Evaluation of the Safety and Efficacy of the Novel Svelte Acrobat Integrated Delivery System via Radial Approach With 5 Fr Catheters.

PURPOSE: To evaluate the safety and efficacy of the Svelte Acrobat integrated delivery system (IDS) via radial approach with 5 Fr catheters. The direct stenting (DS) system enables easy delivery, deployment, and postdilatation of a cobalt-chromium stent. METHODS: Patients with coronary artery disease (CAD) were prospectively enrolled at three centers to undergo percutaneous coronary intervention with DS via radial approach using 5 Fr catheters. The primary endpoint was IDS success, which was defined as DS without postdilatation and final stenosis <20% with Thrombolysis in Myocardial Infarction (TIMI)-3 flow. RESULTS: Fifty consecutive patients with 55 lesions were included. The procedure success rate was 98%. The device could not cross the lesion in 2 cases, so DS success was 96%. Fifty lesions met the primary study objective; thus, IDS success rate was 91%. The procedure duration was 21 ± 9 minutes, fluoroscopy time was 7.3 ± 4.7 minutes, and contrast volume per vessel was 103 ± 33 cm3. The final residual stenosis, by quantitative coronary angiography, was 3.4 ± 4%. The reduced need for additional catheters resulted in a 20% procedural cost reduction. There were no bleeding or vascular complications. At 8 months, the event-free survival rate was 84%. CONCLUSIONS: DS using the Svelte Acrobat IDS via radial approach with low-profile catheters is safe and efficacious in select coronary artery disease patients, and its use is associated with potential procedural cost savings.

Análise comparativa da intervenção coronária percutânea com stents famacológicos versus stents não-farmacológicos na vigência de infarto do miocárdio com supradesnivelamento do segmento ST: dados do registro brasileiro CENIC / Comparative analysis of percutaneous coronary intervention (PCI) with drug-eluting stents versus bare-metal stents in acute ST-segment elevation myocardial infarction (STEMI): data from the CENIC registry

Fundamento: A intervenção coronária percutânea primária (ICPP) com stents farmacológicos apresenta resultados ainda incipientes e controversos na literatura. Objetivo: Comparar os resultados da ICPP com stents farmacológicos e não-farmacológicos no Brasil, no biênio 2006-2007. Método: De janeiro de 2006 a dezembro de 2007, todos os pacientes consecutivos acometidos de infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST, tratados por meio da ICPP com stents farmacológicos ou não, devidamente relacionados no banco de dados da Central Nacional de Intervenções Cardiovasculares (CENIC) foram analisados quanto às características clínicas e angiográficas e aos resultados na fase hospitalar. Resultados: Foram analisados 4.876 pacientes tratados por meio da ICPP, e em 4.674 (95,9%) dos quais foram utilizados stents não-farmacológicos e em 202 (4,1%), stents farmacológicos. O sucesso do procedimento foi maior após os stents farmacológicos em relação aos não-farmacológicos (97,5% vs. 93,5%; p = 0,02). Não houve diferenças entre os grupos quanto à trombose da endoprótese (1,5% vs. 1,3%; p = 0,869) ou mesmo quanto à incidência geral de complicações (1,0% vs. 2,8%; p = 0,119). A mortalidade tendeu a ser menor após stents farmacológicos (2,0% vs. 4,4%; p = 0,098). Conclusão: No Brasil, a ICPP com stents farmacológicos apresenta baixas taxas de trombose e de mortalidade na fase hospitalar, comparáveis às taxas observadas com stents sem fármacos, em amostra populacional relativamente restrita de pacientes, nos quais...

Background: Primary percutaneous coronary interventions (PPCI) with drug-eluting stents have incipient and still controversial results in the literature. Objective: To compare PPCI with drug-eluting and bare-metal stents in Brazil during the period 2006-2007. Method: All consecutive patients with ST-segment elevation myocardial infarction (STEMI) treated with PPCI with drug-eluting or bare-metal stents, reported to the database of the National Center for Cardiovascular Interventions (CENIC) from January 2006 to December 2007, were compared as to their clinical and angiographic characteristics and in-hospital results. Results: 4,876 patients treated with PPCI were analyzed; 4,674 (95.9%) used bare-metal stents and 202 (4.1%), drug-eluting stents. Procedural success rates were higher with drug-eluting stents (97.5% vs. 93.5%; p = 0.02). There were no differences in the rates of stent thrombosis (1.5% vs. 1.3%; p = 0.869) or overall complications (1.0% vs. 2.8%; p = 0.119). Mortality tended to be lower with drug-eluting stents (2.0% vs. 4.4%; p = 0.098). Conclusion: In Brazil, PPCI with drug-eluting stents has a low rate of thrombosis and in-hospital mortality, compared to that observed for bare-metal stents in a relatively selected...