Daniel Chamié - Academia.edu (original) (raw)

Papers by Daniel Chamié

Circulation, 2014

Background: New generation drug-eluting stents (DES), biolimus-eluting stents (BES) and everolimu... more Background: New generation drug-eluting stents (DES), biolimus-eluting stents (BES) and everolimus-eluting stents (EES) were conceived to minimize local coronary inflammation allowing better endothelial healing. The aim of this study is to compare the IVUS patterns observed with both stents at midterm follow-up. Methods: The Bioactive trial is a multicentre, randomized trial (1:1) comparing BES and EES based on surrogate safety and efficacy endpoints. Inclusion criteria was single, de novo lesions in native coronary arteries of 3.0 to 3.5mm and maximum lesion length of 20 mm. Patients with in-stent restenosis, lesion in grafts and treated in the setting of STEMI were excluded. The present analysis aims to compare the main IVUS findings for both DES at 9-month invasive follow-up. IVUS analyses were performed in an independent corelab blinded to the type of DES used. Results: A total of 40 patients were enrolled in the trial and 35 had IVUS performed. Procedure success was achieved in...

The endothelium has a central role in vascular response after percutaneous coronary intervention ... more The endothelium has a central role in vascular response after percutaneous coronary intervention (PCI) with stents. Cellular and molecular mechanisms control the healing response after PCI, and the degree of this response is related to development of untoward events such as restenosis and device thrombosis. In this chapter, we briefly describe the cascade of events, which will ultimately result in stent endothelialization and different responses according to the device deployed: bare-metal vs. drug-eluting stents. Dysfunctional endothelial response, represented by pathologic vessel remodeling and delayed healing, is also addressed, as well as the potential inflammatory mechanism related to these devices. Finally, we briefly discuss the novel bioresorbable vascular scaffolds (BRS or bioabsorbable stent), and potential advantages to endothelium function that might arise from this new technology.

European Heart Journal, 2013

Table 1. Results Endeavour Xience V p value PCI success 299/299 (100%) 237/238 (99.6%) 0.443 Acut... more Table 1. Results Endeavour Xience V p value PCI success 299/299 (100%) 237/238 (99.6%) 0.443 Acute gain, mm 1.37±0.35 1.48±0.42 0.008 9-month follow-up MLD, mm 1.89±0.53 2.46±0.59 < 0.001 Late loss, mm 0.51±0.45 0.02±0.43 < 0.001 Angiographic restenosis 16/224 (7.1%) 5/181 (2.8%) 0.048 TLR 13/291 (4.5%) 3/237 (1.3%) 0.033 MACE 20/291 (6.9%) 9/237 (3.8%) 0.123 24-month follow-up TLR 18/288 (6.3%) 6/237 (2.5%) 0.042 MACE 37/288 (12.8%) 20/237 (8.4%) 0.106 TLR, target lesion revascularisation. point was the mean minimal lumen diameter (MLD) at follow-up angiography at 9 months after PCI. The secondary endpoints were clinical procedural success defined as angiographic success without major adverse cardiac events (MACE) and the rate of MACE at two years follow-up. Results: See table. Conclusion: The Everolimus eluting Xience V stent was superior in terms of angiographic outcome both at short and long term follow-up, with a trend towards superiority in MACE, as compared to the Zotarolimus eluting Endeavor stent.

Circulation, 2013

Introduction: Much effort has been made to understand the mechanisms of coronary artery disease (... more Introduction: Much effort has been made to understand the mechanisms of coronary artery disease (CAD), and to develop therapies to prevent disease progression. Systematic analysis of intravascular ...

EuroIntervention, 2020

Aims-We assessed the safety and efficacy of the DynamX™ Novolimus-Eluting Coronary Bioadaptor Sys... more Aims-We assessed the safety and efficacy of the DynamX™ Novolimus-Eluting Coronary Bioadaptor System, a novel device that initially acts as a second-generation drug-eluting stent, but after six months frees the vessel through uncaging elements. Methods and results-This multi-center study enrolled 50 patients with single de novo lesions. In-device acute lumen gain was 1.61±0.34 mm, and device and procedure success was 100%. Through 12 months, two target lesion failures occurred, both were cardiac deaths (day 255 and 267 post-procedure). No definite or probable device thrombosis was observed. Mean late lumen loss was 0.12±0.18 mm in-device and 0.11±0.16 mm in-segment. Per intravascular ultrasound, the mean device area and mean vessel area increased significantly by 5% and 3%, respectively, while the mean lumen area was maintained. Stationary optical coherence tomography in seven patients demonstrated restoration of cyclic pulsatility with an approximate lumen area variance of 11% between systole and diastole. Conclusions-The DynamX bioadaptor showed drug-eluting stent-like acute performance and safety and efficacy through one year. Positive remodelling with an increase of vessel and device area while maintaining the mean lumen area was demonstrated. Long-term follow-up and randomized trials are required to assess the benefit of this device on events beyond one year.

Arquivos Brasileiros de Cardiologia, 2020

Circulation: Cardiovascular Interventions, 2017

Background— To assess the vessel-healing pattern of Ultimaster drug-eluting stent using optical f... more Background— To assess the vessel-healing pattern of Ultimaster drug-eluting stent using optical frequency domain imaging. Our hypothesis is that biodegradable polymer-based drug-eluting technology allows complete very early strut coverage. Methods and Results— The DISCOVERY 1TO3 study (Evaluation With OFDI of Strut Coverage of Terumo New Drug Eluting Stent With Biodegradable Polymer at 1, 2, and 3 Months) is a prospective, single-arm, multicenter study. A total of 60 patients with multivessel disease requiring staged procedure at 1 month were treated with Ultimaster. Optical frequency domain imaging was acquired at baseline, 1, 2, and 3 months. The primary end point is optical frequency domain imaging–assessed strut coverage at 3 months. Mean age of patients was 67.2±9.9 years, and 73.3% were male, and 36.7% presented with acute coronary syndrome. A total of 132 lesions were treated, with average 1.4 lesions per patient treated at baseline and 1.1 lesions treated at 1 month. Strut c...

Circulation, Nov 23, 2010

Journal of the American College of Cardiology, 2015

Revista Brasileira de Cardiologia Invasiva (English Edition), 2015

Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can ... more Background: Multiple congenital defects are traditionally corrected surgically, but nowadays can be treated percutaneously. There are few reports in the literature attesting to its efficacy and safety. We aimed to describe an experience with combined procedures to treat different congenital and structural defects, in a single therapeutic session. Methods: Since 2007, different defects were treated in a single treatment session. All were selected by echocardiography. The procedures were performed using traditional techniques already described for each defect. Results: Ten patients were treated, five males, aged 1-67 years, weighting 11-90 kilograms. The most prevalent isolated defect was patent ductus arteriosus (PDA, n = 5), followed by ostium secundum atrial septal defects (osASD, n = 4) and ventricular septal defects (VSD, n = 4). The most common combinations were VSD with PDA (n = 2) and VSD with osASD (n = 2). Two pulmonary valve stenosis were dilated with osASD and patent foramen ovale (PFO), and one aortic coarctation with PDA. Additionally, a left atrial appendage with PFO was occluded and an aortopulmonary fistula with PDA was embolized. All procedures were successful. The mean follow-up was 31 ± 28.1 months, with only two complications. There were no deaths. Conclusions: The small number of reported cases showed that the combined procedures were safe and effective and can be reproduced by experienced operators in specialized centers and may be considered as the first therapeutic option in these patients.

Revista Brasileira de Cardiologia Invasiva, 2015

Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, po... more Defeitos congênitos múltiplos são tradicionalmente corrigidos cirurgicamente, mas, atualmente, podem ser tratados percutaneamente. Existem poucos relatos na literatura atestando sua eficácia e segurança. Objetivamos descrever uma experiência com a realização de procedimentos combinados para tratar diferentes defeitos, congênitos e estruturais, numa mesma sessão terapêutica. Métodos: Desde 2007, foram tratados, numa mesma sessão terapêutica, diferentes defeitos. Todos foram selecionados por ecocardiograma. Os procedimentos foram realizados segundo as técnicas tradicionais já descritas para cada defeito encontrado. Resultados: Foram tratados dez pacientes, cinco do sexo masculino, com idades de 1 a 67 anos, e pesos de 11 a 90 kg. O defeito mais prevalente de forma isolada foi a persistência do canal arterial (PCA, n = 5), seguido da comunicação interatrial ostium secundum (CIA OS, n = 4) e da comunicação interventricular (CIV, n = 4). As combinações mais frequentes foram CIV com PCA (n = 2) e CIV com CIA OS (n = 2). Foram dilatadas duas estenoses valvares pulmonares com CIA OS e com forame oval patente (FOP), e uma coarctação de aorta com PCA. Adicionalmente, foi ocluído um apêndice atrial esquerdo com FOP e foi embolizada uma fístula aortopulmonar com PCA. Todos os procedimentos foram bem-sucedidos. O tempo médio de seguimento foi de 31 ± 28,1 meses, havendo apenas duas complicações. Não houve nenhum óbito. Conclusões: A pequena série de casos relatada mostrou que os procedimentos combinados foram seguros e eficazes, podendo ser reproduzidos por operadores experientes em centros especializados, podendo vir a se constituir como primeira opção terapêutica para esses pacientes.

The Journal of invasive cardiology, 2012

Novel vascular scaffolds aim at equipoise between safety and efficacy. Intravascular optical cohe... more Novel vascular scaffolds aim at equipoise between safety and efficacy. Intravascular optical coherence tomography (OCT) allows in-vivo serial assessment of stent-vessel interactions with high resolution and frequent sampling and may complement histology assessment. We investigated the vascular response to a novel absorbable coating sirolimus-eluting stent (AC-SES) by means of serial OCT and histology evaluation in a porcine model. One AC-SES and one bare-metal stent (BMS) were implanted in separate coronary arteries of three Yucatan mini-swine. Serial OCT was performed post procedure and at 3-, 28-, 90-, and 180-day follow-up. Normalized optical density (NOD) was used for the assessment of tissue response over time. Histological evaluation was performed at day 180. A total of 6408 stent struts were analyzed. OCT revealed 100% of struts covered at 28 days, and a significant difference in NOD from 3 to 28 days (0.64 ± 0.07 vs 0.71 ± 0.05, respectively; P<.001) in the AC-SES group. ...

Revista Brasileira de Cardiologia Invasiva, 2011

Revista Brasileira de Cardiologia Invasiva, 2012

A nefropatia induzida pelo contraste (NIC) é uma complicação potencial após a intervenção cor... more A nefropatia induzida pelo contraste (NIC) é uma complicação potencial após a intervenção coronária percutânea (ICP). A patogênese está associada a mecanismos inflamatórios, disfunção endotelial e estresse oxidativo, e as estatinas, por seus efeitos pleiotrópicos, vêm sendo analisadas nesse cenário. Avaliamos se uma dose de reforço de rosuvastatina préICP eletiva, em pacientes em uso crônico de estatina, reduz a ocorrência de NIC. Métodos: Estudo prospectivo, randomizado, aberto, realizado em único centro. Os pacientes foram divididos de acordo com a utilização (grupo 1) ou não (grupo 2) de 40 mg de rosuvastatina, 2 a 6 horas préICP. A frequência de NIC foi comparada entre os dois grupos e nos subgrupos de diabéticos e com disfunção renal prévia. Resultados: Foram incluídos 135 pacientes, com idade de 60,7 + 9,3 anos, rando mizados para o grupo 1 (n = 67) ou para o grupo 2 (n = 68). A prevalência de dia betes foi de 31,1% e de clearance de creatinina < 60 ml/min, de 13,3%. A incidência de NIC foi de 8,1% e não mostrou diferença entre os grupos (9% vs. 7,4%; P = 0,89). A incidência de NIC nos diabéticos foi de 15% vs. 13,6% (P = 0,75) e nos portadores de disfunção re nal prévia foi de 12,5% vs. 0 (P = 0,93). Conclusões: O uso de uma dose de reforço de rosuvastatina em sua posologia

Revista Brasileira de Cardiologia Invasiva, 2009

A gênese do infarto agudo do miocárdio (IAM) está intimamente relacionada à ruptura de "placas vu... more A gênese do infarto agudo do miocárdio (IAM) está intimamente relacionada à ruptura de "placas vulneráveis". Estudos anatomopatológicos sugerem uma distribuição não-homogênea dessas placas ao longo da árvore coronária. Neste estudo, visamos a estabelecer as "zonas vulneráveis", no sentido de obter um mapa do risco de maior probabilidade de ocorrência de IAM. Método: Neste estudo, foram analisados 82 pacientes consecutivos tratados com angioplastia primária em um centro terciário de referência, no período de janeiro a setembro de 2007. Somente foram incluídos pacientes com IAM com elevação do segmento ST, com fluxo coronário TIMI 0/1. Após definir o segmento de oclusão, utilizando a segmentação coronária do Coronary Artery Surgery Study (CASS), mensuramos a distância do ponto de oclusão do vaso culpado até seu óstio, com software dedicado (CMS-Medis). O modelo de regressão de Poisson foi utilizado para determinar o risco de IAM, baseado na distância da oclusão a partir do óstio coronário. Resultados: A média das idades foi de 60 anos e 73,1% dos pacientes eram homens. A artéria descendente anterior foi o vaso culpado mais prevalente (46,3%). O diâmetro médio de referência do vaso foi de 2,8 ± 0,6 mm. Para cada segmento de 10 mm a partir do óstio do vaso-alvo, foi observada, pela regressão de Poisson, redução de 36,9% no risco de oclusão aguda do vaso. Nesta coorte notou-se distribuição nãohomogênea das placas vulneráveis, com maior prevalência nos segmentos proximais dos vasos epicárdicos. Conclusões: Os achados desta análise in vivo estão em concordância com os estudos anatomopatológicos prévios. Identificação das "zonas vulneráveis" na árvore coronária

Journal of the American College of Cardiology, 2013

JACC: Cardiovascular Imaging, 2014

During the study period, a total of 2,323 TTE studies were performed in 251 LVAD patients. Of the... more During the study period, a total of 2,323 TTE studies were performed in 251 LVAD patients. Of them, 10 patients (4.0%) underwent a total of 12 CE studies (0.5%) (2 patients had repeat CE examinations). All patients underwent CE due to suboptimal endocardial border definition during noncontrast TTE. All but 1 patient was supported by a HeartMate II (Thoratec Corporation, Pleasanton, California) continuous-flow LVAD, and this patient was supported by a HeartMate XVE (Thoratec Corporation) pulsatile-flow LVAD. CE was performed successfully in all patients. Definity contrast was used in 9 CE examinations, and Optison was used in 3. Representative 2-dimensional echocardiography images before and after contrast administration are shown in Figure 1. The use of contrast aided image interpretation in 10 CE examinations (83%) and did not change image interpretation in 2 (17%). CE contributed to a change in LVAD patient management in 5 examinations (42%), including adjustment of pump speed in 3 patients, intensification of inotrope support in 1 patient after identification of severe right ventricular systolic dysfunction, and intensification of anticoagulation therapy in 1 patient after identification of a previously unrecognized nonobstructive left ventricular apical thrombus adjacent to the LVAD inflow cannula (Fig. 1, Online Video 1). No adverse events or known side effects of ultrasound contrast agents were reported during or after CE in any patient. Importantly, no changes in device function parameters were noted during or after CE. To our knowledge, this is the first report to describe the use of CE in multiple LVAD patients. CE was successfully performed using a standard imaging protocol used for non-LVAD patients. Uncertainty regarding both the risk of causing adverse reactions or device function interference and the feasibility of diagnostic image acquisition during continuous blood flow into the device cannula has likely led to a significant underuse of CE in this population. Even at our institution, CE was used in only 0.5% of TTE studies performed on LVAD patients, although it is likely that many more would have benefited from its use. By comparison, CE is used in w5% of all resting TTE studies in our laboratory. In summary, CE was feasible and safe and improved image interpretation in a small sample of LVAD patients undergoing clinically indicated echocardiography. CE should be used as needed during the echocardiographic evaluation of LVAD patients with technically difficult images.

The progressive nature of coronary atherosclerotic disease is often neglected in patients submitt... more The progressive nature of coronary atherosclerotic disease is often neglected in patients submitted to percutaneous coronary intervention. Very late (> 1 year) myocardial infarctions affecting the treated myocardial territory are usually attributed to device related complications. We report the case of a patient with acute inferior wall ST-elevation myocardial infarction, who had a thrombotic occlusion of a bare-metal stent implanted 8 years before. Despite the angiographic diagnosis of very late stent thrombosis, optical coherence tomography revealed that the acute myocardial infarction was caused by rupture of an atherosclerotic plaque outside of the previously stented segment. DESCRIPTORS: Myocardial infarction. Percutaneous coronary intervention. Stents. Tomography, optical coherence. Coronary