Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry.

BACKGROUND: The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS: This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS: We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry.

BACKGROUND: Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. METHODS: This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March-June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. RESULTS: We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825-0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31-2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96-1.34], p = 0.12). CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655.

SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion.

SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.

Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

The so-called "smoking paradox", conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS−STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.

Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. METHODS: In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. RESULTS: A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658-1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620-1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. CONCLUSION: This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. TRIAL REGISTRATION NUMBER: NCT04412655 (2nd June 2020).

COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction.

OBJECTIVE: The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS: This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS: In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION: Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.

Circulating interleukin-17A in patients with acute and chronic coronary syndromes.

INTRODUCTION: Interleukin 17 (IL-17) is produced by Th17 and other cells. It is debatable whether IL-17 is atherogenic or atheroprotective. The role of this interleukin in the development and progression of coronary artery disease is unknown. Our aim was to evaluate if there were differences in serum IL-17A levels according to to clinical presentation of coronary artery disease. METHODS: This cross-sectional study enrolled 101 patients with acute coronary syndrome (ACS), 100 patients with chronic coronary syndrome (CCS), and 70 healthy volunteers. Blood samples were collected from patients and controls (within 48 h) to analyze IL-17A levels. Clinical characteristics were recorded using questionnaires. This study was approved by the Ethics Committee. RESULTS: Comparisons of the clinical characteristics between patients with ACS and CCS revealed the following: mean age (62 ± 12.4 years vs. 63.3 ± 9.8 years, P = 0.4), male (63.4% vs. 58%, P = 0.4), hypertension (85.1% vs. 79%, P = 0.1), dyslipidemia (48% vs. 31%, P = 0.01), diabetes mellitus (47.5% vs. 41%, P = 0.3), previous myocardial infarction (57.4% vs. 40%, P = 0.01), and smoking (29.7% vs. 38%, P = 1). The peripheral concentrations of IL-17A in ACS, CCS and controls were 5.36 ± 8.83, 6.69 ± 17.92, and 6.26 ± 11.13, respectively, with P = 0.6. In addition, the comparison between ACS and CCS showed: 5.36 ± 8.83 vs. 6.69 ± 17.92%, P = 0.3. CONCLUSION: The main finding of this study was that circulating IL-17 levels were similar in patients with ACS, CCS, and healthy volunteers. In addition, there was no difference between patients with ACS and those with CCS. Therefore, in patients with ACS and CCS, circulating IL-17A concentrations are low and there were no differences between patients with coronary artery disease and healthy individuals.

Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment. METHODS: The ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients. RESULTS: Our population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010. CONCLUSIONS: This is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients' survival during the hospitalization, neither increased the risk of SARS-CoV2 infection. TRIAL REGISTRATION NUMBER: NCT04412655.

Down regulation of VDR gene expression in metabolic syndrome and atherosclerosis' patients: Cause or consequence?

BACKGROUND: Metabolic syndrome (MS) features a set of clinical manifestations with an increased risk of atherosclerosis development. Vitamin D3 (VD3) pathway influences upon clinical features in MS as well in the formation of atherosclerotic plaque. VD3 acts through the vitamin D receptor (VDR), regulating the transcription of several genes involved in the immune response, growth and homeostasis. AIM: To evaluate whether VDR mRNA levels vary in MS patients according clinical features and atherosclerosis severity. METHODS: We included eighty individuals distributed into four groups: 1 group with MS (n = 20), 2 groups with atherosclerosis based on the report from the angiography (severe lesions - SL and primary lesions - PL) and 1 group enclosing healthy individuals (HC). The expression assays of VDR gene was performed using Real Time qPCR, with specific Taqman probes. We applied the Shapiro-Wilk, Chi-Squared and Student's T-tests for statistical analyses considering as statistically significant p < 0.05. RESULTS: Patients with MS as well with coronary stenosis present a down-regulation of VDR gene expression (-9.01 FC, p = 2.497 × 10-13; -13.62 FC, p = 7.489 × 10-13, respectively) when compared to control group. We also evaluated the VDR gene expression according to atherosclerosis severity, SL and PL patients present a downregulation of -31.51 FC and -8.48 FC, respectively, when compared with healthy controls group (p = 1.369 × 10-11; p = 1.647 × 10-11). When compared different degrees of atherosclerosis severity (SL versus PL) SL present a downregulation of -3.71 FC, when compared to PL group (p = 0.006). CONCLUSION: VDR is downregulated in patients with MS and according atherosclerosis severity. The differential expression of this gene is related to this hormone functions being an ex-vivo gene target for assessment in MS and atherosclerosis.

The Issue of Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) has been considered an important therapy for the treatment of symptomatic severe aortic stenosis. Although the devices and the techniques have been improved some complications may occur and several issues still need to be addressed. The issue of subclinical leaflet thrombosis (SLT) has been recognized as a complication after TAVI, and its incidence ranges from 0% to 40%. Nowadays, computed tomography is considered as the standard method for diagnosis of SLT. The concept of hypoattenuated leaflet thickening (HALT), reduced leaflet motion (RELM), and hypoattenuation affecting motion (HAM) have been used in this topic. Most patients who had SLT were taking single or dual antiplatelet therapy. In addition, these medications were not effective in resolving this complication after TAVI. However, there is a suggestion that oral anticoagulants have a protective and therapeutic effect. With the increasing use of TAVI, it is necessary to have better knowledge about several aspects of this complication, because it may have impact on prognosis. Therefore, some aspects of SLT diagnosis, management, and prognosis are not yet fully understood.

Catheter Reprocessing for Coronary Angiography: It is Not Safe.

BACKGROUND: Coronary angiography and percutaneous coronary intervention are frequently and increasingly performed worldwide. Although catheters for coronary angiography are considered as single-use devices, some people still question this decision. This study evaluated the structural characteristics and thermal stability of new and reprocessed catheters. METHODS: Five catheters (Judkins left) of the same brand and manufacturer were selected for each analysis. We evaluated: new catheters, catheters reprocessed once (first), twice (second), thrice (third), and seven times (seventh). The optical analyses of the proximal, middle and distal parts of the catheters were performed by magnifying glass. Besides, thermogravimetric analyses were done. RESULTS: After reprocessing, the crushing, color changes, folds, dents, deformations, and lumen narrowing were observed; the stainless-steel framework, the external tortuosity, the interlaced mesh of stainless-steel wires and loss of polymeric material were visualized. Thermogravimetric analysis showed lost of mass of the catheters. CONCLUSIONS: This study demonstrated that the structural integrity and mass of catheters are lost with reprocessing. These findings may be caused by several steps of reprocessing; however, regardless of which step or steps were responsible, the presence of structural integrity loss leads to the recommendation of not reusing this type of device.

The Issue of the Antiphospholipid Antibody Syndrome.

Antiphospholipid antibody syndrome (APS) is a state of hypercoagulability secondary to an autoimmune disorder. It is associated with thrombotic events in venous and arterial vessels, obstetric complications characterized by recurrent fetal losses, and increased perinatal morbidity. APS is classified as primary, when not associated with other pathologies; or secondary, when associated with an underlying autoimmune disease with, solid tumor, or hematological disorder. Clinical findings include livedo reticularis, thrombocytopenia or hemolytic anemia, maternal morbidity, and recurrent thrombotic episodes and others. Laboratory tests show circulating antiphospholipid antibodies (aPLs); however, even in the presence of these antibodies, patients can be asymptomatic. Estimates predict that about 5% of the populations have circulating aPLs, but the incidence of APS is only five cases per 100,000 people, as diagnosis of this syndrome requires clinical and laboratory findings to be simultaneously present. In cases of secondary APS, or in acute cases with imminent risk of death (as in catastrophic APS), it may be necessary to reduce aPL serum levels using immunomodulators, immunosuppressants, or plasmapheresis, in order to treat the associated pathologies. In other situations, the use of immunotherapy is not indicated. In other patients heparin, aspirin or anticoagulants either alone or associated should be administered depending on each specific case.

Very Early Coronary Artery Aneurysm After Primary Percutaneous Coronary Intervention in Patient With HIV and Thrombophilia.

The incidence of coronary artery aneurysms ranges from 0.2% to 10.5%. Aneurysms have been described after percutaneous coronary interventions (PCIs) and hypersensitivity to polymers, nickel, cobalt, inflammatory reaction rich in eosinophils, drug released by the stent, fracture and malapposition of the stent, stent endothelialization delay, high pressures used in the procedures, oversizing of balloons and stents, unhealed dissections, atheroablative techniques, and trauma of the arterial wall are related to appearance of coronary artery aneurysms. In this case report, we described a patient with human immunodeficiency virus and thrombophilia who underwent primary PCI and at the end of the procedure had thrombi in the coronary artery. It was decided by triple therapy and new angiographic study 2 days later. This new angiography revealed thrombi resolution but the appearance of an aneurysm in the middle portion of the drug-eluting stent. The anticoagulant was stopped and we performed watchful waiting strategy with new serial angiograms that revealed progressive reduction and disappearance of the aneurysm. Subsequently triple therapy with warfarin, aspirin and clopidogrel was restarted and the patient progressed asymptomatic and performed his daily activities normally. At 6 months of clinical follow-up, we advised the patient to suspend aspirin and to continue secondary prevention of cardiovascular events.

The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming.

The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!

Reprocessing of Catheters Used for Coronary Angiography and Changes in the Polymeric Structures.

BACKGROUND: Catheters are extensively used for coronary angiographies. These devices are long, thin, and flexible tubes of variable diameters that are made of the following polymer compounds: polyamide, polyurethane and Teflon. The objectives of this study are to identify changes that occur in the polymeric structure of the catheters, including an analysis of microcracks, fissures, cuts, perforations, roughness, and porosity in the internal and external layers after the first, second, third, and seventh reprocessing. METHODS: Five catheters of the same brand and manufacturer were selected for each analysis, except for the new and seventh catheters, which had only one sample. The catheters that we analyzed included new catheters, catheter reprocessed once (1st), catheters reprocessed twice (2nd), catheters reprocessed three times (3rd), and catheters reprocessed up to seven times (7th). Samples were cut into small pieces and the scanning electron microscope and infrared spectroscopy were used for analysis. RESULTS: Scanning electron microscopy (SEM) of reprocessed catheters revealed rougher surface with porosity, stainless steel wires, peeling of the inner layers, micropores, small holes, disordered cracks, cracks, grooves, microcracks, granular appearance, dots whitish, diffuse microcracks, desquamation, diffuse recesses, depressions, protrusions and deep crevices. Infrared spectroscopy suggested a possible change in the chemical structures of the polymer. There was a directly proportional relationship between the reprocessing number and the carbonyl ratio. CONCLUSIONS: The combined SEM and infrared analyses reveal that reprocessing damages the integrity of coronary angiography catheters. Therefore, the reprocessing of such catheters is not recommended.

Percutaneous Coronary Intervention: Safety of Methotrexate and Its Possible Benefits on Restenosis After Bare-Metal Stent Deployment.

BACKGROUND: Percutaneous coronary intervention (PCI) revolutionized treatment of coronary artery disease. Drug-eluting stents are effective and safe but their cost is high, especially for some countries. The primary objective was to evaluate the safety of methotrexate (MTX) in patients who underwent PCI and the secondary goal was to evaluate the possibility that MTX has an impact on restenosis. METHODS: This was a transversal, prospective and descriptive study that recruited 16 patients in whom PCI was planned. MTX was administered to patients at a dose of 5 mg/week for 2 weeks before PCI and 8 weeks after PCI. Bare-metal stent (BMS) deployment was performed according to standard practice. Patients were monitored clinically every 15 days during the first 2 months after the procedure and monthly until 9 months after PCI. RESULTS: There were no immediate or late complications associated with PCI. Adverse events and side effects due to MTX occurred in three patients (prevalence 18.7%). These side effects are classified as minor complications. MTX was not discontinued due to these side effects. There were no reported cases of clinical restenosis. CONCLUSIONS: MTX was safe in the study population and raised the possibility that a low-cost drug may have positive effects on restenosis after BMS implantation. However, studies with larger sample sizes and other imagine modalities (intravascular ultrasound and/or optical coherence tomography) are required to confirm this hypothesis.

Toxidade pulmonar secundaria ao sirolimus / Pulmonary toxicity of sirolimus

O sirolimus (Rapamune®) é uma droga imunossupressorautilizada em pacientes transplantados, principalmentenaqueles pacientes com função renal alterada ou nos queapresentam piora da função renal na vigência do tratamentoimunossupressor empregado. Relatamos um caso de um paciente pós-transplantado renal, que apresentou, quatro meses após início da terapia com sirolimus queda do estado geral, dispnéia e febre. Foi realizada investigação laboratorial e radiológica, sendo descartado um processo infeccioso como responsável pelo quadro clínico do paciente. Após excluir outras causas, a hipótese de farmacotoxidade pelo sirolimus foi aventada e confirmada com a melhora clínica e radiológica apresentada após a descontinuação dessa droga. A paciente teve alta hospitalar assintomática

[Prevalence of coronary artery disease in type I diabetic candidates for double transplantation (kidney and pancreas)]. / Prevalência da doença arterial coronariana em diabéticos tipo 1 candidatos a transplante duplo (rim e pâncreas).

OBJECTIVE: To assess the prevalence of coronary artery disease (CAD) in a population of type I diabetic, nephropathic patients in a dialysis program and candidates for double transplantation (kidney and pancreas). METHODS: From January 2000 to July 2002, 58 type I diabetic patients underwent coronary cineangiography as part of an assessment protocol for double transplantation. Coronary artery disease was defined as any irregularity in the coronary arteries and was classified according to the degree of luminal stenosis as mild (< 30%), moderate (> or = 30 to 70%), and severe (> 70%). RESULTS: The mean age of the patients was 34 +/- 12 years, and 32 (55%) were men. No patient had a history of angina or acute myocardial infarction. The major risk factors for the disease were systemic arterial hypertension in 93% of the patients, dyslipidemia in 38%, familial history in 25%, and smoking in 20%. The mean duration of diabetes was 20.8 +/- 9 years, and the duration of dialysis was 26 +/- 9 months. Coronary angiography revealed coronary artery disease in 42 (72%) patients, which was mild in 20 (34%) patients, moderate in 9 (16%), and severe in 13 (22%). CONCLUSION: Patients with type I diabetes in a dialysis program and candidates for double transplantation had an elevated prevalence of coronary artery disease. It is worth noting that those patients had no symptoms of the disease.

Prevalência da doença arterial coronariana em diabéticos tipo 1 candidatos a transplante duplo (rim e pâncreas) / Prevalence of coronary artery disease in type I diabetic candidates for double transplantation (kidney and pancreas)

OBJETIVO: Avaliar a prevalência da doença arterial coronariana (DAC) em população de pacientes diabéticos tipo 1, nefropatas, em programa de diálise e candidatos a transplante duplo (rim e pâncreas). MÉTODOS: De janeiro/2000 a julho/2002, foram submetidos a cinecoronariografia, como protocolo de avaliação para transplante duplo, 58 pacientes diabéticos tipo 1. Doença arterial coronariana foi definida como qualquer irregularidade nas artérias coronárias, e classificada, de acordo com a grau de estenose luminal, em leve (<30 por cento), moderada (>30 a 70 por cento) e grave (>70 por cento). RESULTADOS: A idade dos pacientes foi 34 ± 12 anos, sendo que 32 (55 por cento) eram homens. Nenhum paciente tinha história de angina ou infarto agudo do miocárdio. Os principais fatores de risco para a doença foram hipertensão arterial sistêmica em 93 por cento, dislipidemia em 38 por cento, historia familiar em 25 por cento e tabagismo 20 por cento. O tempo médio de duração do diabetes foi 20,8 ± 9 anos, o tempo de diálise de 26 ± 9 meses. A coronariografia revelou doença arterial coronariana em 42 (72 por cento) pacientes, sendo 20 (34 por cento) discreta, 9 (16 por cento) moderada e 13 (22 por cento) grave. CONCLUSÃO: Pacientes diabéticos tipo 1 em programa de diálise e candidatos a transplante duplo têm elevada prevalência de doença arterial coronariana, tornando-se marcante a observação de que esses pacientes não apresentavam sintomas da doença.

Influência do comprimento dos stents na reestenose clínica. Análise de uma experiência contemporânea / Stents length influence in clinical stenosis. Contemporaneous experience analisis

Objetivos: O objetivo primário deste estudo foi a análise da revascularização da lesão alvo (RLA) seis meses após o implante dos stents, enquanto o secundário foi a ocorrência de acidente vascular cerebral (A VC), infarto agudo do miocárdio (IAM) Q e não Q, cirurgia de revascularização do miocárdio e óbitos na fase hospitalar. Métodos: No período de janeiro a dezembro de 2001 foram estudados, retrospectivamente, 200 pacientes submetidos a implante de stents. De acordo com a extensão dos stents utilizados, os pts foram divididos em dois grupos: de stents longos (> 20 mm) e de stents curtos (£ 20 mm). Utilizando o teste do x2 e t student, realizamos análise comparativa de uma série de variáveis. Resultados: Não houve diferença estatística (p = ns) entre os grupos ST longo e ST curto quanto à ida de (60 ± 13 vs 61 ± 16), sexo masculino (66% vs 63%), Diabetes Mellitus (32% vs 27%), oclusão subaguda (3,3% vs 1,4%), óbito hospitalar (3,3 % vs 1,4%). Os pacientes tratados com ST longos quando comparados aos com ST curto apresentaram mais IAM não Q (11,6% vs 2,1% , p= 0,001) e necessidade de RLA (26 % vs 13%, p= 0,003).Conclusão: O grupo de pacientes tratados com implante de ST longos apresentou taxas mais elevadas de IAM não Q hospitalar e RLA aos seis meses, revelando evolução clínica mais adversa destes quando comparados aos do grupo ST curtos.