Wilton Gomes | UFPR - Academia.edu (original) (raw)

Papers by Wilton Gomes

Research paper thumbnail of A distorted yellowish kidney occupied by foamy macrophages

QJM, 2009

A 70-year-old woman presented with intermittent fever for 3 months accompanied by left flank pain... more A 70-year-old woman presented with intermittent fever for 3 months accompanied by left flank pain, brownish fetid urine and 26-kg body weight loss. She had a known history of diabetes mellitus, nephrolithiasis and several urine cultures before admission positive for Proteus mirabilis or Escherichia coli . An abdominal CT scan …

Research paper thumbnail of Uso Dos Inibidores Do Transporte Da SGLT2 Em Pacientes Com Doença Cardiovascular e Sem Diabetes e Seus Possíveis Efeitos Cardioprotetores: Uma Revisão Integrativa

Medicina: A ciência e a tecnologia em busca da cura 2, 2021

Research paper thumbnail of Epidemiological Profile of Patients Care for Acute Coronary Syndrome in Brazil

International Journal of Health Science, 2022

All content in this magazine is licensed under a Creative Commons Attribution License. Attributio... more All content in this magazine is licensed under a Creative Commons Attribution License. Attribution-Non-Commercial-Non-Derivatives 4.0 International (CC BY-NC-ND 4.0).

Research paper thumbnail of Smartwatches e Saúde Cardiovascular: Vantagens e Desafios

Cardiologia: Teoria e Prática Ed. 2, 2021

Research paper thumbnail of Congestão Pulmonar Pós Ablação De Fibrilação Atrial: Um Relato De Caso

Abordagens em medicina: Estado cumulativo de bem estar físico, mental e psicológico 4

Research paper thumbnail of Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Catheterization and Cardiovascular Interventions, 2015

Objective: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascu... more Objective: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry. Background: Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. Methods: The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events allcause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. Results: A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P 5 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P 5 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. Conclusion: Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI. V C 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Angiographic and 5-Year Clinical Follow-Up After Implantation of Drug-Eluting Stents with Biodegradable Coating in Patients at High Risk of Restenosis : The PAINT Randomized Trial

Background: Biodegradable polymers were developed to reduce the hypersensitivity reaction associa... more Background: Biodegradable polymers were developed to reduce the hypersensitivity reaction associated to durable polymers found with the first generation drug-eluting stents, while maintaining antiproliferative efficacy and increasing safety. This study evaluated the 9-month angiographic follow-up and long-term clinical outcomes of biodegradable polymer-coated drug-eluting stents compared with identical platform metallic stents in patients with high-risk for restenosis. Methods: Patients with a reference diameter ≤ 2.5 mm, lesion length ≥ 15 mm, diabetes, or a combination of these characteristics were selected from the population of the PAINT trial. These patients were previously randomized and allocated for percutaneous coronary intervention with either a sirolimus-eluting biodegradable polymer-coated stent, a paclitaxel-eluting biodegradable polymer-coated stent, or an identical metallic platform stent, at a ratio of 2:2:1. Results: One hundred and seventy-eight patients were treat...

Research paper thumbnail of Very late outcomes of drug-eluting stents coated with biodegradable polymers: insights from the 5-year follow-up of the randomized PAINT trial

Background: Few studies have examined the very long-term outcomes after implantation of drug-elut... more Background: Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (DES) coated with biodegradable polymers (BP). This report presents the 5-year clinical follow-up of patients treated with BP-DES in the randomized PAINT trial. Methods: The PAINT study is a prospective, multicenter randomized controlled trial that allocated 274 patients for treatment with two BP-DES formulations [paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES)] or bare metal stents (BMS) in a 1:2:2 ratio, respectively. The primary end-point of this substudy was defined as the composite of the major cardiac adverse events (MACE) cardiac death, myocardial infarction (MI) or ischemia-driven target vessel revascularization (TVR) at 5 years. Results: The 5-year MACE rates were different among the groups: 35.3%, 22.5% and 16.9% for BMS, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The primary end-point was mainly driven by TVR: 31.8%, 14.1% and 12.2% for bare stents, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The incidence of stent thrombosis (ST) was null for BMS during the entire follow-up. There was no definite or probable ST in the SES group after the second year, while one patient (1.0%) presented with a definite ST episode in the PES group between 4 and 5 years. Conclusions: The tested biodegradable-polymer coated stents releasing either paclitaxel or sirolimus, compared with same bare metal platform, sustained their effectiveness in reducing combined major adverse cardiac events and re-intervention without an increase in ST during 5 years of follow-up.

Research paper thumbnail of Relação Entre Mortes Por Infarto Agudo Do Miocárdio e Variação De Temperatura Na Cidade De Curitiba: Um Estudo Epidemiológico

Medicina: Ciências da saúde e pesquisa interdisciplinar 4

Research paper thumbnail of Resultados Angiográficos e do Seguimento Clínico de 5 Anos Após Implante de Stents Farmacológicos com Revestimento Biodegradável em Pacientes com Alto Risco de Reestenose. Análise de Subgrupo do Estudo Randomizado PAINT

Revista Brasileira de Cardiologia Invasiva, 2014

Introdução: Polímeros biodegradáveis foram desenvolvidos para reduzir a reação de hipersensibilid... more Introdução: Polímeros biodegradáveis foram desenvolvidos para reduzir a reação de hipersensibilidade associada aos po límeros duráveis dos stents farmacológicos de primeira geração, mantendo sua eficácia antiproliferativa e aumentado sua segurança. Avaliamos os resultados angiográficos de 9 meses e os resultados clínicos de longo prazo dos stents farmacológicos com polímeros biodegradáveis em pacientes com alto risco de reestenose. Métodos: Pacientes com diâmetro de referência ≤ 2,5 mm, extensão da lesão ≥ 15 mm, diabetes, ou uma combinação dessas características foram selecionados da população do estudo PAINT. Esses pacientes foram previamente randomizados e alocados para intervenção coronária percutânea recebendo os stents farmacológicos com polímeros biodegradáveis com sirolimus ou com paclitaxel ou stents metálicos, na razão 2:2:1. Resultados: Cento e setenta e oito pacientes foram tratados com stents farmacológicos com polímeros biodegradáveis (n = 142) ou stents metálicos (n = 36). No acompanhamento angiográfico de 9 meses, os primeiros mostraram menor perda tardia (0,40 ± 0,42 mm vs. 0,90 ± 0,47 mm; p < 0,01) e reestenose binária (7,4% vs. 25%; p < 0,01). No acompanhamento clínico de 5 anos, o grupo com stents farmacológicos com polímeros biodegradáveis mostrou menores taxas do desfecho combinado de morte cardíaca, infarto do miocárdio e revascularização do vaso-alvo (16,2% vs. 38,0%; p = 0,03), principalmente devido à redução da revascularização do vaso-alvo (9,9% vs. 36,1%; p < 0,01). Morte total, morte cardíaca e infarto do miocárdio não foram diferentes entre os grupos. A trombose do stent, provável ou

Research paper thumbnail of Very late outcomes of drug-eluting stents coated with biodegradable polymers: insights from the 5-year follow-up of the randomized PAINT trial

Cardiovascular diagnosis and therapy, 2014

Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (... more Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (DES) coated with biodegradable polymers (BP). This report presents the 5-year clinical follow-up of patients treated with BP-DES in the randomized PAINT trial. The PAINT study is a prospective, multicenter randomized controlled trial that allocated 274 patients for treatment with two BP-DES formulations [paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES)] or bare metal stents (BMS) in a 1:2:2 ratio, respectively. The primary end-point of this sub-study was defined as the composite of the major cardiac adverse events (MACE) cardiac death, myocardial infarction (MI) or ischemia-driven target vessel revascularization (TVR) at 5 years. The 5-year MACE rates were different among the groups: 35.3%, 22.5% and 16.9% for BMS, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The primary end-point was mainly driven by TVR: 31.8%, 14.1% and 12.2% for bare...

Research paper thumbnail of P349 * Left atrial myxoma hypervascularized: case report and literature review

Cardiovascular Research, 2014

Introduction: We present the case of a patient admitted electively in general cardiology unit com... more Introduction: We present the case of a patient admitted electively in general cardiology unit complaining of chest pain for 5 months. Research by an imaging compatible with intra atrial tumor hypervascularized. Case Report: Woman, 40, in evaluation for chest pain type B for five months. Physical examination without significant changes and chest X-ray, electrocardiogram and laboratory normal. By means of echocardiography, including transesophageal approach, sessile lesion found in the left atrium of 33 mm in diameter. A hypothetical diagnosis of atrial myxoma. Requested angiography, excluding coronary artery disease, and observed a tumor irrigated by a large branch of the right coronary artery with marked neovascularization(Figure 1), proceeded by complete excision of the same. Pathologic examination confirmed the diagnosis of atrial myxoma, noting intense vascular proliferation. The patient was discharged asymptomatic. Discussion: vascularization of the tumor grade enough to be visualized by coronary arteriography is considered rare in cases of atrial myxoma. The irrigation is the right coronary artery and the circumflex artery fewer or both, with the blood supply of the tumor may change its operating strategy. The hypervascularity of atrial myxoma may also cause theft coronary blood with consequent myocardial ischemia; few cases illustrate this uncommon clinical. The treatment of choice for atrial myxoma is surgical removal, the possibility of embolism or sudden death, and the same curative. Conclusion: Atrial myxoma presents itself as the most common primary cardiac tumor, although in this case manifesting atypically by intense neovascularization. This fact encourages the investigation of differential diagnoses with literature review and updating of the subject.

Research paper thumbnail of Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Catheterization and Cardiovascular Interventions, 2015

To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approac... more To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;real-world&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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; patients from the multi-center Brazilian TAVI registry. Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;real-world&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;, nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI. © 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Spontaneous Coronary Artery Dissection: Therapeutic Approach and Outcomes of a Consecutive Series of Cases

Revista Brasileira de Cardiologia Invasiva English Version, 2014

Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and... more Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and its diagnosis is made by necropsy in more than 70% of the cases. Optimal treatment is still uncertain, and the treatment options are percutaneous coronary intervention, coronary artery bypass surgery and medical therapy. The objective of this study was to evaluate the clinical characteristics, treatment modalities and outcome of a series of cases with spontaneous coronary artery dissection. Methods: Retrospective, single-center study, based on the analysis of the database at a high-complexity cardiology service. Results: We identified 25 patients with spontaneous coronary artery dissection, 56% were female, with a mean age of 48.8 ± 10 years. Only 24% had no risk factor for atherosclerosis and in 92% of the cases, the clinical presentation was of acute coronary syndrome. The left anterior descending artery was the most commonly affected vessel (48.1%) and there was only one case involving multiple vessels. The conservative approach was used in 56%, percutaneous coronary intervention in 40% and coronary artery bypass grafting in 4%. The in-hospital and late event-free survival was 92% and 84.2%, respectively. Conclusions: Spontaneous coronary artery dissection predominated in young women, with at least one risk factor for coronary artery disease. The choice of different therapeutic strategies confirms the still controversial nature of the optimal approach for spontaneous coronary artery dissection. We believe that individualized therapy is still the optimal modality.

Research paper thumbnail of P448 * Infective endocarditis in patent ductus arteriosus by bartonella sp: case report and literature review

Cardiovascular Research, 2014

Research paper thumbnail of Dissecção Espontânea de Artéria Coronária: Abordagem Terapêutica e Desfechos de Uma Série Consecutiva de Casos

Revista Brasileira de Cardiologia Invasiva, 2014

omo publicado no volume 22, número 1 de 2014, na página 32, no artigo "Dissecção espontânea de ar... more omo publicado no volume 22, número 1 de 2014, na página 32, no artigo "Dissecção espontânea de artéria coronária: abordagem terapêutica e desfechos de uma série consecutiva de casos", nos nomes dos autores, onde se lê Jammil Cade, leia-se "Jamil Cade".

Research paper thumbnail of Percutaneous Sympathetic Renal Denervation

Arterial hypertension is a highly prevalent disease and is associated with increased cardiovascul... more Arterial hypertension is a highly prevalent disease and is associated with increased cardiovascular risk. Despite great advances in drug therapy, a considerable number of patients do not have an effective control of the disease, despite the use of multiple drugs, usually in high doses. Renal sympathetic denervation (RSD) has proved to be a promising therapy, with high safety and eficacy in preliminary studies in patients with resistant hypertension. The role of the sympathetic nervous system in the physiopathology of hypertension is well known, and is the rationale for the ablation of sympathetic ibers by transluminal delivery of radiofrequency in the renal arteries. In the last few years, results from case series, non-controlled studies and one multicenter randomized trial with a limited number of patients have shown a signiicant decrease in short and mid-term blood pressure levels. The objective of this review was to gather evidence on the use of RSD in the control of resistant hypertension and describe technical aspects and perspectives of the procedure.

Research paper thumbnail of A distorted yellowish kidney occupied by foamy macrophages

QJM, 2009

A 70-year-old woman presented with intermittent fever for 3 months accompanied by left flank pain... more A 70-year-old woman presented with intermittent fever for 3 months accompanied by left flank pain, brownish fetid urine and 26-kg body weight loss. She had a known history of diabetes mellitus, nephrolithiasis and several urine cultures before admission positive for Proteus mirabilis or Escherichia coli . An abdominal CT scan …

Research paper thumbnail of Uso Dos Inibidores Do Transporte Da SGLT2 Em Pacientes Com Doença Cardiovascular e Sem Diabetes e Seus Possíveis Efeitos Cardioprotetores: Uma Revisão Integrativa

Medicina: A ciência e a tecnologia em busca da cura 2, 2021

Research paper thumbnail of Epidemiological Profile of Patients Care for Acute Coronary Syndrome in Brazil

International Journal of Health Science, 2022

All content in this magazine is licensed under a Creative Commons Attribution License. Attributio... more All content in this magazine is licensed under a Creative Commons Attribution License. Attribution-Non-Commercial-Non-Derivatives 4.0 International (CC BY-NC-ND 4.0).

Research paper thumbnail of Smartwatches e Saúde Cardiovascular: Vantagens e Desafios

Cardiologia: Teoria e Prática Ed. 2, 2021

Research paper thumbnail of Congestão Pulmonar Pós Ablação De Fibrilação Atrial: Um Relato De Caso

Abordagens em medicina: Estado cumulativo de bem estar físico, mental e psicológico 4

Research paper thumbnail of Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Catheterization and Cardiovascular Interventions, 2015

Objective: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascu... more Objective: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry. Background: Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. Methods: The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events allcause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. Results: A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P 5 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P 5 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. Conclusion: Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI. V C 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Angiographic and 5-Year Clinical Follow-Up After Implantation of Drug-Eluting Stents with Biodegradable Coating in Patients at High Risk of Restenosis : The PAINT Randomized Trial

Background: Biodegradable polymers were developed to reduce the hypersensitivity reaction associa... more Background: Biodegradable polymers were developed to reduce the hypersensitivity reaction associated to durable polymers found with the first generation drug-eluting stents, while maintaining antiproliferative efficacy and increasing safety. This study evaluated the 9-month angiographic follow-up and long-term clinical outcomes of biodegradable polymer-coated drug-eluting stents compared with identical platform metallic stents in patients with high-risk for restenosis. Methods: Patients with a reference diameter ≤ 2.5 mm, lesion length ≥ 15 mm, diabetes, or a combination of these characteristics were selected from the population of the PAINT trial. These patients were previously randomized and allocated for percutaneous coronary intervention with either a sirolimus-eluting biodegradable polymer-coated stent, a paclitaxel-eluting biodegradable polymer-coated stent, or an identical metallic platform stent, at a ratio of 2:2:1. Results: One hundred and seventy-eight patients were treat...

Research paper thumbnail of Very late outcomes of drug-eluting stents coated with biodegradable polymers: insights from the 5-year follow-up of the randomized PAINT trial

Background: Few studies have examined the very long-term outcomes after implantation of drug-elut... more Background: Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (DES) coated with biodegradable polymers (BP). This report presents the 5-year clinical follow-up of patients treated with BP-DES in the randomized PAINT trial. Methods: The PAINT study is a prospective, multicenter randomized controlled trial that allocated 274 patients for treatment with two BP-DES formulations [paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES)] or bare metal stents (BMS) in a 1:2:2 ratio, respectively. The primary end-point of this substudy was defined as the composite of the major cardiac adverse events (MACE) cardiac death, myocardial infarction (MI) or ischemia-driven target vessel revascularization (TVR) at 5 years. Results: The 5-year MACE rates were different among the groups: 35.3%, 22.5% and 16.9% for BMS, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The primary end-point was mainly driven by TVR: 31.8%, 14.1% and 12.2% for bare stents, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The incidence of stent thrombosis (ST) was null for BMS during the entire follow-up. There was no definite or probable ST in the SES group after the second year, while one patient (1.0%) presented with a definite ST episode in the PES group between 4 and 5 years. Conclusions: The tested biodegradable-polymer coated stents releasing either paclitaxel or sirolimus, compared with same bare metal platform, sustained their effectiveness in reducing combined major adverse cardiac events and re-intervention without an increase in ST during 5 years of follow-up.

Research paper thumbnail of Relação Entre Mortes Por Infarto Agudo Do Miocárdio e Variação De Temperatura Na Cidade De Curitiba: Um Estudo Epidemiológico

Medicina: Ciências da saúde e pesquisa interdisciplinar 4

Research paper thumbnail of Resultados Angiográficos e do Seguimento Clínico de 5 Anos Após Implante de Stents Farmacológicos com Revestimento Biodegradável em Pacientes com Alto Risco de Reestenose. Análise de Subgrupo do Estudo Randomizado PAINT

Revista Brasileira de Cardiologia Invasiva, 2014

Introdução: Polímeros biodegradáveis foram desenvolvidos para reduzir a reação de hipersensibilid... more Introdução: Polímeros biodegradáveis foram desenvolvidos para reduzir a reação de hipersensibilidade associada aos po límeros duráveis dos stents farmacológicos de primeira geração, mantendo sua eficácia antiproliferativa e aumentado sua segurança. Avaliamos os resultados angiográficos de 9 meses e os resultados clínicos de longo prazo dos stents farmacológicos com polímeros biodegradáveis em pacientes com alto risco de reestenose. Métodos: Pacientes com diâmetro de referência ≤ 2,5 mm, extensão da lesão ≥ 15 mm, diabetes, ou uma combinação dessas características foram selecionados da população do estudo PAINT. Esses pacientes foram previamente randomizados e alocados para intervenção coronária percutânea recebendo os stents farmacológicos com polímeros biodegradáveis com sirolimus ou com paclitaxel ou stents metálicos, na razão 2:2:1. Resultados: Cento e setenta e oito pacientes foram tratados com stents farmacológicos com polímeros biodegradáveis (n = 142) ou stents metálicos (n = 36). No acompanhamento angiográfico de 9 meses, os primeiros mostraram menor perda tardia (0,40 ± 0,42 mm vs. 0,90 ± 0,47 mm; p < 0,01) e reestenose binária (7,4% vs. 25%; p < 0,01). No acompanhamento clínico de 5 anos, o grupo com stents farmacológicos com polímeros biodegradáveis mostrou menores taxas do desfecho combinado de morte cardíaca, infarto do miocárdio e revascularização do vaso-alvo (16,2% vs. 38,0%; p = 0,03), principalmente devido à redução da revascularização do vaso-alvo (9,9% vs. 36,1%; p < 0,01). Morte total, morte cardíaca e infarto do miocárdio não foram diferentes entre os grupos. A trombose do stent, provável ou

Research paper thumbnail of Very late outcomes of drug-eluting stents coated with biodegradable polymers: insights from the 5-year follow-up of the randomized PAINT trial

Cardiovascular diagnosis and therapy, 2014

Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (... more Few studies have examined the very long-term outcomes after implantation of drug-eluting stents (DES) coated with biodegradable polymers (BP). This report presents the 5-year clinical follow-up of patients treated with BP-DES in the randomized PAINT trial. The PAINT study is a prospective, multicenter randomized controlled trial that allocated 274 patients for treatment with two BP-DES formulations [paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES)] or bare metal stents (BMS) in a 1:2:2 ratio, respectively. The primary end-point of this sub-study was defined as the composite of the major cardiac adverse events (MACE) cardiac death, myocardial infarction (MI) or ischemia-driven target vessel revascularization (TVR) at 5 years. The 5-year MACE rates were different among the groups: 35.3%, 22.5% and 16.9% for BMS, PES and SES, respectively (P<0.05 for both DES vs. bare stent comparisons). The primary end-point was mainly driven by TVR: 31.8%, 14.1% and 12.2% for bare...

Research paper thumbnail of P349 * Left atrial myxoma hypervascularized: case report and literature review

Cardiovascular Research, 2014

Introduction: We present the case of a patient admitted electively in general cardiology unit com... more Introduction: We present the case of a patient admitted electively in general cardiology unit complaining of chest pain for 5 months. Research by an imaging compatible with intra atrial tumor hypervascularized. Case Report: Woman, 40, in evaluation for chest pain type B for five months. Physical examination without significant changes and chest X-ray, electrocardiogram and laboratory normal. By means of echocardiography, including transesophageal approach, sessile lesion found in the left atrium of 33 mm in diameter. A hypothetical diagnosis of atrial myxoma. Requested angiography, excluding coronary artery disease, and observed a tumor irrigated by a large branch of the right coronary artery with marked neovascularization(Figure 1), proceeded by complete excision of the same. Pathologic examination confirmed the diagnosis of atrial myxoma, noting intense vascular proliferation. The patient was discharged asymptomatic. Discussion: vascularization of the tumor grade enough to be visualized by coronary arteriography is considered rare in cases of atrial myxoma. The irrigation is the right coronary artery and the circumflex artery fewer or both, with the blood supply of the tumor may change its operating strategy. The hypervascularity of atrial myxoma may also cause theft coronary blood with consequent myocardial ischemia; few cases illustrate this uncommon clinical. The treatment of choice for atrial myxoma is surgical removal, the possibility of embolism or sudden death, and the same curative. Conclusion: Atrial myxoma presents itself as the most common primary cardiac tumor, although in this case manifesting atypically by intense neovascularization. This fact encourages the investigation of differential diagnoses with literature review and updating of the subject.

Research paper thumbnail of Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Catheterization and Cardiovascular Interventions, 2015

To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approac... more To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;real-world&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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; patients from the multi-center Brazilian TAVI registry. Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;real-world&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;, nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI. © 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Spontaneous Coronary Artery Dissection: Therapeutic Approach and Outcomes of a Consecutive Series of Cases

Revista Brasileira de Cardiologia Invasiva English Version, 2014

Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and... more Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and its diagnosis is made by necropsy in more than 70% of the cases. Optimal treatment is still uncertain, and the treatment options are percutaneous coronary intervention, coronary artery bypass surgery and medical therapy. The objective of this study was to evaluate the clinical characteristics, treatment modalities and outcome of a series of cases with spontaneous coronary artery dissection. Methods: Retrospective, single-center study, based on the analysis of the database at a high-complexity cardiology service. Results: We identified 25 patients with spontaneous coronary artery dissection, 56% were female, with a mean age of 48.8 ± 10 years. Only 24% had no risk factor for atherosclerosis and in 92% of the cases, the clinical presentation was of acute coronary syndrome. The left anterior descending artery was the most commonly affected vessel (48.1%) and there was only one case involving multiple vessels. The conservative approach was used in 56%, percutaneous coronary intervention in 40% and coronary artery bypass grafting in 4%. The in-hospital and late event-free survival was 92% and 84.2%, respectively. Conclusions: Spontaneous coronary artery dissection predominated in young women, with at least one risk factor for coronary artery disease. The choice of different therapeutic strategies confirms the still controversial nature of the optimal approach for spontaneous coronary artery dissection. We believe that individualized therapy is still the optimal modality.

Research paper thumbnail of P448 * Infective endocarditis in patent ductus arteriosus by bartonella sp: case report and literature review

Cardiovascular Research, 2014

Research paper thumbnail of Dissecção Espontânea de Artéria Coronária: Abordagem Terapêutica e Desfechos de Uma Série Consecutiva de Casos

Revista Brasileira de Cardiologia Invasiva, 2014

omo publicado no volume 22, número 1 de 2014, na página 32, no artigo "Dissecção espontânea de ar... more omo publicado no volume 22, número 1 de 2014, na página 32, no artigo "Dissecção espontânea de artéria coronária: abordagem terapêutica e desfechos de uma série consecutiva de casos", nos nomes dos autores, onde se lê Jammil Cade, leia-se "Jamil Cade".

Research paper thumbnail of Percutaneous Sympathetic Renal Denervation

Arterial hypertension is a highly prevalent disease and is associated with increased cardiovascul... more Arterial hypertension is a highly prevalent disease and is associated with increased cardiovascular risk. Despite great advances in drug therapy, a considerable number of patients do not have an effective control of the disease, despite the use of multiple drugs, usually in high doses. Renal sympathetic denervation (RSD) has proved to be a promising therapy, with high safety and eficacy in preliminary studies in patients with resistant hypertension. The role of the sympathetic nervous system in the physiopathology of hypertension is well known, and is the rationale for the ablation of sympathetic ibers by transluminal delivery of radiofrequency in the renal arteries. In the last few years, results from case series, non-controlled studies and one multicenter randomized trial with a limited number of patients have shown a signiicant decrease in short and mid-term blood pressure levels. The objective of this review was to gather evidence on the use of RSD in the control of resistant hypertension and describe technical aspects and perspectives of the procedure.