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1.
Rev Med Brux ; 31(1): 30-4, 2010.
Artigo em Francês | MEDLINE | ID: mdl-20384049

RESUMO

Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.


Assuntos
Infarto do Miocárdio/terapia , Reperfusão Miocárdica/métodos , Bélgica/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Infarto do Miocárdio/classificação , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/cirurgia , Qualidade de Vida , Sistema de Registros , Reperfusão , Sociedades Médicas , Estados Unidos/epidemiologia
2.
Rev Med Liege ; 65(1): 23-8, 2010 Jan.
Artigo em Francês | MEDLINE | ID: mdl-20222505

RESUMO

Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.


Assuntos
Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Bélgica , Árvores de Decisões , Serviços Médicos de Emergência , Humanos , Transporte de Pacientes
3.
Eur Heart J ; 23(23): 1849-53, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12445533

RESUMO

INTRODUCTION: Quantitative angiographic assessment after balloon angioplasty is a poor predictor of immediate and long-term outcome. However, the measurement of blood flow velocity during angioplasty has been proved clinically useful. AIMS: To analyse the value of the maximal stenotic flow velocity and the presence of stenotic flow velocity acceleration (aSV) for the long-term outcome after balloon angioplasty. METHODS AND RESULTS: Patients undergoing single lesion angioplasty within the DEBATE trial were included. aSV was defined as acceleration in the stenotic coronary flow velocity >50% baseline velocity assessed at a reference site of the target vessel. After balloon angioplasty diameter stenosis, minimal lumen diameter (MLD) and coronary flow velocity reserve were similar between the aSV (n=54) and non-aSV group (n=125). At follow-up, the aSV group had a higher restenosis rate (52% vs 30%, P=0.006) The presence of aSV was the strongest independent predictor of restenosis (OR 3.08, 95% CI 1.35 to 7.05, P=0.008). The best predictive cut-off value of SV was 101cm.s(-1) (sensitivity of 46%, specificity of 81%, positive predictive value of 85% and a negative predictive value of 58%). CONCLUSION: Following angioplasty, SV appears to be exquisitely sensitive to the changes experienced at the treated area without depending on the status of the microcirculation.


Assuntos
Angioplastia com Balão/métodos , Circulação Coronária/fisiologia , Estenose Coronária/terapia , Velocidade do Fluxo Sanguíneo/fisiologia , Reestenose Coronária/diagnóstico , Reestenose Coronária/fisiopatologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento , Ultrassonografia Doppler
4.
Circulation ; 105(13): 1573-8, 2002 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-11927525

RESUMO

BACKGROUND: Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. METHODS AND RESULTS: As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (> or =2.5 or < 2.5) at the end of the procedure. A CFVR < 2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR before PTCA: odds ratio [OR], 2.26; 95% confidence interval [CI], 1.57 to 3.24; CFVR in reference artery: OR, 1.90; 95% CI, 1.21 to 2.98; both P<0.001) and stent implantation (before PTCA: OR, 2.54; 95% CI, 1.47 to 4.36; reference artery: OR, 1.97; 95% CI, 1.07 to 3.87; both P<0.05). A low CFVR at the end of the procedure was an independent predictor of major adverse cardiac events (MACE) at 30 days (OR, 4.71; 95% CI, 1.14 to 25.92; P=0.034) and at 1 year (OR, 2.06; 95% CI, 1.16 to 3.66; P=0.014). After excluding MACE at 30 days, no difference in MACE at 1 year was observed between the patients with and without a CFVR < 2.5 at the end of the procedure. CONCLUSIONS: A low postprocedural CFVR was associated with a worse periprocedural outcome (which was related to microcirculatory disturbances), but there was no significant difference at late follow-up.


Assuntos
Angioplastia Coronária com Balão , Circulação Coronária , Ecocardiografia Doppler/métodos , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Intervalo Livre de Doença , Feminino , Seguimentos , Previsões , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Análise Multivariada , Miocárdio/enzimologia , Stents , Resultado do Tratamento
5.
Eur Heart J ; 23(2): 133-8, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11785995

RESUMO

AIMS: This study was conducted to analyse flow velocity parameters and predictors of a suboptimal coronary flow reserve (<2.5) following balloon angioplasty. METHODS: Two hundred and twenty-five patients underwent sequential intracoronary Doppler as part of the DEBATE I study. Of these, 183, with complete angiography and Doppler at the 6-month follow-up, were included. Univariate and multivariate logistic analysis was performed to identify independent predictors of post-procedural suboptimal coronary flow reserve, defined as coronary flow reserve <2.5. RESULTS: Forty-eight per cent (n=88) of the patients achieved a suboptimal coronary flow reserve. These patients had higher baseline velocities (cm.s(-1)) before balloon angioplasty (18+/-9 vs 14+/-6, P=0.004), after balloon angioplasty (22+/-11 vs 14+/-5, P<0.001) and at follow-up (19+/-9 vs 16+/-6, P=0.011) than the optimal coronary flow reserve group. Although the suboptimal group had lower hyperaemic velocities (cm.s(-1)) after balloon angioplasty than the optimal group (42+/-17 vs 49+/-16, P=0.008), these velocities became similar at follow-up. Increasing age (odds ratio, OR 1.071, P=0.0002), female gender (OR 2.52, P=0.014) and increasing pre-procedural baseline average peak velocities (OR 1.056, P<0.001) were found to be independent predictors of a suboptimal coronary flow reserve following balloon angioplasty. CONCLUSION: A suboptimal coronary flow reserve was associated with (1) a chronically elevated baseline average peak velocity (2) a transient deficit in the hyperaemic average peak velocity (3) the elderly, and female gender.


Assuntos
Angioplastia com Balão , Vasos Coronários/fisiologia , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Ultrassonografia Doppler
6.
Circulation ; 104(17): 2007-11, 2001 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-11673337

RESUMO

BACKGROUND: We have previously reported a virtual absence of neointimal hyperplasia 4 months after implantation of sirolimus-eluting stents. The aim of the present investigation was to determine whether these results are sustained over a period of 1 year. METHODS AND RESULTS: Forty-five patients with de novo coronary disease were successfully treated with the implantation of a single sirolimus-eluting Bx VELOCITY stent in São Paulo, Brazil (n=30, 15 fast release [group I, GI] and 15 slow release [GII]) and Rotterdam, The Netherlands (15 slow release, GIII). Angiographic and volumetric intravascular ultrasound (IVUS) follow-up was obtained at 4 and 12 months (GI and GII) and 6 months (GIII). In-stent minimal lumen diameter and percent diameter stenosis remained essentially unchanged in all groups (at 12 months, GI and GII; at 6 months, GIII). Follow-up in-lesion minimal lumen diameter was 2.28 mm (GIII), 2.32 mm (GI), and 2.48 mm (GII). No patient approached the >/=50% diameter stenosis at 1 year by angiography or IVUS assessment, and no edge restenosis was observed. Neointimal hyperplasia, as detected by IVUS, was virtually absent at 6 months (2+/-5% obstruction volume, GIII) and at 12 months (GI=2+/-5% and GII=2+/-3%). CONCLUSIONS: This study demonstrates a sustained suppression of neointimal proliferation by sirolimus-eluting Bx VELOCITY stents 1 year after implantation.


Assuntos
Implante de Prótese Vascular/instrumentação , Doença das Coronárias/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Sirolimo/administração & dosagem , Stents , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Brasil , Estudos de Coortes , Angiografia Coronária , Doença das Coronárias/diagnóstico , Doença das Coronárias/tratamento farmacológico , Preparações de Ação Retardada/administração & dosagem , Implantes de Medicamento/administração & dosagem , Endossonografia , Feminino , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Sirolimo/efeitos adversos , Stents/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento , Túnica Íntima/efeitos dos fármacos , Grau de Desobstrução Vascular/efeitos dos fármacos
8.
Heart ; 86(2): 193-8, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11454840

RESUMO

OBJECTIVE: To study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome. METHODS: 523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler endpoints balloon angioplasty trial Europe). After successful balloon angioplasty, patients were randomised to stenting or no further treatment. Dissections were graded at the core laboratory by two observers and divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients were divided into two groups according to the presence (group A, n = 45) or absence (group B, n = 211) of moderate dissection. RESULTS: Following balloon angioplasty, there was no difference in CFVR between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%) v 23 (11%), p = 0.041). However, the risk of major adverse events was similar in the subgroups receiving balloon angioplasty (group A, 6 (19%) v group B, 16 (16%), NS). Among group A patients, the adverse events risk was greater in those randomised to stenting (odds ratios 6.603 v 1.197, p = 0.046), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or >/= 2.5 after balloon angioplasty. CONCLUSIONS: Moderate dissections left untreated result in no increased risk of major adverse cardiac events. Additional stenting does not improve the long term outcome.


Assuntos
Angioplastia Coronária com Balão/métodos , Doença das Coronárias/terapia , Stents , Dissecção Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Doença das Coronárias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
Am Heart J ; 142(1): 81-6, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11431661

RESUMO

BACKGROUND: The coronary flow velocity acceleration at the stenotic site (SVA), defined as a > or = 50% increase in resting stenotic velocity when compared with the reference segment, has been shown to be highly sensitive and specific for the diagnosis of a hemodynamically significant stenosis. In this study, we describe the value of postprocedural SVA for the prediction of a lack of improvement in functional activity at long-term follow-up balloon angioplasty (BA). METHODS: We investigated the improvement in functional activity in patients undergoing single native vessel angioplasty and intracoronary Doppler (before BA, after BA, and again at 6-month follow-up) as part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) I trial. Lack of improvement was defined as no change in Duke Activity Status Index (DASI) at 6-month follow-up, whereas SVA was defined as > or = 50% elevation in resting velocity at the treated area compared with the distal measurement. RESULTS: SVA was found more frequently in patients without improvement in DASI (45% vs 31%, P =.03). Similar percent diameter stenosis and coronary flow velocity reserve were observed in patients with and those without improvement in DASI at follow-up. By multivariate regression analysis, the presence of SVA (P = .029; odds ratio, 1.97; 95% confidence interval, 1.07 to 3.63) and an elevated DASI at baseline (P < .001; odds ratio, 1.05; 95% confidence interval, 1.03 to 1.07) were associated with a lack of improvement at follow-up. CONCLUSIONS: The detection of SVA was associated with failure of improvement in functional activity at follow-up after coronary intervention.


Assuntos
Angioplastia com Balão , Circulação Coronária/fisiologia , Doença das Coronárias/fisiopatologia , Doença das Coronárias/terapia , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão , Resultado do Tratamento
11.
Vnitr Lek ; 46(8): 470-5, 2000 Aug.
Artigo em Tcheco | MEDLINE | ID: mdl-11048512

RESUMO

Intravascular ultrasound (IVUS) is a clinically useful tool that provides cross-sectional images of the coronary arterial lumen and wall. Diagnostic applications of IVUS include the evaluation of ambiguous lesions on angiography particularly at the bifurcations. IVUS is also useful in the assessment of coronary vasculopathy in cardiac transplant patients or it can help to diagnose abnormalities such as syndrome X or coronary artery spasm. IVUS can optimize the performing of percutaneous coronary interventions, especially stent implantation. It represents as well an optimal tool for assessing regression of atherosclerosis. Three-dimensional reconstruction, elastography and imaging guide wires are some of the recent advances in the field of intravascular ultrasound.


Assuntos
Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Ultrassonografia de Intervenção , Angioplastia Coronária com Balão , Humanos
12.
Am J Cardiol ; 86(9): 1047-50, A11, 2000 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-11053728

RESUMO

In 40 patients, we compared linear local shortening assessed with nonfluoroscopic electromechanical mapping as a function of regional wall motion with echocardiographic data in a subset of patients with severe coronary artery disease and subsequently decreased left ventricular function. Our study showed that nonfluoroscopic electromechanical mapping can accurately assess regional wall motion. In addition, this study showed a significant decrease in unipolar voltages among segments with declining regional function.


Assuntos
Mapeamento Potencial de Superfície Corporal , Doença das Coronárias/complicações , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico , Análise de Variância , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Doença das Coronárias/diagnóstico , Eletrodos , Feminino , Fluoroscopia , Humanos , Masculino , Probabilidade , Valores de Referência , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologia
14.
Am Heart J ; 140(4): 596-602, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11011332

RESUMO

BACKGROUND: Recently, a novel nonfluoroscopic 3-dimensional electromechanical mapping technique was introduced in the clinical arena. Although initial in vitro and in vivo studies suggested the reliability of the system in volumetric and hemodynamic evaluation of the left ventricle, no validation in human beings has been performed. METHODS: A nonfluoroscopic electromechanical mapping (NOGA, Biosense-Webster) procedure was performed in 44 patients. All patients received a contrast left ventriculogram during the same session. Volumetric (end-diastolic [EDV] and end-systolic volumes [ESV]) and hemodynamic (left ventricular ejection fraction [LVEF] and stroke volume) parameters of both systems were compared. RESULTS: Two uncomplicated pericardial effusions occurred with the first-generation mapping catheters. No procedural complications were noted with the new-generation mapping catheters. Significant correlations were found between mapping-derived and ventriculography-based measurements for both ESV (r = 0.67, P <.001) and LVEF (r = 0.78, P <.001). Absolute volumes, however, were only comparable for ESV (46.6 +/- 25.3 mL vs 48.8 +/- 37.0 mL, respectively; P =.13) but differed greatly for LVEF (35% +/- 13% vs 65% +/- 19%, respectively; P <.001), EDV (69.1 +/- 28.6 mL vs 125.9 +/- 53.4 mL, respectively; P <.001) and stroke volume (22.4 +/- 9.9 mL vs 77.1 +/- 33.7 respirations; P <.001). Moreover, Bland-Altman analysis showed the clinical noninterchangeability between these techniques for the measurement of hemodynamic parameters. CONCLUSION: Measurement of hemodynamic parameters with nonfluoroscopic mapping of the left ventricle is feasible and safe. The system provides data that strongly correlate but that are in clinical disagreement with angiographic data. Therefore the interchangeability of these techniques may be questioned.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Volume Cardíaco/fisiologia , Volume Sistólico/fisiologia , Função Ventricular , Algoritmos , Angiografia , Cateterismo Cardíaco , Estudos de Viabilidade , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador
15.
Catheter Cardiovasc Interv ; 50(4): 419-25, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10931613

RESUMO

The aim of the study was to assess the safety and feasibility of implantation of the Scimed Radius stent. Secondary objectives were to assess the result of stent placement by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The ESSEX study was a prospective, multicenter, observational study in which candidates for a single elective stent implantation, in a de novo or restenotic lesion, reference diameter 2.75-4.00 mm and target lesion < 14 mm in length, were enrolled. QCA at baseline, postprocedure, and 6-month follow-up was performed. IVUS was used to assess optimal stent implantation. One hundred and three patients were enrolled. Forty-four percent of the patients had unstable angina. Stent implantation was technically successful in all patients. Additional stents were implanted in 17 patients for procedural dissection (16) and spasm (1). Ninety-seven percent of patients were event-free at 1 month and 76% at 6-month follow-up. Angiographic restenosis rates for de novo lesions and for all patients were 19% and 21%, respectively. Clinical events occurred at 1- and 6-month follow-up in 2.9% and 24.3% of patients, respectively. No patients suffered subacute thrombosis. Retrospective analysis of peak balloon inflation pressure (< or = 12 and > 12 atm) as a determinant of clinical, QCA, and IVUS outcomes suggested no benefit or detrimental effect from optimization with high-pressure balloon inflation. Implantation of the self-expanding Radius stent is safe and efficacious. Based on registry data, clinical, angiographic, and IVUS, data comparable with modern balloon-expandable stents were obtained.


Assuntos
Angina Pectoris/terapia , Angioplastia Coronária com Balão , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/diagnóstico por imagem , Angiografia Coronária , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Observação , Estudos Prospectivos , Desenho de Prótese , Recidiva , Segurança , Ultrassonografia de Intervenção
16.
Am J Cardiol ; 86(4): 375-8, 2000 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-10946027

RESUMO

Limited data are available regarding the angiographic healing rate and physiologic impact of coronary artery dissections. Therefore, we studied the impact of coronary dissections on coronary flow velocity and outcome as well as their healing rate at 6-month follow-up balloon angioplasty. Of 297 patients who underwent balloon angioplasty, 225 underwent intracoronary Doppler measurements and 184 had Doppler and angiographic assessment at 6-month follow-up. Dissections were scored by an independent core lab (Cardialysis BV) and divided in 4 groups: mild (types A to B), moderate (type C), severe (D to F), and patients without dissections. Severe dissections (types D to F) were excluded from the analysis. Clinical, angiographic, and Doppler data were compared among the remaining 3 patient groups. From the 67 dissections detected after balloon angioplasty, only 3 (4.5%) remained unhealed at follow-up. Immediately after balloon angioplasty, the moderate dissection group was associated with a lower coronary flow velocity reserve than the patients with mild (2.16 +/- 0.60 vs 2.82 +/- 1.00, p = 0.037) or no dissections (2.16 +/- 0.60 vs 2.71 +/- 0.88, p = 0.046), respectively. In addition, higher recurrence of angina at 30 days was observed in the moderate group rather than in the mild group (5 [50%] vs 8 [16%], p = 0.0160) and in the patients without dissections (11 [12%], p = 0.007). After standard balloon angioplasty, the occurrence of unhealed dissections is a rare phenomenon. An impaired coronary flow reserve was observed after the development of nonocclusive type C dissections, which was associated with a worse short-term outcome.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Circulação Coronária , Doença das Coronárias/terapia , Vasos Coronários/lesões , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Doença das Coronárias/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Cicatrização
20.
Semin Interv Cardiol ; 5(2): 103-6, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10867768

RESUMO

Direct myocardial revascularization (DMR) has been proposed to treat patients with severe coronary artery disease who are not amenable for classical revascularization techniques such as percutaneous coronary intervention (PCI) or bypass surgery (CABG). Although recent reports suggest its benefit in alleviating patients' complaints in the long term, there is still a paucity of data on the immediate impact on regional and global myocardial functioning following this treatment. In this overview we discuss our own experience and provide a summary of other data currently available.


Assuntos
Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Revascularização Miocárdica/métodos , Função Ventricular Esquerda , Humanos , Período Pós-Operatório , Resultado do Tratamento
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