Identifying patients at risk for premature discontinuation of thienopyridine after coronary stent implantation.

We sought to identify patients at risk for premature discontinuation of thienopyridines and to develop a risk score for thienopyridine adherence after coronary stent implantation. Patients were prospectively included from December 2007 to March 2008. At 1-month follow-up, all patients were given the Morisky questionnaire and asked if they had stopped taking thienopyridines. Multivariate analysis identified predictors of thienopyridine discontinuation; points were assigned to each variable according to the odds ratios and the c-statistic of the score was calculated. Mean age of the 400 patients included was 61.0 ± 10.4 years; 66 patients (16.5%) stopped thienopyridines after 1 month. Reasons for discontinuation were cost (62%), lack of information (17%), and recommendation by another doctor to stop treatment (15%). Factors associated with discontinuation included unmarried status (odds ratio 2.48, p = 0.046), lack of private health insurance (odds ratio 4.68, p = 0.041), acute coronary syndrome (odds ratio 2.31, p = 0.004), nondiabetics (odds ratio 2.20, p = 0.041), and patients who earned <2 times (odds ratio 8.23, p <0.001) and 2 to 3 times (odds ratio 4.46, p = 0.021) the minimum wage. Total risk score was 0 to 14 points and was strongly associated with thienopyridine discontinuation. For total scores of 0 to 4, 5 to 8, 9 to 12, and ≥13, 0%, 7%, 20%, and 37% of patients, respectively, stopped thienopyridines (c-statistic 0.76, p <0.0001). Risk score was also significantly associated with complete adherence as assessed by the Morisky questionnaire (c-statistic 0.74, p <0.001). In conclusion, we have identified patients at risk for premature discontinuation of thienopyridines using variables obtained before stent implantation and developed a risk score that accurately predicts premature thienopyridine discontinuation.

Stent direto na intervenção coronária primária: avaliação de seu uso na prática clínica contemporânea / Direct stenting in primary percutaneous coronary intervention: an evaluation in current clinical practice

INTRODUÇÃO: Existem poucos estudos contemporâneos avaliando o implante de stent direto em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM). Método: Estudo de coorte prospectivo com pacientes consecutivamente atendidos com IAM em um centro de referêncioa em cardiologia entre dezembro de 2009 e janeiro de 2010. Dados clínicos e laboratoriais, características angiográficas e evolução hospitalar foram avaliados. Foram excluídos pacientes com mais de 12 horas de evolução, com menos de 18 anos de idade ou por recusa em participar do estudo. Os pacientes submetidos a implante de stent direto foram comparados àqueles tratados com pré-dilatação. Os dados foram armazenados em banco de dados dedicado e analisados com SPSS 17.0. Resultados: No período de estudo, 98 pacientes foram submetidos a angioplastia primária, dos quais em 33 (34,7 por cento) foi implantado stent direto e em 65 (65,3 por cento) foi realizada pré-dilatação. A média de idade dos 98 pacientes foi de 58,6 +- 10,6 anos e 63 por cento eram do sexo masculino. Os procedimentos com stent direto foram menos frequentes em lesões calcificadas (9 por cento vs. 30 por cento; P + 0,02) e mais frequentes naqueles com TIMI 3 pré-procedimento (41 por cento vs. 18 por cento; P=0,06), sendo a tromboaspiração...

BACKGROUND: There are few contemporary studies assessing direct stenting in patients with acute ST-segment elevation myocardial infarction (AMI). METHOD: Prospective cohort study in consecutive patients with AMI seen at a reference cardiology center from December 2009 to January 2010. Clinical and laboratory data, angiographic characteristics and hospital outcomes were evaluated. Patients with over 12 hours of symptom onset, with less than 18 years of age and those who denied participating in the study were excluded. Patients undergoing direct stenting were compared to those treated with stent with balloon pre-dilatation. Data were entered in a dedicated database and analyzed by SPSS 17.0. RESULTS: During the study period, 98 patients were submitted to primary angioplasty, of which 33 (34.7%) received direct stenting and 65 (65.3%) underwent stent with balloon pre-dilatation. Mean age was 58.6 ± 10.6 years and 63% were men. Direct stenting was less frequent in calcified lesions (9% vs. 30%; P = 0.02) and more frequent in those with TIMI 3 before the procedure (41% vs. 18%; P = 0.06) and thrombus aspiration was more frequently used in these cases (41% vs. 14%; P = 0.003). There was no statistically significant difference for the clinical outcome in both groups of patients. CONCLUSION: Direct stenting was more frequently used in patients with normal flow prior the procedure and in combination with thrombus aspiration and less used in calcified lesions. It was not associated to significant differences in clinical outcome rates.

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do registro IC-FUC / Predictors and incidence of vascular complications after percutaneous coronary interventions: findings from the IC-FUC registry

Introdução: As complicações vasculares (CV) são uma das principais causas de morbidade e mortalidade em pacientes submetidos a intervenções coronárias percutâneas (ICPs), porém estudos anteriores não refletem a prática atual. Objetivos: Avaliar a incidência de CV e seus preditores, em uma população de pacientes tratada com ICP contemporaneamente. Método: Estudo observacional de corte transversal, com implantes de stents coronários, de janeiro de 2000 a dezembro de 2007. As características clínicas e angiográficas e a evolução intra-hospitalar foram avaliadas e registradas em banco de dados informatizados. Foram excluídos aqueles com óbito hospitalar ou cirurgia cardíaca de urgência. CV foram definidas como sangramento maior, cirurgia vascular ou hematoma > 10 cm. Os dados foram analisados com SPSS 11,0, e as características dos pacientes com e sem CV foram comparadas com teste t de Student e teste do qui-quadrado. Os preditores independentes de CV foram identificados por análise de regressão logística múltipla. Resultados: Total de 4.595 pacientes com 5.485 stents implantados, com média de idade de 60,64 + - 10,65 anos e 32 por cento de mulheres. As ICPs foram realizadas pela via femoral...

Background: Vascular complications (VC) following percutaneous coronary intervention (PCI) are an important cause of morbidity and mortality. However, available data do not reflect current interventional cardiology practice. Objective: To determinate the incidence of VC and its predictors in a population treated with PCI in contemporary practice. Methods: Cross-sectional study with coronary stent implantation conducted from January/2000 to December/2007. Clinical and angiographic characteristics, as well as in-hospital evolution, were evaluated and recorded in a database. Exclusion criteria included in-hospital death and urgent heart surgery. VC were defined as major bleeding, vascular surgery or hematoma > 10 cm. Data were analyzed using SPSS 11.0 and the characteristics of patients with and without VC were compared using the Student's t test and chi-square test. Multiple Logistic Regression Analysis was performed to determinate the independent predictors of VC. Results: A total of 4,595 patients with 5,485 stents were included in this analysis. Mean age was 60.64 ± 10.65 years and 32% of the patients were female. The transfemoral approach was used in 95% of the PCIs and the transradial approach in 5%. Six French and 7 French introducers were used in 85% and 15% of the PCIs, respectively. A total of 162 (3.3%) patients experienced VC. The multivariate analysis determined that the only predictor for VC was the use of 7 French introducers (odds ratio = 3.05, 95% confidence interval = 1.2-7.8; p = 0.02)...