Coronary procedures via distal transradial access in older as compared with non-older patients: Insights from the DISTRACTION registry.

BACKGROUND: Older patients are at a higher risk of access site complications and bleeding. Systematic reviews and meta-analysis have highlighted the benefits of distal over proximal transradial access (mainly, lower rates of radial artery occlusion and faster hemostasis). We aimed to evaluate the feasibility and safety of distal transradial access (dTRA) for routine coronary procedures in older patients compared with non-older patients. METHODS: Retrospective analysis of a large and real-world sample of 5524 consecutive all-comers patients who underwent coronary procedures via dTRA were included in the DISTRACTION registry. RESULTS: In the older patients (greater than or equal to 65 years) group (n = 2594, 47%), there were higher rates of hypertension (83% vs 71.1%; P less than .0001), diabetes (45.1% vs 34.7%; P less than .0001), previous stroke (2.9% vs 2%; P=.0425), chronic heart failure (9.2% vs 7.1%; P=.0040), severe aortic valvar disease (4.2% vs 2.9%; P=.0070), chronic kidney disease stages 3 and 4 (8.1% vs 3.1%; P less than .0001), previous percutaneous coronary intervention (27.2% vs 24.5%; P=.0253), previous coronary artery bypass grafting (5.1% vs 2.2%; P less than .0001), cardiogenic shock at presentation (1.3% vs 0.4%; P=.0003), rotational atherectomy (0.7% vs 0.2%; P=.0050), and left main percutaneous coronary intervention (2.7% vs 1.5%; P=.0033). No significant differences were observed in the rates of access site crossovers. No major adverse cerebrovascular and cardiac events directly related to dTRA, no hand/thumb dysfunction or ischemia after any procedure, and no access site-related hematomas (early discharge after transradial stenting of coronary arteries greater than or equal to 2) were recorded. CONCLUSIONS: Despite more comorbidities, more complex coronary disease, and more challenging presentation, the adoption of dTRA as the default approach for routine coronary procedures in older patients, by proficient operators, appears to be safe and feasible.

Distal transradial access for coronary procedures: a prospective cohort of 3,683 all-comers patients from the DISTRACTION registry.

Background: Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients. Methods: In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included. Results: The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. Conclusions: In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible.

Pseudoaneurysm After Distal Transradial Coronary Intervention Successfully Managed by Prolonged Pneumatic Compression: Simple Solution for a Rare and Challenging Problem.

A 75-year-old woman with hypertension, hypothyroidism, and diabetes was referred to the catheterization laboratory due to non-ST segment elevation myocardial infarction. Urgent coronary angiography was uneventfully performed via right distal transradial access, despite lusoria subclavian artery. Left anterior descending artery was successfully treated by percutaneous coronary intervention with stenting. A TR band was left in situ for 60 minutes and completely removed after 2 hours, without bleeding. Proximal and distal radial pulses were palpable after hemostasis and at hospital discharge, 24 hours later, uneventfully. Six days after, she noticed subtle and rapidly progressive wrist, hand and fingers swelling, with pain, ecchymosis, and movement limitation.

Unprotected Left Main Primary PCI via Distal Transradial Access in the Setting of STEMI-Related Cardiogenic Shock.

Despite all well-known benefits of transradial access, patients presenting with cardiogenic shock are usually submitted to coronary angiography and percutaneous coronary intervention via traditional transfemoral access, mainly due to challenge puncture of radial artery in the setting of hemodynamic instability. We report a challenging case of STEMI-related cardiogenic shock requiring primary PCI of an occluded and unprotected left main, safety, and successfully performed via right distal trans radial access in the anatomical snuffbox.

Chronic Total Occlusion Recanalization Concurrent to Culprit Primary Percutaneous Coronary Intervention via Distal Transradial Access: Maximizing Revascularization Through Minimalist Approach.

For ST-segment elevation myocardial infarction (STEMI) patients with multi-vessel coronary disease, complete revascularization is superior to culprit-only percutaneous coronary intervention (PCI). Chronic total occlusion represents the most challenging setting for PCI. Distal transradial access (dTRA) has advantages such as faster hemostasis and risk of proximal radial artery occlusion. We report a case of nonculprit coronary total occlusion recanalization concurrent to culprit primary PCI via dTRA in the setting of STEMI.

Distal transradial access for post-CABG coronary and surgical grafts angiography and interventions.

BACKGROUND: Post-CABG coronary and grafts angiography (CGAG) and interventions (PCI) have historically been performed via classic transfemoral approach. Particularly for those with left internal mammary artery (LIMA) grafts, left standard transradial access (lsTRA) represents a feasible alternative, with significant fewer vascular complications, but it has ergonomic disadvantage for the operator because of the need to bend over the patients, especially in obese ones. Distal transradial access (dTRA) may provide important advantages, including shorter hemostasis and greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim to describe the feasibility and safety of right and left dTRA for post-CABG CGAG and PCI. MATERIAL AND METHODS: From February 2019 to April 2021, 111 consecutive post-CABG patients submitted to CGAG and/or PCI via dTRA have been enrolled. RESULTS: Mean patient age was 67.6 years old. Most were male (88.3%) and had chronic coronary syndromes (61.3%). Overall, 35.1% had acute coronary syndromes. Distal RA was successfully punctured in all 111 patients, always without ultrasound guidance. All procedures involving LIMA grafts were done via ipsilateral ldTRA. We had only 5 (4.5%) access site crossovers. Successful dTRA sheath insertion was then achieved in 95.5% of all patients, mostly (74.8%) via ldTRA and with standard 6Fr sheath (99.1%). Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications related to dTRA were recorded. CONCLUSIONS: dTRA for routine post-CABG CGAG and PCI by experienced transradial operators appears to be feasible. Further randomized and larger trials are needed to assure clinical benefits and safety of this new technique.

Complex Coronary Intervention Via Right Distal Transradial Access With Lusoria Subclavian Artery Under Refractory Electrical Storm: A Really Challenging Case.

The adoption of distal transradial access (TRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has advantages in terms of patient and operator comfort and risk of radial artery occlusion. We report herein a very challenging case of coronary angiography followed by complex percutaneous coronary intervention via right distal TRA, with aberrant (lusoria) subclavian artery, in the setting of non-ST segment elevation acute myocardial infarction complicated by refractory electrical storm.

Huge Cavity Spilling Coronary Perforation Management: When the Basic Works Well.

Type III cavity-spilling coronary artery perforation is an unusual but dreaded complication which can be conservatively managed with simple prolonged balloon inflation without compromising the final PCI result by anticoagulation reversal.

Distal transradial access as default approach for coronary angiography and interventions.

BACKGROUND: Distal transradial access (dTRA) as a refinement of the conventional transradial access has advantages in terms of patient and operator comfort and risk of radial artery (RA) occlusion. RA preservation with this new technique could be a relevant issue in patients requiring its future use. In turn, one relevant drawback is the more challenging puncture of a smaller artery. In order to evaluate the real world feasibility and safety of both right (rdTRA) and left (ldTRA) distal transradial access as default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI), this prospective observational registry was conducted. METHODS: From February to July 2019, 435 consecutive patients underwent CAG and/or PCI (620 procedures at all, by two experienced transradial operators) through rdTRA or ldTRA. RESULTS: Mean patient age was 62.4 years old. Most were male (66.0%). The majority (49.4%) of patients had an acute coronary syndrome; overall, 15.2% with ST-elevation acute myocardial infarction (STEMI). Distal RA was successfully punctured in all patients, always without ultrasound guidance, with puncture and sheath insertion at until 2 attempts in the vast majority of patients. We had only 3.0% access site crossovers (successful arterial puncture but failed sheath insertion), mainly performed via the contralateral dTRA (53.8%). Successful dTRA sheath insertion was then achieved in 98.6% of all 435 patients. Redo ipsilateral dTRA was performed in 2.5% of patients. Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications were recorded. CONCLUSIONS: dTRA as default approach for routine CAG and/or PCI by experienced transradial operators appears to be safe and feasible. Further randomized and larger trials are still needed to assure the clinical benefits and the safety of this new technique.

Preditores independentes de doença arterial coronária multiarterial: resultados do Registro Angiocardio / Independent predictors of multivessel coronary artery disease: results from Angiocardio Registry

Introdução: O Registro Angiocardio, que agrega dados de cinco diferentes centros do Estado de São Paulo, oferece a oportunidade de estudar a associação de fatores de risco cardiovasculares com a extensão da doença arterial coronária (DAC), avaliada pela cinecoronariografia. Este estudo buscou analisar preditores independentes de DAC multiarterial em nosso meio. Métodos: De agosto de 2006 a janeiro de 2014, 16.320 pacientes com DAC foram incluídos e divididos nos grupos uni e multiarterial. Resultados: Pacientes multiarteriais (n = 9.512, 58,3%) apresentaram-se, em média, 3 anos mais idosos, com maior prevalência do sexo masculino (69,4% vs. 65,4%; p < 0,01), hipertensão arterial (80,0% vs. 73,5%; p < 0,01), diabetes (40,7% vs. 28,8%; p < 0,01), dislipidemia (39,6% vs. 34,9%; p < 0,01), antecedentes familiares de DAC precoce (23,0% vs. 21,3%; p < 0,01), insuficiência renal crônica (4,1% vs. 2,6%; p < 0,01), acidente vascular cerebral prévio (3,8% vs. 2,8%; p < 0,01), doença vascular periférica (4,0% vs. 3,3%; p = 0,02) e infarto do miocárdio prévio (18,4% vs. 13,9%; p < 0,01), além de menor prevalência de tabagismo (20,0% vs. 24,5%; p < 0,01). À análise multivariada, foram preditores independentes de lesão multiarterial idade > 40 anos (odds ratio - OR = 1,996; IC 95% 1,52-2,63; p < 0,01), sexo masculino (OR = 1,202; IC 95% 1,12-1,28; p < 0,01), hipertensão arterial (OR = 1,439; IC 95% 1,34-1,55; p < 0,01), diabetes (OR = 1,697; IC 95% 1,59-1,81; p < 0,01), dislipidemia (OR = 1,223; IC 95% 1,15-1,30; p < 0,01), infarto agudo do miocárdio prévio (OR = 1,393; IC 95% 1,28-1,52; p < 0,01) e insuficiência renal crônica (OR = 1,597; IC 95% 1,33-1,91; p < 0,01). Conclusões: A DAC multiarterial em nosso meio é associada aos fatores de risco tradicionais para aterosclerose, com exceção do tabagismo. A idade, o diabetes e a insuficiência renal crônica foram os fatores preditores mais fortes para a DAC multiarterial avaliada pela cinecoronariografia

Background: The Angiocardio Registry, which comprises data from five different centers in the state of São Paulo, offers the opportunity to study the association between cardiovascular risk factors and coronary artery disease (CAD) extent, as assessed by coronary angiography. This study aimed to evaluate independent predictors of multivessel CAD in Brazil. Methods: From August 2006 to January 2014, 16,320 patients with CAD were included and divided into the single- and multivessel groups. Results: Patients with multivessel disease (n = 9,512, 58.3%) were on average 3 years older, with a higher prevalence of males (69.4% vs. 65.4%; p < 0.01), arterial hypertension (80.0% vs. 73.5%; p < 0.01), diabetes (40.7% vs. 28.8%; p < 0.01), dyslipidemia (39.6% vs. 34.9%; p < 0.01), family history of CAD (23.0% vs. 21.3%; p < 0.01), chronic renal failure (4.1% vs. 2.6%; p < 0.01), previous stroke (3.8% vs. 2.8%; p < 0.01), peripheral vascular disease (4.0% vs. 3.3%; p = 0.02) and previous myocardial infarction (18.4% vs. 13.9%; p < 0.01), as well as a lower prevalence of smoking (20.0% vs. 24.5%; p < 0.01). At the multivariate analysis, the following were independent predictors of multivessel lesion: age > 40 years (odds ratio - OR = 1.996; 95% CI: 1.52-2.63; p < 0.01), male gender (OR = 1.202; 95% CI: 1.12-1.28; p < 0.01), arterial hypertension (OR = 1.439; 95% CI: 1.34-1.55; p < 0.01), diabetes (OR =1.697; 95% CI: 1.59-1.81; p < 0.01), dyslipidemia (OR = 1.223; 95% CI: 1.15-1.30; p < 0.01), previous acute myocardial infarction (OR = 1.393; 95% CI: 1.28-1.52; p < 0.01), and chronic renal failure (OR = 1.597; 95% CI: 1.33-1.91; p < 0.01). Conclusions: Multivessel CAD in Brazil is associated with traditional risk factors for atherosclerosis, except for smoking. Age, diabetes, and chronic renal failure were the strongest predictors for multivessel CAD assessed by coronary angiography

Impacto do uso prévio de estatinas nos resultados da intervenção coronáriapercutânea na síndrome coronariana aguda / Impact of prior statin use on percutaneous coronary intervention outcomes in acute coronary syndrome

Introdução: O uso de estatinas previamente à intervenção coronária percutânea (ICP) tem reduzidoeventos cardíacos na evolução de curto e longo prazos. Avaliamos o impacto do uso prévio de estatinas nosresultados hospitalares da ICP em pacientes com síndrome coronariana aguda (SCA).Métodos: Análise retrospectiva de registro multicêntrico com 6.288 pacientes submetidos consecutivamenteà ICP. Destes, 35% tinham SCA e foram avaliados de acordo com a utilização (Grupo 1, n = 1.203) ou não (Grupo2, n = 999) de estatinas.Resultados: O Grupo 1 mostrou maior prevalência de dislipidemia, infarto agudo do miocárdio (IAM) prévio,procedimentos de revascularização prévios, insuficiência renal crônica, acometimento multiarterial,lesões em bifurcação uso de stents farmacológicos. O Grupo 2 mostrou maior número de ICPs primária e deresgate, classe funcional Killip III/IV, lesões tipo B2/C, trombos, oclusões totais, fluxo TIMI pré 0/1, presençade circulação colateral, uso de inibidores da glicoproteína IIb/IIIa e de cateteres de aspiração. O sucesso daICP foi maior no Grupo 1 (95,1% vs. 92,5%; p = 0,01), e a ocorrência de eventos cardíacos e cerebrovascularesadversos maiores (ECCAM) (3,7% vs. 5,7%; p = 0,04) foi mais frequente no Grupo 2. Apesar da não utilizaçãode estatina ter apresentado associação com ECCAM na análise univariada, foram preditores independentesde ECCAM hospitalares apenas o IAM em Killip III/IV e a cirurgia de revascularização prévia.Conclusões: Pacientes com SCA submetidos à ICP e que estavam em uso prévio de estatinas apresentarammelhores resultados clínicos hospitalares, mas a utilização desses fármacos não foi preditora independentede ECCAM.

Background: The use of statins prior to percutaneous coronary intervention (PCI) has reduced cardiacevents in both short and long-term follow-up. This study assessed the impact of prior statin use on inhospitalPCI outcomes in patients with acute coronary syndrome (ACS).Methods: Retrospective analysis of a multicenter registry of 6,288 consecutive patients undergoing PCI. Ofthese, 35% had ACS and were evaluated according to statin use (Group 1, n = 1,203) or no use (Group 2, n = 999).Results: Group 1 showed higher prevalence of dyslipidemia, acute myocardial infarction (AMI), previouscoronary artery bypass graft, chronic renal failure, multivessel involvement, bifurcation lesions, and useof drug-eluting stents. Group 2 showed more primary and rescue PCIs, Killip functional class III/IV, B2/Clesions, thrombi, total occlusions, pre-procedural TIMI 0/1 flow, presence of collateral circulation, and useof glycoprotein IIb/IIIa inhibitors and aspiration catheters. PCI success was higher in Group 1 (95.1% vs.92.5%; p = 0.01), and the occurrence of major adverse cerebrovascular and cardiac events (MACCE) (3.7% vs. 5.7%) was more frequent in Group 2. Although the non-use of statins showed an association with MACCEin the univariate analysis, independent predictors of in-hospital MACCE were limited to AMI in Killip III/IVand prior coronary artery bypass graft.Conclusions: ACS patients undergoing PCI who previously used statins had better in-hospital clinicaloutcomes; however, statin use was not an independent predictor of MACCE.

Intervenção coronária percutânea em pacientes jovens / Percutaneous coronary intervention in young patients

Introdução: A doença cardiovascular tem apresentado ocorrência crescente na população jovem e dados da intervenção coronária percutânea (ICP) nesse grupo são escassos. Nosso objetivo foi avaliar retrospectivamente o perfil e os resultados clínicos hospitalares de pacientes jovens do nosso registro de ICP. Métodos: No período de 2006 a 2012, 6.288 pacientes foram submetidos consecutivamente à ICP, sendo 151 com idade < 40 anos (Grupo 1) e 6.137 ≥ 40 anos (Grupo 2). Modelos de regressão logística foram aplicados para identificar os preditores de eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) na população estudada. Resultados: No Grupo 1, prevaleceram o tabagismo, o infarto agudo do miocárdio como apresentação clínica, lesões em um único vaso (sendo a artéria descendente anterior o vaso mais tratado), lesões com trombos e o fluxo TIMI 0/1. O sucesso clínico da ICP (96,0% vs. 95,5%; p = 0,89) e a ocorrência de ECCAM (3,3% vs. 3,3%; p = 0,82), de óbito (0,0% vs. 1,0%; p = 0,39), acidente vascular cerebral (0,0% vs. 0,1%; p > 0,99), infarto agudo do miocárdio (3,3% vs. 2,3%; p = 0,41) ou revascularização de emergência (0,6% vs. 0,03%; p = 0,56) foram semelhantes entre os grupos. Na análise multivariada, a idade e a presença das classes funcionais Killip III e IV foram as variáveis que melhor explicaram a ocorrência de ECCAM. Conclusões: Pacientes com idade < 40 anos representaram uma fração menor dos casos dessa casuística, e apresentaram perfil clínico e angiográfico distinto dos mais velhos, o que sugere a necessidade de instituir medidas de prevenção primária mais precoce nos que se enquadram no perfil observado...

Background: Cardiovascular disease has shown increasing occurrence rates among young people and data of percutaneous coronary intervention (PCI) in this group are scarce. Our objective was to perform a retrospective evaluation of the profile and in-hospital clinical outcomes of young patients in this PCI registry. Methods: From 2006 to 2012, 6,288 patients were consecutively submitted to PCI, of whom 151 were < 40 years of age (Group 1) and 6,127 were ≥ 40 years of age (Group 2). Logistic regression models were applied to identify the predictors of cardiac events and major adverse cardiac and cerebrovascular events (MACCE) in the study population. Results: In Group 1, there was a prevalence of smoking, myocardial infection as a clinical presentation, single vessel disease (left anterior descending artery as the culprit vessel), thrombotic lesions, and TIMI flow 0/1. The clinical success of PCI (96.0 % vs. 95.5 %; p = 0.89), and the occurrence of MACCE (3.3% vs. 3.3%; p = 0.82), death (0.0% vs. 1.0%; p = 0.39, stroke (0.0% vs. 0.1%; p > 0.99), myocardial infarction (3.3% vs. 2.3%; p = 0.41) or emergency revascularization (0.6% vs. 0.03%; p = 0.56) were similar between groups. In the multivariate analysis, age and presence of functional class Killip III and IV were the variables that best explained the occurrence of MACCE. Conclusions: Patients with age < 40 years represented a small fraction of the cases in this series and had a clinical and angiographic profile different from the older patients, suggesting the need to establish primary prevention measures earlier in individuals with the observed profile...

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea primária versus de resgate / In-hospital outcomes on patients submitted to primary versus rescue percutaneous coronary intervention

INTRODUÇÃO: Dificuldades de acesso em tempo hábil a centros que oferecem intervenção coronária percutânea (ICP) primária fazem com que a trombólise química seja a modalidade de reperfusão predominante em pacientes com infarto com supradesnivelamento do segmento ST (IAMCSST) no Brasil. Nesse cenário, a ICP de resgate torna-se importante opção para pacientes com insucesso na reperfusão. Comparamos os desfechos hospitalares dessas duas modalidades de ICP no IAMCSST. MÉTODOS: Entre agosto de 2006 e outubro de 2012, pacientes consecutivos do Registro Angiocardio, com IAMCSST, foram submetidos a ICP primária ou de resgate. Foi comparada a incidência de eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) hospitalares. RESULTADOS: Avaliamos 801 pacientes submetidos a ICP primária (n = 599) ou a ICP de resgate (n = 202). No grupo ICP de resgate foi observada menor frequência de trombos, oclusões totais, fluxo TIMI 0/1 pré-procedimento e presença de circulação colateral. O emprego de stents foi similar, assim como a taxa de sucesso do procedimento (91,7% vs. 90,6%; P = 0,75). A incidência de ECCAM (6,3% vs. 6,9%; P = 0,89), óbito (4% vs. 4%; P > 0,99), acidente vascular cerebral (0,3% vs. 0; P = 0,99) e reinfarto (2,7% vs. 3%; P > 0,99) não diferiu entre os grupos. Na análise multivariada, dislipidemia [odds ratio (OR) 2,190, intervalo de confiança de 95% (IC 95%) 1,14-4,16; P = 0,01], classe funcional Killip III ou IV (OR 7,494, IC 95% 3,90-14,31; P < 0,01) e lesões com calcificação moderada/acentuada (OR 2,852, IC 95% 1,39-5,62; P < 0,01) foram as variáveis que melhor explicaram os ECCAM hospitalares. CONCLUSÕES: Neste registro contemporâneo, a ICP de resgate obteve resultados hospitalares similares aos da ICP primária.

BACKGROUND: Difficulties to reach centers that offer primary percutaneous coronary intervention (PCI) in a timely manner turn intravenous thrombolysis into the predominant reperfusion mode in patients with ST segment elevation myocardial infarction (STEMI) in Brazil. In this scenario, rescue PCI becomes an important therapeutic option for patients who fail reperfusion. We have compared hospital outcomes of these two PCI modalities in STEMI. METHODS: Between August 2006 to October 2012, consecutive patients with STEMI enrolled in the Angiocardio Registry were submitted to primary or rescue PCI. The incidence of in-hospital major adverse cardiac and cerebrovascular events (MACCE) was compared. RESULTS: We evaluated 801 patients undergoing primary (n = 599) or rescue PCI (n = 202). In the rescue PCI group a lower frequency of thrombi, total occlusions, pre-procedure TIMI 0/1 flow and angiographically detectable collaterals was observed. The use of stents was similar, as well as the procedure success rates (91.7% vs 90.6%; P = 0.75). The incidence of MACCE (6.3% vs 6.9%; P = 0.89), death (4% vs 4%; P > 0.99), stroke (0.3% vs 0; P = 0.99) and reinfarction (2.7% vs 3%; P > 0.99) was not different between groups. In the multivariate analysis, the presence of dyslipidemia [odds ratio (OR) 2.190, 95% confidence interval (95% CI) 1.14-4.16; P = 0.01], Killip class III or IV (OR 7.494, 95% CI 3.90-14.31; P < 0.01) and lesions with moderate/severe calcification (OR 2.852, 95% CI 1.39-5.62; P < 0.01), were the variables that best explained in-hospital MACCE. CONCLUSIONS: In this contemporary registry, rescue and primary PCI had similar in-hospital results.

Intervenção coronária percutânea em diabéticos tratados com insulina / Percutaneous coronary intervention in insulin-treated diabetic patients

INTRODUÇÃO: Diabéticos, especialmente os tratados com insulina, apresentam aterosclerose coronária mais extensa e remodelamento vascular comprometido. Nosso objetivo foi avaliar os resultados hospitalares contemporâneos da intervenção coronária percutânea (ICP) em série consecutiva de diabéticos tratados com (DMI) ou sem (DMNI) insulina. MÉTODOS: Análise retrospectiva de um registro multicêntrico com 1.896 diabéticos, dos quais 397 (20,9%) eram do grupo DMI e 1.499, do grupo DMNI. Comparamos os eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) entre os dois grupos. RESULTADOS: O grupo DMI mostrou maior proporção de mulheres e de portadores de insuficiência renal crônica, mas apresentou características de menor complexidade angiográfica, quando comparado ao grupo DMNI, com menor número de lesões tipo B2/C e presença de trombo, oclusões e lesões com fluxo TIMI 0/1 pré-ICP. Foi tratado 1,4 ± 0,7 vaso/paciente com 1,3 ± 0,7 stent/paciente em cada grupo, e o diâmetro e a extensão dos stents não diferiram entre os grupos. Os desfechos clínicos hospitalares não mostraram diferença quanto à ocorrência de ECCAM (3,8% vs. 2,8%; P = 0,40), acidente vascular cerebral (0 vs. 0,1%; P > 0,99), infarto do miocárdio (2,5% vs. 2,1%; P = 0,72), cirurgia de revascularização miocárdica de emergência (0 vs. 0,1%; P > 0,99) ou óbito (1,5% vs. 0,8%; P = 0,24). Foram preditores independentes de ECCAM, em diabéticos, sexo feminino, pacientes com doença multiarterial e fluxo TIMI 0/1 pré-ICP. CONCLUSÕES: Em nosso estudo, o DMI não foi preditor independente de ECCAM hospitalares.

BACKGROUND: Diabetics, especially insulin-treated diabetics, have more extensive coronary atherosclerosis and impaired vascular remodeling. Our objective was to evaluate in-hospital results of contemporaneous percutaneous coronary intervention (PCI) in a consecutive series of diabetics treated with (ITD) or without (NITD) insulin. METHODS: Retrospective analysis of a multicenter registry with 1,896 diabetics, of which 397 (20.9%) were from the ITD group and 1,499 from the NITD group. Major adverse cardiac and cerebrovascular events (MACCE) were compared between groups. RESULTS: The ITD group showed a higher rate of women and of patients with chronic renal failure, but showed less complex angiographic characteristics when compared to the NITD group, with fewer B2/C lesions, thrombus-containing lesions, occlusions and TIMI 0/1 flow prior to PCI. We treated 1.4 ± 0.7 vessels/patient with 1.3 ± 0.7 stents/patient in each group and the diameter and length of stents were not different between groups. Clinical in-hospital outcomes showed no differences regarding the occurrence of MACCE (3.8% vs. 2.8%; P = 0.40), stroke (0 vs. 0.1%; P > 0.99), myocardial infarction (2.5% vs. 2.1%; P = 0.72), emergency cardiovascular bypass graft surgery (0 vs. 0.1%; P > 0.99) or death (1.5% vs. 0.8%; P = 0.24). Independent predictors of MACCE in diabetics were the female gender, patients with multivessel disease and TIMI 0/1 flow prior to PCI. CONCLUSIONS: In our study, ITD was not an independent predictor of in-hospital MACCE.

Mudanças no perfil populacional e resultados da intervenção coronária percutânea do Registro Angiocardio / Changes in the populational profile and outcomes of percutaneous coronary intervention in the Angiocardio Registry

INTRODUÇÃO: A evolução tecnológica tem permitido ampliar a indicação da intervenção coronária percutânea (ICP) para cenários clínicos e angiográficos mais desafiadores. Nosso objetivo foi avaliar os resultados da ICP em dois diferentes períodos, nos últimos 6 anos. MÉTODOS: Registro multicêntrico no qual 6.288 pacientes consecutivos tratados por ICP foram divididos por períodos de tratamento: 2006 a 2008 (P1; n = 1.779) e 2009 a 2012 (P2; n = 4.509). Buscamos comparar as taxas de eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) hospitalares e identificar seus preditores. RESULTADOS: Pacientes do Grupo P2 mostraram ser mais jovens, com maior prevalência de tabagismo e diabetes. Esses pacientes mostraram maior acometimento de múltiplos vasos, maior número de lesões trombóticas e lesões em bifurcações. A relação de vasos tratados/paciente foi maior no Grupo P2, assim como a relação stent/paciente e a utilização de stents farmacológicos. ECCAM foi mais frequente no Grupo P2 (2,5% vs. 3,5%; P = 0,04), às custas do infarto periprocedimento (1,7% vs. 2,6%; P = 0,05), não havendo diferenças quanto a óbito (1,0% vs. 1,0%; P = 0,87), acidente vascular cerebral (0,2% vs. 0,1%; P = 0,47) ou cirurgia de revascularização de emergência (0,1% vs. 0; P = 0,68). Idade (odds ratio - OR - de 1,02; intervalo de confiança de 95% - IC 95% - de 1,00-1,05; P = 0,04) e Killip III/IV (OR = 6,03, IC 95%; 3,39-10,90; P < 0,01) foram as variáveis que melhor explicaram a presença de ECCAM. CONCLUSÕES: Nessa grande coorte, mudanças substanciais ocorreram nas características de pacientes tratados por ICP nos últimos 6 anos. O cenário mais complexo associou-se a discreto aumento de infartos periprocedimento, mas não a outros eventos adversos clínicos hospitalares.

BACKGROUND: Technological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years. METHODS: This was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n = 1,779) and 2009 to 2012 (P2; n = 4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors. RESULTS: P2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P = 0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P = 0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P = 0.87), stroke (0.2% vs. 0.1%; P = 0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P = 0.68). Age (odds ratio - OR - 1.02; 95% confidence interval - CI 95% - 1.00-1.05; P = 0.04) and Killip III/IV (OR = 6.0, 95% CI; 3.3-10.9; P < 0.01) were the variables that best explained the presence of MACCE. CONCLUSIONS: In this large cohort, substancial changes occurred in the characteristics of patients treated by PCI in the last 6 years. This more complex scenario was associated to a slight increase of periprocedural myocardial infarctions, but not to other in-hospital clinical adverse events.