RESUMO
INTRODUCTION AND OBJECTIVES: Transfemoral access is the most frequently used vascular approach in chronic total occlusion percutaneous coronary interventions (CTO-PCI). The aim of this study was to evaluate the safety and feasibility of a transradial access CTO-PCI program and its impact on angiographic and clinical results and length of hospital stay. METHODS: Retrospective multicenter cohort study including 2550 consecutive CTO-PCI procedures included in a multicenter registry with accurate information on vascular access. A total of 896 procedures were performed as radial-only access while 1654 were performed through at least 1 femoral puncture. Clinical and angiographic data were collected. RESULTS: The mean age was 66.3± 11.4 years. The mean Japan-chronic total occlusion score (2.7±0.3) was similar in the 2 groups. Successful revascularization was achieved in 2009 (79.6%) cases, 78.2% and 82.1% in the femoral and radial access cohorts, respectively (P=.002). Periprocedural in-hospital complications were observed in 5.1% and 2.3% (P=.02), with fewer access site-dependant vascular complications in the transradial cohort (2.3% vs 0.2%; P=.009). The mean length of hospital stay was significantly shorter in the transradial access group (0.89±1.4 vs 2.2±3.2 days, P<.001). CONCLUSIONS: A transradial program for CTO-PCI is safe and effective in most CTO lesions. The transradial strategy has fewer vascular complications and shorter length of hospital stay without compromising the success rate.
Assuntos
Doenças Cardiovasculares , Oclusão Coronária , Intervenção Coronária Percutânea , Humanos , Pessoa de Meia-Idade , Idoso , Intervenção Coronária Percutânea/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Estudos de Viabilidade , Estudos de Coortes , Artéria Radial/cirurgia , Artéria Femoral/cirurgia , Resultado do Tratamento , Angiografia Coronária , Sistema de Registros , Doença CrônicaRESUMO
INTRODUCTION AND OBJECTIVES: Up to 25% of patients who undergo a percutaneous coronary intervention show some limitation in the use of drug-eluting stents. The aim of this study was to evaluate if titanium-nitride-oxide-coated stents could be a good alternative to everolimus-eluting stents in diabetic patients. METHODS: A total of 173 diabetic patients with lesions at moderate risk of restenosis (exclusion criteria: diameter < 2.5 mm or length > 28 mm in vessels < 3mm, chronic occlusion) were randomized to a titanium group (83 patients) or an everolimus group (90 patients). RESULTS: Baseline characteristics were well balanced; 28.3% of patients were insulin dependent. At 1 year, the incidence of major adverse cardiac events (death, nonfatal myocardial infarction, stroke, or repeat target vessel revascularization) was significantly higher in the titanium group than in the everolimus group (total, 14.5% vs 4.4%; P = .02; noninsulin-dependent subgroup, 9.7% vs 3.2%; P = .14; insulin-dependent subgroup, 28.6% vs 7.1%; P = .04). The incidence of death, nonfatal myocardial infarction, stroke, or any revascularization was 16.9% in the titanium group and 7.8% in the everolimus group (P = .06). Target lesion and vessel revascularizations occurred in 8.4% compared with 3.3% (P = .15) and in 13.3% compared with 3.3% (P = .01) in the titanium and everolimus groups, respectively. Angiographic follow-up at 9 months showed significantly less late lumen loss in the everolimus group (in-segment, 0.52 [standard deviation, 0.58) mm vs -0.05 [0.32] mm; in-stent, 0.76 [0.54] mm vs 0.13 [0.31] mm; P < .0001). CONCLUSIONS: The everolimus-eluting stent is superior to the titanium stent for clinical and angiographic end points in diabetic patients with lesions at moderate risk of restenosis.
Assuntos
Reestenose Coronária/prevenção & controle , Complicações do Diabetes/terapia , Stents Farmacológicos , Imunossupressores/uso terapêutico , Sirolimo/análogos & derivados , Stents , Idoso , Reestenose Coronária/epidemiologia , Reestenose Coronária/mortalidade , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/mortalidade , Everolimo , Feminino , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Sirolimo/administração & dosagem , Sirolimo/uso terapêutico , TitânioRESUMO
INTRODUCTION AND OBJECTIVES: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI. METHODS: The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically. RESULTS: Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs. 45%; P=1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%. CONCLUSIONS: Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of ST-segment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved.
Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/etiologia , Tratamento de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Infarto do Miocárdio/complicações , Choque Cardiogênico/complicaçõesRESUMO
Existe un grupo de medidas que pueden ser implementadas sin que requieran grandes esfuerzos materiales, encaminadas a disminuir la mortalidad por infarto agudo del miocardio. Es nuestro objetivo hacer meditar sobre el tema, por ello aportamos datos tomados de la literautra médica. Sugerimos algunas actuaciones que pueden resultar beneficiosas al paciente
Assuntos
Humanos , Infarto do Miocárdio , Serviços Médicos de Emergência/métodosRESUMO
Con el objetivo de comparar la eficacia antihipertensiva del quinapril y la nitrendipina en sendas dosis de 20 mg QD se realizó un ensayo aleatorizado, paralelo, doble ciego, precedido de una etapa de "lavado" con placebo durante 14 días. Se incluyó a 30 pacientes hipertensos clase I o II de acuerdo con el VI Reporte Nacional Conjunto. La etapa de tratamiento duró 30 días. Después de la primera semana se le registró a cada paciente un tensiograma. Antes y al final del tratamiento cada paciente realizó una prueba ergométrica con el objetivo de medir la capacidad al esfuerzo y la respuesta hipertensiva. La nitrendipina redujo a cifras normales de presión arterial (< 90/< 140 mmHg) en el 20 (por ciento) más de pacientes que el quinapril (p < 0,01). La presión sistólica también se normalizó en más pacientes con nitrendipina (73 (por ciento) vs 27 (por ciento); p < 0,001). La reducción de la presión diastólica también fue significativamente mayor en los pacientes que recibieron nitrendipina. Al ejercicio ambos medicamentos aumentaron la carga al esfuerzo, disminuyeron el doble producto y la presión sistólica a la misma carga, aunque las diferencias no fueron estadísticamente significativas. Se concluye que la nitrendipina es, como monoterapia antihipertensiva y dosis similares, más efectiva que el quinapril
Assuntos
Anti-Hipertensivos , Di-Hidropiridinas , Eficácia , Hipertensão/tratamento farmacológicoRESUMO
El termino "crisis hipertensivas" frecuentemente usado para designar aumentos de la tension arterial, se divide en la actualidad en emergencias (poco frecuentes) y urgencias (mucho mas frecuentes). Esta clasificacion permite un enfoque racional del problema y destaca que no debe tratarse solo un nivel absoluto de presion. En este trabajo presentamos situaciones frecuentes en la practica medica y su forma de atenderlas, fundamentalmente las urgencias hipertensivas. Se comentan posibles variantes terapeuticas y se senala el mal uso de otras (por ejemplo, la furosemida). Se ofrecen elementos que permiten individualizar a cada paciente y actuar segun los recursos disponibles, se debe recordar que es mas dificil mantener el control cronico de la hipertension que llevar a la normalidad las alzas tensionales agudas
Assuntos
Atenolol/uso terapêutico , Captopril/uso terapêutico , Clonidina/uso terapêutico , Emergências , Furosemida/uso terapêutico , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Nifedipino/uso terapêuticoRESUMO
Con el propósito de explorar la influencia de la isquemia posinfato sobre la fracción de eyección ventricualr izquierda (FEVI), se estudiaron 68 pacientes con un infarto del miocardio mediante una ventriculografía nuclear en reposo y esfuerzo. Los pacientes fueron divididos en 2 grupos: grupo I (n=30) con isquemia transitoria residual y grupo II (n=38) sin isquemia residual. A su vez los pacientes del grupo I se subdividieron en: con isquemia en la zona de infarto (n=19) y a distancia del mismo (n=11). Veintisiete paciente (90 %) del grupo I no presentaron angina durante el esfuerzo. La FEVI durante el esfuerzo disminuyó en el grupo I y aumentó en el grupo II. En el grupo I hubo más hipocinesias y acinecias en reposo que en el grupo II (p < 0,01). Los casos con isquemia en el infarto tuvieron una FEVI significativamente menor en reposo que aquéllos con isquemia a distancia, pero también hubo más pacientes con infarto de cara anterior entre ellos. La FEVI al esfuerzo disminuyó significativamente más en los que tuvieron isquemia a distancia. Se concluye que la localización del infarto es determinante en la FEVI de reposo, mientras que la isquemia a distancia influye en mayor magnitud sobre la disminución de la FEVI en esfuerzo