Aterosclerosis en puente venoso aorto-coronario: hallazgos del OFDI: caso clínico / Findings of optical coherence tomography in saphenous grafts failure: report of one case

Atherosclerosis is the main cause of late saphenous vein graft (SVG) failure. Intracoronary images using optical coherence tomography (OCT) in addition to angiography allow a detailed analysis of the lesion beyond the degree of stenosis. We report a 67 years old diabetic male who underwent coronary surgery in 2009, consulting for an acute coronary syndrome. Angiography showed two different lesions on one aortocoronary venous grafts. OCT demonstrates atherosclerosis in different stages identifying the culprit lesion. Stent placement were successfully carried out.

Sobrevida a largo plazo de pacientes con infarto agudo del miocardio en presencia de oclusiones crónicas totales en vaso no culpable / Prognostic value of the presence of a chronic total occlusion in patients with acute myocardial infarction

BACKGROUND: The presence of a chronic total occlusion (CTO) in a non-infarct-related artery in patients with acute myocardial infarction (AMI), may be a sign of bad prognosis. AIM: To estimate the long-term survival of patients with AMI who were studied with coronarography during 2013-2014 who had one or more CTO in a non-infarct-related artery. MATERIAL AND METHODS: Review of coronary angiograms performed between 2013 and 2014 to patients with an AMI. Patients were grouped as having or not a CTO in a non-infarct-related artery. Their medical records were reviewed, and mortality was determined requesting their death certificates. RESULTS: Of 993 patients with AMI under-going coronarography, 233 (23.5%) had at least one CTO. Patients with CTO were older (66 and 62 years respectively). They also had a higher prevalence of hypertension, diabetes mellitus (DM), kidney failure and moderate to severe systolic ventricular dysfunction. The independent predictors of mortality were CTO, age, DM and kidney failure. Survival at an average follow-up period of 57 months was significantly higher in patients without CTO (89.5 and 80.3% respectively, p < 0.01). CONCLUSIONS: The presence of CTO in patients with acute myocardial infarction is associated with a higher frequency of cardiovascular risk factors and lower long-term survival.

Sobrevida alejada de los pacientes con estenosis aórtica severa tratados con implante valvular percutáneo / Long-term survival of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS). Aim: To analyze the clinical results and long-term survival of TAVI in our center. Material and Methods: Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%. Results: In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%. Conclusions: In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival.

Diferencias en la aterosclerosis coronaria entre hombres y mujeres con Diabetes Mellitus tipo 2 evaluados con el Score de Gensini / Differences in coronary atherosclerosis assessed with the Gensini score between men and women with type 2 Diabetes

Antecedentes y Objetivos: Las mujeres diabéticas tienen mayor morbi-mortalidad asociada a eventos coronarios isquémicos que los hombres. Este estudio describe la extensión, magnitud y severidad de la ateros-clerosis coronaria entre hombres y mujeres con diabetes mellitus tipo 2. Métodos: Estudio de tipo descriptivo que incluyó a 162 pacientes diabéticos consecutivos con sospecha de aterosclerosis coronaria y estudiados con coronariogra-fía. La magnitud de la aterosclerosis fue cuantificada utilizando el Score de Gensini. Resultados: La edad promedio fue 64.8 años. Noventa y cuatro eran mujeres (58.0 por ciento). El tiempo de evolución de la diabetes fue mayor para mujeres que para hombres (152.1 +/- 90.0 vs 120.2 +/- 99.4 meses) respectivamente (p<0.05). Las mujeres tuvieron un índice de masa corporal (30.5 +/- 5.1), superior al de los hombres (28.5 +/- 5.2) (p<0.05). La aterosclerosis coronaria significativa estuvo presente en el 61.7 por ciento de toda la población diabética, siendo en hombres de 76.5 por ciento versus 51.5 por ciento en mujeres (odds ratio: 1.5). El número de placas ateroscle-róticas fue 195 en 68 hombres (2,86 placa/paciente) y de 168 en 94 mujeres (1,78 placa/paciente) (p<0.0043). La presencia de aterosclerosis significativa en 1, 2 y 3 vasos se observó en el 7.4 por ciento; 17.6 por ciento y 51.5 por ciento de los hombres, respectivamente, versus el 12.8 por ciento; 10.6 por ciento y 27.7 por ciento en las mujeres, (p<0.0002). La magnitud de la enfermedad coronaria medida con el Score de Gensini fue 69.4 +/- 66.7 en hombres versus 35.6 +/- 47.3 en mujeres (p<0.005). Conclusión: En este estudio observamos que hombres diabéticos tienen mayor extensión, magnitud y severidad de aterosclerosis coronaria que las mujeres diabéticas.

Diabetic women have higher morbidity and mortality associated with ischemic coronary events than diabetic men, but the extension of coronary artery disease in both groups is less well established. Aim: to compare the extension, magnitude and severity of coronary atherosclerosis between men and women with type 2 diabetes mellitus. Method: 162 consecutive diabetic patients with suspected coronary atherosclerosis studied by coronary angiography were included. The magnitude of atherosclerosis was quantified using the Gensini Score. Results: The average age was 64.8 years. Ninety-four patients were women (58.0 percent). Diabetes was present for 152 +/- 90.0 months for women and 120 +/- 99.4 months for men (p <0.05). Women had a higher body mass index (30.5 +/- 5.1) than men (28.5 +/- 5.2, p<0.05). The presence of significant coronary atherosclerosis in the entire diabetic population was of 61.7 percent: 76.5 percent in men and 51.5 percent in women (OR 1.5). The mean number of atherosclerotic plaques was 195 in 68 men (2.86 plaques/patient) and 168 in 94 women (1.78 plaques/patient, p=0.0043). Significant atherosclerosis in 1, 2 and 3 vessels was observed in 7.4 per cent, 17.6 percent and 51.5 percent of men, respectively, versus 12.8 percent, 10.6 percent and 27.7 percent in women (p<0.0002). The magnitude of coronary disease measured by Gensini Score was 69.4 + 66.7 in men versus 35.6 +/- 47.3 in women (p<0.005). Conclusion: Men with diabetes have greater extension, magnitude and severity of coronary atherosclerosis than diabetic women.

Acceso radial durante la angioplastía primaria en el infarto agudo al miocardio / Radial artery access to perform primary angyoplasty in acute myocardial infarction

Introdución: El acceso radial (AR) ha demostrado reducir las complicaciones vasculares asociadas a la coronariografía y angioplastía coronaria; sin embargo, su rol en la angioplastía primaria (AP) durante el infarto agudo al miocardio con supradesnivel del segmento ST (IAM c/SDST) es muy escasa. En diciembre de 2007, nuestro equipo adoptó esta técnica como primera opción durate la AP Objetivo. Estudiar si el AR durante la AP es tan rápido y seguro como el acceso femoral (AF). Métodos: Utilizando el registro de nuestro laboratorio, analizamos todos los pacientes con IAM c/SDST que fueron tratados con AP en nuestro hospital en el período Septiembre 2005 - Agosto 2009, y luego de identificar los pacientes de acuerdo al AF y AR, comparamos el tiempo "puerta-balón", los resultados an-giográficos, el éxito clínico y las complicaciones relacionadas al acceso. El seguimiento se efectuó a través de las visitas médicas y vía telefónica. Los valores se muestran como promedio +/- DS. Resultados: En el periodo estudiado, en 354 (75 por ciento) pacientes se utilizó AF y en 118 (25 por ciento) el AR. La edad promedio de ambos grupos fue similar, 61+/-12 años en el grupo con AF vs 62+/-12 años en AR (p=ns) y no hubo diferencias en las características clínicas de los grupos. El tiempo "puerta-balón" fue 62+/-37 minutos vs 61+/-29 minutos en AF y AR respectivamente (p=ns) con una tasa de éxito superior al 94 por ciento en ambo grupos. En el grupo de AF hubo 3 por ciento de complicaciones vasculares vs 0 por ciento en AR. La mortalidad global a 30 días fue 5,1 por ciento en el grupo de AF y de 4,0 por ciento en AR (p=ns). Conclusión: El acceso radial para la AP permite abrir la arteria culpable en tiempos similares al AF y con una menor incidencia de complicaciones vasculares.

Background: Radial access (RA) has been shown to help reduce vascular complications of coronary ar-teriography and angioplasty (PTCA). However, little experience has been reported with RA to perform primary PTCA in ST elevation acute myocardial infarction (STEMI). Since December 2007, we selected RA as a first option for primary PTCA in STEMI. Aim: to determine whether RA is as effective, safe and expeditious as femoral access (FA) in primary PTCA for STEMI Method: we performed a retrospective review of our database of all patients undergoing primary PTCA in our laboratory from Sept 2005 through August 2009. We compared all patients who had a PTCA using a FA to those in whom the RA was used. The door to balloon time, angiographic results, clinical success rate and complications related to the vascular access were compared between groups. Follow-up was based con clinical visits and phone calls. Values are expressed as mean and SD. Results: 375 patients had an FA (75 percent) and 118 an RA (25 percent). Mean age was similar in both groups (61+/-12 vs 62+/-12, respectively, NS). Selected clinical characteristics did no differ between groups. Door to balloon time was 62+/-37 min for FA and 61+/-29 min for RA (NS). Clinical success rate exceeded 94 percent in both groups. Vascular complications occurred in 3 percent in the AF group. No vascular complications were observed in the RA group. Thirty day overall mortality rates were 5.2 percent in FA and 4.0 percent in RA (NS). Conclusion: Radial access can be used for primary PTCA in STEMI with similar success rates and lower incidence of vascular complications, when compared to the traditional femoral access.