Revista Brasileira de Cardiologia Invasiva (English Edition)最新文献

{"title":"Right heart catheterization through ultrasound-guided antecubital vein approach","authors":"Felipe Homem Valle ,&nbsp;Paola Severo Romero ,&nbsp;Bruno da Silva Matte ,&nbsp;Sandro Cadaval Gonçalves ,&nbsp;Luiz Carlos Corsetti Bergoli ,&nbsp;Ana Maria Rocha Krepsky ,&nbsp;Gustavo Neves de Araújo ,&nbsp;Eneida Rejane Rabelo da Silva ,&nbsp;Marco Vugman Wainstein ,&nbsp;Rodrigo Vugman Wainstein","doi":"10.1016/j.rbciev.2017.08.002","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.08.002","url":null,"abstract":"<div><h3>Background</h3><p>Complications in right heart catheterization are almost all access-site related. Forearm veins may be a target to reduce access-site complications during the procedure. However, data regarding wide application of this technique is scarce.</p></div><div><h3>Methods</h3><p>This is a case-series that reports our first experiences in right heart catheterization through the antecubital approach.</p></div><div><h3>Results</h3><p>We attempted to perform right heart catheterization in 20 patients using antecubital approach on January 2016. The antecubital approach was successful in 19 (95.0%) cases. All venous access were obtained with ultrasound guidance. Simultaneous right and left heart catheterization was performed in 12 cases (60.0%). Left heart catheterization was performed through right radial artery in 11 cases (91.7%) and through the right brachial artery in 1 case (8.3%). Antecubital access was obtained through the basilic vein in 18 (94.7%) cases and through the cephalic vein in 1 (5.3%) case.</p></div><div><h3>Conclusions</h3><p>Right heart catheterization through the antecubital fossa veins appears to be feasible and safe. Further controlled studies are required to establish the best access site to perform right heart catheterization.</p></div><div><h3>Introdução</h3><p>As complicações no cateterismo cardíaco direito estão quase sempre relacionadas ao local de acesso. As veias do antebraço podem ser um alvo para reduzir tais complicações durante o procedimento. No entanto, dados relativos à ampla aplicação desta técnica são escassos.</p></div><div><h3>Métodos</h3><p>Série de casos que relata nossas primeiras experiências com o cateterismo cardíaco direito por acesso venoso antecubital.</p></div><div><h3>Resultados</h3><p>Tentamos realizar o cateterismo cardíaco direito em 20 pacientes com abordagem antecubital em janeiro de 2016. A abordagem antecubital foi bem-sucedida em 19 casos (95,0%). Todos os acessos venosos foram obtidos guiados por ultrassonografia. Os cateterismos cardíacos direito e esquerdo foram realizados simultaneamente em 12 casos (60,0%). O cateterismo cardíaco esquerdo foi realizado através da artéria radial direita em 11 casos (91,7%), e da artéria braquial direita em 1 caso (8,3%). O acesso antecubital foi obtido pela veia basílica em 18 (94,7%) casos, e pela veia cefálica em 1 (5,3%) caso.</p></div><div><h3>Conclusões</h3><p>O cateterismo cardíaco direito através das veias da prega antecubital parece ser viável e seguro. Outros estudos controlados são necessários para estabelecer o melhor local de acesso para realizar o cateterismo cardíaco direito.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 35-37"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of primary percutaneous coronary intervention requiring predilation","authors":"Thiago Augusto Rubini Miranda ,&nbsp;Ana Cristina Felicio Rios Miranda ,&nbsp;Paulo Cícero Aidar Maiello ,&nbsp;Waigner Bento Pupim Filho ,&nbsp;Wellington Borges Reis ,&nbsp;Pedro Beraldo de Andrade","doi":"10.1016/j.rbciev.2017.10.003","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Although predilation during primary percutaneous coronary intervention offers greater predictability for stent implantation, it is associated with complications that may negatively influence immediate and late outcomes. The objective of this study was to characterize procedures requiring predilation, comparing them to those performed by direct stent implantation.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Primary percutaneous coronary interventions registered at the &lt;em&gt;Central Nacional de Intervenções Cardiovasculares&lt;/em&gt; (CENIC) from 2006 to 2016 were analyzed. The clinical and angiographic profiles of the procedures performed with or without predilation, hospital outcome measures, and predictors of mortality were characterized.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The sample consisted of 17,515 patients. Those who underwent predilation differed from the direct stent implantation group regarding clinical characteristics, with a higher prevalence of elderly, women, and associated comorbidities. In the first group, the rates of calcified lesions, bifurcations, occlusions, and multivessel coronary disease were higher. Intervention failure rates were also higher in patients undergoing predilation, as well as the rates of major adverse cardiac events. In the multiple logistic regression model, the need for predilation was correlated with the occurrence of hospital death.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Primary percutaneous coronary intervention requiring predilation was characterized by a higher prevalence of clinical comorbidities and by angiographic and technical complexity of the procedures. Predilation is an independent predictor of hospital mortality in this clinical setting.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;Embora a pré-dilatação durante a intervenção coronária percutânea primária confira maior previsibilidade ao implante do stent, ela associa-se a complicações que podem influenciar negativamente em seus resultados imediatos e tardios. O objetivo deste estudo foi caracterizar os procedimentos com necessidade de pré-dilatação, comparando-os àqueles realizados pelo implante direto de stent.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Foram analisadas as intervenções coronárias percutâneas primárias cadastradas na Central Nacional de Intervenções Cardiovasculares (CENIC) durante o período de 2006 a 2016, tendo sido caracterizados os perfis clínico e angiográfico dos procedimentos efetivados com ou sem pré-dilatação, aferição de desfechos hospitalares e preditores de mortalidade.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;A amostra foi composta por 17.515 pacientes. Aqueles submetidos à pré-dilatação diferiram do grupo stent direto, quanto às características clínicas, com maior prevalência de idosos, mulheres e comorbidades associadas. No primeiro, as taxas de lesões calcificadas, bifurcações, oclusões e coronariopatia multiarterial foram maiores. Também foram maiores as taxas de insucesso da intervenção entre pacientes submetidos à pré-dilata","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 14-18"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute myocardial infarction in the Brazilian Unified Health System: a bridge too far for reperfusion?","authors":"Luiz Alberto Piva e Mattos ,&nbsp;Dinaldo Cavalcanti Oliveira","doi":"10.1016/j.rbciev.2017.10.012","DOIUrl":"10.1016/j.rbciev.2017.10.012","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 2-3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"103380260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary or rescue percutaneous coronary intervention in smokers","authors":"Fernando Augusto Molinari di Castro Curado ,&nbsp;Gustavo Carvalho ,&nbsp;Ana Tereza de Azeredo Bastos Filho ,&nbsp;Wellington Borges Custodio ,&nbsp;Wilson Albino Pimentel Brito ,&nbsp;Marcelo Cantarelli","doi":"10.1016/j.rbciev.2017.10.004","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Despite the close association between smoking and atherosclerotic disease development, little is known about the clinical characteristics and outcomes related to percutaneous coronary intervention (PCI) in smokers with acute coronary syndrome in Brazil. This study aimed to analyze the clinical, angiographic, and procedural profile, in addition to in-hospital outcomes, in smokers and non-smokers with acute myocardial infarction with ST-segment elevation (STEMI) submitted to primary or rescue PCI.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Cross-sectional study of the &lt;em&gt;Central Nacional de Intervenções Cardiovasculares&lt;/em&gt; (CENIC) registry between 2006 and 2016. The study population included patients aged ≥ 18 years who presented with STEMI and were submitted to primary or rescue PCI.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 20,319 patients were included, of whom 6,880 (34.4%) were smokers. The group of smokers was significantly younger, male, and with a lower prevalence of comorbidities. At angiography, smokers showed greater complexity, with a higher prevalence of thrombi, long lesions or TIMI flow 0/1. During the procedure, smokers received a lower proportion of drug-eluting stents and thrombus aspiration was more frequent, as well as procedural success (94.2% vs. 92.1%; &lt;em&gt;p&lt;/em&gt; &lt; 0.0001). In the univariate analysis, smokers showed lower mortality (2.9% vs. 4.5%; &lt;em&gt;p&lt;/em&gt; &lt; 0.0001) and fewer major adverse cardiac events (3.3% vs. 4.8%; &lt;em&gt;p&lt;/em&gt; &lt; 0.0001). However, after multivariate analysis, smoking was not associated with a lower risk of mortality.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Although the clinical outcomes associated with the PCI were favorable to smokers, the multivariate analysis did not show a protective effect of smoking. Such results are due to differences in clinical and angiographic characteristics between smokers and non-smokers.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;Apesar da estreita relação do tabagismo com o desenvolvimento da doença aterosclerótica, pouco se sabe sobre as características clínicas e os desfechos relacionados à intervenção coronária percutânea (ICP) em tabagistas com síndrome coronariana aguda no Brasil. O objetivo deste estudo foi analisar o perfil clínico, angiográfico e do procedimento, além de desfechos hospitalares, em pacientes tabagistas e não tabagistas com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) submetidos à ICP primária ou de resgate.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Estudo transversal do registro da Central Nacional de Intervenç&lt;em&gt;õ&lt;/em&gt;es Cardiovasculares (CENIC) entre 2006 e 2016. A população do estudo incluiu pacientes com idade ≥ 18 anos que apresentassem IAMCST submetidos à ICP primária ou de resgate.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Foram incluídos 20.319 pacientes, dos quais 6.880 (34,4%) eram tabagistas. O grupo de pacientes tabagistas era significativamente mais jovem, do sexo masculino e com menor prevalência de","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 19-24"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72245678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and late clinical outcomes after saphenous vein graft treatment with MGuardTM stents vs. drug-eluting stents","authors":"Danillo Taiguara da Silva ,&nbsp;J. Ribamar da Costa Jr. ,&nbsp;Antonio de Castro Filho ,&nbsp;Rodolfo Staico ,&nbsp;Ricardo A. Costa ,&nbsp;Adriana Moreira ,&nbsp;Dimytri Siqueira ,&nbsp;Daniel Chamié ,&nbsp;Marinella Centemero ,&nbsp;Galo Maldonado ,&nbsp;Manoel Cano ,&nbsp;Luiz Fernando Tanajura ,&nbsp;Áurea J. Chaves ,&nbsp;Fausto Feres ,&nbsp;Alexandre Abizaid ,&nbsp;Amanda Sousa ,&nbsp;J. Eduardo Sousa","doi":"10.1016/j.rbciev.2017.02.007","DOIUrl":"10.1016/j.rbciev.2017.02.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;The MGuard&lt;sup&gt;TM&lt;/sup&gt; stent, which has a microscopic polymer mesh coating, is intended to reduce the distal embolization of fragments during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVG). This study evaluated the early and late clinical outcomes of patients undergoing PCI in SVG with MGuard&lt;sup&gt;TM&lt;/sup&gt; stents vs. drug-eluting stents (DES).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Observational, retrospective study conducted at two tertiary centers, involving a cohort of patients with SVG lesions submitted to elective or emergency treatment with MGuard&lt;sup&gt;TM&lt;/sup&gt; stents or DES.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 271 patients were included, of whom 220 were treated with DES. The MGuard&lt;sup&gt;TM&lt;/sup&gt; group had a higher proportion of women (25.5% vs. 10.5%; &lt;em&gt;p&lt;/em&gt; = 0.01), with a mean age of 65.0 ± 13.9 years vs. 69.0 ± 9.6 years (&lt;em&gt;p&lt;/em&gt; = 0.06). The DES group more frequently used distal protection filter (5.8% vs. 10.0%; &lt;em&gt;p&lt;/em&gt; = 0.001). Angiographic success was attained in most cases (96.2% vs. 98.0%; &lt;em&gt;p&lt;/em&gt; = 0.22). The MGuard&lt;sup&gt;TM&lt;/sup&gt; group had lower rates of early major adverse cardiovascular events (MACE) than the DES group (1.9% vs. 13.6%; &lt;em&gt;p&lt;/em&gt; = 0.01), due solely to the lower incidence of periprocedural infarction. However, the MACE rate at 1 year was higher in the MGuard&lt;sup&gt;TM&lt;/sup&gt; group (14.3% vs. 4.4%; &lt;em&gt;p&lt;/em&gt; = 0.01) at the expense of a higher rate of target lesion revascularization (7.1% vs. 1.3%; &lt;em&gt;p&lt;/em&gt; = 0.048).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The use of the MGuard&lt;sup&gt;TM&lt;/sup&gt; stent resulted in a reduction of events during hospitalization; however, in the long term the DES were superior in reducing major outcomes, mainly the need for target lesion revascularization.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;O stent MGuard&lt;sup&gt;TM&lt;/sup&gt;, revestido por malha polimérica microscópica, tem a finalidade de reduzir a embolização distal de fragmentos durante a intervenção coronária percutânea (ICP) em enxertos de veia safena (EVS). Avaliamos os desfechos clínicos precoces e tardios de pacientes submetidos à ICP de EVS com stents MGuard™ vs. stents farmacológicos (SF).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Estudo observacional, retrospectivo, realizado em dois centros terciários, envolvendo uma coorte de pacientes com lesões em EVS, tratados de forma eletiva ou de emergência com stents MGuard™ ou SF.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Foram incluídos 271 pacientes, sendo 220 tratados com SF. O Grupo MGuard™ apresentou maior proporção de mulheres (25,5% vs. 10,5%; p=0,01), com média de idades de 65,0 ± 13,9 anos vs. 69,0 ± 9,6 anos (&lt;em&gt;p&lt;/em&gt; = 0,06). O Grupo SF utilizou com maior frequência filtro de proteção distal (5,8% vs. 10,0%; &lt;em&gt;p&lt;/em&gt; = 0,001). Sucesso angiográfico foi obtido na maioria dos casos (96,2% vs. 98,0%; &lt;em&gt;p&lt;/em&gt; = 0,22). O Grupo MGuard™ teve menores taxas de eventos cardiovasculares adversos maiores (ECAM) na fase hospitalar que o Grup","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 251-255"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100973394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgements to the Revista Brasileira de Cardiologia Invasiva – 2015","authors":"","doi":"10.1016/j.rbciev.2017.01.001","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.01.001","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 288-289"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137391769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimized contrast use with intravascular ultrasound-guidance percutaneous coronary intervention. One-year follow-up of the MOZART randomized study","authors":"José Mariani Jr.,&nbsp;Fernando Roberto De Fazzio,&nbsp;Fernando Luis Melo Bernardi,&nbsp;Breno de Alencar Araripe Falcão,&nbsp;Cristiano Guedes Bezerra,&nbsp;Antonio Esteves Filho,&nbsp;Paulo Rogério Soares,&nbsp;Sílvio Zalc,&nbsp;Roberto Kalil Filho,&nbsp;Pedro Alves Lemos Neto","doi":"10.1016/j.rbciev.2015.08.011","DOIUrl":"https://doi.org/10.1016/j.rbciev.2015.08.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Recently, the MOZART study demonstrated that using intravascular ultrasound (IVUS) for guiding percutaneous coronary intervention (PCI) reduces the volume of contrast used in the procedure. The authors assessed the incidence of late adverse cardiovascular events in these patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Patients at risk for contrast-induced nephropathy (CIN) or volume overload were randomized to angiography-guided versus IVUS-guided PCI, and followed-up for a 1-year period.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Eighty-three patients were included in the angiography-guided (n = 42) or IVUS-guided (n = 41) groups, of whom 77.1% were diabetics and 44.6% had creatinine clearance &lt; 60&lt;!--&gt; &lt;!--&gt;mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;. Clinical and angiographic characteristics did not differ between the groups. Most had type B2/C lesions (89.8%) and a median of two stents were used (interquartile range: 1.0-2.0 stents). The duration of IVUS-guided PCI was 14&lt;!--&gt; &lt;!--&gt;minutes longer than the angiography-guided PCI group (&lt;em&gt;p&lt;/em&gt; = 0.006). However, the groups did not differ regarding fluoroscopy time or mean image acquisitions per procedure. CIN occurred in 19.0% vs. 7.3% (&lt;em&gt;p&lt;/em&gt; = 0.26). During the 1-year follow-up, 12% of patients had a major cardiovascular event, with two deaths (one in each group), and no differences were found between groups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The contrast reduction strategy with IVUS-guided PCI in patients at risk for CIN or volume overload was shown to be safe in the short and long term.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;Recentemente, o estudo MOZART demonstrou que a utilização do ultrassom intracoronário (USIC) para guiar a intervenção coronariana percutânea (ICP) diminui o volume de contraste utilizado no procedimento. Avaliamos a incidência de eventos adversos cardiovasculares tardios desses pacientes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Pacientes com risco para nefropatia induzida por contraste (NIC) ou para sobrecarga de volume, e com indicação de ICP, foram randomizados para procedimento guiado pela angiografia ou USIC, e acompanhados por um período de 1 ano.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Incluídos 83 pacientes nos grupos ICP guiado por angiografia (n = 42) ou USIC (n = 41), sendo que 77,1% eram diabéticos e 44,6% tinham &lt;em&gt;clearance&lt;/em&gt; de creatinina &lt; 60&lt;!--&gt; &lt;!--&gt;mL/min/1,73m&lt;sup&gt;2&lt;/sup&gt;. As características clínicas e angiográficas não mostraram diferenças entre os grupos. A maioria tinha lesões tipo B2/C (89,8%) e uma mediana de dois stents foram usados (intervalo interquartil: 1,0-2,0 stents). O tempo de procedimento da ICP guiada por USIC foi 14 minutos maior do que no grupo guiado por angiografia (&lt;em&gt;p&lt;/em&gt; = 0,006). No entanto, os grupos não diferiram em relação ao tempo de fluoroscopia ou à média de aquisições de imagem por procedimento. A NIC ocorreu em 19,0% vs. 7,3% (&lt;em&gt;p&lt;/em&gt; = 0,26). No período de seguimento de 1 ano, 12% dos pacientes apresentaram algu","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 247-250"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72236028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous aortic valve implantation – an experience with the LotusTM repositionable device","authors":"Vinicius Esteves ,&nbsp;Julio F. Marchini ,&nbsp;Guilherme Bernardi ,&nbsp;Marden A. Tebet ,&nbsp;Fernando Bernardi ,&nbsp;Sérgio Kreimer ,&nbsp;Paulo Prates ,&nbsp;José Mariani Jr. ,&nbsp;Rogério Sarmento-Leite ,&nbsp;Luiz Alberto Mattos ,&nbsp;Eberhard Grube ,&nbsp;Pedro A. Lemos","doi":"10.1016/j.rbciev.2017.02.005","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.02.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;The second-generation Lotus&lt;sup&gt;TM&lt;/sup&gt; transcatheter aortic valve was designed to provide the interventional cardiologist with complete control of its release during the procedure. This study presents the initial experience and in-hospital outcomes of patients treated with this prosthesis in Brazil.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;This observational and retrospective study included patients with symptomatic severe aortic stenosis considered at high surgical risk, treated in seven centers.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The device was used in 31 patients, 61.3% female, aged 82.9 ± 6.9 years, and with STS score of 6.5 ± 4.1%. The aortic valve area was 0.73 ± 0.18&lt;!--&gt; &lt;!--&gt;cm&lt;sup&gt;2&lt;/sup&gt; and the mean gradient was 51.7 ± 13.9&lt;!--&gt; &lt;!--&gt;mmHg. All procedures were performed by the transfemoral access route, and pre-dilation was necessary in 65% of cases. The success rate of the procedure was 96.7%. There were no vascular complications requiring surgical intervention nor cases of stroke. The mean gradient after the procedure was 10.5 ± 5.8&lt;!--&gt; &lt;!--&gt;mmHg; no cases of moderate to severe aortic regurgitation were observed. The rate of permanent pacemaker implantation was 38.7%, and mean in-hospital length of stay was 8.5 ± 4.8 days.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;In the initial experience with the use of the Lotus&lt;sup&gt;TM&lt;/sup&gt; aortic valve, in-hospital results demonstrated the safety and efficacy of the device; no cases of significant aortic regurgitation were observed.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;A válvula aórtica transcateter de segunda geração Lotus&lt;sup&gt;TM&lt;/sup&gt; foi desenhada para proporcionar ao intervencionista o controle completo de sua liberação durante o procedimento. O presente estudo apresenta a experiência inicial e os desfechos hospitalares de pacientes tratados com essa prótese no Brasil.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Registro observacional, retrospectivo, que incluiu pacientes com estenose aórtica grave sintomáticos, considerados de alto risco cirúrgico, tratados em sete centros.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Receberam o dispositivo 31 pacientes, sendo 61,3% do sexo feminino, com idade de 82,9 ± 6,9 anos e escore STS de 6,5 ± 4,1%. A área valvar aórtica foi de 0,73 ± 0,18&lt;!--&gt; &lt;!--&gt;cm&lt;sup&gt;2&lt;/sup&gt; e o gradiente médio de 51,7 ± 13,9&lt;!--&gt; &lt;!--&gt;mmHg. Todos os procedimentos foram realizados pela via transfemoral, e a pré-dilatação foi necessária em 65% dos casos. A taxa de sucesso do procedimento foi de 96,7%. Não houve complicação vascular com necessidade de intervenção cirúrgica e nem casos de acidente vascular cerebral. O gradiente médio após o procedimento foi de 10,5 ± 5,8&lt;!--&gt; &lt;!--&gt;mmHg e não foram observadas regurgitações aórticas de graus moderado/importante. A taxa de implante de marca-passo definitivo foi de 38,7%, e a permanência hospitalar de 8,5 ± 4,8 dias.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusões&lt;/h3&gt;&lt;p&gt;Na experiência inicial com o implante da válvula aórtica Lotus&lt;sup&gt;TM&lt;/sup&gt;, os resultad","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 238-241"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72236358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New generation devices for transcatheter aortic valve replacement","authors":"Áurea J. Chaves","doi":"10.1016/j.rbciev.2017.02.002","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.02.002","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Page 233"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72204878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second-generation drug-eluting stent treatment for isolated proximal left anterior descending artery stenoses. The SAFIRA Registry data","authors":"Fernanda Marinho Mangione ,&nbsp;Maria Fernanda Zulliani Mauro ,&nbsp;Paulo Vasconcelos Silva ,&nbsp;Nádia Mendonça Carnieto ,&nbsp;Salvador André Bavaresco Cristóvão ,&nbsp;Adnan Ali Salman ,&nbsp;Gustavo Alexandre Dutra ,&nbsp;Bernardo Monteiro de Aguillar Giordano ,&nbsp;Fabio Musa Mustafa Dessiyeh ,&nbsp;Marcelo P. Gomes ,&nbsp;Tanas Jatene ,&nbsp;José Armando Mangione","doi":"10.1016/j.rbciev.2017.02.011","DOIUrl":"10.1016/j.rbciev.2017.02.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Severe stenosis of the proximal left anterior descending artery (LAD) is classified as a high-risk lesion, as it may affect a large part of the left ventricular myocardium. Second-generation drug-eluting stents (DES) have been shown to be more effective and safer when compared to bare-metal or first-generation ones. There are few reports in the literature on the use of these devices for the treatment of isolated lesions in the proximal LAD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Observational and prospective study, which included single-vessel patients with &lt;em&gt;de novo&lt;/em&gt; lesions in the proximal LAD, electively treated with second-generation DES. In-hospital and late clinical outcomes were evaluated.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Seventy patients were included, most of them males (70%), with a mean age of 65.4 ± 11.2 years and a high prevalence of diabetes (37%). The most common clinical presentation was stable angina (57.1%) and half of the lesions were type B2 or C. A total of 70 lesions were treated with 71 stents, with 100% angiographic success. The primary endpoint, consisting of cardiac death, nonfatal infarction, or target-vessel revascularization during the 2.5-year clinical follow-up, occurred in 3% of the patients. Cardiac death was 1.5%, and target-lesion revascularization was required in only 1.5% of the patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Elective treatment with second-generation DES seems to be a safe option in single-vessel patients with &lt;em&gt;de novo&lt;/em&gt; lesions in the proximal LAD, with low rates of adverse cardiac events or need for additional revascularization procedure.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introdução&lt;/h3&gt;&lt;p&gt;A estenose grave do terço proximal da artéria descendente anterior (ADA) é classificada como lesão de alto risco, visto que pode comprometer grande parte do miocárdio ventricular esquerdo. Os stents farmacológicos (SF) de segunda geração têm demonstrado maior eficácia e segurança quando comparados aos não farmacológicos ou aos de primeira geração. São escassos os relatos na literatura do emprego desses dispositivos para o tratamento de lesões isoladas do terço proximal da ADA.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Métodos&lt;/h3&gt;&lt;p&gt;Estudo observacional e prospectivo, que incluiu pacientes uniarteriais, portadores de lesão &lt;em&gt;de novo&lt;/em&gt; no terço proximal da ADA, tratados eletivamente com SF de segunda geração. Avaliamos os desfechos clínicos hospitalares e tardios.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Foram incluídos 70 pacientes, sendo a maioria do sexo masculino (70%), com média de idades de 65,4 ± 11,2 anos e com alta prevalência de diabetes (37%). O quadro clínico mais frequente foi angina estável (57,1%) e metade das lesões era do tipo B2 ou C. Foram tratadas 70 lesões com 71 stents, com sucesso angiográfico de 100%. O desfecho primário composto por óbito cardíaco, infarto não fatal ou revascularização do vaso alvo no seguimento clínico de 2,5 anos ocorreu em 3% dos pacientes. A mortalidade cardíaca foi de ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 4","pages":"Pages 256-260"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.02.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"108031173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}