Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal.

INTRODUCTION: The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. OBJECTIVES: To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. METHODS: Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017-2019). RESULTS: The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (-36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, -25% (p<0.019), -20% (p<0.068) and -59% (p<0.001). CONCLUSIONS: Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.

Fifteen years of coronary intravascular ultrasound in percutaneous coronary intervention in Portugal. / Quinze anos de ecografia intravascular coronária em intervenção coronária percutânea em Portugal.

INTRODUCTION: Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal. METHODS: A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized. RESULTS: A total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C-type or bifurcated coronary lesions, and in-stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery. CONCLUSION: Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.

RIVER: Portuguese registry to monitor unnecessary right ventricular pacing.

The aim of this prospective registry is to evaluate a new algorithm designed to reduce the percentage of unnecessary ventricular pacing (%VP) in patients implanted with a dual-chamber pacemaker, through a dedicated pacing mode (called AAISafeR2) operating in AAI mode with back-up ventricular pacing in DDD mode, and to describe the incidence and distribution of atrioventricular (AV) block in this population. Investigators were free to assign patients to AAISafeR2 mode or to standard DDD (if AAISafeR was contraindicated, mainly due to permanent high-degree AV block). Patients underwent routine follow-up visits at 3, 6, 12, 18 and 24 months after implantation. At each follow-up visit, data were retrieved from pacemaker memories and analyzed to extract %VP and incidence of AV block. Up to December 2006, 158 patients (94 men, mean age 69 +/- 14 years) from nine Portuguese centers had been consecutively included. We also determined the distribution of AV block (according to the criteria used by the pacemaker to classify AV block and switch to DDD mode). AAISafeR was shown to be effective in reducing unnecessary VP in our patient population. The analysis also reveals a high incidence of paroxysmal AV block, often unknown at the time of implantation. There were no complications associated with AAISafeR programming.

Clinical and angiographic profile of the diabetic patient: one-year follow-up.

UNLABELLED: Diabetes mellitus is associated with significant cardiovascular morbidity and mortality. The authors describe the clinical and angiographic profile of a diabetic population undergoing percutaneous coronary intervention, with one-year follow-up. METHODS: We retrospectively studied 769 patients (241 diabetic [D] and 528 nondiabetic [ND]) in terms of clinical and demographic characteristics, angiography and angioplasty data, and medical therapy, and analyzed the composite endpoint of adverse cardiac events at one month and one year. RESULTS: Women, older mean age, hypertension, dyslipidemia, previous stroke and renal insufficiency were more prevalent in the D group. It also had more patients with left ventricular dysfunction, multivessel disease and complex coronary lesions. A significantly higher number of stents per patient and more drug-eluting stents were implanted in this group. Occurrence of the composite endpoint at one-year follow-up was significantly higher in diabetic patients (D = 23.6% vs. ND = 15.9%; p = 0.012), and one-year total mortality was 5.8% in the D group vs. 2.3% in the ND group (p = 0.012). CONCLUSION: Even with aggressive percutaneous and pharmacological management, diabetes mellitus still has an adverse long-term prognosis.

Acute myocardial infarction after thrombolytic treatment of acute ischemic stroke.

Thrombolytic treatment in patients with acute ischemic stroke improves their clinical prognosis when administered within three hours of symptom onset. We report the case of a 57-year-old patient with a history of paroxysmal atrial fibrillation and hypertension who developed an anterior acute myocardial infarction after systemic thrombolytic treatment for acute ischemic stroke. Embolization of a pre-existing cardiac thrombus or in situ formation of a thrombus in a coronary artery has to be considered as a potential adverse effect of thrombolytic therapy in stroke patients.