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BACKGROUND: The prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and previous percutaneous coronary intervention (PCI) is uncertain. OBJECTIVE: To evaluate if previous PCI in patients with STEMI increases the risk of major cardiovascular events, and if final epicardial blood flow differs according to the reperfusion strategy. MATERIAL AND METHODS: Observational, longitudinal, comparative sub-study of the PHASE-MX trial that included patients with STEMI and reperfusion within 12 hours of symptom onset, who were classified according to their history of PCI. The occurrence of the composite primary endpoint (cardiovascular death, re-infarction, congestive heart failure and cardiogenic shock) within 30 days was evaluated using Kaplan-Meier estimates, log-rank test and Cox proportional hazards model. Epicardial blood flow was assessed using the TIMI grading system after reperfusion. RESULTS: A total of 935 patients were included; 85.6% were males and 6.9% had a history of PCI; 53% underwent pharmacoinvasive therapy, and 47%, primary PCI. The incidence of the composite primary endpoint at 30 days in patients with a history of PCI was 9.8% vs 13.3% in those with no previous PCI (p = 0.06). Among the patients with previous PCI, 87.1% reached a final TIMI grade 3 flow after primary PCI vs. 75% in the group with pharmacoinvasive strategy (p = 0.235). CONCLUSIONS: A history of PCI does not increase the risk of major cardiovascular events at 30 days; however, it impacted negatively on the final angiographic blood flow of patients that received pharmacoinvasive therapy (compared to primary PCI).

ANTECEDENTES: El pronóstico de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y antecedente de intervención coronaria percutánea (ICP) es incierto. Objetivos: Evaluar si la ICP previa en pacientes con IAMCEST incrementa el riesgo de eventos cardiovasculares mayores y si el flujo final epicárdico varía según la estrategia de reperfusión. MATERIAL Y MÉTODOS: Subestudio de PHASE-MX, observacional, longitudinal y comparativo, de pacientes con IAMCEST reperfundidos en menos de 12 horas de iniciados los síntomas, divididos conforme el antecedente de ICP. El acaecimiento del criterio de valoración principal (muerte cardiovascular, reinfarto, insuficiencia cardíaca y choque cardiogénico) dentro de los 30 días se comparó con estimaciones de Kaplan-Meier, prueba de rangos logarítmicos y modelo de riesgos proporcionales de Cox. El flujo epicárdico final se evaluó con el sistema de clasificación del flujo TIMI después de la reperfusión. RESULTADOS: Se incluyeron 935 pacientes, 85.6 % del sexo masculino, 6.9 % de los cuales tenía antecedente de ICP; 53 % recibió terapia farmacoinvasiva y 47 %, ICP primaria. La incidencia del criterio de valoración principal en pacientes con ICP previa fue de 9.8 % versus 13.3 % en aquellos sin ese antecedente (p = 0.06); 87.1 % de los pacientes con ICP previa obtuvo flujo final de grado TIMI 3 versus 75 % del grupo con estrategia farmacoinvasiva (p = 0.235). CONCLUSIONES: El antecedente de ICP no incrementa el riesgo de eventos cardiovasculares mayores a los 30 días en pacientes con IAMCEST; sin embargo, impacta negativamente en el flujo sanguíneo angiográfico final de los pacientes que recibieron terapia farmacoinvasiva (en comparación con ICP primaria).

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Resumen Antecedentes: El pronóstico de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y antecedente de intervención coronaria percutánea (ICP) es incierto. Objetivos: Evaluar si la ICP previa en pacientes con IAMCEST incrementa el riesgo de eventos cardiovasculares mayores y si el flujo final epicárdico varía según la estrategia de reperfusión. Material y métodos: Subestudio de PHASE-MX, observacional, longitudinal y comparativo, de pacientes con IAMCEST reperfundidos en menos de 12 horas de iniciados los síntomas, divididos conforme el antecedente de ICP. El acaecimiento del criterio de valoración principal (muerte cardiovascular, reinfarto, insuficiencia cardíaca y choque cardiogénico) dentro de los 30 días se comparó con estimaciones de Kaplan-Meier, prueba de rangos logarítmicos y modelo de riesgos proporcionales de Cox. El flujo epicárdico final se evaluó con el sistema de clasificación del flujo TIMI después de la reperfusión. Resultados: Se incluyeron 935 pacientes, 85.6 % del sexo masculino, 6.9 % de los cuales tenía antecedente de ICP; 53 % recibió terapia farmacoinvasiva y 47 %, ICP primaria. La incidencia del criterio de valoración principal en pacientes con ICP previa fue de 9.8 % versus 13.3 % en aquellos sin ese antecedente (p = 0.06); 87.1 % de los pacientes con ICP previa obtuvo flujo final de grado TIMI 3 versus 75 % del grupo con estrategia farmacoinvasiva (p = 0.235). Conclusiones: El antecedente de ICP no incrementa el riesgo de eventos cardiovasculares mayores a los 30 días en pacientes con IAMCEST; sin embargo, impacta negativamente en el flujo sanguíneo angiográfico final de los pacientes que recibieron terapia farmacoinvasiva (en comparación con ICP primaria).

Abstract Background: The prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and previous percutaneous coronary intervention (PCI) is uncertain. Objectives: To evaluate if previous PCI in patients with STEMI increases the risk of major cardiovascular events, and if final epicardial blood flow differs according to the reperfusion strategy. Material and methods: Observational, longitudinal, comparative sub-study of the PHASE-MX trial that included patients with STEMI and reperfusion within 12 hours of symptom onset, who were divided according to their history of PCI. The occurrence of the composite primary endpoint (cardiovascular death, re-infarction, congestive heart failure and cardiogenic shock) within 30 days was evaluated using Kaplan-Meier estimates, log-rank test and Cox proportional hazards model. Final epicardial blood flow was assessed using the TIMI grading system after reperfusion. Results: A total of 935 patients were included; 85.6% were males, and 6.9% had a history of PCI; 53% underwent pharmacoinvasive therapy, and 47%, primary PCI. The incidence of the composite primary endpoint at 30 days in patients with a history of PCI was 9.8% vs. 13.3% in those with no previous PCI (p = 0.06). Among the patients with previous PCI, 87.1% reached a final TIMI grade 3 flow after primary PCI vs. 75% in the group with pharmacoinvasive strategy (p = 0.235). Conclusions: A history of PCI does not increase the risk of major cardiovascular events at 30 days; however, it impacted negatively on the final angiographic blood flow of patients that received pharmacoinvasive therapy (compared to primary PCI).

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RESUMEN El ejercicio físico evita las enfermedades cardiovasculares pero cuando es intenso debe tener planificación y dosificación correctas y, de ser posible, es muy útil contar con una prueba ergométrica previa y un especialista orientador; porque también puede producir accidentes cardiovasculares en deportistas de alto rendimiento, entre otras cosas, por no cumplir con una programación bien definida con un basamento científico. La complicación más temida es la muerte súbita cardíaca, habitualmente por arritmias malignas y enfermedad isquémica. Se presenta el caso de un deportista de alto rendimiento, de 34 años de edad, en fase desentrenamiento y sin factores de riesgo cardiovascular u otros antecedentes de interés, que sufrió un infarto agudo de miocardio anterior extenso, con angina postinfarto, debido a una estenosis suboclusiva de la descendente anterior proximal. Se realizó angioplastia de rescate, con implantación de un stent farmacoactivo y el paciente evolucionó favorablemente.

ABSTRACT Physical exercise avoids cardiovascular diseases but when it is intense, it must have correct planning and dosage and, if possible, a previous ergometric test and a guidance specialist could be very useful; because it can also cause cardiovascular events in high performance athletes, among other things, for not complying with a well-defined schedule with a scientific base. The most feared complication is sudden cardiac death, usually due to malignant arrhythmias and ischemic heart disease. Here is presented the case of a 34-year-old high-performance athlete, in the detraining phase and without cardiovascular risk factors or other history of interest, who suffered an extensive acute myocardial infarction, with post-infarction angina, due to a stricture suboclusive of the proximal left anterior descending artery. A rescue angioplasty was performed, with implantation of a drug-eluting stent and the patient evolved favorably.

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Resumen Introducción La oclusión coronaria aguda, asociada a alta tasa de morbimortalidad en el infarto agudo del miocardio con elevación del segmento ST (IAMCEST), representa un desafío para el intervencionista cuando desconoce el importe de carga de trombo y las características distales a la oclusión (obstrucción microvascular (OMV), estenosis distal) que complican la angioplastia primaria (ACTP) y el fenómeno de no reflujo (FNR), el cual tiene una incidencia reportada de 20 a 40%. Objetivos Evaluar la eficacia de la angiografía distal con microcatéter al orientar una estrategia terapéutica individualizada con la finalidad de prevenir el FNR en oclusión coronaria aguda por IAMCEST en ACTP. Material y métodos Se incluyeron 70 pacientes con IAMCEST. Se realizó angiografía con microcatéter distal a la obstrucción y se eligió la estrategia terapéutica en la angioplastia de conformidad con hallazgos: estenosis, carga de trombo y OMV. Posteriormente se evaluó la incidencia de FNR al finalizar la ACTP. Resultados Reporte de 70 pacientes, la mayoría hombres (80%), clase Killip-Kimball I (95%), con afección de la arteria coronaria derecha en 57% de ellos y de la descendente anterior en 37%. Trombo distal presente en 47% de los pacientes estudiados, se observó en 21% de los casos que la longitud de obstrucción fue mayor de 30 mm, disección de las arterias también en 21%, OMV presente en 41% y 25% con estenosis distal. Estrategias terapéuticas utilizadas: se aplicó stent con fármaco en 81% de los pacientes, balón largo en 93% y trombolítico en 30%. Se observó una incidencia del FNR de 18.6%. Conclusiones En IAMCEST la técnica propuesta disminuye el FNR en comparación con lo reportado. La obstrucción > 30 mm es factor independiente de FNR, por lo que en estos casos recomendamos el uso de esta técnica y balón largo.

Abstract Introduction The acute coronary occlusion associated with a high valuation of morbimortalidad in the acute infarction of the myocardium with elevation of the ST segment (STEMI), represents a challenge for the interventionist, due the unknown amount of thrombus load and its characteristics beyond the occlusion (microvascular obstruction (MVO), distal stenosis), which leads to complicate the primary angioplasty (PTCA) and to the no reflow phenomenon (NFP), which has an overall incidence reported from 20 to 40%. Objectives To evaluate the efficacy of the distal coronary angiography with microcatheter, that leads to an individualized therapeutic strategy, with the purpose of prevent the NFP in the accute coronary occlusion in STEMI treated with PTCA. Material and methods 70 patients were included with STEMI. We performed coronary angiography with microcatheter distal to the obstruction, and the therapeutic strategy was chosen in accordance with findings: stenosis, thrombus amount or MVO. After the PTCA were performed, we evaluated the NFP incidence. Results Report of 70 patients, the majority men (80%), class Killip Kimbal I (95 %), with disease of the right coronary artery in 57%, and anterior descending coronary artery in 37%. Distal thrombus was present in 47% of the studied patients. An obstruction length of more than 30 mm was observed in 21% of the cases, also we observed dissection of the arteries in a 21%, MVO was presented in 41%, and distal stenosis in 25%. Used therapeutic strategies: It was applied medicated stent in 81% of the patients, long balloon in 93%, and thrombolytic therapy in 30%. We observed a NFP incidence of 18.6 %. Conclusions The diagnostic and therapeutic approach for STEMI that this study recommends, diminishes the NFP in comparison with reported. An obstruction > 30 mm is an independent factor for NFP, therefore in these cases we recommend use the described diagnostic approach and long balloon.

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Con la aprobación y concesión del Registro Sanitario 201300 4713 del 25 de febrero de 2013, con vigencia hasta el año 2023, por parte del Instituto Nacional de Vigilancia de Medicamentos y Alimentos como órgano oficial del Ministerio de Salud y Protección Social de Colombia, a la plataforma biorreabsorbible Absorb BVS®, con el nombre de stent medicado biorreabsorbible, la introducción de estas plataformas al portafolio terapéutico del cardiólogo intervencionista para el tratamiento de pacientes seleccionados con enfermedad coronaria, ha generado gran expectativa gracias a la seguridad y eficacia que han demostrado en comparación con los stents liberadores de medicamento, con resultados de no inferioridad y con el ofrecimiento de una serie de ventajas por las cuales ha sido considerado la «cuarta revolución¼. En este artículo se hace una revisión acerca de las plataformas existentes, de su mecanismo de acción, así como de sus potenciales ventajas y limitaciones.

The approval and the concession of the Health Registration 201300 4713 dated February 25th 2013, in force until 2013, by the National Institute of Food and Drug Monitoring as a body of the Colombian Ministry of Health and Social Protection, in favor of the Absorb BVS® bioresorbable scaffold, under the name of bioresorbable medicated stent, has created high expectations regarding the introduction of these scaffolds in the therapeutic repertoire of the interventional cardiologist for treatment of selected patients with coronary disease. The security and efficiency that they have shown in comparison to the drug-eluting stents, with results of non-inferiority and offering various advantages, have been the reasons why they have been called the fourth revolution. This article reviews the existing scaffolds and their operating methods, as well as their advantages and limitations.

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La disección coronaria espontánea es una causa rara de infarto agudo del miocardio y puede debutar además como angina estable o síndrome de falla cardiaca. Se presenta el caso de una mujer de 35 años quien tuvo eventos recurrentes de dolor torácico en el primer mes de posparto y en quien se diagnosticó disección coronaria de la arteria circunfleja, la cual fue intervenida con stents medicados. Veinte meses después permanecía libre de síntomas y sin evidencia de isquemia miocárdica inducible.

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction which may also occur as stable angina or heart failure syndrome. Here reported the case of a 35 years old woman who presented recurrent chest pain events in the first month of postpartum and in whom coronary dissection of the circumflex artery was diagnosed, which was intervened with drug eluting stents. Twenty months later she remained free of symptoms and with no evidence of inducible myocardial ischemia.

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Fundamentos: A intervenção coronariana percutânea(ICP) promove melhora sintomática e menor necessidade de antianginosos na doença coronariana estável, masnão reduz a incidência de infarto do miocárdio e morte. Objetivo: Avaliar a adequação das indicações de ICPem pacientes com doença coronariana estável em um hospital universitário.Métodos: Foram estudados 102 pacientes com doença coronariana estável submetidos consecutivamentea ICP em um hospital universitário, com média de idade de 65,9±10,7 anos, sendo 67,3 % homens. Coletaram-se informações referentes ao paciente(dados clínico-epidemiológicos, resultados de testes provocativos de isquemia e uso de antianginosos) e aomédico solicitante (tempo de formação e especialidade). Considerou-se adequada a indicação de ICP a pacientes com angina do peito refratária ao tratamento clínico ou a pacientes assintomáticos apresentando grande área de isquemia miocárdica em testes provocativos.Resultados: A indicação de ICP foi considerada adequada em 34 (33,3 %) pacientes, inadequada em 2 e incerta nos 66 restantes. À análise univariada,mostraram-se significativamente associadas à indicação de ICP inadequada/incerta as variáveis: idade mais elevada (p=0,001), aposentadoria (p=0,006) e ausência de tabagismo (p=0,041) e de dislipidemia(p=0,039), observando-se tendência à significância em relação a sedentarismo (p=0,094), renda mais baixa(p=0,013) e tempo de formação do médico solicitante ≥10 anos (p=0,094). Após análise de regressão logística,apenas idade mais elevada (OR=1,10 [1,06-11,1]; p=0,048), renda mais baixa (OR=2,84 [1,5-7,6]; p=0,039)e maior tempo de formação do médico solicitante...

Background: Percutaneous coronary intervention (PCI) results in improved symptoms and less need forantianginal medications for stable coronary artery disease, but does not reduce myocardial infarction and death rates. Objective: To assess the appropriateness of PCIindications in patients with stable coronary artery disease at a university hospital. Methods: The study involved 102 patients with stable coronary artery disease consecutively undergoing PCIat a university hospital, with a mean age of 65.9 ± 10.7 years and 67.3% male. Information was collected on the patient (clinical and epidemiological data,ischemia provocation test results and antianginal drug use) and the requesting physician (time since graduation and speciality). PCI indications wereconsidered appropriate for patients with angina pectoris to clinical treatment, or for asymptomatic patients presenting large areas of myocardial ischemia in provocation tests. Results: PCI indications were consideredappropriate for 34 (33.3%) patients, inappropriate for two others, and uncertain for the remaining 66.In the univariate analysis, the following variables were significantly associated with inappropriate/uncertain ICP indications: older (p=0.001), retired(p=0.006), non-smoker (p=0.041) and dyslipidemia (p=0.039), noting a trend towards sedentary lifestyles (p=0.094), lower income (p=0.013) and≥10 years time since graduation (p=0.094). After the logistic regression analysis, only the older (OR=1.10 [1.06-11.1]; p=0.048), lower income(OR=2.84[1.5-7.6]; p=0.039) and longer time since...

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Estudo descritivo exploratório com abordagem quantitativa que objetivou mensurar, através do tempo porta-balão, o tempo médio de atendimento dos pacientes com infarto agudo do miocárdio e indicação de reperfusão miocárdica pela angioplastia transluminal coronariana primária. A amostra foi composta por 19 pacientes. Na triagem classificatória doze pacientes relataram dor torácica / epigástrica irradiada, sete relataram dor torácica localizada e três relataram náuseas/vômitos. Em 42,1% o tempo porta-balão total ficou menor ou igual a 90 minutos; em 52,6% maior que 90 minutos e menor que 120 minutos e em 5,2% acima de 120 minutos. É fundamental esforços da equipe de saúde para reduzir os tempos entre as fases do tempo porta-balão para agilizar o atendimento e reduzir o tempo entre o início do evento e a reperfusão miocárdica na hemodinâmica.

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A associação entre o uso de quimioterápicos e a ocorrência de síndromes coronarianas agudas (SCA) ou mesmo infarto agudo do miocárdio (IAM) é rara, todavia constitui complicação por vezes de natureza grave, surpreendendo pacientes em curso de tratamento de uma doença já debilitante. Relata-se um caso dessa ocorrência, representada por um lado pelo uso de paclitaxel (taxol) para o tratamento de câncer de ovário e, do outro, por uma lesão complexa, de bifurcação, tratada percutaneamente.

Although associations between chemotherapy and acutecoronary syndromes or even acute myocardial infarctions are rare, they may result in complications that might even be severe, surprising patients during treatments of diseases that are already debilitating. We present a case study of such an association, represented on the one hand by the use of paclitaxel (Taxol), with a complex coronary lesion (bifurcation) treated percutaneously on the other.

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Objetivo: determinar si los valores de la fracción de eyección ventricular (FEV) pre y post procedimiento se relacionan con una mejoría en la calidad de vida (CdV) de los pacientes que fueron sometidos a cirugía de bypass coronario vs. angioplastia coronaria. Diseño: estudio prospectivo observacional realizado en la clínica Guayaquil con 56 pacientes en quienes se llevó a cabo un procedimiento de revascularización coronaria, entre abril de 2010 y marzo de 2011. La CdV fue evaluada por medio del cuestionario SF-36v2 y la FEV mediante ecocardiografía; se hizo una reevaluación de los pacientes 4 a 8 semanas posteriores a la intervención. Resultados: de la muestra, 27 (48.2%) fueron tratados con angioplastia y 29 (51.8%) con cirugía de bypass. Se observó una mejoría en 7 de las 8 dimensiones de la salud, siendo mayor en el grupo de bypass coronario, aunque la diferencia no fue significativa (p>0.05); en cambio, la dimensión de dolor corporal mostró un incremento similar en ambas técnicas (p>0.05). En cuanto a la FEV, el mayor porcentaje de mejoría se obtuvo en aquellos sometidos a bypass (41.4% vs. 25%, p>0.05). No se encontró relación entre FEV y CdV (R2=0.27 para angioplastia, R2=0.07 para bypass). Conclusiones: ambas estrategias resultaron en una mejoría de la CdV durante las cuatro semanas de seguimiento; no se encontró una relación entre los cambios en la CdV y los valores de FEV en los pacientes.

Objective: to determine if the pre and post-procedure ventricular ejection fraction (VEF) values are associated with improved quality of life (QOL) of the patients who underwent coronary bypass surgery vs. coronary angioplasty. Design: prospective observational study conducted in the Guayaquil clinic with 56 patients who underwent a coronary revascularization procedure between April 2010 and March 2011. QOL was assessed using the SF-36v2 questionnaire and the VEF through echocardiography. Patients were re-assessed 4 to 8 weeks after the operation. Results: of the sample, 27 (48.2%) were treated with angioplasty and 29 (51.8%) with bypass surgery. Improvement was observed in 7 of the 8 health dimensions, being higher in the coronary bypass group, although the difference was not significant (p>0.05). The bodily pain dimension showed a similar increase in both techniques (p> 0.05). In terms of VEF, the highest percentage of improvement was obtained with those undergoing the bypass (41.4% vs. 25%, p> 0.05). No relationship was found between VEF and QOL (R2= 0.27 for angioplasty, R2= 0.07 for bypass). Conclusions: both strategies resulted in an improvement of QOL during the four-week follow up; no relationship was found between changes in QOL and FEV values in the patients.

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BACKGROUND: In Brazil, despite the recommendations of the Brazilian Society of Hemodynamics and Interventional Cardiology, the National Health System has not yet approved the use of drug-eluting stents. In percutaneous coronary interventions performed in the public and part of the private health care system, bare metal stents are used as the only option. Therefore, new information on bare metal stents is of great importance. The primary endpoint was to evaluate the influence of the alloy and the profile of coronary stents on late loss and restenosis rates 6 months after implantation in patients with multivessel coronary disease. METHODS: Single center, randomized and prospective study comparison of cobalt-chromium versus stainless steel stent implantation in 187 patients with multivessel coronary disease. At least one cobalt-chromium and one stainless steel stent were implanted per patient. RESULTS: Mean age of patients was 59.5 + 10.1 years with a prevalence of males (66.3 percent) and patients with acute coronary syndrome (56 percent). Baseline clinical characteristics were similar with hypertension in 146 (78 percent), dyslipidemia in 85 (45.5 percent) and diabetes in 68 (36.4 percent). Two hundred and twenty-nine cobalt-chromium and 284 stainless steel stents were implanted. Angiographic variables showed no statistically significant difference. Angiographic follow-up to 6 months after implantation showed similar late loss and restenosis rates. CONCLUSION: The use of two different alloys, stainless steel and cobalt-chrome stents, in the same patient and in the same vessel produced similar 6-month restenosis and late loss rates.

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CONTEXT AND OBJECTIVE: The safety and efficacy of drug-eluting stents reduce the need for surgical revascularization. The objective of the present study was to investigate whether paclitaxel or rapamycin-eluting stent are effective in avoiding the need for coronary-artery bypass grafting. METHODS: This was a systematic review of the literature using the methodology of the Cochrane Collaboration. The type of study considered was controlled randomized trials; the type of intervention was drug-eluting or bare-metal stents; and the main outcome investigated was coronary-artery bypass grafting. RESULTS: The ten studies included in this systematic review did not show any statistically significant difference between the drug-eluting stents and the bare-metal stents with regard to the outcome of coronary-artery bypass grafting (confidence interval: 0.31 to 1.42). CONCLUSION: The surgical revascularization rate was not reduced by the use of drug-eluting stents.

CONTEXTO E OBJETIVO: A segurança e eficácia dos stents recobertos com drogas reduz a necessidade da cirurgia de revascularização cardíaca. O objetivo foi verificar se os stents recobertos com paclitaxel ou rapamicina são efetivos para evitar a necessidade de revascularização cirúrgica das coronárias. MÉTODOS: Revisão sistemática da literatura usando a metodologia do Centro Cochrane. Tipos de estudos: estudos clínicos randomizados; tipo de intervenção: stents recobertos com drogas ou stents convencionais; desfecho principal: cirurgia de revascularização cardíaca. RESULTADOS: Os 10 estudos incluídos nesta revisão sistemática não mostram diferença estatisticamente significante entre os stents recobertos com drogas e os stents convencionais no desfecho principal, com intervalo de confiança de 0.31, 1.42. CONCLUSÃO: A taxa de revascularização cardíaca não é reduzida pelo uso de stents recobertos com drogas.

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PURPOSE: To evaluate the immediate and long term results of percutaneous transluminal coronary balloon angioplasty (PTCA) in patients over 80 years old. METHODS: From 1/1/89 to 6/31/95, 97 patients with 80 years of age or older were submitted to PTCA and were divided into three groups: group A (GrA)-30 patients with stable angina, mean age of 82.5 years, 24 (80) men; group B(GrB)-40 patients with unstable angina, mean age 81.2 years, 31 (77.5) men; group C (GrC)-27 patients with myocardial infarction (MI), mean age of 82 years, 16 (59.2) men. RESULTS: Early outcome-general success rate of 84.5 and mortality rate of 5.1. The success and mortality rate were in GrA 83.3 and 3.3, in GrB 85 and 5 and in GrC 85.2 and 7.4, respectively. Late outcome-the number and percentage of patients with late follow-up and the clinic-angiographic and angiographic restenosis rates were for GrA 19(76), 52.9, 75; GrB 30(88.2), 30.8, 61.5 and GrC 12(52.2), 66.6, 85.7, respectively. CONCLUSION: PTCA can be considered an important revascularization alternative in octogenarian patients because of high early success rate, low mortality and acceptable long-term outcome.

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Objetivo - Determinar angiograficamente a retraçäo elástica (RE) nos primeiros 15 minutos após angioplastia coronária (AC) por cateter baläo. Métodos - E um estudo prospectivo, 154 pacientes, portadores de angina estável, foram submetidos a AC com sucesso. Realizaram-se angiografias imediatamente após a última insuflaçäo com sucesso e aos 5,10 e 15 min. Na análise quantitativa utilizou-se caliper eletrônico. Quantificaram-se o diâmetro luminal mínimo (DLM) e a RE no controle imediato, aos 5, 10 e 1min. Relacionaram-se a magnitude da RE e o DLM com as características angiográficas da lesäo tratada, com o diâmetro do baläo e com o grau de lesäo residual imediatamente após a AC. Resultados - O diâmetro de referência médio do vaso foi de 3,09+/_0,61 mm e o diâmetro do baläo de 2,95+/_0,52 mm. O DLM mínimo pré dilataçäo foi de 0,65+/_0,42 mm, atingindo 2,23+/_0,55 mm após a dilataçäo (p<0,0001), decrescendo para 2,09+/_0,47 mm e 5 min (p<0,0001), 2,01+/_0,47 mm em 10 min (p<0,0001) e para1,91+/_0,56 mem 15 min. (p<0,0001). A RE aumentou progressivamente, atingindo 34,29+/_20,40 por cento aos 15 min. Nos vaso tratados onde a relaçäo baläo/artéria < ou igual a 1 a RE foi de 0,90+/_0,74 mm em 15 min. e de 1,20+/_0,50 mm quando a relaçäo foi >1 (p<0,0001). Identificou-se maior RE nos primeiros 15 min. no grupo de pacientes onde a lesäo residual no controle imediato situou-se entre 30 a 50 por cento do que no grupo onde a lesäo residual foi < 30 por cento. Conclusäo - A RE é um fenômeno dinâmico e progrssvo que ocorre dentro de 15 min. após a AC com sucesso. Determinou reduçäo média de 34,29+/_20,40 por cento no diâmetro do vaso em 15 min. e é maior quando a relaçäo baläo/artéria é >1. A lesäo residual que situa entre 30 e 50 por cento no controle angiográfico imediato é fator preditor de maior RE ao longo dos 15 min.

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PURPOSE: To evaluate the clinical efficacy and safety of subcutaneous (SC) low molecular weight heparin (LMWH) compared to intravenous (IV) non fractioned heparin (NFH) in unstable angina, acute myocardial infarction and post-percutaneous transluminal coronary angioplasty. METHODS: From September/92 to April/94, 314 patients were randomized in two groups. Group I-- 154 patients treated with SC LMWH, using in the 1st phase SC LMWH with a dosage of 160 UaXa IC/kg/day (group IA--92 patients), and in the 2nd, a dosage of 320 UaXa IC/kg/day (group IB--62 patients). Group II--160 patients treated with IV NFH 100UI/kg (bolus), followed by 1000UI/h with adjusted dosage by activated partial thromboplastin time. RESULTS: There was not a statistically significant difference among the three groups in relation to cardiac events, hemorrhagic complications and deaths. CONCLUSION: The clinical efficacy and safety of SC LMWH in patients with unstable angina, acute myocardial infarction and post-percutaneous transluminal coronary angioplasty were similar to IV NFH with the dosages used in this study.

Objetivo - Comparar a eficácia clínica e segurança da heparina de baixo peso molecular (HPBM) subcutânea (SC) à da heparina não fracionada (HNF) intravenosa (IV) na angina instável, infarto agudo do miocárdio (IAM) e pós-angioplastia percutânea transluminal coronária. Métodos - De setembro/92 a abril/94, foram randomizados 314 pacientes, em 2 grupos: grupo 1 com 154 pacientes, tratados com HBPM via SC, usando na 1ª fase a dose de 160 UaXa IC/kg/dia (grupo IA - 92 pacientes) e na 2ª, a dose de 320 UaXalC/kgldia (grupo IB - 62 pacientes); grupo II com 160 pacientes, tratados com HNF via IV, 100UI/kg (bolus), seguido de 1000UI/h, infusão contínua, ajustando-se a dose de acordo como tempo de tromboplastina parcial ativado (TTPa). Resultados - Não houve diferença estatisticamente significante entre os três grupos em relação a eventos cardíacos, complicações hemorrágicas e óbitos. Conclusão - A eficácia clínica e segurança do uso da HBPM SC em pacientes com angina instável, IAM e pós-angioplastia percutânea transluminal coronária foi semelhante à HNF IV com as doses empregadas neste estudo

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PURPOSE: To describe the use of myocardial reperfusion strategies (percutaneous transluminal coronary angioplasty-PTCA and intravenous trombolysis) whenever it is possible to use emergency cinecoronariography in acute myocardial infarction (AMI). METHODS: The records of patients admitted with initial diagnosis of AMI, until six hours after the beginning of symptoms, were reviewed retrospectively, between March/92 and December/93. RESULTS: One hundred forty-three patients were admitted with suspected AMI. Eighty-one (57) presented definitive criteria for this diagnosis. Fifty-two patients (64) were admitted in the first six hours from the beginning of symptoms. Thirty-eight (73) were male and the mean age was 59 +/- 12 years. Cinecoronariography was indicated immediately in 36 of 52 (69) patients, with purpose to use PTCA. That was done in 30 (58). Two (4) patients were submitted to emergency surgical myocardial revascularization. Intravenous thrombolysis was used in 11 (21) patients. At admission, the conservative treatment was chosen for five out of nine left patients, based on clinical grounds. CONCLUSION: The availability of emergency cinecoronariography made an early reperfusion strategy possible in 83 of patients admitted with AMI in the first six hours after the beginning of symptoms

Objetivo - Descrever a utilização de estratégias de reperfusão miocárdica (angioplastia transluminal coronária primária - ATCP e a trombólise intravenosa) e o emprego da cinecoronariografia de emergência no infarto agudo do miocárdio (IAM). Métodos - Foram revistos, retrospectivamente, entre março/92 e dezembro/93, os prontuários dos pacientes admitidos com diagnóstico de IAM, com até 6h após o início dos sintomas. Resultados - Foram admitidos com suspeita de IAM, 143 pacientes dos quais 81 (57%) com critérios definitivos para este diagnóstico, sendo que 52 (64%) admitidos durante as 6 primeiras horas dos sintomas. Eram do sexo masculino 38 (73%), com média de idade de 59±12 anos. A cinecoronariografia foi indicada de forma imediata em 36 (69%) dos 52 pacientes, visando ATCP que foi realizada em 30 (58%). Dois (4%) pacientes foram encaminhados para cirurgia de revascularização miocárdica de emergência. A trombólise intravenosa foi utilizada em 11 (21%) pacientes. Na admissão optou-se pelo tratamento conservador em 5 dos 9 pacientes restantes, baseado no julgumento clínico. Conclusão - A disponibilidade da cinecoronariografia de emergência possibilitou a utilização de estratégias de reperfusão precoce em 83% dos pacientes admitidos com IAM durante as primeiras 6h

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Objetivo - Mostrar a experiência do Instituto de Cardiologia do Rio Grande do Sul/Fundaçäo Universitária de Cardiologia, com angioplastia transluminal coronária (ATC), após uso de trombolítico no infarto agudo do miocárdio (IAM). Métodos - De 1984-1989, 193 pacientes foram tratados com estreptoquinase e, destes, 54 foram submetidos à ATC. A idade média foi de 50 anos e a maioria dos pacientes era do sexo masculino. A área predominante do IAM foi a parede anterior. A artéria coronária "culpada" mais freqüente foi a descendente anterior. A indicaçäo para ATC foi lesäo uniarterial com menos de 20 mm de extensäo. Resultados - Obteve-se sucesso imediato em 44 pacientes (81,5%). Dez pacientes foram considerados insucessos sendo seis enviados à cirurgia de revascularizaçäo miocárdica de urgência. O índice de infarto pós ATC na fase hospitalar foi de 5,5%. No seguimento tardio observou-se um índice de reestenose de 11% e reoclusäo de 3,7%, sendo necessária uma nova ATC em 3 pacientes (5,5) e cirurgia de revascularizaçäo em um (1,8%). Conclusäo - Conclui-se que a ATC é um mêtodo seguro e importante na complementaçäo terapêutica pós uso de droga trombolítica com baixa morbidade e mortalidade

Purpose - To presente the Cardiology Institute of Rio Grande do Sul experience with percutaneous coronary angioplasty (PTCA). af ter thrombolitic therapy in acute myocardial infarction (AMI). Methods - Fifty-three patients with transmural AMI in whom early successful intravenous streptokinase recanalization was followed by PTCA. The mean age WAS 50 years, male patients were more frequent, the predominant area of infarct was anterior wall and more frequently the culprit coronary was the left anterior descendent. The main indication of PTCA was uniarterial lesion with less than 20 mm of length. Results - The success comes out in 44 patients (81.5%). Ten patients (18,5%) were considered unsuccessful and were referred to emergency bypass graft surgery. The in-hospital AMI rate after PTCA was 5.5%. In the follow-up the reestenose rate was 11% and reocclusion was 3.7%. New PTCA was necessary in 3 patients (5.5%) and in one, by-pass graft (1,8%). Conclusion - PTCA is an important and secure modality of complementary therapy after thrombolitic therapy with low mortality and mortality

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Objetivo Apresentar os resultados imediatos de pacientes submetidos a angioplastia coronária com cateteres de baixo perfil. Métodos No período de 16/6/89 a 28/9/90, foram tratados deforma consecutiva, 74 pacientes, com idade média de 55 anos, a maioria com doença de um vaso (92%) e boa função ventricular (88%), totalizando 80 lesões, 26 tipo A, 54 tipo B, de acordo com a classificação da Força Tarefa sobre angioplastia coronária do American College of Cardiology American Heart Association (FT-ACC/AHA). Os resultados foram analisados por quatro observadores: um cardiologista clínico (Ocli), um cirurgião cardiovascular (Ocir) e dois hemodinamicistas (H1, H2). Resultados Observou-se queda significativa do grau de obstrução pós-angioplastia, na opinião dos quatro observadores: 0cli = 83 ± 10,7/9,0 ± 14; 0cir = 86 ± 13/9,3 ± 11; H1 = 88,6 ± 7,0/8,5 ± 12; H2 = 88,5 ± 8,0/8,3 ± 12 (P < 0.001). O sucesso foi alcançado em 94,5% dos casos e a incidência de complicações foi de 2,7%. Conclusão O elevado perceptual de sucesso primário e a baixa incidência de complicações observados nessa série, podem ser creditados à seleção dos casos e à qualidade do material utilizado.

Purpose To present immediate results of percutaneous transluminal coronary angioplasty (PTCA) with the use of last generation catheter devices. Methods 74 pacients underwent PTCA meanage 55 years the majority of them with disease of one vessel (92%) and good left ventricular function (88%). There was a total of 80 lesions treated, 26 type A and 54 type B according to the Task Force for Coronary Angioplasty of the American College of Cardiology American Heart Association Classification. Results were analysed by separate observers: one clinical cardiologist (C), one cardiovascular surgeon (S) and two hemodynamicists (H1, H2). Results A significant fail in the degree of coronary obstruction was demonstrated post PTCA in the opinion of the observers: C = 83 ± 10.7/9.0 ± 14; S = 86 ± 13.0/9.3 ± 11; H1 = 88.6 ± 7.0/8.5 ±12; H2 = 88.5 ± 8.0/8.3 ± 12 (P < 0.001). Angiographic sucess was attained in 94.6% of the cases and the complication rate was low 2,7%. Conclusion The high primary success and the low complication rates seen in this series can be attributed to the careful selection of cases and advanced performance of the catheterization devices that were used

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