André Spadaro - Academia.edu (original) (raw)
Papers by André Spadaro
Revista Brasileira de Cardiologia Invasiva, 2007
Background: Several studies have shown that routine invasive strategies reduce major events compa... more Background: Several studies have shown that routine invasive strategies reduce major events compared to a conservative strategy for patients with acute coronary syndrome without ST elevation. However, the optimal time to institute this approach is still debatable. Methods: From May 2003 to November 2005, 466 patients with myocardial infarction without ST elevation, excluding patients with hemodynamic instability, were treated by percutaneous coronary interventions (PCI) in our hospital. Patients were divided in 2 groups according to time from admission to PCI: 1) Early Group (≤6 h) involving 152 patients and 2) Late Group (>6 h) including 314 patients. Procedure data and in-hospital mortality were analyzed. Results: Baseline clinical characteristics were similar in both groups, except for prior CABG that was more frequent in late group. Median time from admission to PCI was 3 hours (interquartile interval: 2-4hours) in the Early Group and 23 hours (interquartile interval: 14-48hours) in the Late Group. In-hospital mortality was significantly reduced in the Early Group (0.7 vs. 4.8%; p=0.02). Age, heart failure and time from admission to PCI were independent predictors of in-hospital mortality by multivariate analysis. Conclusion: Early PCI for myocardial infarction without ST elevation seems to reduce the inhospital mortality in the daily practice. The clinical impact
Circulation, 2014
Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual ... more Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronar...
Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been d... more Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1 % vs 81.9%; p = 0.035), dyslipidemia (57.8 % vs. 67.7%; p = 0.02) and three-vessel disease (38.8 % vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baselin...
SUMMARY Background: Elderly patients with obstructive coronary disease are frequently a clinical ... more SUMMARY Background: Elderly patients with obstructive coronary disease are frequently a clinical dilemma, usually in need of management for multiple comorbidities. The present study aims at evaluating the short- and long-term survival of Brazilian octogenarians treated with coronary angioplasty. Methods: A total of 246 consecutive patients aged ≥ 80 years, treated with percutaneous coronary intervention in the Brazilian Public Health System comprise the study population. Baseline and procedural characteristics were collected prospectively. After discharge the occurrence of death was evaluated through the review of medical records and phone contact. Results: Mean age was 83.7 ± 3.0 years (range 80 years to 94 years). The overall survival at 30 days, 1 year, and 2 years were 86.7%, 78.1% and 76.0%, respectively. Only acute infarction at admission and the presence of triplevessel disease were identified as multivariate predictors of death (Infarction at admission: adjusted HR 1.76; 95%...
características tão escassas em nossa realidade atual. Dedico este trabalho em especial a você pa... more características tão escassas em nossa realidade atual. Dedico este trabalho em especial a você pai, pelo convívio apaixonante e pelas oportunidades proporcionadas e caminhos apontados em minha vida. À minha mãe, Sueli Maria Gasparini Spadaro, pelo amor incondicional, capacidade de acolhimento sem limite, presença reconfortante. Estar ao seu lado é uma garantia de me sentir sempre em casa. Às minhas irmãs Patrícia e Juliana, pelo convívio harmonioso, repleto de bom humor, respeito, compreensão e admiração. À minha esposa Silvana, amor da minha vida, parceira dos melhores momentos e também de alguns difíceis. Nossa trajetória reúne as etapas mais marcantes e que dão sentido à minha vida. À nossa "estrelinha" fica reservada a memória e o espaço no coração. Te amo. Que nossa união seja eterna. Às minhas filhas Gabriela e Luisa, maiores paixões da minha vida. Vocês fazem de mim uma pessoa completa. Verdadeiras razões da minha existência. Agradecimentos Agradecimentos Ao Prof. Dr. Pedro Alves Lemos Neto, meu orientador, pela oportunidade e confiança depositada em mim para o desenvolvimento desta tese, além dos ensinamentos e suporte em todas as etapas do projeto, desde sua concepção, execução, análise e interpretação de dados, até a submissão do artigo científico. Serei sempre grato pelo seu apoio. Ao Prof. Dr. Edimar Alcides Bocchi, pela concepção do projeto e orientações fornecidas nas diferentes fases do trabalho, particularmente por ocasião do exame de qualificação e revisões críticas de seu conteúdo. Ao Dr. Antônio Esteves Filho, pela contribuição na idealização do projeto e por anos de convívio proveitoso no Serviço de Hemodinâmica do
Catheterization and Cardiovascular Interventions, 2019
This article refers to 'Renal denervation in heart failure with preserved ejection fraction (RDT-... more This article refers to 'Renal denervation in heart failure with preserved ejection fraction (RDT-PEF): a randomized controlled trial', by H.C. Patel et al., published in this issue on pages 703-712. Heart failure (HF) represents a significant and growing health burden affecting nearly 25 million people worldwide. 1 Up to 50% of all patients with clinical signs of HF present with heart failure with presevered ejection fraction (HFpEF), which is defined as a clinical HF state accompanied by objective evidence of diastolic dysfunction. The pathophysiology of HFpEF is still incompletely understood but may involve, among others, impaired LV filling, increased LV stiffness, abnormal ventricular-arterial coupling, chronotropic incompetence, hypertension, CAD, and microvascular dysfunction. 2 Sympathetic nervous system (SNS) activation with a subsequent increase in the activity of the renin-angiotensin system plays a crucial role and is related to cardiovascular outcomes in chronic systolic HF. 3 Current evidence also suggests a relationship between increased SNS activity and HFpEF, measured by MIBG (metaiodobenzylguanidine) scintigraphy, muscle sympathetic nerve activity (MSNA), plasma norepinephrine (NE) levels, and heart rate variability. 4 However, available evidence appears insufficient to identify whether features of HFpEF potentiate SNS activity or whether increased SNS causes HFpEF. 4 Irrespective of the exact underlying mechanisms, modulation of autonomic tone represents an increasingly interesting treatment target. 3,5 Several experimental studies have nicely shown that surgical sympathectomy of the kidneys after myocardial infarction can down-regulate angiotensin AT1 receptor-mediated maladaptive responses, improve sodium excretion, increase cardiac output, and enhance renal blood flow. 3,6 In light of limited treatment options and the fact that various interventions in HFpEF patients were neutral at best, alternative treatment strategies are urgently needed. Catheter-based renal denervation (RDN) has evolved as an interventional treatment option under investigation for patients with hypertension. 7 It has been shown to lower blood The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.
American Journal of Case Reports, 2015
Rare co-existance of disease or pathology Background: Pulmonary artery dilatation is a common fea... more Rare co-existance of disease or pathology Background: Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown. Case Report: In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a "heart team" that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events. Conclusions: This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial ischemia in this kind of patient. It also shows that percutaneous stenting technique may be an appropriate treatment for this unusual situation.
Arquivos Brasileiros de Cardiologia, 2015
Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been d... more Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm 2 , while the staged group, to 139.2 ± 75.3 Gycm 2 (p < 0.001). Conclusion: Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0) (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0
Revista Brasileira de Cardiologia Invasiva, 2015
Apesar de a alta hospitalar no mesmo dia (AHMD) após intervenção coronária percutânea (ICP) eleti... more Apesar de a alta hospitalar no mesmo dia (AHMD) após intervenção coronária percutânea (ICP) eletiva não complicada ser adotada mundialmente, ela permanece pouco estudada em nosso meio. Objetivamos, assim, avaliar nossa experiência inicial com a AHMD após ICP eletiva, em relação à sua segurança e aos preditores de sucesso. Métodos: Foram incluídos 161 pacientes consecutivos para AHMD, de único centro, selecionados em ambulatório especializado. Para a identificação dos fatores associados ao sucesso da AHMD, foram ajustados modelos de regressão logística simples e múltipla. Resultados: A AHMD foi realizada com sucesso em 114 pacientes (70,8%), tendo os 47 pacientes restantes permanecido internados (45 com alta na manhã seguinte e 2 pacientes após 2 dias). Nenhum paciente com AHMD apresentou evento cardíaco adverso maior ou complicação vascular importante aos 30 dias e no seguimento mediano de 12 meses. No grupo internação, ocorreu apenas um caso de infarto agudo do miocárdio por oclusão de ramo lateral e dois hematomas > 5 cm relacionados ao sítio de punção. Os preditores de sucesso da AHMD foram: via de acesso radial (OR = 5,92; IC95% 1,73-20,21; p = 0,005), presença de lesões tipo A/B1 (OR = 14,09; IC95% 1,70-116,49; p = 0,01) e volume de contraste (OR = 0,76; IC95% 0,65-0,88; p < 0,001). Conclusões: A AHMD foi segura e pôde ser realizada com sucesso na maioria dos pacientes selecionados para ICP eletiva, sendo seus preditores de sucesso o acesso radial, as lesões menos complexas e um volume menor de contraste.
Revista Brasileira de Cardiologia Invasiva, 2010
Revista Brasileira de Cardiologia Invasiva English Version, 2013
Revista Brasileira de Cardiologia Invasiva, 2008
Revista Brasileira de Cardiologia Invasiva (English Version), 2014
Introduction: We evaluated the safety and efficacy of protamine administration, guided by activat... more Introduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.
Journal of the American College of Cardiology, 2014
Background: Early recognition of viable myocardium is of great clinical importance after acute my... more Background: Early recognition of viable myocardium is of great clinical importance after acute myocardial infarction (AMI). Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viability. An alternative method for detecting viability is the perfusable tissue index (PTI), a positron emission tomography (PET) derived parameter, which is inversely related to the extent of myocardial scar (nonperfusable tissue). The aim was to investigate the predictive value of PTI on recovery of LV function after percutaneous coronary intervention (PCI) for AMI. Methods: Twenty-six patients with AMI successfully treated by PCI were included. Subjects were examined one week and three months after AMI with H 2 15 O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening (SWT) ! 3.0 mm at followup. Results: A total of 396 segments were available for serial analysis. At baseline, 166 segments were dysfunctional, of which 125 (75%) exhibited significant DCE and were located in the myocardial territory supplied by the culprit-artery. Fortynine of these dysfunctional segments showed full recovery during follow-up (viable), whereas 76 segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 AE 0.07 and was significantly higher compared to nonviable segments (0.80 AE 0.11, p ¼ 0.01). The optimal cutoff value for the PTI was 0.85 with a sensitivity of 92% and specificity of 71%, and an area under the curve (AUC) of 0.88. In comparison, a cutoff value of 40% for the extent of DCE resulted in a sensitivity of 75% and a specificity of 65%, and an AUC of 0.75 (p ¼ 0.02 vs PTI). Conclusions: This study shows that assessment of myocardial viability shortly after reperfused AMI is feasible with PET, and that the PTI is a good prognostic indicator for recovery of contractile function when compared to DCE-CMR.
Revista Brasileira de Cardiologia Invasiva, 2008
Revista Brasileira de Cardiologia Invasiva, 2007
Revista Brasileira de Cardiologia Invasiva, 2007
EuroIntervention, 2010
We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound v... more We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated. We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;added calcium&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;calcium&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The…
Revista Brasileira de Cardiologia Invasiva, 2011
Late Percutaneous Coronary Intervention Outcomes with Drug-Eluting Stent in Saphenous Vein Grafts... more Late Percutaneous Coronary Intervention Outcomes with Drug-Eluting Stent in Saphenous Vein Grafts-Data from the InCor Registry Background: The safety and efficacy of drug-eluting stents in the treatment of saphenous vein graft (SVG) lesions remains controversial. This study assessed the late follow-up of patients with SVG lesions treated with drug-eluting stents. Methods: Single center registry including patients undergoing SVG interventions using drug-eluting stents (n = 82), without clinical or angiographic exclusion criteria, from 2003 to 2009. The rates of major adverse cardiac events (MACE), death, acute myocardial infarction (AMI), target vessel revascularization (TVR) and stent thrombosis were evaluated. Results: Mean age was 67.8 + 10.2 years, most of them were male (85.4%), 40.2% were diabetic and 52.4% had stable angina. An average of 1.45 + 0.5 stents per patient were implanted and Cypher TM was the stent used in most of the cases (61%). Stent diameter was 3.22 + 0.39 mm and stent length was 20.1 + 7.3 mm. Angiographic success rate was 96.3%. In the 4.1-year follow-up, the rate of MACE was 28%, death 6%, AMI 19.5% and TVR 18.2%. There were two cases of definitive or probable stent thrombosis (2.4%) within the follow-up period. Conclusions: Longterm follow-up showed high MACE rates in patients with SVG lesions treated with drug-eluting stents, probably due to the accelerated atherosclerosis that develops within the grafted vein conduits.
Revista Brasileira de Cardiologia Invasiva, 2012
Background: Cardiogenic shock is the leading cause of death in patients with ST-segment elevation... more Background: Cardiogenic shock is the leading cause of death in patients with ST-segment elevation myocardial infarction (STEMI). The present study evaluated patients with STEMI and cardiogenic shock undergoing primary percutaneous coronary intervention, in order to establish their profile and predictors of in-hospital mortality. Methods: A single centre registry, including 100 patients evaluated from 2001 to 2009, was used to compile clinical, angiographic and procedure-related characteristics and in-hospital outcomes. The independent predictors of in-hospital mortality were determined by multivariate analysis. Results: A high prevalence of risk factors was observed. The angiographic success rate was 92%, despite the lesion complexity (83.1% were type B2/C). The left anterior descending artery was the most affected artery (45%), and 73% of the patients had multivessel disease. The mortality rate was 45%, and its independent predictors were multivessel disease (odds ratio [OR] 2.62; 95% confidence interval [95% CI] 1.16-5.90) and TIMI flow < 3 at the end of the procedure (OR 2.11; 95% CI 1.48-3.02). Conclusions: Patients with STEMI complicated by cardiogenic shock presented high-risk clinical and angiographic characteristics, and despite the high angiographic success rate of the procedure, mortality rates were high. The presence of multivessel disease and TIMI flow < 3 at the end of the procedure were independent predictors of mortality.
Revista Brasileira de Cardiologia Invasiva, 2007
Background: Several studies have shown that routine invasive strategies reduce major events compa... more Background: Several studies have shown that routine invasive strategies reduce major events compared to a conservative strategy for patients with acute coronary syndrome without ST elevation. However, the optimal time to institute this approach is still debatable. Methods: From May 2003 to November 2005, 466 patients with myocardial infarction without ST elevation, excluding patients with hemodynamic instability, were treated by percutaneous coronary interventions (PCI) in our hospital. Patients were divided in 2 groups according to time from admission to PCI: 1) Early Group (≤6 h) involving 152 patients and 2) Late Group (>6 h) including 314 patients. Procedure data and in-hospital mortality were analyzed. Results: Baseline clinical characteristics were similar in both groups, except for prior CABG that was more frequent in late group. Median time from admission to PCI was 3 hours (interquartile interval: 2-4hours) in the Early Group and 23 hours (interquartile interval: 14-48hours) in the Late Group. In-hospital mortality was significantly reduced in the Early Group (0.7 vs. 4.8%; p=0.02). Age, heart failure and time from admission to PCI were independent predictors of in-hospital mortality by multivariate analysis. Conclusion: Early PCI for myocardial infarction without ST elevation seems to reduce the inhospital mortality in the daily practice. The clinical impact
Circulation, 2014
Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual ... more Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronar...
Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been d... more Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1 % vs 81.9%; p = 0.035), dyslipidemia (57.8 % vs. 67.7%; p = 0.02) and three-vessel disease (38.8 % vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baselin...
SUMMARY Background: Elderly patients with obstructive coronary disease are frequently a clinical ... more SUMMARY Background: Elderly patients with obstructive coronary disease are frequently a clinical dilemma, usually in need of management for multiple comorbidities. The present study aims at evaluating the short- and long-term survival of Brazilian octogenarians treated with coronary angioplasty. Methods: A total of 246 consecutive patients aged ≥ 80 years, treated with percutaneous coronary intervention in the Brazilian Public Health System comprise the study population. Baseline and procedural characteristics were collected prospectively. After discharge the occurrence of death was evaluated through the review of medical records and phone contact. Results: Mean age was 83.7 ± 3.0 years (range 80 years to 94 years). The overall survival at 30 days, 1 year, and 2 years were 86.7%, 78.1% and 76.0%, respectively. Only acute infarction at admission and the presence of triplevessel disease were identified as multivariate predictors of death (Infarction at admission: adjusted HR 1.76; 95%...
características tão escassas em nossa realidade atual. Dedico este trabalho em especial a você pa... more características tão escassas em nossa realidade atual. Dedico este trabalho em especial a você pai, pelo convívio apaixonante e pelas oportunidades proporcionadas e caminhos apontados em minha vida. À minha mãe, Sueli Maria Gasparini Spadaro, pelo amor incondicional, capacidade de acolhimento sem limite, presença reconfortante. Estar ao seu lado é uma garantia de me sentir sempre em casa. Às minhas irmãs Patrícia e Juliana, pelo convívio harmonioso, repleto de bom humor, respeito, compreensão e admiração. À minha esposa Silvana, amor da minha vida, parceira dos melhores momentos e também de alguns difíceis. Nossa trajetória reúne as etapas mais marcantes e que dão sentido à minha vida. À nossa "estrelinha" fica reservada a memória e o espaço no coração. Te amo. Que nossa união seja eterna. Às minhas filhas Gabriela e Luisa, maiores paixões da minha vida. Vocês fazem de mim uma pessoa completa. Verdadeiras razões da minha existência. Agradecimentos Agradecimentos Ao Prof. Dr. Pedro Alves Lemos Neto, meu orientador, pela oportunidade e confiança depositada em mim para o desenvolvimento desta tese, além dos ensinamentos e suporte em todas as etapas do projeto, desde sua concepção, execução, análise e interpretação de dados, até a submissão do artigo científico. Serei sempre grato pelo seu apoio. Ao Prof. Dr. Edimar Alcides Bocchi, pela concepção do projeto e orientações fornecidas nas diferentes fases do trabalho, particularmente por ocasião do exame de qualificação e revisões críticas de seu conteúdo. Ao Dr. Antônio Esteves Filho, pela contribuição na idealização do projeto e por anos de convívio proveitoso no Serviço de Hemodinâmica do
Catheterization and Cardiovascular Interventions, 2019
This article refers to 'Renal denervation in heart failure with preserved ejection fraction (RDT-... more This article refers to 'Renal denervation in heart failure with preserved ejection fraction (RDT-PEF): a randomized controlled trial', by H.C. Patel et al., published in this issue on pages 703-712. Heart failure (HF) represents a significant and growing health burden affecting nearly 25 million people worldwide. 1 Up to 50% of all patients with clinical signs of HF present with heart failure with presevered ejection fraction (HFpEF), which is defined as a clinical HF state accompanied by objective evidence of diastolic dysfunction. The pathophysiology of HFpEF is still incompletely understood but may involve, among others, impaired LV filling, increased LV stiffness, abnormal ventricular-arterial coupling, chronotropic incompetence, hypertension, CAD, and microvascular dysfunction. 2 Sympathetic nervous system (SNS) activation with a subsequent increase in the activity of the renin-angiotensin system plays a crucial role and is related to cardiovascular outcomes in chronic systolic HF. 3 Current evidence also suggests a relationship between increased SNS activity and HFpEF, measured by MIBG (metaiodobenzylguanidine) scintigraphy, muscle sympathetic nerve activity (MSNA), plasma norepinephrine (NE) levels, and heart rate variability. 4 However, available evidence appears insufficient to identify whether features of HFpEF potentiate SNS activity or whether increased SNS causes HFpEF. 4 Irrespective of the exact underlying mechanisms, modulation of autonomic tone represents an increasingly interesting treatment target. 3,5 Several experimental studies have nicely shown that surgical sympathectomy of the kidneys after myocardial infarction can down-regulate angiotensin AT1 receptor-mediated maladaptive responses, improve sodium excretion, increase cardiac output, and enhance renal blood flow. 3,6 In light of limited treatment options and the fact that various interventions in HFpEF patients were neutral at best, alternative treatment strategies are urgently needed. Catheter-based renal denervation (RDN) has evolved as an interventional treatment option under investigation for patients with hypertension. 7 It has been shown to lower blood The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.
American Journal of Case Reports, 2015
Rare co-existance of disease or pathology Background: Pulmonary artery dilatation is a common fea... more Rare co-existance of disease or pathology Background: Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown. Case Report: In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a "heart team" that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events. Conclusions: This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial ischemia in this kind of patient. It also shows that percutaneous stenting technique may be an appropriate treatment for this unusual situation.
Arquivos Brasileiros de Cardiologia, 2015
Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been d... more Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm 2 , while the staged group, to 139.2 ± 75.3 Gycm 2 (p < 0.001). Conclusion: Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0) (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0
Revista Brasileira de Cardiologia Invasiva, 2015
Apesar de a alta hospitalar no mesmo dia (AHMD) após intervenção coronária percutânea (ICP) eleti... more Apesar de a alta hospitalar no mesmo dia (AHMD) após intervenção coronária percutânea (ICP) eletiva não complicada ser adotada mundialmente, ela permanece pouco estudada em nosso meio. Objetivamos, assim, avaliar nossa experiência inicial com a AHMD após ICP eletiva, em relação à sua segurança e aos preditores de sucesso. Métodos: Foram incluídos 161 pacientes consecutivos para AHMD, de único centro, selecionados em ambulatório especializado. Para a identificação dos fatores associados ao sucesso da AHMD, foram ajustados modelos de regressão logística simples e múltipla. Resultados: A AHMD foi realizada com sucesso em 114 pacientes (70,8%), tendo os 47 pacientes restantes permanecido internados (45 com alta na manhã seguinte e 2 pacientes após 2 dias). Nenhum paciente com AHMD apresentou evento cardíaco adverso maior ou complicação vascular importante aos 30 dias e no seguimento mediano de 12 meses. No grupo internação, ocorreu apenas um caso de infarto agudo do miocárdio por oclusão de ramo lateral e dois hematomas > 5 cm relacionados ao sítio de punção. Os preditores de sucesso da AHMD foram: via de acesso radial (OR = 5,92; IC95% 1,73-20,21; p = 0,005), presença de lesões tipo A/B1 (OR = 14,09; IC95% 1,70-116,49; p = 0,01) e volume de contraste (OR = 0,76; IC95% 0,65-0,88; p < 0,001). Conclusões: A AHMD foi segura e pôde ser realizada com sucesso na maioria dos pacientes selecionados para ICP eletiva, sendo seus preditores de sucesso o acesso radial, as lesões menos complexas e um volume menor de contraste.
Revista Brasileira de Cardiologia Invasiva, 2010
Revista Brasileira de Cardiologia Invasiva English Version, 2013
Revista Brasileira de Cardiologia Invasiva, 2008
Revista Brasileira de Cardiologia Invasiva (English Version), 2014
Introduction: We evaluated the safety and efficacy of protamine administration, guided by activat... more Introduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.
Journal of the American College of Cardiology, 2014
Background: Early recognition of viable myocardium is of great clinical importance after acute my... more Background: Early recognition of viable myocardium is of great clinical importance after acute myocardial infarction (AMI). Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viability. An alternative method for detecting viability is the perfusable tissue index (PTI), a positron emission tomography (PET) derived parameter, which is inversely related to the extent of myocardial scar (nonperfusable tissue). The aim was to investigate the predictive value of PTI on recovery of LV function after percutaneous coronary intervention (PCI) for AMI. Methods: Twenty-six patients with AMI successfully treated by PCI were included. Subjects were examined one week and three months after AMI with H 2 15 O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening (SWT) ! 3.0 mm at followup. Results: A total of 396 segments were available for serial analysis. At baseline, 166 segments were dysfunctional, of which 125 (75%) exhibited significant DCE and were located in the myocardial territory supplied by the culprit-artery. Fortynine of these dysfunctional segments showed full recovery during follow-up (viable), whereas 76 segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 AE 0.07 and was significantly higher compared to nonviable segments (0.80 AE 0.11, p ¼ 0.01). The optimal cutoff value for the PTI was 0.85 with a sensitivity of 92% and specificity of 71%, and an area under the curve (AUC) of 0.88. In comparison, a cutoff value of 40% for the extent of DCE resulted in a sensitivity of 75% and a specificity of 65%, and an AUC of 0.75 (p ¼ 0.02 vs PTI). Conclusions: This study shows that assessment of myocardial viability shortly after reperfused AMI is feasible with PET, and that the PTI is a good prognostic indicator for recovery of contractile function when compared to DCE-CMR.
Revista Brasileira de Cardiologia Invasiva, 2008
Revista Brasileira de Cardiologia Invasiva, 2007
Revista Brasileira de Cardiologia Invasiva, 2007
EuroIntervention, 2010
We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound v... more We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated. We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;added calcium&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;calcium&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The…
Revista Brasileira de Cardiologia Invasiva, 2011
Late Percutaneous Coronary Intervention Outcomes with Drug-Eluting Stent in Saphenous Vein Grafts... more Late Percutaneous Coronary Intervention Outcomes with Drug-Eluting Stent in Saphenous Vein Grafts-Data from the InCor Registry Background: The safety and efficacy of drug-eluting stents in the treatment of saphenous vein graft (SVG) lesions remains controversial. This study assessed the late follow-up of patients with SVG lesions treated with drug-eluting stents. Methods: Single center registry including patients undergoing SVG interventions using drug-eluting stents (n = 82), without clinical or angiographic exclusion criteria, from 2003 to 2009. The rates of major adverse cardiac events (MACE), death, acute myocardial infarction (AMI), target vessel revascularization (TVR) and stent thrombosis were evaluated. Results: Mean age was 67.8 + 10.2 years, most of them were male (85.4%), 40.2% were diabetic and 52.4% had stable angina. An average of 1.45 + 0.5 stents per patient were implanted and Cypher TM was the stent used in most of the cases (61%). Stent diameter was 3.22 + 0.39 mm and stent length was 20.1 + 7.3 mm. Angiographic success rate was 96.3%. In the 4.1-year follow-up, the rate of MACE was 28%, death 6%, AMI 19.5% and TVR 18.2%. There were two cases of definitive or probable stent thrombosis (2.4%) within the follow-up period. Conclusions: Longterm follow-up showed high MACE rates in patients with SVG lesions treated with drug-eluting stents, probably due to the accelerated atherosclerosis that develops within the grafted vein conduits.
Revista Brasileira de Cardiologia Invasiva, 2012
Background: Cardiogenic shock is the leading cause of death in patients with ST-segment elevation... more Background: Cardiogenic shock is the leading cause of death in patients with ST-segment elevation myocardial infarction (STEMI). The present study evaluated patients with STEMI and cardiogenic shock undergoing primary percutaneous coronary intervention, in order to establish their profile and predictors of in-hospital mortality. Methods: A single centre registry, including 100 patients evaluated from 2001 to 2009, was used to compile clinical, angiographic and procedure-related characteristics and in-hospital outcomes. The independent predictors of in-hospital mortality were determined by multivariate analysis. Results: A high prevalence of risk factors was observed. The angiographic success rate was 92%, despite the lesion complexity (83.1% were type B2/C). The left anterior descending artery was the most affected artery (45%), and 73% of the patients had multivessel disease. The mortality rate was 45%, and its independent predictors were multivessel disease (odds ratio [OR] 2.62; 95% confidence interval [95% CI] 1.16-5.90) and TIMI flow < 3 at the end of the procedure (OR 2.11; 95% CI 1.48-3.02). Conclusions: Patients with STEMI complicated by cardiogenic shock presented high-risk clinical and angiographic characteristics, and despite the high angiographic success rate of the procedure, mortality rates were high. The presence of multivessel disease and TIMI flow < 3 at the end of the procedure were independent predictors of mortality.