados: Foram analisados 192 pacientes, sendo a via radial utilizada em 78,1% dos casos. A idade dos pacientes foi de 63,1 ± 11,9 anos, a maioria era do sexo masculino (55,7%) e 21,4% eram diabéticos. O tempo do procedimento foi menor no grupo radial 12,0 minutos (9,0 a 17,2 minutos) vs. 18,3 minutos (12,0 a 34,5 minutos), p < 0,01. O tempo de fluoroscopia foi de 270,0 segundos (180,0 a 389,5 segundos) vs. 244,0 segundos (175,3 a 705,0 segundos), sem diferença entre os grupos (p = 0,59). O volume de contraste foi menor nos pacientes avaliados por via radial 100,0 mL (75,0 a 117,5 mL) vs. 100,0 mL (80,0 a 150,0 mL), p < 0,01. Conclusões: Em nosso laboratório, que privilegiou a via radial como via de acesso para cateterismos cardíacos, os tempos do procedimento e de fluoroscopia, bem como o volume de contraste, foram menores ou comparáveis aos da abordagem femoral...

Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access...

Experiência inicial com o uso do autopulse em sala de hemodinâmica / Initial experience with autopulse in the catheterization laboratory

Os autores apresentam a experiência inicial do uso de dispositivo mecânico de reanimação AutoPulse®. O dispositivo foi utilizado em caso de parada cardiorrespiratória em sala dehemodinâmica, permitindo a continuidade do procedimentopercutâneo concomitantemente à ressuscitação cardiopulmonar. O dispositivo proporcionou compressões torácicas ininterruptas e efetivas, bem como liberou um médico da equipe paraoutras funções durante o procedimento. Houve dificuldades quanto à rapidez na instalação do dispositivo no momento daemergência e em relação à radiopacidade dos componenteseletrônicos, que impediram algumas projeções angiográficas.O uso de dispositivos mecânicos de compressões torácicasdurante parada cardiorrespiratória é factível, porém ainda nãohá comprovação de seus benefícios em relação à ressuscitaçãocardiopulmonar com compressões manuais.