Noncontrast Myocardial Characterization in Acute Myocardial Infarction Using Electron Density Imaging.

PURPOSE: Spectral computed tomography (CT) enables improved tissue characterization, although virtually all research has focused on contrast-enhanced examinations. We hypothesized that changes in myocardial tissue related to acute myocardial infarction (AMI) might potentially be identified without the need for contrast administration using electron density (ED) imaging. PATIENTS AND METHODS: This retrospective observational study involved a small series (n = 15) of patients admitted to our institution with a first AMI without signs of hemodynamic instability and identification of a culprit vessel with invasive coronary angiography during the same admission, who also underwent a noncontrast, low-dose chest CT using a dual-layer spectral CT scanner. Images were assessed in search of dark areas with low density on ED imaging, and the mean percentage ED relative to water (%EDW) was calculated. RESULTS: Using a qualitative approach, ED assessment enabled the identification of 11/15 (73%) affected coronary territories, with a sensitivity of 73% (95% CI: 45; 92%) and a specificity of 87% (95% CI: 69; 96%). AMI segments showed significantly lower ED values than the remote myocardium (103.8 ± 0.8 vs 104.3 ± 0.6 %EDW, P < 0.0001), and a threshold below 103.9 %EDW had a sensitivity of 66% and specificity of 79% for the identification of AMI. In a control group of patients without a history of cardiovascular disease, none had areas with focal reduction of ED following the shape of the myocardial wall. CONCLUSIONS: In our preliminary series, ED imaging showed the potential to enable the identification of myocardial tissue changes related to AMI without iodinated contrast requirement.

Determinantes no convencionales de la salud cardiovascular de la mujer en Latinoamérica / Non-conventional Determinants of Cardiovascular Health in Latin American Women

RESUMEN Introducción: Más allá de los factores de riesgo (FR) tradicionales, hay determinantes no convencionales (DnoC) de la salud cardiovascular (CV) que operan en las mujeres como factores de riesgo adicional. Es por ello necesario explorarlos y establecer su prevalencia y vínculo con el género femenino. Objetivo: conocer la prevalencia de los DnoC socioeconómicos (SE) y psicosociales (PS) y su impacto en la salud CV de la mujer en Latinoamérica (LATAM). Material y métodos: estudio observacional, de corte transversal realizado a través de una encuesta anónima en mujeres de LATAM entre mayo y junio de 2022. Se recabaron datos sobre DnoC (SE y PS), FR convencionales y enfermedad cardiovascular (ECV). Resultados: participaron 4915 mujeres con edad media de 49 ± 13 años. El 49,6% residía en Argentina, el 55,8% en grandes ciudades, el 94,4% declaró acceso adecuado a la salud y el 89% tuvo acceso a algún nivel de educación. Si bien el 79,9% expresó tener trabajo remunerado, más de la mitad refirió percibir un salario no acorde (59,5%) y una exposición a la violencia en el ámbito laboral (26,7%). Los determinantes PS más prevalentes fueron el bajo a moderado nivel de satisfacción (68,3%), la ansiedad o irritabilidad (51,9%), el desinterés, los pensamientos negativos o la infelicidad (41,7%). El grupo de edad mayor de 45 años se asoció significativamente a más sobrepeso, obesidad, desempleo y violencia laboral. En el análisis multivariado se encontró asociación independiente con ECV para el trastorno del sueño (OR 1,7; p = 0,001), residir en una ciudad de baja densidad poblacional (OR 0,5; p <0,001), la violencia laboral (OR 1,8; p = 0,001), la ansiedad (OR 1,5; p = 0,001) y al haber padecido complicaciones del embarazo (OR 1,6; p = 0,022). Conclusión: se demostró una importante prevalencia de factores PS y SE que impactan en la salud CV de las mujeres en LATAM. Variables como la violencia laboral, la ansiedad o la irritabilidad, residir en ciudades de baja densidad poblacional, así como los trastornos del sueño y complicaciones del embarazo se asociaron de forma independiente con la ECV. Esta encuesta muestra el impacto de los DnoC SE y PS en la carga cardiometabólica (CCM) y la salud CV de las mujeres en LATAM, principalmente en aquellas mayores de 45 años.

ABSTRACT Background: Besides traditional risk factors (RF), non-conventional determinants (NCD) of cardiovascular (CV) health are additional risk factors in women. Therefore, they should be explored to establish their prevalence and association with the female gender. Objective: The aim of this study is to know the prevalence of socioeconomic (SE) and psychosocial (PS) factors as NCD in CV health in Latin American (LATAM) women. Methods: We conducted an observational, cross-sectional study using an anonymous survey distributed among LATAM women between May and June 2022. The information gathered included SE and PS NCD, traditional RF and cardiovascular disease (CVD). Results: A total of 4915 women participated; mean age was 49 ± 13 years. Most respondents (49.6%) lived in Argentina, 55.8% in large cities; 94.4% reported adequate access to healthcare services and 89% had access to some level of education. Although 79.9% had a paid job, more than half reported their salary was not commensurate (59.5%) and 26.7% reported exposure to violence at the workplace. The most prevalent PS factors were low to moderate level of satisfaction (68.3%), anxiety or irritability (51.9%), apathy, negative thoughts, or unhappiness (41.7%). Age >45 years was significantly associated with overweight, obesity, unemployment, and violence at the workplace. On multivariate analysis, sleep disorders (OR 1.7; p = 0.001), living in a city with low population density (OR 0.5; p <0.001), violence at the workplace (OR 1.8; p = 0.001), anxiety (OR 1.5; p = 0.001) and a history of pregnancy complications (OR 1.6; p = 0.022) were independently associated with CVD. Conclusion: The prevalence of PS and SE factors affecting the CV health of LATAM women was significant. Variables such as violence at the workplace, anxiety, or irritability, living in cities with low population density, sleep disorders and pregnancy complications were independently associated with CVD. This survey shows the impact of SE and PS factors as NCD on the cardiometabolic burden and CV health of women in LATAM, mainly in those > 45 years.

Encuesta sobre factores de riesgo de enfermedad cardiovascular en la mujer, su percepción, conocimiento y conducta de prevención / Survey on Women's Perception and Awareness of Cardiovascular Risk Factors and How They Are Managed

RESUMEN Introducción : La enfermedad cardiovascular (ECV) es la principal causa de muerte en la mujer. A pesar de esto, las mujeres reciben menos frecuentemente que los hombres asesoramiento y/o tratamiento preventivo con el objetivo de disminuir la ECV. Objetivo : Detectar la prevalencia de factores de riesgo cardiovascular (FRC) y pesquisar el nivel de percepción y conocimiento de la mujer sobre FRC y ECV. Material y métodos : Estudio observacional, de corte transversal realizado en julio 2021, mediante una encuesta en formato digital de participación anónima y voluntaria. Se recabó información sobre edad, FRC, ECV, percepción de riesgo, implemen tación de hábitos y conductas saludables. Resultados : Participaron 3338 mujeres. El 50,1% tenía entre 46 y 65 años. El 34,1% tenía sobrepeso, el 43,6% perímetro de cintura mayor que 80 cm, el 24,2% hipertensión (HTA), el 19,6% colesterol mayor que 200 mg/dL, el 5,4% diabetes (DBT); 44,3% eran sedentarias, 11,3% fumaban y 34,5% eran exfumadoras. El 82,1% tuvo al menos un embarazo y el 26,9% refirió alguna complicación. Entre las pacientes con antecedentes de complicaciones del embarazo fueron significativamente más frecuentes la HTA (34% vs 24%, p <0,01), la DBT (7% vs 5%, p = 0,04) y la ECV (14% vs 11%, p <0,01). Del total de encuestadas 10,9% refirió ECV, el antecedente de infarto de miocardio fue el más frecuente (51,1%). El 62% de las encuestadas consideró que la principal causa de muerte en la mujer es el cáncer, particularmente de mama (53,4%). Conclusiones : Se encontró una alta prevalencia de FRC modificables con baja percepción del riesgo cardiovascular. El antecedente de complicaciones del embarazo se asoció con mayor prevalencia de FRC.

ABSTRACT Background : Cardiovascular disease (CVD) is the leading cause of death in women. Nevertheless, women are less likely than men to receive guidance or preventive treatment to reduce it. Objective : The aim of this study was to detect the prevalence of cardiovascular risk factors (CRF) and detect the level of women's perception and awareness of CRF and CVD. Methods : We conducted an observational, cross-sectional study in July 2021 using a voluntary, anonymous, and online survey. The information collected included age range, CRF, CVD, risk perception and implementation of healthy habits and behaviors. Results : A total of 3888 women participated (with age range between 46 and 65 years in 50.1%); 34.1% had excess weight and 43.6% had a waist circumference > 80 cm. Hypertension (HTN) was reported by 24.2%; total cholesterol was > 200 mg/ dL in 19.6%; 5,4% were diabetics (DM); 44.3% had sedentary lifestyle; 11.3% were current smokers and 34.5% were former smokers; 82.1% had been pregnant at least once and 26.9% reported a complication during pregnancy. A bad obstetric history was more commonly associated with HTN (34% vs. 24%, p < 0.01), DM (7% vs. 5%, p = 0.04) and CVD (14% vs. 11%, p <0.01). Among the 10.9% who reported a history of CVD, myocardial infarction was the most common condition (51.1%). Sixty-two percent of survey respondents considered that cancer, and particularly breast cancer (53.4%), is the main cause of death in women (53.4%). Conclusions : We found a high prevalence of modifiable CRFs with low perception of cardiovascular risk. A bad obstetric history was associated with higher prevalence of CRF.

Equidad laboral, violencia de género y factores de riesgo cardiovascular en especialistas en cardiología argentinos / Labor Equity, Gender Violence and Cardiovascular Risk Factors in Cardiology Specialists

RESUMEN Los especialistas en cardiología pueden sufrir estresores que afecten su salud, como inequidad laboral y violencia de género, además de padecer factores de riesgo (FR) tradicionales para enfermedad cardiovascular (ECV) Objetivo: Detectar el nivel de bienestar, equidad laboral y violencia de género y conocer la prevalencia de los FR en especialistas en cardiología en Argentina Material y métodos: Estudio observacional, de corte transversal a través de una encuesta anónima realizada en septiembre de 2021 a los especialistas del padrón de la Sociedad Argentina de Cardiología. Se recabaron datos sobre equidad laboral, violencia laboral y doméstica y FR. Resultados: Participaron 611 profesionales (40,5% mujeres). El 63% trabajaba más de 44 horas semanales; 3 de cada 10 cumplían guardias de 12 o 24 horas (38,5% mujeres vs 28% varones, p <0,01). El 72% consideró excesiva la carga laboral, con remuneración no acorde a su formación académica (70%). La mitad de las cardiólogas encuestadas consideró que la maternidad limitó el desarrollo profesional en la especialidad. La violencia de género laboral fue más frecuente en las cardiólogas (58% vs 10% p <0,01) al igual que la violencia doméstica (16% vs 6% p <0,01). Los varones tenían más sobrepeso (67% vs 34% mujeres, p <0,01) y obesidad (16% vs 11%, p<0,01) y las mujeres resultaron ser más sedentarias (53% vs 45%, p< 0,01). Conclusión: Resultó evidente la disconformidad en las condiciones laborales en ambos sexos y la mayor prevalencia de violencia de género laboral y doméstica en las especialistas mujeres encuestadas. A pesar de contar con el conocimiento sobre ECV y FR los especialistas encuestados tienen una alta prevalencia de FR.

ABSTRACT Background: Cardiology specialists may suffer from stressors that affect their health, such as labor inequity and gender violence, in addition to traditional cardiovascular risk factors (RF) for cardiovascular disease (CVD). Objective: The aim of this study was to detect the level of well-being, labor equity and gender violence and to establish the prevalence of CRF in cardiology specialists in Argentina. Methods: This was an observational, cross-sectional study through an anonymous survey conducted in September 2021 among specialists included in the Argentine Society of Cardiology registry. Data on labor equity, labor and domestic violence and CRF were collected. Results: Six hundred and eleven professionals (40.5% women) participated in the survey: 63% worked more than 44 hours per week; 3 out of 10 were on duty for 12 or 24 hours (38.5% women vs. 28% men, p<0.01). Seventy-two percent of respondents considered the workload excessive while 70% thought their payment was not in accordance with the academic training. Half of female cardiologists surveyed considered that motherhood limited professional development in the specialty. Work-related violence was more frequent in female cardiologists (58% vs. 10% p <0.01), as was domestic violence (16% vs. 6% p <0.01). Men were more overweight (67% men vs. 34% women, p <0.01) and obese (16% vs. 11%, p <0.01) and women were more sedentary (53% vs. 45%, p <0.01). Conclusion: The disconformity in working conditions experienced by both genders was evident, as was the evidence of higher workplace and domestic gender violence in the female specialists surveyed. Despite having knowledge about CVD and cardiovascular RF, the surveyed specialists have a high prevalence of RF.

Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region.

BACKGROUND: Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America. METHODS: We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19. RESULTS: A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043). CONCLUSIONS: Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.

Evaluación del score de calcio coronario y valvular aórtico mediante TC de tórax no gatillada de baja dosis / Coronary and aortic valve calcium score assessment using low-dose non-gated chest CT

RESUMEN Introducción: El score de calcio coronario (SCC) es una herramienta de prevención subutilizada, en parte debido a su elevado costo, que no debería diferir del de una tomografía computarizada (TC) de tórax. El SCC puede ser evaluado mediante una TC de tórax convencional, generalmente utilizando escalas visuales o semicuantitativas, y con valor pronóstico similar al gatillado. Material y métodos: En este estudio observacional retrospectivo, incluimos pacientes (n = 35) en quienes se realizó dentro de la misma internación una TC de tórax no gatillada de baja dosis y un SCC gatillado. Resultados: Identificamos una buena concordancia entre los métodos tanto en su valoración cualitativa como cuantitativa, con una media de 3,86 ± 0,7 segmentos con calcificaciones arteriales coronarias mediante SCC gatillado, comparado con 3,79 ± 0,6 segmentos mediante TC de tórax no gatillada de baja dosis (coeficiente de correlación de concordancia 0,98 [IC 95% 0,95-0,99]) y una subestimación del SCC evaluado mediante unidades Agatston del 9,8 %. Conclusión: En este estudio, demostramos que el SCC podría ser evaluado con precisión de forma tanto cualitativa como cuantitativa mediante estudios de TC de tórax no gatillada de baja dosis.

ABSTRACT Background: Coronary calcium scoring (CCS) is an underused prevention tool, possibly due to its high cost, which should not differ from a chest computed tomography (CT) scan. CCS can be assessed using conventional chest CT, generally through a visual or semiquantitative approach, and with a similar prognostic value compared to ECG-gated CCS. Methods: In this retrospective observational study, we included patients (n = 35) who underwent a low-dose non-gated chest CT (LDCT) and an ECG-gated CCS within the same hospitalization. Results: We identified a good agreement between techniques both in their qualitative and quantitative assessment, with a mean of 3.86 ± 0.7 segments with calcifications by ECG-gated compared to 3.79 ± 0.6 segments by LDCT (concordance correlation coefficient 0.98 (95% CI 0.95-0.99), and a 9.8% underestimation of the Agatston score. Conclusions: In this study, we showed that the CCS might be accurately assessed both qualitatively and quantitatively by LDCT studies.

Utilidad de la TC espectral cardíaca para la evaluación de complicaciones trombóticas en pacientes con ataque cerebrovascular isquémico / Usefulness of Spectral Cardiac Computed Tomography for the Evaluation of Thrombotic Complications in Patients with Ischemic Stroke

RESUMEN Objetivo: Evaluar la utilidad de la angiotomografía computada (TC) espectral cardíaca en pacientes con ataque cerebrovascular isquémico (ACVi). Material y métodos: En el contexto de pandemia de COVID-19 incorporamos la utilización de la TC espectral cardíaca en pacientes con ACVi para descartar en una única sesión, tanto fuentes cardioembólicas (FCE) como la presencia de complicaciones trombóticas o daño miocárdico. A partir de julio de 2020 incorporamos una adquisición tardía a las TC cardíacas en contexto de ACVi. Se presentan cuatro casos representativos sobre su utilidad y hallazgos cardiovasculares. Resultados: Se presentan cuatro casos registrados en un lapso de 40 días. Dos pacientes con FCE (aorta y orejuela izquierda) y dos con ACVi de origen indeterminado donde se evidenció miocardiopatía (isquémica y no isquémica). Conclusiones: En el contexto del ACVi, la TC espectral cardíaca, que incluía adquisición tardía, permitiría, eventualmente, descartar la presencia de FCE e identificar la etiología subyacente.

ABSTRACT Objective: The aim of this study was to evaluate the usefulness of spectral cardiac computed tomography (CT) angiography in patients with ischemic stroke. Methods: In the setting of COVID-19 pandemic, we incorporated the use of spectral cardiac CT in patients with ischemic stroke to rule out the presence of cardioembolic sources, thrombotic complications or myocardial damage in a single session. Since July 2020, a delayed-phase image acquisition was incorporated to cardiac CT scans in the context of ischemic stroke. We describe four representative cases of the usefulness of the method and the cardiovascular findings. Results: We present four cases recorded recorded within a 40-day period. Two patients with patients with cardioembolic source (aorta and left atrial appendage) and two with ischemic stroke of undetermined source with evidence of cardiomyopathy (ischemic and non-ischemic). Conclusions: In the setting of ischemic stroke, spectral cardiac CT with delayed acquisition could be useful to rule out the presence of cardioembolic sources and identify the underlying etiology.

One-year outcome of patients with diabetes mellitus after percutaneous coronary intervention with three different revascularization strategies: results from the Diabetic Argentina Registry (DEAR).

AIMS: Percutaneous coronary interventions (PCI) in patients with diabetes mellitus (DM) are associated with a high incidence of coronary restenosis, myocardial infarction (MI) and death. This study was to assess the potential role of a paclitaxel-eluting balloon (PEB) treatment in patients with DM with coronary lesions compared to those treated either with bare-metal stents (BMS) or drug-eluting stents (DES). METHODS AND RESULTS: The Diabetic Argentina Registry (DEAR) was an observational, prospective, non-randomised, open-label study that enrolled 92 patients with diabetes mellitus in three centers from Buenos Aires, Argentina, between April 2009 and March 2011, to be treated with PEB. Results were compared with previous outcome data in all patients with DM treated with DES (n=129 pts) or BMS (n=96 pts) in clinical studies conducted at our institutions. At one-year follow-up, patients with DM who received PEB followed by BMS implantation (96%) had a significantly lower incidence of major adverse cardiac events (MACE) compared to the BMS group (BMS 32.3%, PEB 13.2%; P=.003). The incidence of target-vessel failure (TVF) was 30.2% (BMS) and 11% (PEB) (P=.003), that of target-vessel revascularization (TVR) was 22.9% (BMS) and 8.3% (PEB) (P=.005) and the composite of death/MI occurred in 13.5% (BMS) and in 2.2% for PEB (P=.05). These positive results are persistent even after subgroups analysis. When comparing with previous DES patients, TVF was 18.6% in DES vs. 11.0% in PEB (P=.13), MACE was 18.6% in DES vs. 13.2% in PEB (P=.29), TVR rate was 14.0% in DES vs. 8.3% in PEB (P=.14) and the composite death/MI was 9.3% in DES vs. 4.4% in PEB (0.18) CONCLUSIONS: Diabetic patients treated with PEB followed by BMS resulted in a significantly better outcome than BMS alone and appeared to be comparable to DES treatment.

Randomized comparison of cost-saving and effectiveness of oral rapamycin plus bare-metal stents with drug-eluting stents: three-year outcome from the randomized oral rapamycin in Argentina (ORAR) III trial.

OBJECTIVES: The Oral Rapamycin in ARgentina (ORAR) III trial is a randomized study comparing a strategy of oral rapamycin (OR) plus bare-metal stent (BMS) versus a strategy of drug-eluting stents (DES) in patients with de novo coronary lesions. The purpose of this study was to assess the 3 years cost-effectiveness outcome of each strategy. BACKGROUND: OR after BMS has been associated with reduction of target vessel revascularization (TVR) although its value in long-term efficacy in comparison with DES is unknown. METHODS: In three hospitals in Buenos Aires, Argentina, 200 patients were randomized to OR plus BMS (n = 100) or DES (n = 100). Primary objectives were costs and effectiveness. Cost analysis included in-hospital and follow-up costs. Safety was defined as the composite of death, myocardial infarction (MI), and stroke. Efficacy was defined as TVR. RESULTS: Baseline characteristics between groups were similar. The 3-year follow-up rate was 99%. Cardiac mortality was 2% and 5% in OR group and DES group, respectively (P = 0.44). The composite of death, MI and stroke rate was 11% in OR group and 20% in DES group (P = 0.078). TVR rate was 14.5% in OR group and 17.6% in DES group (P = 0.50), respectively. Three year cumulative costs were significantly lower in the OR arm as compared to the DES arm (P = 0.0001) and DES strategy did not result cost-effective according to the non-inferiority test. CONCLUSIONS: At 3 years follow-up, there were no differences in effectiveness between the two strategies, and DES strategy was not more cost-effective as compared to OR plus BMS.

Advantages and disadvantages of biodegradable platforms in drug eluting stents.

Coronary angioplasty with drug-eluting stent (DES) implantation is currently the most common stent procedure worldwide. Since the introduction of DES, coronary restenosis as well as the incidence of target vessel and target lesion revascularization have been significantly reduced. However, the incidence of very late stent thrombosis beyond the first year after stent deployment has more commonly been linked to DES than to bare-metal stent (BMS) implantation. Several factors have been associated with very late stent thrombosis after DES implantation, such as delayed healing, inflammation, stent mal-apposition and endothelial dysfunction. Some of these adverse events were associated with the presence of durable polymers, which were essential to allow the elution of the immunosuppressive drug in the first DES designs. The introduction of erodable polymers in DES technology has provided the potential to complete the degradation of the polymer simultaneously or immediately after the release of the immunosuppressive drug, after which a BMS remains in place. Several DES designs with biodegradable (BIO) polymers have been introduced in preclinical and clinical studies, including randomized trials. In this review, we analyze the clinical results from 6 observational and randomized studies with BIO polymers and discuss advantages and disadvantages of this new technology.

Efficacy and safety of a double-coated paclitaxel-eluting coronary stent: the EUCATAX trial.

OBJECTIVES: The aim of this study was the comparison of a new double-coated paclitaxel-eluting coronary stent with bare-metal stent (BMS) in patients undergoing percutaneous coronary intervention. BACKGROUND: Stent coating with biodegradable polymers as a platform for elution of drugs has the potential for complete elution of drugs and for decreasing the risk of late complications. METHODS: Multicenter randomized trial comparing a paclitaxel-eluting stent (PES) coated with a biodegradable polymer and glycocalyx with the equivalent BMS. We randomly assigned 422 patients with de novo coronary lesions to PES (211 patients) or to BMS (211 patients). Primary end point was target vessel failure (TVF) defined as cardiac death, myocardial infarction, and target vessel revascularization. Clinical secondary end points were target vessel revascularization, target lesion revascularization, stent thrombosis (ST), and major adverse cardiovascular events (MACE). Angiographic secondary end points were late loss and binary restenosis. RESULTS: At 1 year of follow-up, TVF rate was 9.5% in the PES group and 17.1% in the BMS group (P=0.02), and MACE rate was 10% in PES and 19% in BMS arm (P=0.009). All other secondary end points were reached but ST. ST rate was low and similar in both study arms. CONCLUSIONS: The study shows that patients treated with PES with dual coating technology had significantly lower incidence of TVF and MACE than those treated with BMS design; however, longer follow-up should be necessary to assess true advantages of this technology compared with the previous one.

New coating stent design for patients with high-risk coronary lesions for thrombotic events: early and long-term results of the Camouflage registry.

BACKGROUND: Semisynthetic coating of the Camouflage bare-metal stent (BMS) (Eucatech AG, Rheinfelden, Germany) mimics luminal endothelial cell glycocalix, potentially preventing the activation of the coagulation system. Purpose. We sought to determine in a clinical registry the acute and long-term clinical and angiographic outcomes of this BMS design in patients with acute coronary syndromes (ACS) or who were unable to be on long-term clopidogrel therapy. METHODS: From March 2007 to December 2008, 150 patients undergoing coronary stent implantation at three centers in Buenos Aires, Argentina, were included in our registry. Patients with ACS, including non-ST-elevation myocardial infarction (NSTEMI) and STelevation MI (STEMI), or those unable to be on long-term dual antiplatelet therapy were considered for inclusion. The primary endpoint was a major adverse cardiovascular event (MACE) defined as the incidence of cardiac death, MI or target lesion revascularization (TLR). The incidence of acute and late stent thrombosis (ST) was also analyzed. Angiographic late loss and the presence of late stent malapposition (LSM) was recorded at 9-month follow up. Clopidogrel was prescribed for 1 month. RESULTS: 54.7% of patients had acute MI, 36% had STEMI and 20.7% of patients were ineligible for long-term clopidogrel therapy because of previously planned non-vascular or general surgery within 30 days after percutaneous coronary intervention. During 11.5 months of clinical follow up, 2% suffered cardiac death, 4% had a MI, 8.9% underwent TLR and the overall cumulative major adverse cardiac event rate was 15.3%. No patient developed acute or late ST. There were no in-hospital complications for patients who underwent surgery. Intravascular ultrasound studies did not detect the presence of late malapposition. CONCLUSION: In this high-risk thrombotic patient population, the Camouflage coated stent design demonstrated a very good safety profile, as reflected by the low incidence of hard adverse cardiac events including ST at follow up.