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1.
Open Heart ; 6(2): e001069, 2019.
Article in English | MEDLINE | ID: mdl-31413846

ABSTRACT

Objective: To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata. Methods: We analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0-2), moderate (3-4) or high (5-9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared. Results: Cardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively). Conclusions: In patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.

4.
Arq Bras Cardiol ; 91(2): e25-7, 2008 Aug.
Article in English, Portuguese | MEDLINE | ID: mdl-18709253

ABSTRACT

The patent ductus arteriosus (PDA) is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controversial and high-risk. This report describes an alternative endovascular approach in an adult patient.


Subject(s)
Cardiac Catheterization/methods , Ductus Arteriosus, Patent/surgery , Prosthesis Implantation/methods , Adult , Ductus Arteriosus, Patent/diagnosis , Female , Humans , Treatment Outcome
5.
Arq. bras. cardiol ; 91(2): e17-e19, ago. 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-488903

ABSTRACT

A persistência do canal arterial (PCA) é uma anomalia relativamente freqüente e de simples correção. A correção envolve a ligadura do ducto com ou sem a sua secção. A anomalia em adultos pode provocar hipertensão pulmonar persistente e disfunção ventricular. A correção em adultos é controversa e de maior risco. Um caso de correção endovascular com acesso intra-abdominal da PCA em adulto é descrito.


The patent ductus arteriosus (PDA) is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controversial and high-risk. This report describes an alternative endovascular approach in an adult patient.


Subject(s)
Adult , Female , Humans , Ductus Arteriosus, Patent/surgery , Cardiac Catheterization/methods , Prosthesis Implantation/methods , Ductus Arteriosus, Patent/diagnosis , Treatment Outcome
6.
Arq Bras Cardiol ; 79(4): 405-18, 2002 Oct.
Article in English, Portuguese | MEDLINE | ID: mdl-12426649

ABSTRACT

OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2%) patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001). Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001). Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001). Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001) as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01). In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53). Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94), and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08). CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.


Subject(s)
Angioplasty, Balloon, Coronary/statistics & numerical data , Myocardial Infarction/therapy , Angioplasty, Balloon, Coronary/mortality , Brazil/epidemiology , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Odds Ratio , Prognosis , Recurrence , Regression Analysis , Retrospective Studies , Stents , Treatment Outcome
7.
Arq. bras. cardiol ; 79(4): 405-418, Oct. 2002. tab
Article in Portuguese, English | LILACS, Sec. Est. Saúde SP | ID: lil-323361

ABSTRACT

OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2 percent) patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6 percent vs. 2000=13.1 percent; p<0.001). Coronary stent implantation increased (1996=20 percent vs. 2000=71.9 percent; p<0.001). Success was greater (1998=89.5 percent vs. 1999=92.5 percent; p<0.001). Reinfarction decreased (1998=3.9 percent vs. 99=2.4 percent vs. 2000=1.5 percent; p<0.001) as did emergency bypass surgery (1996=0.5 percent vs. 2000=0.2 percent; p=0.01). In-hospital deaths remained unchanged (1996=5.7 percent vs. 2000=5.1 percent, p=0.53). Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95 percent] 1.58-22.94), and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95 percent] 3.19-6.08). CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure


Subject(s)
Humans , Male , Female , Middle Aged , Angioplasty, Balloon, Coronary , Myocardial Infarction , Prognosis , Recurrence , Brazil , Angioplasty, Balloon, Coronary , Stents , Retrospective Studies , Treatment Outcome , Hospital Mortality , Myocardial Infarction
8.
Arq. bras. cardiol ; 76(6): 483-495, June 2001. tab
Article in Portuguese, English | LILACS, Sec. Est. Saúde SP | ID: lil-286366

ABSTRACT

OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA) or stent implantation because of an acute myocardial infarction (AMI) related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC). From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3 percent) of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47 percent) patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment


Subject(s)
Humans , Male , Middle Aged , Female , Adult , Saphenous Vein/transplantation , Angioplasty, Balloon, Coronary , Stents , Graft Occlusion, Vascular/therapy , Myocardial Infarction/therapy , Aged, 80 and over , Brazil/epidemiology , Registries , Treatment Outcome , Myocardial Infarction/mortality
9.
Arq. bras. cardiol ; 63(3): 179-184, set. 1994. ilus, graf
Article in Portuguese | LILACS | ID: lil-155547

ABSTRACT

PURPOSE--Comparative and prospective evaluation of three methods (transthoracic echo-Doppler (TTE), computerized tomography (CT) and aortography (AORT) utilized for aortic dissection diagnosis. METHODS--The 39 patients with confirmed aortic dissection (surgery or autopsy) underwent, within a few hours of each other, all three methods scrutinized. There were 19 cases of type A and 20 of type B dissection. RESULTS--In type A dissection the methods were equivalent (TTE = 73.7//, CT = 84.2//, AORT = 73.7//p = NS) but for type B, TTE was significantly inferior to the other two methods (TTE = 60//, TC 90//, AORT = 80//, p < 0.05 for TTE, for TC and AORT p = NS). In three occasions, even though all three methods were performed, the diagnosis was not obtained. CONCLUSION--The methods which were evaluated make the diagnosis in the majority of cases. In type A all methods are similar, however, in type B, TC and AORT are superior to TTE. Even performing all three methods in each patient, in three instances the diagnosis was not made


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aortography , Echocardiography, Doppler , Tomography, X-Ray Computed , Echocardiography, Transesophageal , Aortic Dissection/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Prospective Studies , Diagnosis, Differential
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