Prevalence of moderate-severe aortic stenosis in patients with cardiac amyloidosis in a referral center.

BACKGROUND: Aortic stenosis (AS) is currently the most common valvular disease, with an estimated prevalence of over 4% in octogenarians. OBJECTIVE: To describe the prevalence of moderate-severe aortic stenosis (AS) in patients with wild type transthyretin amyloidosis (ATTRwt). Also, describe the clinical features, echocardiographic characteristics and clinical evolution. METHOD: Retrospective cohort of patients with diagnosis of ATTRwt, belonging to Hospital Italiano de Buenos Aires Institutional Amyloidosis Registry, from 30/11/2007 to 31/05/2021. Patients follow up was carried out through the institution clinical history. The prevalence of moderate-severe AE was estimated and presented as a percentage with its 95% confidence interval (95% CI). The characteristics were compared by groups according to whether or not they had moderate-severe AS. RESULTS: 104 patients with ATTRwt were included. Median follow up was 476 days [interquartile range: 192-749]. Moderate-severe AS prevalence at the ATTRwt time of diagnosis was 10.5% (n = 11; 95% CI: 5-18%). The median age of patients with AS moderate-severe at the time of diagnosis of ATTRwt was 86 years [78-91] and the male sex predominated (82%). Most of the patients had a history of heart failure (n = 8) and atrial fibrillation (n = 8) prior to the diagnosis of ATTRwt. Most of the patients were subclassified as low flow low gradient severe AS group (n = 7). Four patients underwent some intervention on the aortic valve. During follow-up, 5 patients (46%) were hospitalized for decompensated heart failure and 4 (36%) died. CONCLUSIONS: In our cohort, the coexistence of both pathologies had a similar prevalence as reported in the international literature. It was an elderly population with a high percentage of atrial fibrillation and history of heart failure. Most of the patients presented with severe AS with low flow low gradient.

ANTECEDENTES: La estenosis aórtica (EA) es actualmente la enfermedad valvular más frecuente, con una prevalencia estimada de más del 4 % en octogenarios. OBJETIVO: Describir la prevalencia de estenosis aórtica (EA) moderada-grave en pacientes con amiloidosis por transtiretina wild type (ATTRwt). Además, describir las características clínicas, ecocardiográficas y la evolución en este grupo de pacientes. MÉTODO: Estudio de cohorte retrospectiva de pacientes con diagnóstico de ATTRwt, pertenecientes al Registro Institucional de Amiloidosis del Hospital Italiano de Buenos Aires, en el periodo del 30/11/2007 al 31/05/2021. El seguimiento de los pacientes se realizó a través de la historia clínica electrónica de la institución. Se estimó la prevalencia de EA moderada-grave, que se presenta como porcentaje con su intervalo de confianza del 95% (IC 95%). Se compararon las características por grupos según tuvieran o no EA moderada-grave. RESULTADOS: Se incluyeron 104 pacientes con diagnóstico de ATTRwt. La mediana de seguimiento fue de 476 días [rango intercuartílico: 192-749]. La prevalencia de EA moderada-grave al momento del diagnóstico de ATTRwt fue del 10.5% (n = 11; IC95%: 5-18%). La mediana de edad de los pacientes con EA fue de 86 años [78-91] y predominó el sexo masculino (81.8%). La mayoría de los pacientes tenían el antecedente de insuficiencia cardiaca (n = 8) y fibrilación auricular (n = 8). Predominaron los pacientes con EA grave de bajo flujo y bajo gradiente (n = 7). Cuatro pacientes fueron sometidos a alguna intervención en la válvula aórtica. Durante el seguimiento, 5 pacientes (46%) tuvieron internaciones por insuficiencia cardiaca descompensada y 4 (36%) fallecieron. CONCLUSIONES: En nuestra cohorte, la coexistencia de ambas patologías tuvo una prevalencia similar a la reportada en la literatura internacional. Se trató de una población añosa con alto porcentaje de fibrilación auricular y antecedente de insuficiencia cardiaca. La mayoría presentaron EA grave de bajo flujo y bajo gradiente.

Impact of C-reactive protein levels and role of anakinra in patients with ST-elevation myocardial infarction.

BACKGROUND: Interleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). The effectiveness of anakinra according to the degree of systemic inflammation in STEMI has not been addressed. METHODS: We analyzed 139 patients from three Virginia Commonwealth University Anakinra Response Trial randomized clinical trials to assess whether CRP levels predicted HF hospitalization or death in patients with STEMI, and if CRP levels influenced the effects of treatment with anakinra. RESULTS: CRP cut-off levels for prediction of the composite of death or HF hospitalization for CRP at admission, 3 and 14 days were, respectively 6.45 mg/L (100% of sensitivity and 66.1% specificity), 26 mg/L (100% of sensitivity and 78% specificity) and 9.56 mg/L (100% of sensitivity and 80% specificity). More patients with elevated CRP levels died or had a HF hospitalization (5/47 [11%] vs 0/82 [0%], p = 0.004 for CRP at admission; 5/32 [15.6%] vs 0/92 [0%], p < 0.001 for day 3 and 5/26 [19%] vs 0/89 [0%], p < 0.001 for day 14). A greater number of patients treated with anakinra had low CRP levels at 3 and 14 days compared to placebo (Odds Ratio 0.11 [95% IC 0.04-0.28], p < 0.0001 and OR 0.35 [95% CI 0.14-0.86], p = 0.02, respectively). Anakinra significantly prevented death or HF hospitalization in patients with high inflammatory burden (p = 0.04 for admission, p = 0.24 for day 3, and p = 0.05 for day 14). CONCLUSION: Patients with elevated CRP had higher incidence of HF hospitalization or death. Anakinra reduced the number of patients with elevated CRP levels and prevented death or HF hospitalization in patients with elevated CRP levels.

Response to interleukin-1 blockade with anakinra in women and men with ST-segment elevation myocardial infarction.

BACKGROUND: Interleukin-1 blockade with anakinra reduces high-sensitivity C-reactive protein (hsCRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra. METHODS: We analyzed the systemic inflammation and composite end-point of new-onset HF or death in women and men with STEMI treated with anakinra from three different Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials. RESULTS: We analyzed 139 patients, 29 (21%) were women while 110 (79%) were men. Baseline hsCRP was higher in women compared to men (8.9 [5.2-13.5] vs. 4.2 [2.1-7.7] mg/L, P<0.001). Eighty-four patients were treated with anakinra (22 [75%] women and 62 [56%] men). The area under the curve of hsCRP (hsCRP-AUC) after 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs. 223 [119-374] mg day/L) and in women (73 [46-313] vs. 242 [102-988] mg day/L) (P<0.001 for multiple groups, P for interaction 0.22). The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs. 14 [29.1%]) and in women (3 [13.6%] vs. 2 [28.5%]) (P=0.019 for multiple groups, P for interaction 0.44). There were no statistically significant differences between women and men in hsCRP-AUC and death or HF events when comparing separately the anakinra and placebo groups (all P>0.05). CONCLUSIONS: Women were underrepresented in the VCUART trials, they appeared to have higher hsCRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.

Chronic systemic glucocorticoid therapy is associated with increased risk of major vascular complications and cardiac tamponade after transcatheter aortic valve implantation: a systematic review and meta-analysis.

INTRODUCTION: TAVI-related complications, such as conduction disturbances, vascular complications or death may be related to increased inflammatory response. The aim of this study was to elucidate the efficacy and safety of the systemic glucocorticoid therapy regarding the adverse events after TAVI deployment. EVIDENCE ACQUISITION: We conducted a systemic search of PubMed, a reference list of relevant articles, and Medline. The main efficacy outcomes of interest were all-cause death, cardiac and non-cardiac death, permanent pacemaker implantation (PPM), new left bundle branch block (LBBB), stroke, and myocardial infarction (MI). Safety endpoints were major vascular complications, major bleeding events, and cardiac tamponade. EVIDENCE SYNTHESIS: A total of 7 studies including data from 3439 patients with a median follow-up was 30 days. Systemic glucocorticoid compared to the control group were associated with an increased risk of non-cardiac death (Relative Risk [RR] 5.90 95%CI [2.95; 11.80], P<0.001) major vascular complications (RR 1.78, 95%CI [1.22 - 2.61], P=0.003) and cardiac tamponade (RR 3.42, 95%CI [1.69 - 6.92], P<0.001). However, there were no differences in all-cause death, cardiac death, new LBBB, stroke, MI, or major bleeding events (all P values >0.05). CONCLUSIONS: Glucocorticoid therapy before the TAVI procedure was associated with an increase in non-cardiac death, major vascular events and cardiac tamponade. There were no differences in the risk of all-cause death, cardiac death, PPM or LBBB, stroke, or MI.

Dual Role of Guide Extension Catheters for the Management of High Thrombus Burden in STEMI: Case Report and Mini Review.

High thrombus burden in ST segment elevation myocardial infarction (STEMI) patients increases the risk of adverse events. In this report, we review current strategies for high thrombus burden and present a case report with the combination of two different techniques: aspiration through a guide extension catheter followed by local intracoronary thrombolysis with 'marinade' technique.

Prevalencia, predictores e impacto clínico de la rehospitalización en pacientes con estenosis valvular aórtica valorados por un Heart Team / Prevalence, Predictors and Clinical Impact of Readmission in Patients with Aortic Stenosis Evaluated by a Heart Team

RESUMEN Introducción: En nuestro medio existe escasa evidencia sobre la incidencia de rehospitalización, factores predictores y evolución clínica de los pacientes con estenosis aórtica (EAo) grave valorados por un Heart Team. Objetivos: Determinar la prevalencia, los predictores de rehospitalización y la evolución clínica de pacientes con EAo grave valorados por el Heart Team. Material y métodos: Estudio unicéntrico de cohorte retrospectivo, que incluyó pacientes con EAo grave valorados por el Heart Team. Se analizaron las características del total de la cohorte, y según la presencia o ausencia de rehospitalización, en un seguimiento de 2 años. Resultados: La edad promedio de la población (n = 275) fue de 83,3 ± 6,9 años, con 51,1% de sexo femenino y una incidencia de rehospitalización de 21,5%. Los pacientes rehospitalizados fueron más añosos (85,54 ± 6,66 vs. 82,62 ± 6,87 años; p = 0,003), más frágiles (97,4% vs. 89,3%; p = 0,035), con mayor riesgo quirúrgico (STS score 6,11 ± 4,79 vs. 4,72 ± 4,12; p = 0,033), y fibrilación auricular (FA) previa (40,7% vs. 23,6%; p = 0,009), en comparación con los no rehospitalizados. Se identificó la FA previa como factor de riesgo independiente de rehospitalización (OR 4,59; IC 95% 1,95-10,81, p<0,001). La incidencia de rehospitalización fue de 33,9% para el implante percutáneo de válvula aórtica (TAVI), 1,7% para la cirugía de reemplazo valvular (CRVAo), y 64,4% para el tratamiento conservador (p = 0,002). A 2 años, la rehospitalización se asoció a una mayor mortalidad (47,5% vs. 13,4%; p <0,001). Conclusiones: En pacientes con EAo grave valorados por un Heart Team se observó una significativa incidencia de rehospitalización a 2 años, que se asoció a mayor mortalidad. La FA fue un factor de riesgo independiente de rehospitalización.

ABSTRACT Background: There is scarce evidence in our setting regarding the prevalence of readmission, risk factors and clinical evolution of patients with severe aortic stenosis (AS) evaluated by a Heart Team. Objective: The aim of this study was to assess the prevalence, predictors and clinical evolution of readmission in patients with severe AS evaluated by a Heart Team. Methods: This was an observational, single-center, retrospective cohort study including patients with severe AS evaluated by a Heart Team. Total cohort characteristics were analyzed at baseline, and after stratification according to the presence or absence of readmission during a 2-year follow-up period. Results: Mean population age (n = 275) was 83.3 ± 6.9 years, and 51.1% were female patients. The prevalence of readmissions was 21.5%. Readmitted patients were older (85.54 ± 6.66 vs. 82.62 ± 6.87 years; p = 0.003) and had greater frailty (97,4% vs. 89.3%; p = 0.035), surgical risk (STS 6.11 ± 4.79 vs. 4.72 ± 4.12; p = 0.033), and previous history of atrial fibrillation (AF) (40.7% vs. 23.6%; p = 0.009), compared with non-readmitted patients. Prior AF was an independent risk factor of readmission (OR 4.59 [IC95% 1.95-10.81]; p <0.001). The prevalence of readmission was 33.9% for percutaneous aortic valve implantation (TAVI), 1.7% for valve replacement surgery (AVRS), and 64.4% for conservative treatment (p = 0.002). At 2 years, readmission was associated with lower survival (47.5% vs. 13.4%; p <0.001). Conclusions: In patients with severe AS evaluated by a Heart Team, a significant prevalence of readmission was observed at 2 years, and this was associated with higher mortality. Atrial fibrillation was an independent risk factor of readmissions.

Balloon aortic valvuloplasty through the novel transradial technique.

BACKGROUND: Balloon aortic valvuloplasty (BAV) has been typically performed through a femoral approach thus increasing the risk of bleeding and access site-related vascular complications. The aim of this study was to describe the safety and efficacy of transradial aortic valve valvuloplasty (TRBAV). METHODS: The present research is a retrospective, single-center study including patients undergoing TRBAV (October 2019-July 2020). BAV was performed using 18-25 mm balloons through an 8-10 French (F) radial sheath. Successful BAV was defined as ≥50% reduction in peak-to-peak gradient (efficacy endpoint). Procedural complications, including radial artery occlusion (RAO) at follow-up were evaluated (safety endpoint). RESULTS: Twenty-four patients underwent TRBAV were included, aged 81 (73-85) years, 70% males, EuroScoreII 3.1 (2.1-5.5). Aortic valve gradient was significantly reduced (pre-50±24 vs. 18.7±13 mmHg post, P<0.001), and 91% had successful BAV. Mean gradient drop was 31.4±16.8 mmHg. One patient (4%) required cross-over to femoral access for severe vasospasm and was excluded from the analysis. Most used sheaths were 8F (46%) and 9F (37%), mostly for 20 mm (50%) and 23 mm (38%) balloons. There were neither major procedural complications (neither balloon entrapment nor compartmental syndrome) nor minor complications (any access-site bleeding). RAO was observed in 2 patients (8%), both asymptomatic. CONCLUSIONS: TRBAV was safe, feasible, and efficacious with a small rate of conversion and RAO, suggesting reproducibility of this novel technique. TRBAV may represent an alternative to femoral access in selected patients although larger studies are warranted.

Prognostic impact of myocardial contraction fraction in patients undergoing transcatheter aortic valve replacement for aortic stenosis.

BACKGROUND: Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shortening, may help to improve risk stratification in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) especially in those with preserved left ventricular ejection fraction (LVEF). We investigated the association between MCF and 1-year all-cause mortality in patients with severe AS who underwent TAVR. METHODS: MCF was calculated as the ratio of stroke volume (SV) to myocardial volume. Patients referred for TAVR from 2011 to 2015 were eligible for inclusion and were divided into two groups according to the estimated MCF (MCF ≤30% vs. MCF >30%). The primary endpoint was 1-year all-cause mortality. A Cox regression analysis was performed for independent risk factors of mortality. Receiver operating curve (ROC) was performed for assessing the best cut-off point of MCF for predicting the primary outcome [area under the curve (AUC) 0.60; 95% confidence interval (CI): 0.453-0.725]. Baseline patient and echo characteristics were included for multivariate analysis. RESULTS: Of 126 patients (mean age 82±5 years, 45.2% male), 44.4% showed MCF ≤30%. Patient with reduced MCF showed higher body mass index (28.1±5.8 vs. 26.0±4.5 kg/m2, P=0.031), higher surgical EuroScore II (6.2±4.5 vs. 4.7±3.2, P=0.032), lower LVEF (54.2%±11.9% vs. 58.5%±10.8%, P=0.042) and more severe AS (indexed aortic valve area 0.40±0.09 vs. 0.45±0.10 cm2/m2, P=0.030). The median follow-up was of 14 [3.5-33] months, and 16% of patients died. Patients with MCF ≤30% showed significantly increased all-cause mortality (Log-rank P=0.002). In a multivariate model adjusting for clinical and echo variables, MCF ≤30% was independently associated with increased risk for all-cause 1-year mortality [hazard ratio (HR) 2.76, 95% CI: 1.03-7.77, P=0.04]. CONCLUSIONS: In a population of patients undergoing TAVR, MCF ≤30% was independently associated with increased mortality.

Balloon rupture during aortic valvuloplasty with compliant balloon: predictors and outcomes.

Objectives of the study were the prevalence and clinical consequences of balloon rupture with compliant balloons in balloon aortic valvuloplasty (BAV). Compliant low-profile balloons have been developed to reduce access site complications. Made by thinner materials, these balloons are more prone to rupture. This is a single-center retrospective analysis (2016-2018) of patients undergoing BAV with compliant balloons. Baseline echocardiography and computed tomography (CT) were analyzed. Best cutoff point for calcium score was assessed. Long-term mortality was analyzed with Kaplan-Maier. In vitro test was performed. Rupture occurred in 30/90 (33%) of BAVs independent of risk factors, surgical risk and frailty scores. Patients experiencing rupture had increased mean gradient [53.5 (44-64) vs 44 (35-49) mmHg, p < 0.05] and reduced aortic valve area [0.61 (0.46-0.76) vs 0.76 (0.64-0.83) mm2, p < 0.05]. Valve calcium score on CT > 2686 AU was more frequent in the rupture group (41% vs 10%, p < 0.05) and more patients in the third tertile of calcium score experienced rupture (75% vs 23% vs 41% for second and first tertile, p < 0.05). Median gradient reduction from baseline was similar among groups [30 (20-50) vs 30 (17-39) mmHg]. No patient with rupture had any complication. One-month and long-term mortality were similar (rupture 0% vs 3.5% no rupture from 1 month). In vitro test required more volume and strength to rupture the balloon than used in BAV. Balloon rupture is frequent in BAV using compliant balloons, occurs with more severe aortic stenosis, does not affect BAV efficacy and does not impair outcomes.

Economic benefits of fractional flow reserve utilization on intermediate lesions and its clinical impact after one year-follow up.

Background: Fractional flow reserve (FFR) is a proven technology for guiding percutaneous coronary intervention, but it is not reimbursed despite the fact that it frequently allows to defer revascularization. Our goal was to determine the economic benefit of FFR on intermediate lesions, as well as the clinical endpoints at 1 year follow up. Methods: Observational prospective study that included consecutive patients with intermediate lesions evaluated with FFR between April 2013 and March 2016. For the economic analysis we evaluated the specific resources used during the procedure. Clinical endpoints including cardiovascular death, target lesion revascularization and acute myocardial infarction, were followed up over a one-year period. Results: FFR was performed on 222 lesions in 151 consecutive patients. FFR was positive in 26.1% of the assessed lesions. The estimated total cost using FFR was US$ 891,290.08 while cost estimate without FFR was US$ 1,557,352, meaning 43% in cost savings. There was one cardiovascular death and two readmissions during follow up in the positive FFR group. Conclusions: FFR guided revascularization on intermediate coronary lesions resulted in an economic benefit by reducing overall costs without harming clinical outcomes.

Antecedentes: La reserva de flujo fraccional (FFR) es una herramienta con evidencia demostrada para guiar las angioplastias coronarias. El reembolso por los sistemas de cobertura de salud es parcial o nulo a pesar de frecuentemente diferir la angioplastia. Nuestro objetivo fue determinar el beneficio económico de la utilización del FFR en la evaluación de lesiones intermedias, y evaluar asimismo puntos finales clínicos en el seguimiento a un año. Métodos: Estudio observacional prospectivo que incluyó una cohorte de pacientes consecutivos con lesiones coronarias intermedias, evaluadas con FFR, entre abril de 2013 y marzo de 2016. Para el análisis económico se evaluaron los recursos específicos utilizados para la realización del procedimiento. Se analizaron puntos finales clínicos (muerte cardiovascular, revascularización de la arteria objetivo e infarto agudo de miocardio) durante la internación y en el seguimiento a un año. Resultados: Se incluyeron 222 lesiones en 151 pacientes consecutivos. Se registró FFR positivo en el 26.1% de las lesiones evaluadas. Se estimó que sin la utilización de FFR, 126 pacientes hubieran sido tratados con angioplastia transluminal coronaria y 25 con cirugía de revascularización miocárdica. El costo estimado con la utilización de FFR fue US$ 891,290.08, mientras que sin el mismo hubiera sido de US$ 1,557,352. Esto implicó un ahorro del 43% de los gastos. Se observaron una muerte de origen cardiovascular y dos reinternaciones en el grupo FFR positivo en el seguimiento a un año. Conclusiones: La revascularización de lesiones intermedias guiada por FFR resultó en un beneficio económico al reducir los costos generales sin resultar clínicamente perjudicial.

Beneficio económico en la utilización de reserva fraccional de flujo en lesiones coronarias intermedias y su impacto clínico a un año / Economic benefits of fractional flow reserve utilization on intermediate lesions and its clinical impact after one year-follow up

Resumen Antecedentes: La reserva de flujo fraccional (FFR) es una herramienta con evidencia demostrada para guiar las angioplastias coronarias. El reembolso por los sistemas de cobertura de salud es parcial o nulo a pesar de frecuentemente diferir la angioplastia. Nuestro objetivo fue determinar el beneficio económico de la utilización del FFR en la evaluación de lesiones intermedias, y evaluar asimismo puntos finales clínicos en el seguimiento a un año. Métodos: Estudio observacional prospectivo que incluyó una cohorte de pacientes consecutivos con lesiones coronarias intermedias, evaluadas con FFR, entre abril de 2013 y marzo de 2016. Para el análisis económico se evaluaron los recursos específicos utilizados para la realización del procedimiento. Se analizaron puntos finales clínicos (muerte cardiovascular, revascularización de la arteria objetivo e infarto agudo de miocardio) durante la internación y en el seguimiento a un año Resultados: Se incluyeron 222 lesiones en 151 pacientes consecutivos. Se registró FFR positivo en el 26.1% de las lesiones evaluadas. Se estimó que sin la utilización de FFR, 126 pacientes hubieran sido tratados con angioplastia transluminal coronaria y 25 con cirugía de revascularización miocárdica. El costo estimado con la utilización de FFR fue US$ 891,290.08, mientras que sin el mismo hubiera sido de US$ 1,557,352. Esto implicó un ahorro del 43% de los gastos. Se observaron una muerte de origen cardiovascular y dos reinternaciones en el grupo FFR positivo en el seguimiento a un año. Conclusiones: La revascularización de lesiones intermedias guiada por FFR resultó en un beneficio económico al reducir los costos generales sin resultar clínicamente perjudicial.

Abstract Background: Fractional flow reserve (FFR) is a proven technology for guiding percutaneous coronary intervention, but it is not reimbursed despite the fact that it frequently allows to defer revascularization. Our goal was to determine the economic benefit of FFR on intermediate lesions, as well as the clinical endpoints at 1 year follow up. Methods: Observational prospective study that included consecutive patients with intermediate lesions evaluated with FFR between April 2013 and March 2016. For the economic analysis we evaluated the specific resources used during the procedure. Clinical endpoints including cardiovascular death, target lesion revascularization and acute myocardial infarction, were followed up over a one-year period. Results: FFR was performed on 222 lesions in 151 consecutive patients. FFR was positive in 26.1% of the assessed lesions. The estimated total cost using FFR was US$ 891,290.08 while cost estimate without FFR was US$ 1,557,352, meaning 43% in cost savings. There was one cardiovascular death and two readmissions during follow up in the positive FFR group. Conclusions: FFR guided revascularization on intermediate coronary lesions resulted in an economic benefit by reducing overall costs without harming clinical outcomes.

Angioplastia coronaria en pacientes octogenarios. Resultados alejados y predictores de mal pronóstico / Percutaneous Coronary Intervention in Octogenarian Patients. Long-term Results and Predictors of Poor Outcome

RESUMEN: Introducción: La angioplastia coronaria en octogenarios aumenta, pero esta población está poco representada en los estudios aleatorizados por su alto riesgo. Objetivos: Evaluar los resultados de angioplastia coronaria de pacientes octogenarios e identificar predictores independientes de mala evolución en el seguimiento. Material y métodos: Estudio retrospectivo, pacientes consecutivos con angioplastia coronaria junio 2011 a Septiembre 2013 en un Hospital Polivalente. Se compararon octogenarios (edad ≥ 80 años) con el resto. Se evaluaron las características basales y del procedimiento. Se evaluó la mortalidad y los eventos cardiovasculares mayores (MACE, muerte, infarto o stroke) a 30 días, 1 y 3 años. Se realizó un análisis univariado y multivariado para predictores de mala evolución. Resultados: Se incluyeron 1030 pacientes, 20,2% octogenarios. La edad promedio de los octogenarios era de 83 años (RIC 81-86). Estos presentaron más factores de riesgo y comorbilidades. La tasa de éxito y la cantidad de stents fue similar entre los grupos. La tasa de MACE fue mayor en octogenarios a 30 días (14,4% vs. 4,9%; p < 0,001), 1 año (23,9% vs. 8,5%; p < 0,001) y a 3 años (p < 0,0001), a expensas de mortalidad sin diferencias en el infarto (4,8% vs. 3,8%), el stroke (1,7% vs. 1,6%), ni en complicaciones del procedimiento. Los predictores independientes de muerte en octogenarios incluyen IRC, EPOC y deterioro de la función ventricular. La edad ≥ 80 años fue un predictor independiente de MACE en la población general. Conclusiones: Observamos una aceptable tasa de éxito de angioplastia coronaria en pacientes octogenarios, asociada con un aumento de la mortalidad inmediata y alejada que no parece relacionada con el procedimiento. La IRC, el EPOC y el deterioro de la función ventricular son predictores independientes de mal pronóstico en estos pacientes.

Avaliação do stent coronário eluidor de everolimus XIENCE TM V na cpopulação feminina latino-americana do estudo de braço único SPIRIT Women: acompanhamento clínico de um ano / Evaluation of the XIENCE TM V everolimus-eluting coronary stent system in the female latin american population of the SPIRIT Women single-arm study: one-year clinical follow-up data

INTRODUÇÃO: Os estudos com stents farmacológicos têm avaliado predominantemente populações masculinas de descendência europeia. O estudo de braço único SPIRIT Women avalia o stent eluidor de everolimus XIENCE TM V em lesões de novo complexas em uma população feminina do mundo real, incluindo pacientes latino-americanas. Esta análise permite compreender como essa população responde ao implante de stent, comparativamente a pacientes não-latino-americanas. MÉTODOS: Das 1.572 pacientes matriculadas em 73 locais fora dos Estados Unidos, 138 (9%) foram recrutadas na Argentina, no Brasil e na Venezuela. RESULTADOS: As lesões-alvo tinham diâmetro de referência do vaso entre 2,25 mm e 4 mm e extensão da lesão ≤ 28 mm. As características basais foram semelhantes entre os grupos, com exceção de maior prevalência de hipertensão arterial, infarto do miocárdio (IM) de parede anterior e história familiar de doença arterial coronária na coorte latino-americana. As lesões tendiam a ser mais complexas em mulheres latino-americanas, com menor diâmetro de referência do vaso-alvo, maior extensão da lesão, maior excentricidade e angulação e mais lesões tipo B2/C. Os eventos foram adjudicados de acordo com as definições do Academic Research Consortium. Em um ano, o desfecho combinado de morte por todas as causas, IM e revascularização do vaso-alvo (RVA) foi de 12,1% na população não-latino-americana e de 10,1% na população latino-americana (P = 0,58). CONCLUSÕES: Em um ano, os baixos índices de eventos cardíacos adversos, incluindo trombose do stent, falha da lesão-alvo, morte cardíaca, IM e RVA nas mulheres latino-americanas foram comparáveis aos das mulheres não-latino-americanas, apesar da maior complexidade das lesões. Esses resultados demonstram a segurança e a eficácia do stent XIENCE TM V nessa pequena coorte de pacientes latino-americanas, à semelhança do que é observado com populações maiores e mais variadas.

BACKGROUND: Drug-eluting stent trials have predominantly examined male populations of European descent. SPIRIT Women single-arm study evaluates the XIENCE TM V everolimus-eluting stent in complex de novo lesions in a real world female population, including Latin American patients. This analysis provides an insight into how this population responds to stenting when compared to non-Latin American patients. METHODS: Of the 1,572 patients enrolled from 73 non-US sites, 138 (9%) were recruited from Argentina, Brazil and Venezuela. RESULTS: Target lesions had reference vessel diameter ranging between 2.25 mm and 4 mm and lesion length ≤ 28 mm. Baseline characteristics were similar between the groups, with exception to a higher prevalence of hypertension, anterior myocardial infarction (MI) and family history of coronary artery disease in the Latin American cohort. Lesions tended to be more complex in Latin American women with a smaller reference vessel diameter, longer lesion length, increased eccentricity and angulation, and more type B2/C lesions. Events were adjudicated according to the guidelines of the Academic Research Consortium. At 1 year, the composite endpoint of death, MI and target vessel revascularization (TVR) was 12.1% in the non-Latin American population and 10.1% in the Latin American population (P = 0.58). CONCLUSIONS: At 1 year, the low rates of adverse cardiac events, including stent thrombosis, target lesion failure, cardiac death, MI and TVR in Latin American women were comparable to those of the non-Latin American women, despite the higher complexity of lesions. These results demonstrate the safety and efficacy of the XIENCE TM V stent in this small cohort of Latin American patients, in line with what is observed in larger and more varied populations.