Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve.

BACKGROUND: The effects of rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve remain uncertain. METHODS: In this randomized trial, we compared rivaroxaban (20 mg once daily) with dose-adjusted warfarin (target international normalized ratio, 2.0 to 3.0) in patients with atrial fibrillation and a bioprosthetic mitral valve. The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months. RESULTS: A total of 1005 patients were enrolled at 49 sites in Brazil. A primary-outcome event occurred at a mean of 347.5 days in the rivaroxaban group and 340.1 days in the warfarin group (difference calculated as restricted mean survival time, 7.4 days; 95% confidence interval [CI], -1.4 to 16.3; P<0.001 for noninferiority). Death from cardiovascular causes or thromboembolic events occurred in 17 patients (3.4%) in the rivaroxaban group and in 26 (5.1%) in the warfarin group (hazard ratio, 0.65; 95% CI, 0.35 to 1.20). The incidence of stroke was 0.6% in the rivaroxaban group and 2.4% in the warfarin group (hazard ratio, 0.25; 95% CI, 0.07 to 0.88). Major bleeding occurred in 7 patients (1.4%) in the rivaroxaban group and in 13 (2.6%) in the warfarin group (hazard ratio, 0.54; 95% CI, 0.21 to 1.35). The frequency of other serious adverse events was similar in the two groups. CONCLUSIONS: In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin with respect to the mean time until the primary outcome of death, major cardiovascular events, or major bleeding at 12 months. (Funded by PROADI-SUS and Bayer; RIVER ClinicalTrials.gov number, NCT02303795.).

The First Brazilian Cardiovascular Registry of Atrial Fibrillation: Primary Results of the RECALL Study.

BACKGROUND: It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry. METHODS: RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models. RESULTS: Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death. CONCLUSIONS: RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.

In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE).

BACKGROUND: Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS: BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 SUGGESTION FOR REPHRASING: In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS: A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS: In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.

A randomized clinical trial to evaluate the efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valve and atrial fibrillation or flutter: Rationale and design of the RIVER trial.

The efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valves and atrial fibrillation or flutter remain uncertain. DESIGN: RIVER was an academic-led, multicenter, open-label, randomized, non-inferiority trial with blinded outcome adjudication that enrolled 1005 patients from 49 sites in Brazil. Patients with a bioprosthetic mitral valve and atrial fibrillation or flutter were randomly assigned (1:1) to rivaroxaban 20 mg once daily (15 mg in those with creatinine clearance <50 mL/min) or dose-adjusted warfarin (target international normalized ratio 2.0-30.); the follow-up period was 12 months. The primary outcome was a composite of all-cause mortality, stroke, transient ischemic attack, major bleeding, valve thrombosis, systemic embolism, or hospitalization for heart failure. Secondary outcomes included individual components of the primary composite outcome, bleeding events, and venous thromboembolism. SUMMARY: RIVER represents the largest trial specifically designed to assess the efficacy and safety of a direct oral anticoagulant in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. The results of this trial can inform clinical practice and international guidelines.

Primary results of the brazilian registry of atherothrombotic disease (NEAT).

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725.

Long-term clinical outcomes of the Drug-Eluting Stents in the Real World (DESIRE) Registry.

BACKGROUND: Recently, cardiologists have treated more complex patients and lesions with drug-eluting stents (DES). However, long-term efficacy and safety of the off-label use of these new devices is yet to be demonstrated. METHODS: The Drug-Eluting Stents in the Real World (DESIRE) registry is a prospective, nonrandomized single-center registry with consecutive patients treated solely with DES between May 2002 and May 2007. The primary end-point was long-term occurrence of major adverse cardiac events (MACE). Patients were clinically evaluated at 1, 3, and 6 months and then annually up to 5 years. RESULTS: A total of 2,084 patients (2,864 lesions and 3,120 DES) were included. The mean age was 63.8 +/- 11.5 years. Diabetes was detected in 28.9% and 40.7% presented with acute coronary syndrome. Cyphertrade mark was the predominant DES in this registry (83.5%). Mean follow-up time was 2.6 +/- 1.2 years and was obtained in 96.5% of the eligible patients. Target lesion revascularization (TLR) was performed in 3.3% of the patients. Q wave myocardial infarction (MI) occurred in only 0.7% of these patients and total stent thrombosis rate was 1.6% (n = 33). Independent predictors of thrombosis were PCI in the setting of MI (HR 11.2; 95% CI, 9.6-12.4, P = 0.001), lesion length (HR 4.6; 95% CI, 3.2-5.3, P = 0.031), moderate to severe calcification at lesion site (HR 13.1; 95% CI, 12.1-16.7, P < 0.001), and in-stent residual stenosis (HR 14.5; 95% CI, 10.2-17.6, P < 0.001). CONCLUSION: The use of DES in unselected population is associated with long-term safety and effectiveness with acceptable low rates of adverse clinical events.

HIPERTENSÃO E TECNOLOGIA: USO DE SOLUÇÃO DIGITAL E SEU IMPACTO NO ENGAJAMENTO DE PACIENTES E DESFECHOS CLÍNICOS / HYPERTENSION AND TECHNOLOGY: USE OF DIGITAL SOLUTION AND ITS IMPACT ON PATIENT ENGAGEMENT AND CLINICAL OUTCOMES

A hipertensão arterial sistêmica, principal fator de risco para as doenças cardiovasculares, é considerada a maior causa de mortes prematuras ao redor do mundo. Pacientes com baixa adesão ao tratamento apresentam maior risco de complicações, hospitalizações e morte prematura, além de aumentar a carga nos sistemas de saúde, onerando as economias nacionais. No Brasil, grande parte dos pacientes ainda apresenta um controle ruim dos fatores de risco cardiovascular, não atingindo as recomendações das principais diretrizes nacionais e internacionais. Com o intuito de trazer soluções para a falta de adesão, a tecnologia se torna uma importante aliada no automonitoramento e regularidade de tratamento. Aplicativos de automonitoramento com programas de gamificação são tecnologias emergentes, e seus resultados têm encorajado sua adoção porque estimulam os pacientes a se comprometerem com mudanças comportamentais e de estilo de vida. Elfie é uma solução digital inovadora e gratuita, validada pela Sociedade Brasileira de Cardiologia, pela Sociedade Brasileira de Diabetes e pela Associação Nacional de Atenção ao Diabetes, que, além de permitir que os usuários monitorem a sua condição física, também possam aprendam sobre sua saúde e recebam suporte personalizado por meio de um smartphone ou tablet, além de manter um banco de dados eletrônico para posterior consulta do próprio paciente e dos prestadores de cuidado à saúde, como médicos e nutricionistas. Os profissionais de saúde devem ser encorajados a discutir a utilidade desse tipo de ferramenta com seus pacientes, oferecendo, assim, a oportunidade de melhores desfechos clínicos e, consequentemente, reduzindo hospitalizações, mortalidade e custos em saúde.

Systemic Arterial Hypertension, the main risk factor for cardiovascular disease, is considered the greatest cause of premature deaths worldwide. Patients with low adherence to treatment are more susceptible for complications, hospitalizations, and premature death. In addition, there is an increasing burden on health systems and national economies for cardiovascular disease purposes. In Brazil, a large number of patients still have poor control of the risk factors, not reaching the recommendations of national and international guidelines. In order to attend with solutions, technology becomes an important ally in self-monitoring and regularity of treatment. Self-monitoring apps with gamification programs are emerging technologies which the results have encouraged their adoption because they inspire patients to commit with behavioral and lifestyle changes. Elfie is a novel free digital solution, endorsed by the Brazilian Society of Cardiology, the Brazilian Society of Diabetes and the National Diabetes Care Association. It allows the users to monitor and learn about their health and to receive personalized support through a smartphone or tablet. It also has a database that can be later accessed by the patient or healthcare providers, such as physicians and nutritionists. Healthcare professionals should be encouraged to discuss the advantages of these tools with their patients to offer an opportunity for better clinical outcomes and, consequently reduce hospitalizations, mortality and healthcare costs

Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism.

BACKGROUND: Evidence-based guidelines recommend that acutely ill hospitalized medical patients who are at risk of venous thromboembolism (VTE) should receive prophylaxis. Our aim was to characterize the clinical practices for VTE prophylaxis in acutely ill hospitalized medical patients enrolled in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). METHODS: IMPROVE is an ongoing, multinational, observational study. Participating hospitals enroll the first 10 consecutive eligible acutely ill medical patients each month. Patient management is determined by the treating physicians. An analysis of data on VTE prophylaxis practices is presented. RESULTS: From July 2002 to September 30, 2006, 15,156 patients were enrolled from 52 hospitals in 12 countries, of whom 50% received in-hospital pharmacologic and/or mechanical VTE prophylaxis. In the United States and other participating countries, 52% and 43% of patients, respectively, should have received prophylaxis according to guideline recommendations from the American College of Chest Physicians (ACCP). Only approximately 60% of patients who either met the ACCP criteria for requiring prophylaxis or were eligible for enrollment in randomized clinical trials that have shown the benefits of pharmacologic prophylaxis actually received prophylaxis. Practices varied considerably. Intermittent pneumatic compression was the most common form of medical prophylaxis utilized in the United States, although it was used very rarely in other countries (22% vs 0.2%, respectively). Unfractionated heparin was the most frequent pharmacologic approach used in the United States (21% of patients), with low-molecular-weight heparin used most frequently in other participating countries (40%). There was also variable use of elastic stockings in the United States and other participating countries (3% vs 7%, respectively). CONCLUSIONS: Our data suggest that physicians' practices for providing VTE prophylaxis to acutely ill hospitalized medical patients are suboptimal and highlight the need for improved implementation of existing evidence-based guidelines in hospitals.

O papel das startups / The role of startups

A incorporação de novas tecnologias na medicina e mais recentemente na cardiologia tem crescido em volume, e em ritmo cada vez mais acelerado. O conjunto de dados acumulados e as recentes demandas por otimização dos resultados com custos cada vez mais enxutos tem estimulado o surgimento de novas ideias e de ferramentas que atendam essas demandas. Nesse contexto surgiram as startups, inicialmente concebidas no meio financeiro nos Estados Unidos, criadas por grupos de jovens com ideias inovadoras e potencial para aumentar lucros com custos muito baixos. Por esse motivo, as startups foram originalmente criadas na internet. O artigo descreve características das startups desde a sua criação até os dias atuais, bem como suas aplicações na área do ensino e na prática da medicina cardiovascular

The incorporation of new technologies in medicine and more recently in cardiology has been increasing in volume and at an ever-faster rate. The set of accumulated data and the recent demands for optimizing results with low costs have stimulated new ideas and tools that meet these demands. In this context, the startups emerged in the financial sector of the United States, created by youth groups with innovative ideas. For this reason, startups were created on the Internet. The article describes characteristics of startups from their inception to the present, as well as their applications in the field of teaching and practicing cardiovascular medicine

Terapia de antiagregação plaquetária: prevenção primária e secundária / Platelet antiaggregation therapy: primary and secondary prevention, peculiarities in anticoagulation of the patient with DM

O diabetes mellitus (DM) é um importante e crescente problema de saúde, sendo que a doença aterosclerótica é uma importante comorbidade. Além do uso de fármacos, a prevenção da aterosclerose envolve mudança do estilo de vida como exercícios, nutrição, controle do peso e interrupção do tabagismo. O uso da aspirina possui papel bem estabelecido na prevenção secundária da doença cardiovascular (DCV) em pacientes com DM2, porém, o seu uso na prevenção primária permanece controverso e ainda com estudos em andamento. O objetivo desse estudo consistia em realizar uma revisão na literatura sobre as principais indicações para o uso da terapia de antiagregação plaquetária nos pacientes diabéticos. Já na prevenção secundária, o uso da aspirina é um consenso e a dupla terapia é indicada após síndromes coronárias agudas. As diretrizes não trazem informações específicas aos pacientes diabéticos, assim como, suas indicações clássicas na anticoagulação.

Terapia coagulante nas miocardiopatias / Anticoagulant therapy in myocardiopathies

Pacientes portadores de miocardiopatias (MCP) de etiologias variadas mesmo sem dilatação das cavidades atriais ou ventriculares podem apresentar elevação das taxas de eventos tromboembólicos (TE) no território arterial ou venoso. Idosos, pacientes com aumento no diâmetro do átrio esquerdo, que apresentem quadros congestivos eventualmente associados à fibrilação atrial (FA) representam o grupo de maior risco de TE. A identificação desses pacientes de maior risco, mesmo na ausência de sintomas correlatos ou de documentação de FA em exames de rotina, auxilia a redução do TE com impactos positivos sobre a morbidade e mortalidade dos pacientes portadores de MCP. A anticoagulação oral (ACO) por períodos curtos ou prolongados (ACOP) poderá ser prescrita para esse grupo de pacientes

Patients with cardiomyopathies (CMP) of varying etiologies, even without dilatation of the atrial or ventricular cavities, may present elevations in the rates of thromboembolic (TE) events in the arterial or venous territory. Elderly patients with increased left atrial diameter who present congestive symptoms possibly associated with atrial fibrillation (AF) represent the group with higher risks of TE. The identification of these higher-risk patients, even in the absence of correlated symptoms or documentation of AF in routine examinations, helps reduce TE, with positive impacts on the morbidity and mortality of patients with CMP. Short- -term or prolonged oral anticoagulation (OAC) may be prescribed for this group of patients

Terapia anticoagulante nas valvopatias / Anticoagulant therapy in valvulopathies

As valvopatias, especialmente na presença da fibrilação atrial (FA), aumentam o risco de eventos tromboembólicos que, além de modificar a história natural da doença, têm impacto significativo na sobrevida e na qualidade de vida dos pacientes. Além do envelhecimento da população mundial, com o consequente número crescente de pacientes com fibrilação atrial, há cada vez mais associações de valvopatias com a doença arterial coronariana (DAC). Nesse grupo de pacientes para os quais há indicação emergencial ou eletiva de intervenção coronariana percutânea (ICP) com implante de stents, serão prescritos antiplaquetários e anticoagulantes ao menos nos primeiros meses pós-ICP. A prevenção do tromboembolismo (TE) com anticoagulantes, como a varfarina ou com os anticoagulantes orais diretos (AOD), é recomendada na maioria das diretrizes. O emprego dos escores CHADS2-VASc e HAS-BLED são úteis para a quantificação dos riscos TE e hemorrágicos

Valvulopathies, especially in the presence of atrial fibrillation (AF), increase the risk of thromboembolic events, which in addition to modifying the natural history of the disease; have a significant impact on survival and quality of life of patients. In addition to the aging of the world's population, with a consequent increase in the number of patients with atrial fibrillation, there are increasing cases of associations of valvular diseases with coronary artery disease (CAD). In this group of patients, in whom there is an emergency or elective indication for percutaneous coronary intervention (PCI) with the implantation of stents, antiplatelet and anticoagulant therapies will be prescribed, at least in the first months after PCI. The prevention of thromboembolic events (TE) with anticoagulants, such as warfarin, or with direct oral anticoagulants (DAOCs), is recommended in most of the Guidelines. The use of the CHADS2-VASc and HAS-BLED scores are useful in the quantification of TE and hemorrhagic risks

Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators.

BACKGROUND: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. METHODS: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. RESULTS: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. CONCLUSIONS: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.

Predictive and associative models to identify hospitalized medical patients at risk for VTE.

BACKGROUND: Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization. METHODS: Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk. RESULTS: Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥ 2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥ 4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥ 2 was associated with higher overall and VTE-related mortality. CONCLUSIONS: Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.

Incidence and predictors of very late (>or=4 years) major cardiac adverse events in the DESIRE (Drug-Eluting Stents in the Real World)-Late registry.

OBJECTIVES: Our aim was to access the incidence of late major adverse cardiac events (MACE) and stent thrombosis (ST) in nonselected, complex patients followed for a period >/=4 years. BACKGROUND: Despite the efficacy of drug-eluting stents (DES) in reducing repeated target lesion revascularization, concerns regarding the occurrence of late and very late ST have partially obscured the benefits of this novel technology. METHODS: All consecutive patients treated solely with DES between May 2002 and January 2005 were enrolled into this prospective, nonrandomized, single-center registry. The primary end point was long-term occurrence of MACE up to 7 years. Independent predictors of MACE, cardiac death, target lesion revascularization, and ST were obtained by a multivariate Cox proportional hazards regression model. RESULTS: A total of 1,010 patients were enrolled. Most of them were men (77%) with a mean age of 63.7 years. Stent/patient rate was 1.4. Patients were kept in dual antiplatelet therapy for 3 and 6 months after Cypher (Cordis, Johnson & Johnson, Miami Lakes, Florida) and Taxus (Boston Scientific Corp., Natick, Massachusetts) stent implantation, respectively. Follow-up was obtained in 98.2% of the cohort (median 5.01 years). Survival free of MACE and cumulative incidence of definite/probable ST were 84.6% and 1.7%, respectively. Independent predictors of ST were percutaneous coronary intervention in the setting of acute myocardial infarction, DES overlapping, treatment of multivessel disease, presence of moderate-to-severe calcification at lesion site, and in-stent residual stenosis. CONCLUSIONS: The deployment of DES in complex, real-world patients resulted in a low rate of very long-term MACE and ST. However, ST still occurs very long after the index procedure.

Destaques do VII international symposium of thrombosis and anticoagulation (ISTA) / Highlights of VII international symposium of thrombosis and anticoagulation (ISTA)

O VII Simpósio Internacional de Trombose e Anticoagulação (ISTA) foi realizado em São Paulo, SP, Brasil, nos dias 24 e 25 de outubro de 2014, tendo como principais propósitos a discussão e o compartilhamento de conhecimentos sobre os avanços recentes na abordagem diagnóstica e terapêutica de pacientes com distúrbios trombóticos, nas suas diversas formas de apresentação clínica. O programa científico deste simpósio foi cuidadosamente desenvolvido por líderes de três importantes institutos de pesquisa clínica: o Instituto Brasileiro de Pesquisa Clínica(BCRI), o Duke Clinical Research Institute (DCRI), e Instituto de Pesquisa do Hospital do Coração. Composto por dois dias de apresentações acadêmicas e discussão aberta, o simpósio teve como principal objetivo educar, motivar e inspirar os clínicos, cardiologistas, hematologistas, e outros médicos através de apresentações e discussões de aspectos práticos de condutas que envolvem síndromes relacionadas à trombose e suas respectivas terapias antitrombóticas. Estas atividades possibilitaram uma interação direta entre a plateia e o corpo de palestrantes, composto por médicos de grande experiência clínica e pelos médicos pesquisadores que desenvolveram os principais estudos publicados que guiam nossas condutas em situações relacionadas ao tema "trombose e anticoagulação". Este artigo resume os anais deste simpósio.

The VII International Symposium on Thrombosis and Anticoagulation (ISTA) was held in São Paulo, Brazil, on 24 and 25 October 2014, with the main objectives to discuss and share knowledge on recent advances in the diagnosis and management of patients with thrombotic disorders. The scientific program of this symposium was carefully developed by leaders of three major clinical research institutes: the Brazilian Institute of Clinical Research (BCRI), the Duke Clinical Research Institute from Duke University, and the Research Institute from Hospital do Coração. Comprising two days of academic presentations and open discussion, the symposium aimed to educate, motivate and inspire clinicians, cardiologists, hematologists, and other doctors through presentations and discussions of practical aspects in themes related to thrombosis and anticoagulation. These activities were presented by physicians of great clinical experience and who participated in the main publications that guide our approach on situations related to the theme "thrombosis and anticoagulation". This article summarizes the proceedings of this symposium.