RESUMO
BACKGROUND: Direct implantation of metallic drug-eluting stents is recommended for lesions with high thrombotic burden; however, this can't be applied to bioresorbable scaffold for which adequate lesion preparation is recommended. AIM: We aimed at assessing the feasibility and safety of direct scaffold implantation based only on angiographic assessment in patients presented with non-ST segment elevation acute coronary syndrome. METHODS: The study was a retrospective two-centre study conducted over patients diagnosed with NSTE-ACS presented to cardiology department at Juan Ramon Hospital, Spain and critical care department, Cairo University in the period between February 2016 to May 2017. We included patients for whom we depend only on angiographic assessment for decision making whether to directly implant the scaffold or predilate the lesion and we excluded patients for whom intracoronary imaging was used at the index procedure either for pre or post-implantation. The primary outcome of interest was the device-oriented composite endpoints (DOCE) including cardiac death, and MI attributed to the target vessel and TLR. The secondary endpoints were the broader patient-oriented composite outcome (POCE) and scaffold/stent thrombosis. POCE includes all-cause mortality, any MI and any revascularisation (including TLR, TVR and revascularisation of non- target vessel). RESULTS: Among 46 patients with NSTE-ACS treated with BVS, we did direct implantation in 20 patients (group A), and we used pre dilatation in 26 patients (group B). The two groups have similar demographics and clinical criteria. Procedural success was obtained in all study population. Mean follow up duration was 12 months. We have total of 10% device-oriented composite endpoints in group A versus 15% in group B (p-value = 0.684). We didn't document any cardiac death in both groups. In group B we had one (3.8%) non-fatal MI while there was no MI in group A (P-value = 1). In group A we had 2 cases (10%) of TLR while in group B there were 3 cases (11.5%) TLR (P-value = 1). We have two cases (7.7%) of TVR in group B and one in group A p-value = 1. All cases were planned staged PCI. Scaffold thrombosis occurred in one case in group A (5%) and two cases in group B (7.7%) p-value = 1. CONCLUSION: With proper lesion selection, direct BVS implantation in all-comers NSTE-ACS patients is feasible and safe even without the aid of intracoronary imaging.
RESUMO
Introducción y objetivos: La hormona tiroidea afecta al metabolismo de todos los tejidos del organismo. El objetivo es analizar la prevalencia y las implicaciones de las alteraciones tiroideas en una cohorte de pacientes consecutivos con disección coronaria espontánea (DCE). Métodos: Se evaluó a 73 pacientes diagnosticados de DCE y se compararon las características y la evolución clínica de los pacientes eutiroideos frente a los hipotiroideos. Se comparó posteriormente la prevalencia de alteraciones tiroideas y las características clínicas de estos pacientes con las de 73 pacientes con síndrome coronario agudo pero sin DCE emparejados por edad, sexo y presentación clínica. Resultados: La media de edad fue 55 +/- 12 años y el 26% tenía hipotiroidismo. Los pacientes con DCE e hipotiroidismo eran todas mujeres (el 100 frente al 69%; p = 0,01), tenían disecciones más distales (el 74 frente al 41%; p = 0,03), en arterias en tirabuzón (el 68 frente al 41%; p = 0,03) y recibieron tratamiento más conservador (el 79 frente al 41%; p = 0,007). Durante un seguimiento medio de 4,1 +/- 3,8 años, la tasa de eventos adversos fue del 23%, sin diferencias según el estado de la función tiroidea. La prevalencia de hipotiroidismo fue significativamente mayor en los pacientes con DCE que en el grupo con síndrome coronario agudo sin DCE (el 26 frente al 8%; p = 0,004). Conclusiones: Hay una elevada prevalencia de hipotiroidismo en los pacientes con DCE. Los pacientes hipotiroideos con DCE son más frecuentemente mujeres, tienen disecciones más distales y en arterias en tirabuzón y reciben tratamiento más conservador
Introduction and objectives: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). Methods: A total of 73 patients with SCAD were analyzed. Baseline characteristics and clinical outcomes were compared between euthyroid and hypothyroid patients. Subsequently, the prevalence of thyroid function abnormalities and the clinical characteristics of SCAD patients were compared with those in 73 patients with acute coronary syndrome but without SCAD, matched by age, sex, and presentation. Results: Mean age was 55 +/- 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 +/- 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). Conclusions: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy
