Multicenter Study – ABC CARDIOL

ABC

Research Letter

Spontaneous Coronary Artery Dissection: Are There Differences between Men and Women?

Teresa Alvarado et al. Marcos García-Guimaraes Juan Manuel Nogales Marcelo Jimenez-Kockar … Fernando Macaya Fernando Alfonso

Introduction

Spontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognized cause of acute coronary syndrome (ACS) that mainly affects women. It is the main cause of ACS during pregnancy and in up to one-third of women > 50 years old.^, Owing to a unique demographic profile and a low prevalence of traditional cardiovascular risk factors, its cause appears to be multifactorial, with contributions from genetic factors, hormonal influences, inherited or acquired arteriopathies, and systemic inflammatory diseases. SCAD is defined as a spontaneous – non-iatrogenic – separation of the coronary artery wall layers. Two main mechanisms could explain the pathophysiology of SCAD. In the first one, the primary event is hemorrhage within the media without intimal rupture; in the second mechanism, the primary event is the formation of a tear leading to an intimal flap. This initial disruption leads to the formation of an intramural hematoma or a true and false lumen that may cause myocardial ischemia.^, Our understanding of this disease has increased greatly in the last decade as a result of international research efforts.^, However, since ~90% of the cases affect women, the characteristics of SCAD in men and the potential clinical differences between sex remain poorly established. According to previous data, men with SCAD have different predisposing and precipitating factors compared to women. The presence of fibromuscular dysplasia (FMD) and an association with mental disorders seem to be less frequent in men, while intense physical exercise is most commonly observed as a trigger of SCAD in this group.^, The aim of this study was to compare baseline characteristics, clinical presentation, angiographic features, management strategies, and hospital course between men and women with SCAD.

[…]

Read Full Article

IJCS

Editorial

REBECGA Registry: A Multicenter Study for the Reduction of Maternal Mortality Due to Heart Diseases Manifested During Pregnancy

Karyne Pollo de Souza et al. Christianne Brêtas Vieira Scaramello

According to the literature, although the prevalence of heart disease in pregnancy varies considerably among countries, cardiovascular disease is responsible for 1% to 4% of complicated pregnancies in industrialized countries. This pattern is related to cardiovascular risk factors, such as smoking, diabetes, obesity, and hypertension, especially in low- and middle-income countries, as well as late motherhood and the presence of congenital heart disease, mainly in high-income countries.^,

Improved diagnostic methods and therapeutic alternatives have encouraged maternity by promoting safer pregnancies. However, heart disease is still the leading non-obstetric cause of maternal mortality worldwide. Although the rate of maternal mortality has decreased in Brazil over the last three decades, it continues to be higher than estimated for this millennium.

[…]

Read Full Article

ABC

Original Article

Takotsubo Multicenter Registry (REMUTA) – Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality

Gustavo Luiz Gouvêa de Almeida Junior et al. João Mansur Filho Denilson Campos de Albuquerque Sergio Salles Xavier … Álvaro Pontes Elias Pimentel Gouvêa Alexandre Bahia Barreiras Martins Nágela S. V. Nunes Lilian Vieira Carestiato João Luiz Fernandes Petriz Armando Márcio Gonçalves Santos Bruno Santana Bandeira Bárbara Elaine de Jesus Abufaiad Luciana da Camara Pacheco Maurício Sales de Oliveira Paulo Eduardo Campana Ribeiro Filho Pedro Paulo Nogueres Sampaio Gustavo Salgado Duque Luiz Felipe Camillis André Casarsa Marques Francisco Carlos Lourenço Jr José Ricardo Palazzo Cláudio Ramos da Costa Bibiana Almeida da Silva Cleverson Neves Zukowski Romulo Ribeiro Garcia Fernanda de Carvalho Zonis Suzana Andressa Morais de Paula Carolina Gravano Ferraz Ferrari Bruno Soares da Silva Rangel Roberto Muniz Ferreira Bárbara Ferreira da Silva Mendes Isabela Ribeiro Carvalho de Castro Leonardo Giglio Gonçalves de Souza Luiz Henrique dos Santos Araújo Alexandre Giani

Abstract

Background

Takotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil.

Objective

To describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up.

Methods

This is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted.

Results

The registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality.

Conclusion

The results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216)

Read Full Article

ABC

Original Article

Creation and Implementation of a Prospective and Multicentric Database of Patients with Acute Myocardial Infarction: RIAM

Jacqueline Vaz et al. Anibal Pereira Abelin Marcia Moura Schmidt Pedro Piccaro de Oliveira … Carlos A. M. Gottschall Clarissa Garcia Rodrigues Alexandre Schaan de Quadros

Abstract

Background

Multicenter registries representing the real world can be a significant source of information, but few studies exist describing the methodology to implement these tools.

Objective

To describe the process of implementing a database of ST-segment elevation acute myocardial infarction (STEMI) at a reference hospital, and the application of this process to other centers by means of an online platform.

Methods

In 2009, our institution implemented an Registry of Acute Myocardial Infarction (RIAM), with the prospective and consecutive inclusion of every patient admitted to the institution who received a diagnosis of STEMI. From March 2014 to April 2016, the registries were uploaded to a web-based system using the REDCap software and the registry was expanded to other centers. Upon subscription, the REDCap platform is a noncommercial software made available by Vanderbilt University to institutions interested in research.

Results

The following steps were taken to improve and expand the registry: 1. Standardization of variables; 2. Implementation of institutional REDCap (Research Electronic Data Capture); 3. Development of data collection forms (Case Report Form – CRF); 4. Expansion of registry to other reference centers using the REDCap software; 5. Training of teams and participating centers following an SOP (Standard Operating Procedure).

Conclusion

The description of the methodology used to implement and expand the RIAM may help other centers and researchers to conduct similar studies, share information between institutions, develop new health technologies, and assist public policies regarding cardiovascular diseases. (Arq Bras Cardiol. 2020; 114(3):446-455)

Read Full Article

ABC

Original Article

Analysis of the Appropriate Use Criteria for Coronary Angiography in Two Cardiology Services of Southern Brazil

Luis Sérgio Carvalho Luciano et al. Roberto Léo da Silva Ozir Miguel Londero Filho Leandro Waldrich … Luciano Panata Ana Paula Trombetta Julio Cesar Preve Tammuz Fattah Luiz Carlos Giuliano Luiz Eduardo Koenig São Thiago

Abstract

Background:

Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization.

Objective:

To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil.

Methods:

This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05).

Results:

Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment.

Conclusion:

We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

Read Full Article

ABC

Original Article

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

Alexandre de Matos Soeiro et al. Pedro Gabriel Melo de Barros e Silva Eduardo Alberto de Castro Roque Aline Siqueira Bossa … Bruno Biselli Tatiana de Carvalho Andreucci Torres Leal Maria Carolina Feres de Almeida Soeiro Fábio Grunspun Pitta Carlos V. Serrano Jr. Múcio Tavares Oliveira Jr.

Abstract

Background:

Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented.

Objective:

To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis.

Methods:

This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months.

Results:

The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events.

Conclusion:

Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Read Full Article

ABC

Artigo Original

Rationale and design for the PAINT randomized trial

Pedro A. Lemos et al. Bruno Moulin Marco A. Perin Ludmilla A.R.R. Oliveira … J. Airton Arruda Valter C. Lima Antonio A.G. Lima Paulo R.A. Caramori Cesar R. Medeiros Mauricio R. Barbosa Fabio S. Brito Jr Expedito E. Ribeiro Eulógio E. Martinez

BACKGROUND: We describe the rationale and design for the “PercutAneous INTervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions – PAINT trial”. OBJECTIVES: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution. METHODS: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio. Patients had de novo coronary lesions in native vessels with a diameter between 2.5 and 3.5 mm, amenable for treatment with a single stent of 29 mm or less in length. The primary objetive was to compare the in-stent late loss at 9 months of both paclitaxel- and sirolimus-eluting versus the late loss of control bare metal stents. Important secondary objectives included the comparison in outcomes between sirolimus and paclitaxel stents, as well as the analysis of the incidence of major adverse cardiac events. RESULTS AND CONCLUSIONS: The PAINT trial had a unique design that allowed for the evaluation of the safety and efficacy profiles of two novel drug-eluting stent formulations, with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). As the drug-eluting stents differed by the drug, but were identical otherwise, the trial also allowed the comparison of the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).

Read Full Article

ABC

Artigo Original

Multicenter study of elderly patients in outpatient clinics of cardiology and geriatric brazilian institutions

Cláudia F. Gravina Taddei et al. Luiz Roberto Ramos José Cássio de Moraes Maurício Wajngarten … Alberto Libberman Silvio Carlos Santos Felício Savioli Giuseppe Dioguardi Roberto Franken

PURPOSE: To evaluate epidemiological, clinical and therapeutic aspects of elderly patients with cardiovascular disease in Brazil. METHODS: Elderly patients with cardiovascular disease treated in 36 centers of cardiology and geriatrics were investigated through a questionnaire applied to those who had an appointment during the analyzed period . RESULTS: 2196 elderly patients ranging from 65 to 96 years of age were analyzed, 60% of which were females. The main risk factors were: sedentarism (74%); high blood pressure (53%), high LDL-cholesterol (33%), high total cholesterol (30%), obesity (30%), low HDL-cholesterol (15%), diabetes (13%) and smoking (6%). A higher prevalence of females existed among those with > 3 risk factors. The main reason for the medical appointment was high blood pressure (48%). Stress test and coronariography were requested more often in males. The most common diagnoses were hypertension (67%), and coronary disease (29%). The most often used medications were diuretics (42%). CONCLUSION: There was high prevalence of risk factors (93%), mainly in females; sedentarism was the most common risk factor and prevalence increased with age; hypertension was the most common reason for a medical appointment . Diuretics were the most used drugs; congestive heart failure was the main disease associated to hospitalization (31%) and emergencies (10%).

Read Full Article