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

{"title":"Safety and predictors of same day discharge after elective percutaneous coronary intervention","authors":"Fabio Conejo,&nbsp;Henrique Barbosa Ribeiro,&nbsp;André Gasparini Spadaro,&nbsp;Roger Renault Godinho,&nbsp;Sandro M. Faig,&nbsp;Camila Gabrilaitis,&nbsp;Mariana Y. Okada,&nbsp;Alexandre Spósito,&nbsp;Carlos Vinícius Espirito-Santo,&nbsp;Marcelo Jamus Rodrigues,&nbsp;J. Carlos Teixeira Garcia,&nbsp;Pedro Gabriel Melo de Barros e Silva,&nbsp;Valter Furlan,&nbsp;Expedito E. Ribeiro","doi":"10.1016/j.rbciev.2015.01.002","DOIUrl":"10.1016/j.rbciev.2015.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Although same-day discharge (SDD) after elective uncomplicated percutaneous coronary intervention (PCI) be adopted worldwide, it remains poorly studied in our country. We aim to evaluate our initial experience with SDD after elective PCI, regarding its safety and predictors of success.</p></div><div><h3>Methods</h3><p>A hundred and sixty-one single-center consecutive patients, selected in a specialized outpatient clinic, were included for SDD. To identify the factors associated with SDD, single and multiple logistic regression models were adjusted.</p></div><div><h3>Results</h3><p>SDD was successfully performed in 114 patients (70.8%) and the remaining 47 patients remained hospitalized (45 with discharge in the following morning and 2 patients after 2 days). No patient with SDD presented major adverse cardiac events or major vascular complications at 30 days or at a median follow-up of 12 months. In the inpatient group, there was only one case of acute myocardial infarction due to a lateral branch occlusion and two patients with &gt; 5<!--> <!-->cm hematoma related to the access site. The SDD predictors were radial access route (OR = 5.92; 95%CI 1.73-20.21; <em>p</em> = 0.005), presence of type A/B1 lesions (OR = 14.09; 95%CI 1.70-116.49%; <em>p</em> = 0.01) and contrast volume (OR = 0.76; 95%CI 0.65-0.88; <em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>SDD was safe and could be successfully performed in most patients selected for elective PCI, and its predictors were the radial access, less complex coronary lesions and a and lower contrast volume.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 42-47"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"103465530","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":"Transradial approach for post-coronary artery bypass graft patients: is it worth the efforts?","authors":"Olivier F. Bertrand,&nbsp;Alberto Barria Perez","doi":"10.1016/j.rbciev.2015.06.004","DOIUrl":"10.1016/j.rbciev.2015.06.004","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 2-3"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"94410980","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":"Clinical profile and outcomes of primary percutaneous coronary intervention in young patients","authors":"Ivan Petry Feijó,&nbsp;Márcia Moura Schmidt,&nbsp;Renato Budzyn David,&nbsp;João Maximiliano Pedron Martins,&nbsp;Karine Elisa Schmidt,&nbsp;Carlos Antonio Mascia Gottschall,&nbsp;Alexandre Schaan de Quadros","doi":"10.1016/j.rbciev.2015.01.007","DOIUrl":"10.1016/j.rbciev.2015.01.007","url":null,"abstract":"<div><h3>Background</h3><p>The epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those &gt; 40 years undergoing primary percutaneous coronary intervention (pPCI).</p></div><div><h3>Methods</h3><p>Prospective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.</p></div><div><h3>Results</h3><p>A total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; <em>p</em> = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients &gt; 40 years (<em>p</em> = 0.07).</p></div><div><h3>Conclusions</h3><p>Patients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those &gt; 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 48-51"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.01.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100618597","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":"Mid-Ventricular Hypertrophic Obstructive Cardiomyopathy","authors":"Fernando Pivatto Jr. ,&nbsp;Márcio Mossmann ,&nbsp;Ana Maria Krepsky ,&nbsp;Alexandre do Canto Zago","doi":"10.1016/S2214-1235(15)30013-2","DOIUrl":"10.1016/S2214-1235(15)30013-2","url":null,"abstract":"<div><p>Mid-ventricular hypertrophic obstructive cardiomyopathy is a rare variant form (1%) of hypertrophic obstructive cardiomyopathy. In this case, we report a patient referred for elective cardiac catheterization due to angina and dyspnea on moderate exertion, with no significant coronary obstruction, and left ventriculography indicating the presence of mid-ventricular hypertrophic obstructive cardiomyopathy with an intraventricular pressure gradient of 130<!--> <!-->mmHg.</p></div><div><h3>RESUMO</h3><p>Cardiomiopatia Hipertrófica Obstrutiva Médio-Ventricular</p><p>A cardiomiopatia hipertrófica obstrutiva médio-ventricular é uma variante rara (1%) da miocardiopatia hipertrófica obstrutiva. Neste relato de caso, apresentamos uma paciente encaminhada para realização de cateterismo cardíaco eletivo por angina e dispneia aos moderados esforços, sem obstrução coronariana significativa e com ventriculografia esquerda, demostrando cardiomiopatia hipertrófica obstrutiva médio-ventricular com um gradiente pressórico intraventricular de 130<!--> <!-->mmHg.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 180-182"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30013-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75345236","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":"Results of Primary Percutaneous Coronary Intervention According to the Total Ischemic Time","authors":"Roberto Ramos Barbosa ,&nbsp;Felipe Bortot Cesar ,&nbsp;Renato Giestas Serpa ,&nbsp;Denis Moulin dos Reis Bayerl ,&nbsp;Vinicius Fraga Mauro ,&nbsp;Walkimar Ururay Gloria Veloso ,&nbsp;Roberto de Almeida Cesar ,&nbsp;Pedro Abilio Ribeiro Reseck ,&nbsp;Valmin Ramos-Silva","doi":"10.1016/S2214-1235(15)30007-7","DOIUrl":"10.1016/S2214-1235(15)30007-7","url":null,"abstract":"<div><h3>Background</h3><p>Treatment of ST-elevation acute myocardial infarction has primary percutaneous coronary intervention as the preferred method of reperfusion. This study aimed to evaluate in-hospital outcomes of patients with ST-elevation acute myocardial infarction according to the total ischemic time until performing primary percutaneous coronary intervention.</p></div><div><h3>Methods</h3><p>Single-center registry of patients admitted with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention between March/2012 and February/2014, followed from admission to hospital discharge, and compared according to the total ischemic time (Group 1: symptom onset-to-balloon time<!--> <!-->&lt;<!--> <!-->6<!--> <!-->hours; Group 2: symptom onset-to-balloon time<!--> <!-->&gt;<!--> <!-->6 and<!--> <!-->&lt;<!--> <!-->12<!--> <!-->hours).</p></div><div><h3>Results</h3><p>Two hundred seventy nine patients underwent primary percutaneous coronary intervention, 118 in Group 1 (42.3%) and 161 in Group 2 (57.7%). Group 2 was older, had higher prevalence of hypertension, fewer smokers, more patients in Killip-Kimball class<!--> <!-->&gt;<!--> <!-->2 and lower primary percutaneous coronary intervention success rate. The incidences of death or non-fatal infarction (11.0% vs. 18.6%; <em>p</em> <!-->=<!--> <!-->0.08), death (8.5% vs. 16.8%; <em>p</em> <!-->=<!--> <!-->0.04) and acute renal failure (7.6% vs. 19.9%; <em>p</em> <!-->&lt;<!--> <!-->0.01) were greater in Group 2.</p></div><div><h3>Conclusions</h3><p>Patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention with symptom onset-to-balloon time<!--> <!-->&gt;<!--> <!-->6<!--> <!-->hours presented higher clinical complexity and worse in-hospital outcomes when compared to patients treated earlier. Joint actions in different critical areas of patient care are essential to increase treatment efficacy and reduce adverse outcomes.</p></div><div><h3>RESUMO</h3><p>Resultados da Interveção Coronária Percutânea Primária de Acordo com o Tempo Total de Isquemia</p></div><div><h3>Introdção</h3><p>O tratamento do infarto agudo do miocárdio com supradesnivelamento de ST tem a intervenção coronária percutânea primária como método preferencial de reperfusão. Este estudo teve como objetivo avaliar a evolução hospitalar de pacientes com infarto agudo do miocárdio com supradesnivelamento de ST, conforme o tempo total de isquemia, até a realização de intervenção coronária percutânea primária.</p></div><div><h3>Métodos</h3><p>Registro unicêntrico, de pacientes admitidos com infarto agudo do miocárdio com supradesnivelamento de ST submetidos à intervenção coronária percutânea primária entre março de 2012 e fevereiro de 2014, acompanhados da admissão até a alta hospitalar e comparados conforme o tempo total de isquemia (Grupo 1: tempo dor-balão<!--> <!-->&lt;<!--> <!-->6 horas; Grupo 2: tempo dor-balão<!--> <!-->&gt;<!--> <!-->6 e<!--> <!","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 137-142"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30007-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76632047","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":"Immunohistochemical Characteristics of Coronary Thrombi in Patients with ST-Elevation Myocardial Infarction and Diabetes Mellitus: Pilot Studyy","authors":"Daniel Rios Pinto Ribeiro,&nbsp;Eduardo Cambruzzi,&nbsp;Juliana Canedo Sebben,&nbsp;Karina Pezzi Melleu,&nbsp;Marcia Moura Schmidt,&nbsp;Carlos AM Gottschall,&nbsp;Alexandre Schaan de Quadros","doi":"10.1016/S2214-1235(15)30006-5","DOIUrl":"10.1016/S2214-1235(15)30006-5","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes mellitus is associated with increased mortality rates in the setting of acute myocardial infarction. The aim of this study was to evaluate whether there are peculiarities in the atherothrombotic process that might be implicated in increased risk for this outcome in patients with diabetes.</p></div><div><h3>Methods</h3><p>Pilot study in a cohort of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention and aspiration thrombectomy. Clinical and laboratory variables were evaluated in all of the cases. Thrombi were analyzed for histopathological features as well as immunohistochemical expression of CD34, CD61 and factor VIII.</p></div><div><h3>Results</h3><p>Our sample included the first ten diabetic patients with material available for analysis, who were matched according to age, gender and time elapsed since myocardial infarction with ten patients without diabetes. There was no significant association between the immunohistochemical expression of CD34, CD61 and factor VIII with other histopathological, clinical and laboratory variables, including the presence of diabetes mellitus.</p></div><div><h3>Conclusions</h3><p>In this preliminary analysis, it was not possible to demonstrate any significant difference in the expression of endothelial cell activity, platelet function and activation of the coagulation cascade between thrombi of patients with and without diabetes undergoing primary coronary intervention.</p></div><div><h3>RESUMO</h3><p>Características Imuno-Histoquímicas de Trombos Coronarianos de Pacientes com Infarto do Miocárdio com Elevação de ST e <em>Diabetes Mellitus</em>: Estudo Piloto</p></div><div><h3>Introdução</h3><p>No contexto do infarto agudo do miocárdio, o <em>diabetes mellitus</em> está associado à maior mortalidade. O objetivo deste estudo foi avaliar se existem, entre os diabéticos, peculiaridades no processo de aterotrombose que poderiam estar implicadas em maior risco para tal desfecho.</p></div><div><h3>Métodos</h3><p>Estudo piloto, proveniente de coorte de pacientes com diagnòstico de infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronária percutânea primária e à tromboaspiração. Foram estudadas variáveis clínico-laboratoriais de cada caso. Os trombos foram analisados quanto às características histopatológicas e às expressöes imuno-histoquímicas de CD34, CD61 e fator VIII.</p></div><div><h3>Resultados</h3><p>Foram incluídos os primeiros dez pacientes portadores de <em>diabetes mellitus</em> com material disponível para análise, pareados por idade, sexo e tempo de evolução do infarto com dez pacientes sem <em>diabetes mellitus</em>. Não houve associação significativa entre as expressões imuno-histoquímicas de CD34, CD61 e fator VIII com relação às variáveis histopatológicas, laboratoriais e clínicas estudadas, inclusive com relação à presença de <em>diabetes mellitus</em>.</p></div><div><h3>Conclusões","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 131-136"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30006-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83447389","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":"Effects of Renal Sympathetic Denervation in Renal Artery Diameter Evaluated By Quantitative Angiography","authors":"Luciana Armaganijan,&nbsp;Rodolfo Staico,&nbsp;Dalmo Moreira,&nbsp;Celso Amodeo,&nbsp;Flávio Borelli,&nbsp;Márcio Sousa,&nbsp;Amanda Sousa,&nbsp;Alexandre Abizaid","doi":"10.1016/S2214-1235(15)30010-7","DOIUrl":"https://doi.org/10.1016/S2214-1235(15)30010-7","url":null,"abstract":"<div><h3>Background</h3><p>Percutaneous renal sympathetic denervation was developed as an adjunct method to treat clinical conditions associated to sympathetic hyperactivity. Percutaneous renal sympathetic denervation increases the renal blood flow and reduces vasoconstriction. The effects of percutaneous renal sympathetic denervation in renal artery diameter have not been reported. Our objective was to evaluate such effects by quantitative angiography.</p></div><div><h3>Methods</h3><p>Prospective, observational, study including consecutive patients undergoing percutaneous renal sympathetic denervation.</p></div><div><h3>Results</h3><p>Thirty-one patients were selected, 21 were submitted to percutaneous renal sympathetic denervation to control resistant arterial hypertension and 10 to control refractory ventricular arrhythmias. Seventeen patients did not perform renal arteriography in the follow-up due to clinical contraindications or because they did not complete the 6-month period established by the protocol. In addition, one patient performed a unilateral percutaneous renal sympathetic denervation and was also excluded from this analysis. Therefore, 52 renal angiographies (26 pairs) of 13 patients were analyzed. Mean maximal diameter of the right renal artery before the procedure was 4.54<!--> <!-->±<!--> <!-->0.21<!--> <!-->mm and increased to 5.2<!--> <!-->±<!--> <!-->0.44<!--> <!-->mm at 6 months (<em>p</em> <!-->=<!--> <!-->0.01). Likewise, there was a significant increase in the diameter of the left renal artery at 6 months of follow-up, increasing from 4.37<!--> <!-->±<!--> <!-->0.42 to 5.23<!--> <!-->±<!--> <!-->0.77<!--> <!-->mm (<em>p</em> <!-->=<!--> <!-->0.02).</p></div><div><h3>Conclusions</h3><p>The results of this analysis illustrate the significant increment in renal artery diameter after percutaneous renal sympathetic denervation. Randomized controlled clinical trials are required to consolidate our observations.</p></div><div><h3>RESUMO</h3><p>Efeitos da Denervação Simpática Renal no Diâmetro da Artéria Renal Avaliados Pela Angiografia Quantitativa</p></div><div><h3>Introdução</h3><p>A denervação simpática renal percutânea surgiu como método adjunto no controle de condições clínicas as- sociadas à hiperatividade simpática. Ela resulta em aumento do fluxo sanguíneo renal e em redução da vasoconstrição. Os efeitos da denervação simpática renal percutânea no diâmetro da artéria renal ainda não foram descritos. Nosso objetivo foi avaliar tais efeitos por meio da angiografia quantitativa. Métodos: Estudo prospectivo e observacional que incluiu pacientes consecutivos submetidos à denervação simpática renal percutânea.</p></div><div><h3>Resultados</h3><p>Selecionamos 31 pacientes, sendo 21 submetidos à denervação simpática renal percutânea para controle da hipertensão arterial resistente e 10 para controle de arritmias ventriculares refratárias. Dezessete pacientes não realizaram arteriografia renal no seguimento por não completarem ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 155-160"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30010-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137225639","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":"Performance of the Titanium-Nitride-Oxide Coated Stent in Patients with Multivessel Coronary Artery Disease","authors":"Thomas Edison Cintra Osterne ,&nbsp;Wilson Albino Pimentel Filho ,&nbsp;Fernando Augusto Molinori di Castro Curado ,&nbsp;Edson Alcides Bocchi ,&nbsp;Wellington Borges Custódio ,&nbsp;Gustavo Mello Gomes de Matos ,&nbsp;Pedro Henrique Luiggi Teixeira ,&nbsp;Marcos Venício Martins Gori ,&nbsp;Waigner Bento Pupin Filho ,&nbsp;Gustavo Vinicius Lambert Olivotti ,&nbsp;Jorge Roberto Büchler ,&nbsp;Stoessel Figueiredo de Assis","doi":"10.1016/S2214-1235(15)30008-9","DOIUrl":"10.1016/S2214-1235(15)30008-9","url":null,"abstract":"<div><h3>Background</h3><p>To date, there are no studies evaluating the use of the titanium-nitride-oxide coated stent in patients with multivessel coronary artery disease. We have compared the performance of the Titan-2® stent to that of the second generation drug-eluting stents in this scenario.</p></div><div><h3>Methods</h3><p>From 2011 to 2012, 284 patients were treated with the Titan-2® stent, of which 100 (35.2%) had multivessel coronary artery disease. This group was compared to 100 patients, of a group of 304 (38.9%) patients with multivessel coronary artery disease treated with second generation drug-eluting stents with durable or biodegradable polymers. The primary endpoint was the occurrence of major adverse cardiovascular events at 1 year.</p></div><div><h3>Results</h3><p>Clinical, angiographic and procedure-related characteristics of the patients did not show differences between groups. Most patients in the Titan-2® group were male (70%), mean age was 68.4 ± 12.9 years and 25% were diabetic. Stable symptomatic patients were prevalent (68%), 51% had three-vessel disease and ventricular function was preserved (55.6 ± 12.7%). The incidence of major adverse cardiovascular events at 1 year in the Titan-2® group was 21% (vs. 17%; <em>p</em> = 0.59), death was observed in 3% (vs. 2%; <em>p</em> &gt; 0.99) of the patients, acute myocardial infarction in 5% (vs. 4%; <em>p</em> &gt; 0.99) and a new revascularization procedure in 13% (vs. 11%; <em>p</em> = 0.83). Definitive stent thrombosis was not observed in either group.</p></div><div><h3>Conclusions</h3><p>The Titan-2® stent showed similar results to those of the second-generation drug-eluting stents, which makes it attractive for use in the complex scenario of patients with multivessel coronary artery disease.</p></div><div><h3>RESUMO</h3><p>Desempenho do Stent Recoberto por Titânio-Óxido Nítrico em Pacientes com Doença Coronária Multiarterial</p></div><div><h3>Introdção</h3><p>Até o momento, nenhum estudo avaliou o stent recoberto por titânio-óxido nítrico em pacientes com doença arterial coronariana multiarterial. Comparamos o desempenho do stent Titan-2® ao stents farmacológicos de segunda geragao nesse cenário.</p></div><div><h3>Métodos</h3><p>No período de 2011 a 2012, 284 pacientes foram tratados com o stent Titan-2®, dos quais 100 (35,2%) eram portadores de doença arterial coronariana multiarterial. Esse grupo foi comparado a 100 pacientes, de um grupo de 304 (38,9%), com doença arterial coronariana multiarterial, tratados com o stent farmacológico de segunda geração com polímeros duráveis ou biodegradáveis. O desfecho primário foi a ocorrência de eventos cardíacos adversos maiores em 1 ano.</p></div><div><h3>Resultados</h3><p>Características clínicas, angiográficas e do procedimento não apresentaram diferenças entre os grupos. A maioria dos pacientes do grupo Titan-2® era do sexo masculino (70%), com idade de 68,4 ± 12,9 anos e 25% eram diabéticos. Predominaram os quadros clínicos ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 143-148"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30008-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86523196","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":"Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the Amplatzer™ Duct Occluder in Children: A Systematic Review","authors":"Rodrigo Nieckel da Costa ,&nbsp;Marcelo Silva Ribeiro ,&nbsp;André Ferreira da Silva ,&nbsp;Rodrigo Antonini Ribeiro ,&nbsp;Otavio Berwanger ,&nbsp;Alexandre Biasi ,&nbsp;Helio Penna ,&nbsp;Carisi Anne Polanczyk ,&nbsp;Marcelo Queiroga ,&nbsp;Carlos Augusto Cardoso Pedra","doi":"10.1016/S2214-1235(15)30012-0","DOIUrl":"10.1016/S2214-1235(15)30012-0","url":null,"abstract":"<div><h3>Background</h3><p>Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA &gt; 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System <em>(Sistema Único de Saúde –</em>SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies.</p></div><div><h3>Methods</h3><p>Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of Amplatzer™ Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved.</p></div><div><h3>Results</h3><p>Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS.</p></div><div><h3>Conclusions</h3><p>Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result in a aceptable ICER threshold for possible incorporation by the SUS.</p></div><div><h3>DESCRIPTORS</h3><p>Ductus arteriosus, patent, Heart defects, congenital, Surgery, Prostheses and implants, Cost-benefit analysis.</p></div><div><p>Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática</p></div><div><h3>Introdução</h3><p>A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais &gt; 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias.</p></div><div><h3>Métodos</h3><p>Revisão sistemática em relação a desfechos clínicos e criaçã","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 168-179"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30012-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84713099","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":"Radial vs. Femoral Artery Access in Elderly Patients Undergoing Percutaneous Coronary Intervention","authors":"Cleverson Neves Zukowski ,&nbsp;láscara Wozniak ,&nbsp;Newton Fernando Stadler de Souza Filho ,&nbsp;Emile Alencar Cordeiro ,&nbsp;Alessandro Rell ,&nbsp;Marisa Leal ,&nbsp;Jackson Stadler ,&nbsp;José Augusto Ribas Fortes ,&nbsp;Rodrigo Cerci","doi":"10.1016/S2214-1235(15)30005-3","DOIUrl":"10.1016/S2214-1235(15)30005-3","url":null,"abstract":"<div><h3>Background</h3><p>Studies demonstrate that radial artery access reduces the risk of vascular and bleeding complications associated to percutaneous coronary intervention. Our objective was to evaluate in-hospital results of the transradial approach in elderly patients undergoing percutaneous coronary intervention.</p></div><div><h3>Methods</h3><p>Prospective registry including patient’s<!--> <!-->≥<!--> <!-->70 years of age; safety and efficacy endpoints were compared for the radial and femoral artery access groups.</p></div><div><h3>Results</h3><p>We included 255 patients, 117 (52%) treated using the radial approach and 108 using the femoral approach. Except for age, the remaining clinical characteristics did not show differences between groups. Male patients prevailed (60%), 36.7% were diabetic and over one third were diagnosed with acute coronary syndrome. Angiographic and procedure-related variables did not show differences between groups. When vascular complication rates were compared only hematomas<!--> <!-->&lt;<!--> <!-->5<!--> <!-->cm (5.1% vs. 17.6%; <em>p</em> <!-->&lt;<!--> <!-->0.01) were more prevalent with the femoral access. Major bleedings, according to the ACUITY criteria (zero vs. 5.6%; <em>p</em> <!-->=<!--> <!-->0.01) and minor bleedings, according to the TIMI criteria (zero vs. 7.4%; <em>p</em> <!-->&lt;<!--> <!-->0.01), were also more frequent in the femoral group. In-hospital clinical endpoints, death (0.9% vs. 5.6%; <em>p</em> <!-->=<!--> <!-->0.06) and non-fatal infarction (zero vs. 3.7%; <em>p</em> <!-->=<!--> <!-->0.05) were more frequent in patients treated by the femoral access.</p></div><div><h3>Conclusions</h3><p>In a non-selected patient population<!--> <!-->≥<!--> <!-->70 years of age, percutaneous coronary intervention by radial access was associated to a lower incidence of in-hospital clinical endpoints, especially of bleeding events related to the vascular access route.</p></div><div><h3>RESUMO</h3><p>Acesso Radial vs. Acesso Femoral em Pacientes com Idade Avançada Submetidos à Intervenção Coronária Percutânea</p></div><div><h3>Introdução</h3><p>Estudos demonstram que o acesso via artéria radial diminui o risco de complicações vasculares e hemorrágicas associadas à intervenção coronária percutânea. Nosso objetivo foi avaliar os resultados hospitalares da utilização da via radial em pacientes idosos submetidos à intervenção coronária percutânea.</p></div><div><h3>Métodos</h3><p>Registro prospectivo, que incluiu pacientes<!--> <!-->≥<!--> <!-->70 anos, tendo sido comparados os desfechos de segurança e de eficácia entre os grupos tratados pelas vias radial e femoral.</p></div><div><h3>Resultados</h3><p>Incluímos 225 pacientes, sendo 117 (52%) tratados por via radial e 108 por via femoral. À exceção da idade, as demais características clínicas não mostraram diferençãs entre os grupos. Predominaram os pacientes do sexo masculino (60%); 36,7% eram diabéticos e mais de um terço foi tratado na vigência de quad","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 125-130"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30005-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79554403","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}