Angioplasty

IJCS

Original Article

ST-Segment Elevation Myocardial Infarction Metrics Before and During the COVID-19 Pandemic: Experience from a Brazilian Center

Caio de Assis Moura Tavares et al. Tarso A. D. Accorsi Milena Ribeiro Paixão Tarsila Mota … Fabio Pitta Pedro Alves Lemos Marcelo Franken Karine De Amicis Lima Karen Francine Kohler José Leão de Souza Jr.

Abstract

Background:

The impact of the COVID-19 pandemic on the healthcare of patients with ST-segment elevation acute myocardial infarction (STEMI) in Brazil remains unclear.

Objective:

Provide a descriptive analysis of clinical profiles, time intervals, performance metrics, and outcomes in patients with STEMI before and during the COVID-19 pandemic.

Methods:

Among a cohort of 193 patients with STEMI diagnosed in five emergency departments within a single Brazilian healthcare network, 187 patients were included between January 2017 and April 2021 and stratified into two cohorts: Cohort I (pre-pandemic, 146 patients) and Cohort II (pandemic, 41 patients). Statistical significance was defined as a two-sided p value < 0.05.

Results:

The mean age of the participants was 62.7 years (standard deviation: 13.2); 83.4% were male, and 86.1% underwent primary percutaneous coronary intervention (PCI). Duration from symptom onset to emergency department presentation was 60 minutes in both cohorts (interquartile range, IQR: 30 to 150 in Cohort I versus 30 to 152 in Cohort II, p = 0.273). Total ischemic time was 132 minutes in Cohort I (IQR: 94 to 222), and 117 minutes in Cohort II (IQR: 76.3 to 185.6) (p = 0.159). The observed STEMI time delays and performance metrics were comparable between groups, with reperfusion rates within the recommended time frame above 90% in both cohorts. Hospital mortality was 3.4% in Cohort I and 7.3% in Cohort II (p = 0.376).

Conclusion:

In the context of the COVID-19 pandemic, within a private healthcare network system in Brazil, this study did not uncover statistically significant disparities in clinical profiles, time intervals, performance metrics, or in-hospital mortality when compared to the pre-pandemic period.

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IJCS

Editorial

After a STEMI, is Less Sugar more Protective to Myocardium?

Rafael Willain Lopes et al. Alexandre Hohl

The infarct size reduction in acute myocardial infarction (AMI) has been studied for more than 50 years. Animal experiments were conducted in the 1970s, followed by the first clinical studies to reduce infarct size (IS), with fibrinolytic agents or with mechanical coronary angioplasty (PTCA). The clinical experience of coronary reperfusion indicated that left ventricle function was not normalized in 30% of the patients, and despite unblocking the epicardial vessel, demonstrated hemodynamically, there was no equivalent in myocardial perfusion. New concepts emerged such as reperfusion injury, microvascular dysfunction, “no-reflow” phenomenon, and stunned and hibernating myocardium, which became the focus of basic research and clinical investigation. To improve characterization, different technologies were used, such as contrast echocardiography, isotopic studies, including positron emission tomography, and magnetic resonance.

Cardioprotection (CP) aims to reduce IS and improve clinical outcomes. The translation of CP from preclinical and promising proof-of-concept studies to clinical benefit (CB) for patients has been quite unsatisfactory. Almost all these studies that did not translate into CB had infarct size reduction as the primary endpoint and used protocols selected to achieve IS reduction.

[…]

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IJCS

Case Report

Coronary Angioplasty with Stent in Woman with Active Vaginal Bleeding

Felipe José de Andrade Falcão et al. Fabiano Lima Cantarelli Aline Hofmann Baião Marco Rivera … Verônica Monteiro Flavio Roberto Azevedo de Oliveira

Abstract

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty.

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IJCS

Original Article

Incidence and Characteristics Angiographic of Patients with Acute Myocardial

Cynthia Kallás Bachur et al. José Alexandre Bachur Juliana Pereira Machado Eugenia Velludo Veiga … Sarah da Silva Candido Ricardo Barbosa Julia Granado Carraro Danielle de Freitas Gonçalves Maria Georgina Marques Tonello

Abstract

Background:

Acute myocardial infarction (AMI) is defined as the death of cardiomyocytes due to prolonged ischemia, caused by thrombosis and / or vasospasm on an atherosclerotic plaque.

Objective:

To determine the incidence of patients with myocardial infarction undergoing primary angioplasty; characterize the anthropometric variables and identify the risk factors in this population.

Methods:

This was a cross-sectional, observational, retrospective study in which we collected secondary data from medical records of a hospital in a city in the state of São Paulo, where the largest number of interventions is via Public Health System, patients with a diagnosis of Myocardial Infarction, undergoing primary coronary angioplasty, from January 2011 to December 2013.

Results:

The total sample consisted of 437 subjects, 282 male and 155 female. In this study, there was predominance of myocardial infarction in the anterior descending artery ADA (45.51%), followed by right coronary artery RCA (38.46%), in carrying out the rescue angioplasty and stent implantation in 96.62% of cases. There was a predominance of high blood pressure as risk factors for 73.71%, followed by smoking with 41.66% of the sample.

Conclusion:

According to the present study data, it appears a higher prevalence of infarction occurred in the ADA, with individuals performing the rescue angioplasty procedure and the placement of the stent, and a growing incidence of drug stent placement. We observed a high incidence of risk factors, prevailing hypertension. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0).

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IJCS

Original Article

Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox

Yasmin Falcon Lacerda et al. Nicole Cruz de Sá Jessica Gonzalez Suerdieck Letícia Fonseca … Fernanda Lopes Gabriella Sant'Ana Sodré Mateus dos Santos Viana Marcia Maria Noya Rabelo Luis Claudio Lemos Correia

Abstract

Background:

In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach.

Objectives:

To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access.

Methods:

Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05.

Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access – age (OR = 0.98; 95%CI = 0.96 – 0.99), creatinine (OR = 0.54; 95%CI = 0.3 – 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 – 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 – 0.166).

Conclusion:

The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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ABC

Original Article

A comparative analysis of primary stenting and optimal balloon coronary angioplasty in acute myocardial infarction. Six month results from the STENT PAMI trial

Luiz Alberto Mattos et al. Cindy L. Grines David Cox J. Eduardo Sousa … Costantino Costantini Gregg Stone Marie C. Morice William O'Neill Eulógio Garcia Judith Boura

OBJECTIVE: To compare the outcome of balloon PTCA with final coronary stenosis diameter (SD) <=30%, with elective coronary stenting. METHODS: We performed a comparative analysis of the 6 month outcomes in patients treated with primary stenting and those who obtained an optimal balloon PTCA result treated during the first 12 hours of AMI onset included in the STENT PAMI randomized trial. RESULTS: The results were analysed into 3 groups: primary stenting (441 patients, SD=22±6%), optimal PTCA (245 patients), and nonoptimal PTCA (182 patients, SD= 37±5%). At the end of the 6 months primary stent group presented with the lowest restenosis(23 vs. 31 vs. 45%, p=0.001, respectively). Ischemia-driven target vessel revascularization rate (TVR) (7 vs. 15.5 vs. 19%, p=0.001, respectively). CONCLUSION: At the 6 month follow-up, primary stenting offered the lowest restenosis and ischemia-driven TVR rates. Compared to optimal balloon PTCA. Nonoptimal primary balloon PTCA pts (SD=31-50%), had the worst late angiographic outcomes and should be treated more actively with coronary stent implantation.

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ABC

Original Article

Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

Luiz Alberto Mattos et al. Alexandre Zago Áurea Chaves Ibraim Pinto … Luiz Tanajura Rodolfo Staico Marinella Centemero Fausto Feres Galo Maldonado Manoel Cano Andréa Abizaid Alexandre Abizaid Amanda G.M.R. Sousa J. Eduardo Sousa

OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022), and the death rate was higher in > or = 70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). CONCLUSION: Elderly patients ( > or = 70 years) presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

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ABC

Original Article

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Luiz Alberto Mattos et al. Ibraim Pinto Alexandre Abizaid Andrea Abizaid … Aurea Chaves Fausto Feres Galo Maldonado Luiz Tanajura Marinella Centemero Amanda G. M. R. Sousa J. Eduardo Sousa

PURPOSE: The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. METHODS: The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). RESULTS: During the study period, 1,390 coronary stents were implanted in 1,200 vessels of 1,126 patients; 477 patients were treated in the year 1996 and 649 in 1997. The number of percutaneous procedures performed using stents increased significantly in 1997 compared to 1996 (64 % vs 48%, p=0.0001). The 30-day results were similar in both years; the success and stent thrombosis rates were equal (97% and 0.8%, respectively). The occurrence of new Q wave MI (1.3% vs 1.1%, 1996 vs 1997, p=NS), emergency coronary bypass surgery (1% vs 0.6%, 1996 vs 1997, p=NS) and 30-day death rates (0.2% vs 0.5%, 1996 vs 1997, p=NS) were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). CONCLUSIONS: Intracoronary stenting showed a high success rate and a low incidence of 30-day occurrence of new major coronary events in both periods, despite the greater angiographic complexity of the patients treated with in 1997. These adverse variables did not have a negative influence at the 6-month clinical and angiographic follow-up, with similar rates of restenosis and ischemia-driven target lesion revascularization rates.

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