Pub Date : 2015-01-01DOI: 10.1016/j.rbciev.2015.01.002
Fabio Conejo, Henrique Barbosa Ribeiro, André Gasparini Spadaro, Roger Renault Godinho, Sandro M. Faig, Camila Gabrilaitis, Mariana Y. Okada, Alexandre Spósito, Carlos Vinícius Espirito-Santo, Marcelo Jamus Rodrigues, J. Carlos Teixeira Garcia, Pedro Gabriel Melo de Barros e Silva, Valter Furlan, Expedito E. Ribeiro
Background
Although same-day discharge (SDD) after elective uncomplicated percutaneous coronary intervention (PCI) be adopted worldwide, it remains poorly studied in our country. We aim to evaluate our initial experience with SDD after elective PCI, regarding its safety and predictors of success.
Methods
A hundred and sixty-one single-center consecutive patients, selected in a specialized outpatient clinic, were included for SDD. To identify the factors associated with SDD, single and multiple logistic regression models were adjusted.
Results
SDD was successfully performed in 114 patients (70.8%) and the remaining 47 patients remained hospitalized (45 with discharge in the following morning and 2 patients after 2 days). No patient with SDD presented major adverse cardiac events or major vascular complications at 30 days or at a median follow-up of 12 months. In the inpatient group, there was only one case of acute myocardial infarction due to a lateral branch occlusion and two patients with > 5 cm hematoma related to the access site. The SDD predictors were radial access route (OR = 5.92; 95%CI 1.73-20.21; p = 0.005), presence of type A/B1 lesions (OR = 14.09; 95%CI 1.70-116.49%; p = 0.01) and contrast volume (OR = 0.76; 95%CI 0.65-0.88; p < 0.001).
Conclusions
SDD was safe and could be successfully performed in most patients selected for elective PCI, and its predictors were the radial access, less complex coronary lesions and a and lower contrast volume.
{"title":"Safety and predictors of same day discharge after elective percutaneous coronary intervention","authors":"Fabio Conejo, Henrique Barbosa Ribeiro, André Gasparini Spadaro, Roger Renault Godinho, Sandro M. Faig, Camila Gabrilaitis, Mariana Y. Okada, Alexandre Spósito, Carlos Vinícius Espirito-Santo, Marcelo Jamus Rodrigues, J. Carlos Teixeira Garcia, Pedro Gabriel Melo de Barros e Silva, Valter Furlan, Expedito E. Ribeiro","doi":"10.1016/j.rbciev.2015.01.002","DOIUrl":"10.1016/j.rbciev.2015.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Although same-day discharge (SDD) after elective uncomplicated percutaneous coronary intervention (PCI) be adopted worldwide, it remains poorly studied in our country. We aim to evaluate our initial experience with SDD after elective PCI, regarding its safety and predictors of success.</p></div><div><h3>Methods</h3><p>A hundred and sixty-one single-center consecutive patients, selected in a specialized outpatient clinic, were included for SDD. To identify the factors associated with SDD, single and multiple logistic regression models were adjusted.</p></div><div><h3>Results</h3><p>SDD was successfully performed in 114 patients (70.8%) and the remaining 47 patients remained hospitalized (45 with discharge in the following morning and 2 patients after 2 days). No patient with SDD presented major adverse cardiac events or major vascular complications at 30 days or at a median follow-up of 12 months. In the inpatient group, there was only one case of acute myocardial infarction due to a lateral branch occlusion and two patients with > 5<!--> <!-->cm hematoma related to the access site. The SDD predictors were radial access route (OR = 5.92; 95%CI 1.73-20.21; <em>p</em> = 0.005), presence of type A/B1 lesions (OR = 14.09; 95%CI 1.70-116.49%; <em>p</em> = 0.01) and contrast volume (OR = 0.76; 95%CI 0.65-0.88; <em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>SDD was safe and could be successfully performed in most patients selected for elective PCI, and its predictors were the radial access, less complex coronary lesions and a and lower contrast volume.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 42-47"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"103465530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-01DOI: 10.1016/j.rbciev.2015.06.004
Olivier F. Bertrand, Alberto Barria Perez
{"title":"Transradial approach for post-coronary artery bypass graft patients: is it worth the efforts?","authors":"Olivier F. Bertrand, Alberto Barria Perez","doi":"10.1016/j.rbciev.2015.06.004","DOIUrl":"10.1016/j.rbciev.2015.06.004","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 2-3"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"94410980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-01DOI: 10.1016/j.rbciev.2015.01.007
Ivan Petry Feijó, Márcia Moura Schmidt, Renato Budzyn David, João Maximiliano Pedron Martins, Karine Elisa Schmidt, Carlos Antonio Mascia Gottschall, Alexandre Schaan de Quadros
Background
The epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).
Methods
Prospective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.
Results
A total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).
Conclusions
Patients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low.
{"title":"Clinical profile and outcomes of primary percutaneous coronary intervention in young patients","authors":"Ivan Petry Feijó, Márcia Moura Schmidt, Renato Budzyn David, João Maximiliano Pedron Martins, Karine Elisa Schmidt, Carlos Antonio Mascia Gottschall, Alexandre Schaan de Quadros","doi":"10.1016/j.rbciev.2015.01.007","DOIUrl":"10.1016/j.rbciev.2015.01.007","url":null,"abstract":"<div><h3>Background</h3><p>The epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).</p></div><div><h3>Methods</h3><p>Prospective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.</p></div><div><h3>Results</h3><p>A total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; <em>p</em> = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (<em>p</em> = 0.07).</p></div><div><h3>Conclusions</h3><p>Patients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 1","pages":"Pages 48-51"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.01.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100618597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30013-2
Fernando Pivatto Jr. , Márcio Mossmann , Ana Maria Krepsky , Alexandre do Canto Zago
Mid-ventricular hypertrophic obstructive cardiomyopathy is a rare variant form (1%) of hypertrophic obstructive cardiomyopathy. In this case, we report a patient referred for elective cardiac catheterization due to angina and dyspnea on moderate exertion, with no significant coronary obstruction, and left ventriculography indicating the presence of mid-ventricular hypertrophic obstructive cardiomyopathy with an intraventricular pressure gradient of 130 mmHg.
A cardiomiopatia hipertrófica obstrutiva médio-ventricular é uma variante rara (1%) da miocardiopatia hipertrófica obstrutiva. Neste relato de caso, apresentamos uma paciente encaminhada para realização de cateterismo cardíaco eletivo por angina e dispneia aos moderados esforços, sem obstrução coronariana significativa e com ventriculografia esquerda, demostrando cardiomiopatia hipertrófica obstrutiva médio-ventricular com um gradiente pressórico intraventricular de 130 mmHg.
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Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30007-7
Roberto Ramos Barbosa , Felipe Bortot Cesar , Renato Giestas Serpa , Denis Moulin dos Reis Bayerl , Vinicius Fraga Mauro , Walkimar Ururay Gloria Veloso , Roberto de Almeida Cesar , Pedro Abilio Ribeiro Reseck , Valmin Ramos-Silva
Background
Treatment of ST-elevation acute myocardial infarction has primary percutaneous coronary intervention as the preferred method of reperfusion. This study aimed to evaluate in-hospital outcomes of patients with ST-elevation acute myocardial infarction according to the total ischemic time until performing primary percutaneous coronary intervention.
Methods
Single-center registry of patients admitted with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention between March/2012 and February/2014, followed from admission to hospital discharge, and compared according to the total ischemic time (Group 1: symptom onset-to-balloon time < 6 hours; Group 2: symptom onset-to-balloon time > 6 and < 12 hours).
Results
Two hundred seventy nine patients underwent primary percutaneous coronary intervention, 118 in Group 1 (42.3%) and 161 in Group 2 (57.7%). Group 2 was older, had higher prevalence of hypertension, fewer smokers, more patients in Killip-Kimball class > 2 and lower primary percutaneous coronary intervention success rate. The incidences of death or non-fatal infarction (11.0% vs. 18.6%; p = 0.08), death (8.5% vs. 16.8%; p = 0.04) and acute renal failure (7.6% vs. 19.9%; p < 0.01) were greater in Group 2.
Conclusions
Patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention with symptom onset-to-balloon time > 6 hours presented higher clinical complexity and worse in-hospital outcomes when compared to patients treated earlier. Joint actions in different critical areas of patient care are essential to increase treatment efficacy and reduce adverse outcomes.
RESUMO
Resultados da Interveção Coronária Percutânea Primária de Acordo com o Tempo Total de Isquemia
Introdção
O tratamento do infarto agudo do miocárdio com supradesnivelamento de ST tem a intervenção coronária percutânea primária como método preferencial de reperfusão. Este estudo teve como objetivo avaliar a evolução hospitalar de pacientes com infarto agudo do miocárdio com supradesnivelamento de ST, conforme o tempo total de isquemia, até a realização de intervenção coronária percutânea primária.
Métodos
Registro unicêntrico, de pacientes admitidos com infarto agudo do miocárdio com supradesnivelamento de ST submetidos à intervenção coronária percutânea primária entre março de 2012 e fevereiro de 2014, acompanhados da admissão até a alta hospitalar e comparados conforme o tempo total de isquemia (Grupo 1: tempo dor-balão < 6 horas; Grupo 2: tempo dor-balão > 6 e
背景st段抬高急性心肌梗死的治疗首选经皮冠状动脉介入治疗。本研究旨在评估st段抬高急性心肌梗死患者的住院结果，根据缺血总时间进行首次经皮冠状动脉介入治疗。方法对2012年3月~ 2014年2月收治的经皮冠状动脉介入治疗的st段抬高急性心肌梗死患者进行单中心登记，从入院到出院进行随访，比较总缺血时间(第一组:症状发作至球囊时间<6小时;第二组:症状发作至球囊时间>6和<12小时)。结果经皮冠状动脉介入治疗共279例，其中1组118例(42.3%)，2组161例(57.7%)。2组患者年龄较大，高血压患病率较高，吸烟者较少，Killip-Kimball级患者较多;2、原发性经皮冠状动脉介入治疗成功率降低。死亡或非致死性梗死的发生率(11.0% vs. 18.6%;P = 0.08)，死亡(8.5% vs. 16.8%;P = 0.04)和急性肾衰竭(7.6% vs. 19.9%;p & lt;0.01)。结论st段抬高急性心肌梗死患者行经皮冠状动脉介入治疗，发病至球囊时间;与早期治疗的患者相比，6小时出现更高的临床复杂性和更差的住院结果。在患者护理的不同关键领域采取联合行动对于提高治疗效果和减少不良后果至关重要。RESUMOResultados da Intervecao良性Percutanea Primaria de Acordo com o节奏总de IsquemiaIntrodcaoO tratamento做infarto agudo做miocardio com supradesnivelamento德圣tem intervencao良性Percutanea Primaria科莫德reperfusao metodo优惠。Este estudo teve como objetivo avaliar a evolutional o hospitalar de pacientes com infarto agudo do miocárdio com supradesnivelamento de ST，符合tempo total de isquemia, at a realizao de interpatiente o coronária percut nea primária。1 . 数据交换系统unicêntrico， 数据交换系统miocárdio， 数据交换系统数据交换系统， 数据交换系统数据交换系统， coronária - 数据交换系统， primária - 数据交换系统，2012 - 数据交换系统，2012 - 数据交换系统，2014 - 数据交换系统，数据交换系统，数据交换系统，数据交换系统，数据交换系统，数据交换系统，数据交换系统，数据交换系统，数据交换系统;6小时;第二组:节奏-节奏 >6 e & t;12小时)。结果:(1)次中压性椎体间干预 (coronária percut) primária 279例，1组118例(42.3%)，2组161例(57.7%)。2组:主要动脉性动脉病变(idade mais avanada)，主要prevalência de hipertens;主要动脉性动脉病变(menor proporente);主要número de pacentes em class。2 . menor类群de successo da interventiar o coronária percut primária。As incidências de óbito ou infarto n o fatal (11.0% vs. 18.6%;P = 0,08)， óbito (8.5% vs. 16.8%;P = 0.04);肾功能不全(7.6% vs. 19.9%;p & lt;2001)有孔的主要没有组2。ConclusõesPacientes com infarto agudo do miocárdio com supradesnivelamento de ST submetidos interinter o coronária percut nea primária com tempo dor- balo >6小时apresentaram星座complexidade我们e pior evolucao hospitalar em relagao aqueles tratados但是precocemente。Ações conjuntas em diversos pontos críticos da assistência ao paciente s o fundamentais para umar a eficácia do treatment e reduzir o desfechos adversos。
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Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30006-5
Daniel Rios Pinto Ribeiro, Eduardo Cambruzzi, Juliana Canedo Sebben, Karina Pezzi Melleu, Marcia Moura Schmidt, Carlos AM Gottschall, Alexandre Schaan de Quadros
Background
Diabetes mellitus is associated with increased mortality rates in the setting of acute myocardial infarction. The aim of this study was to evaluate whether there are peculiarities in the atherothrombotic process that might be implicated in increased risk for this outcome in patients with diabetes.
Methods
Pilot study in a cohort of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention and aspiration thrombectomy. Clinical and laboratory variables were evaluated in all of the cases. Thrombi were analyzed for histopathological features as well as immunohistochemical expression of CD34, CD61 and factor VIII.
Results
Our sample included the first ten diabetic patients with material available for analysis, who were matched according to age, gender and time elapsed since myocardial infarction with ten patients without diabetes. There was no significant association between the immunohistochemical expression of CD34, CD61 and factor VIII with other histopathological, clinical and laboratory variables, including the presence of diabetes mellitus.
Conclusions
In this preliminary analysis, it was not possible to demonstrate any significant difference in the expression of endothelial cell activity, platelet function and activation of the coagulation cascade between thrombi of patients with and without diabetes undergoing primary coronary intervention.
RESUMO
Características Imuno-Histoquímicas de Trombos Coronarianos de Pacientes com Infarto do Miocárdio com Elevação de ST e Diabetes Mellitus: Estudo Piloto
Introdução
No contexto do infarto agudo do miocárdio, o diabetes mellitus está associado à maior mortalidade. O objetivo deste estudo foi avaliar se existem, entre os diabéticos, peculiaridades no processo de aterotrombose que poderiam estar implicadas em maior risco para tal desfecho.
Métodos
Estudo piloto, proveniente de coorte de pacientes com diagnòstico de infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronária percutânea primária e à tromboaspiração. Foram estudadas variáveis clínico-laboratoriais de cada caso. Os trombos foram analisados quanto às características histopatológicas e às expressöes imuno-histoquímicas de CD34, CD61 e fator VIII.
Resultados
Foram incluídos os primeiros dez pacientes portadores de diabetes mellitus com material disponível para análise, pareados por idade, sexo e tempo de evolução do infarto com dez pacientes sem diabetes mellitus. Não houve associação significativa entre as expressões imuno-histoquímicas de CD34, CD61 e fator VIII com relação às variáveis histopatológicas, laboratoriais e clínicas estudadas, inclusive com relação à presença de diabetes mellitus.
Conclusões
背景:糖尿病与急性心肌梗死的死亡率增加有关。本研究的目的是评估动脉粥样硬化血栓形成过程中是否存在可能与糖尿病患者发生这种结果的风险增加有关的特殊性。方法对st段抬高急性心肌梗死患者进行经皮冠状动脉介入治疗和吸入性血栓切除术的队列研究。对所有病例的临床和实验室变量进行评估。分析血栓组织病理学特征及CD34、CD61和因子VIII的免疫组化表达。结果我们的样本包括了前10例可用于分析的糖尿病患者，他们根据年龄、性别和心肌梗死后的时间与10例非糖尿病患者相匹配。CD34、CD61和因子VIII的免疫组化表达与其他组织病理学、临床和实验室变量(包括糖尿病的存在)之间无显著相关性。结论在本初步分析中，无法证明接受初级冠状动脉介入治疗的糖尿病患者和非糖尿病患者血栓在内皮细胞活性表达、血小板功能和凝血级联激活方面存在显著差异。RESUMOCaracteristicas Imuno-Histoquimicas de Trombos Coronarianos de Pacientes com Infarto做Miocardio com Elevacao德圣e糖尿病:Estudo PilotoIntroducaoNo contexto做Infarto agudo Miocardio, o糖尿病esta associado星座mortalidade。目的:研究不同类型的个体存在、不同类型的个体存在、不同类型的个体存在、不同类型的个体存在、不同类型的个体存在、不同类型的个体存在、不同类型的个体存在。m (miocárdio) - (coronária) - (primária) - - ) - - - - - - - - - - - o。Foram eststudadas variáveis clínico-laboratoriais de cada caso。Os trombos foram analisados quanto às características histopatológicas e às expressöes imuno-histoquímicas de CD34, CD61 e fator VIII。结果:(1)对糖尿病患者的初步诊断(incluídos)，对糖尿病患者的诊断(disponível)，对糖尿病患者的诊断(disponível)，对糖尿病患者的诊断(disponível)，对糖尿病患者的诊断(disponível)，对糖尿病患者的诊断(disponível)。无相关中心为expressões imuno-histoquímicas de CD34, CD61，因子8，相关中心为às variáveis histopatológicas，实验室为clínicas，包括糖尿病相关中心为。ConclusoesEm解析preliminar, nao信息自由possivel demonstrar高差significativa quanto expressao da atividade de中和endoteliais, da funcao plaquetaria e哒ativacao哒cascata de coagulacao之间trombos de pacientes com e sem o记录de糖尿病submetidos intervencao coronariana primaria。
{"title":"Immunohistochemical Characteristics of Coronary Thrombi in Patients with ST-Elevation Myocardial Infarction and Diabetes Mellitus: Pilot Studyy","authors":"Daniel Rios Pinto Ribeiro, Eduardo Cambruzzi, Juliana Canedo Sebben, Karina Pezzi Melleu, Marcia Moura Schmidt, Carlos AM Gottschall, Alexandre Schaan de Quadros","doi":"10.1016/S2214-1235(15)30006-5","DOIUrl":"10.1016/S2214-1235(15)30006-5","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes mellitus is associated with increased mortality rates in the setting of acute myocardial infarction. The aim of this study was to evaluate whether there are peculiarities in the atherothrombotic process that might be implicated in increased risk for this outcome in patients with diabetes.</p></div><div><h3>Methods</h3><p>Pilot study in a cohort of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention and aspiration thrombectomy. Clinical and laboratory variables were evaluated in all of the cases. Thrombi were analyzed for histopathological features as well as immunohistochemical expression of CD34, CD61 and factor VIII.</p></div><div><h3>Results</h3><p>Our sample included the first ten diabetic patients with material available for analysis, who were matched according to age, gender and time elapsed since myocardial infarction with ten patients without diabetes. There was no significant association between the immunohistochemical expression of CD34, CD61 and factor VIII with other histopathological, clinical and laboratory variables, including the presence of diabetes mellitus.</p></div><div><h3>Conclusions</h3><p>In this preliminary analysis, it was not possible to demonstrate any significant difference in the expression of endothelial cell activity, platelet function and activation of the coagulation cascade between thrombi of patients with and without diabetes undergoing primary coronary intervention.</p></div><div><h3>RESUMO</h3><p>Características Imuno-Histoquímicas de Trombos Coronarianos de Pacientes com Infarto do Miocárdio com Elevação de ST e <em>Diabetes Mellitus</em>: Estudo Piloto</p></div><div><h3>Introdução</h3><p>No contexto do infarto agudo do miocárdio, o <em>diabetes mellitus</em> está associado à maior mortalidade. O objetivo deste estudo foi avaliar se existem, entre os diabéticos, peculiaridades no processo de aterotrombose que poderiam estar implicadas em maior risco para tal desfecho.</p></div><div><h3>Métodos</h3><p>Estudo piloto, proveniente de coorte de pacientes com diagnòstico de infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronária percutânea primária e à tromboaspiração. Foram estudadas variáveis clínico-laboratoriais de cada caso. Os trombos foram analisados quanto às características histopatológicas e às expressöes imuno-histoquímicas de CD34, CD61 e fator VIII.</p></div><div><h3>Resultados</h3><p>Foram incluídos os primeiros dez pacientes portadores de <em>diabetes mellitus</em> com material disponível para análise, pareados por idade, sexo e tempo de evolução do infarto com dez pacientes sem <em>diabetes mellitus</em>. Não houve associação significativa entre as expressões imuno-histoquímicas de CD34, CD61 e fator VIII com relação às variáveis histopatológicas, laboratoriais e clínicas estudadas, inclusive com relação à presença de <em>diabetes mellitus</em>.</p></div><div><h3>Conclusões","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 131-136"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30006-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83447389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Percutaneous renal sympathetic denervation was developed as an adjunct method to treat clinical conditions associated to sympathetic hyperactivity. Percutaneous renal sympathetic denervation increases the renal blood flow and reduces vasoconstriction. The effects of percutaneous renal sympathetic denervation in renal artery diameter have not been reported. Our objective was to evaluate such effects by quantitative angiography.
Methods
Prospective, observational, study including consecutive patients undergoing percutaneous renal sympathetic denervation.
Results
Thirty-one patients were selected, 21 were submitted to percutaneous renal sympathetic denervation to control resistant arterial hypertension and 10 to control refractory ventricular arrhythmias. Seventeen patients did not perform renal arteriography in the follow-up due to clinical contraindications or because they did not complete the 6-month period established by the protocol. In addition, one patient performed a unilateral percutaneous renal sympathetic denervation and was also excluded from this analysis. Therefore, 52 renal angiographies (26 pairs) of 13 patients were analyzed. Mean maximal diameter of the right renal artery before the procedure was 4.54 ± 0.21 mm and increased to 5.2 ± 0.44 mm at 6 months (p = 0.01). Likewise, there was a significant increase in the diameter of the left renal artery at 6 months of follow-up, increasing from 4.37 ± 0.42 to 5.23 ± 0.77 mm (p = 0.02).
Conclusions
The results of this analysis illustrate the significant increment in renal artery diameter after percutaneous renal sympathetic denervation. Randomized controlled clinical trials are required to consolidate our observations.
RESUMO
Efeitos da Denervação Simpática Renal no Diâmetro da Artéria Renal Avaliados Pela Angiografia Quantitativa
Introdução
A denervação simpática renal percutânea surgiu como método adjunto no controle de condições clínicas as- sociadas à hiperatividade simpática. Ela resulta em aumento do fluxo sanguíneo renal e em redução da vasoconstrição. Os efeitos da denervação simpática renal percutânea no diâmetro da artéria renal ainda não foram descritos. Nosso objetivo foi avaliar tais efeitos por meio da angiografia quantitativa. Métodos: Estudo prospectivo e observacional que incluiu pacientes consecutivos submetidos à denervação simpática renal percutânea.
Resultados
Selecionamos 31 pacientes, sendo 21 submetidos à denervação simpática renal percutânea para controle da hipertensão arterial resistente e 10 para controle de arritmias ventriculares refratárias. Dezessete pacientes não realizaram arteriografia renal no seguimento por não completarem
背景:经皮肾交感神经断行是一种辅助治疗交感神经过度活跃相关临床疾病的方法。经皮肾交感神经断行增加肾血流量，减少血管收缩。经皮肾交感神经断行对肾动脉直径的影响尚未见报道。我们的目的是通过定量血管造影来评估这种效果。方法前瞻性、观察性研究，包括连续接受经皮肾交感神经切断手术的患者。结果31例患者经皮行肾交感神经切断术治疗顽固性高血压21例，顽固性室性心律失常10例。17例患者在随访中由于临床禁忌症或未完成方案规定的6个月期而未进行肾动脉造影。此外，一名患者进行了单侧经皮肾交感神经断行，也被排除在本分析之外。因此，我们对13例患者的52张肾血管造影(26对)进行了分析。术前右肾动脉平均最大直径为4.54±0.21 mm，术后6个月增大至5.2±0.44 mm (p = 0.01)。随访6个月时左肾动脉直径也明显增加，从4.37±0.42 mm增加到5.23±0.77 mm (p = 0.02)。结论经皮肾交感神经切断术后肾动脉直径明显增加。需要随机对照临床试验来巩固我们的观察结果。RESUMOEfeitos da denerva o Simpática肾no didimetro da art肾脏血管增生定量分析a denerva血管增生定量分析a denerva o simpática肾经皮手术como m与未控制的condições clínicas as- sociadas hiperatividade simpática。结果:肾血管收缩、肾血管收缩、肾脏收缩、肾脏收缩、肾脏收缩、肾脏收缩、肾脏收缩、肾脏收缩、肾脏收缩、肾脏收缩。Os efeitos da denerva。目的探讨血管成形术中血管损伤的定量诊断效果。观察性研究包括连续的中毒者神经变性或simpática肾穿刺患者。结果:选择31例患者，发送21例肾神经下膜或simpática肾经膜，控制血压升高或动脉阻力，10例控制心室炎refratárias。肾小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球小球Adicionalmente, uma pacente实现神经变性 simpática肾经切单侧，送tamb excluída desta análise。合并血管成形术52例(26例)，分析有孔畸形患者13例。媒体做diametro maximo da动脉肾direita,什么做procedimento,信息自由de 4, 54±0,21毫米e aumentou对位5 2±0,44毫米横穿6 mes (p = 0 01)。Da mesma forma, observous -se aumento significativo do dimetro Da artassria renal esquerda aos 6 meses de seguimento, ampliando de 4,37±0,42 para 5,23±0,77 mm (p = 0,02)。ConclusõesOs resultados desta análise插图o显著性增加diámetros das art simpática肾过cutnea。Ensaios clínicos randomizados e controlados s o necessários para consolidar nossas observações。
{"title":"Effects of Renal Sympathetic Denervation in Renal Artery Diameter Evaluated By Quantitative Angiography","authors":"Luciana Armaganijan, Rodolfo Staico, Dalmo Moreira, Celso Amodeo, Flávio Borelli, Márcio Sousa, Amanda Sousa, Alexandre Abizaid","doi":"10.1016/S2214-1235(15)30010-7","DOIUrl":"https://doi.org/10.1016/S2214-1235(15)30010-7","url":null,"abstract":"<div><h3>Background</h3><p>Percutaneous renal sympathetic denervation was developed as an adjunct method to treat clinical conditions associated to sympathetic hyperactivity. Percutaneous renal sympathetic denervation increases the renal blood flow and reduces vasoconstriction. The effects of percutaneous renal sympathetic denervation in renal artery diameter have not been reported. Our objective was to evaluate such effects by quantitative angiography.</p></div><div><h3>Methods</h3><p>Prospective, observational, study including consecutive patients undergoing percutaneous renal sympathetic denervation.</p></div><div><h3>Results</h3><p>Thirty-one patients were selected, 21 were submitted to percutaneous renal sympathetic denervation to control resistant arterial hypertension and 10 to control refractory ventricular arrhythmias. Seventeen patients did not perform renal arteriography in the follow-up due to clinical contraindications or because they did not complete the 6-month period established by the protocol. In addition, one patient performed a unilateral percutaneous renal sympathetic denervation and was also excluded from this analysis. Therefore, 52 renal angiographies (26 pairs) of 13 patients were analyzed. Mean maximal diameter of the right renal artery before the procedure was 4.54<!--> <!-->±<!--> <!-->0.21<!--> <!-->mm and increased to 5.2<!--> <!-->±<!--> <!-->0.44<!--> <!-->mm at 6 months (<em>p</em> <!-->=<!--> <!-->0.01). Likewise, there was a significant increase in the diameter of the left renal artery at 6 months of follow-up, increasing from 4.37<!--> <!-->±<!--> <!-->0.42 to 5.23<!--> <!-->±<!--> <!-->0.77<!--> <!-->mm (<em>p</em> <!-->=<!--> <!-->0.02).</p></div><div><h3>Conclusions</h3><p>The results of this analysis illustrate the significant increment in renal artery diameter after percutaneous renal sympathetic denervation. Randomized controlled clinical trials are required to consolidate our observations.</p></div><div><h3>RESUMO</h3><p>Efeitos da Denervação Simpática Renal no Diâmetro da Artéria Renal Avaliados Pela Angiografia Quantitativa</p></div><div><h3>Introdução</h3><p>A denervação simpática renal percutânea surgiu como método adjunto no controle de condições clínicas as- sociadas à hiperatividade simpática. Ela resulta em aumento do fluxo sanguíneo renal e em redução da vasoconstrição. Os efeitos da denervação simpática renal percutânea no diâmetro da artéria renal ainda não foram descritos. Nosso objetivo foi avaliar tais efeitos por meio da angiografia quantitativa. Métodos: Estudo prospectivo e observacional que incluiu pacientes consecutivos submetidos à denervação simpática renal percutânea.</p></div><div><h3>Resultados</h3><p>Selecionamos 31 pacientes, sendo 21 submetidos à denervação simpática renal percutânea para controle da hipertensão arterial resistente e 10 para controle de arritmias ventriculares refratárias. Dezessete pacientes não realizaram arteriografia renal no seguimento por não completarem ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 155-160"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30010-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137225639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30008-9
Thomas Edison Cintra Osterne , Wilson Albino Pimentel Filho , Fernando Augusto Molinori di Castro Curado , Edson Alcides Bocchi , Wellington Borges Custódio , Gustavo Mello Gomes de Matos , Pedro Henrique Luiggi Teixeira , Marcos Venício Martins Gori , Waigner Bento Pupin Filho , Gustavo Vinicius Lambert Olivotti , Jorge Roberto Büchler , Stoessel Figueiredo de Assis
Background
To date, there are no studies evaluating the use of the titanium-nitride-oxide coated stent in patients with multivessel coronary artery disease. We have compared the performance of the Titan-2® stent to that of the second generation drug-eluting stents in this scenario.
Methods
From 2011 to 2012, 284 patients were treated with the Titan-2® stent, of which 100 (35.2%) had multivessel coronary artery disease. This group was compared to 100 patients, of a group of 304 (38.9%) patients with multivessel coronary artery disease treated with second generation drug-eluting stents with durable or biodegradable polymers. The primary endpoint was the occurrence of major adverse cardiovascular events at 1 year.
Results
Clinical, angiographic and procedure-related characteristics of the patients did not show differences between groups. Most patients in the Titan-2® group were male (70%), mean age was 68.4 ± 12.9 years and 25% were diabetic. Stable symptomatic patients were prevalent (68%), 51% had three-vessel disease and ventricular function was preserved (55.6 ± 12.7%). The incidence of major adverse cardiovascular events at 1 year in the Titan-2® group was 21% (vs. 17%; p = 0.59), death was observed in 3% (vs. 2%; p > 0.99) of the patients, acute myocardial infarction in 5% (vs. 4%; p > 0.99) and a new revascularization procedure in 13% (vs. 11%; p = 0.83). Definitive stent thrombosis was not observed in either group.
Conclusions
The Titan-2® stent showed similar results to those of the second-generation drug-eluting stents, which makes it attractive for use in the complex scenario of patients with multivessel coronary artery disease.
RESUMO
Desempenho do Stent Recoberto por Titânio-Óxido Nítrico em Pacientes com Doença Coronária Multiarterial
Introdção
Até o momento, nenhum estudo avaliou o stent recoberto por titânio-óxido nítrico em pacientes com doença arterial coronariana multiarterial. Comparamos o desempenho do stent Titan-2® ao stents farmacológicos de segunda geragao nesse cenário.
Métodos
No período de 2011 a 2012, 284 pacientes foram tratados com o stent Titan-2®, dos quais 100 (35,2%) eram portadores de doença arterial coronariana multiarterial. Esse grupo foi comparado a 100 pacientes, de um grupo de 304 (38,9%), com doença arterial coronariana multiarterial, tratados com o stent farmacológico de segunda geração com polímeros duráveis ou biodegradáveis. O desfecho primário foi a ocorrência de eventos cardíacos adversos maiores em 1 ano.
Resultados
Características clínicas, angiográficas e do procedimento não apresentaram diferenças entre os grupos. A maioria dos pacientes do grupo Titan-2® era do sexo masculino (70%), com idade de 68,4 ± 12,9 anos e 25% eram diabéticos. Predominaram os quadros clínicos
到目前为止，还没有研究评估氮化钛涂层支架在多支冠状动脉疾病患者中的应用。在这种情况下，我们比较了Titan-2®支架与第二代药物洗脱支架的性能。方法2011年至2012年，284例患者接受Titan-2®支架治疗，其中100例(35.2%)患有多支冠状动脉疾病。这一组与304名(38.9%)多支冠状动脉疾病患者中的100名患者进行了比较，这些患者接受了耐用或可生物降解聚合物的第二代药物洗脱支架治疗。主要终点是1年内主要不良心血管事件的发生。结果两组患者的临床、血管造影及手术相关特征无明显差异。Titan-2®组患者以男性为主(70%)，平均年龄68.4±12.9岁，糖尿病患者占25%。症状稳定的患者普遍存在(68%)，51%有三支血管疾病，心室功能保留(55.6±12.7%)。Titan-2®组1年主要不良心血管事件发生率为21% (vs. 17%;P = 0.59)，死亡率为3% (vs. 2%;p比;0.99)，急性心肌梗死发生率为5% (vs. 4%;p比;0.99)和新的血运重建术(13%)(vs. 11%;P = 0.83)。两组均未见明确的支架血栓形成。结论Titan-2®支架与第二代药物洗脱支架具有相似的效果，这使得其在多支冠状动脉疾病患者的复杂情况下具有吸引力。RESUMODesempenho做支架Recoberto为什么Titanio-Oxido Nitrico em Pacientes com Doenca良性MultiarterialIntrodcaoAte o纪念品,nenhum estudo avaliou o支架Recoberto为什么Titanio-Oxido Nitrico em Pacientes com Doenca动脉coronariana multiarterial。泰坦-2®支架与支架的比较farmacológicos de segunda geragao nesse cenário。2011年至2012年，共有284例患者接受了Titan-2®支架治疗，100例(35,2%)患者接受了多动脉冠状动脉支架治疗。对比组100例，对比组304例(38.9%)，动脉冠状动脉多动脉，血管支架farmacológico第二段血管支架polímeros duráveis ou biodegradáveis。O desfecho primário foi a ocorrência de eventos cardíacos adversos maiores em 1 ano。ResultadosCaracterísticas clínicas, angiográficas e . do procedure to n在两组中呈现不同的形式。Titan-2®组的大部分患者为男性(70%)，其余患者(68,4±12,9)为男性(25%)。占主导地位的四轴动脉clínicos estáveis(68%)， 51%的三动脉血管和心室瓣膜保存。与泰坦-2®组相比，泰坦-2®组心血管不良事件发生率为21% (vs. 17%;P = 0,59)， óbito ocorreu = 3% (vs. 2%;p比;[0,99] DOS患者中，infarto do miocárdio发生率为5% (vs. 4%;p比;[0,99]新星血管重建术- - miocárdica - em 13% (vs. 11%;P = 0,83)。无孔虫固定状态，无支架固定状态。ConclusõesO uso do Titan-2®目前的结果与使用支架farmacológico de segunda gerapart的结果相似，不使用复合支架cenário de pacies portadores de doenadara动脉冠状动脉多动脉。
{"title":"Performance of the Titanium-Nitride-Oxide Coated Stent in Patients with Multivessel Coronary Artery Disease","authors":"Thomas Edison Cintra Osterne , Wilson Albino Pimentel Filho , Fernando Augusto Molinori di Castro Curado , Edson Alcides Bocchi , Wellington Borges Custódio , Gustavo Mello Gomes de Matos , Pedro Henrique Luiggi Teixeira , Marcos Venício Martins Gori , Waigner Bento Pupin Filho , Gustavo Vinicius Lambert Olivotti , Jorge Roberto Büchler , Stoessel Figueiredo de Assis","doi":"10.1016/S2214-1235(15)30008-9","DOIUrl":"10.1016/S2214-1235(15)30008-9","url":null,"abstract":"<div><h3>Background</h3><p>To date, there are no studies evaluating the use of the titanium-nitride-oxide coated stent in patients with multivessel coronary artery disease. We have compared the performance of the Titan-2® stent to that of the second generation drug-eluting stents in this scenario.</p></div><div><h3>Methods</h3><p>From 2011 to 2012, 284 patients were treated with the Titan-2® stent, of which 100 (35.2%) had multivessel coronary artery disease. This group was compared to 100 patients, of a group of 304 (38.9%) patients with multivessel coronary artery disease treated with second generation drug-eluting stents with durable or biodegradable polymers. The primary endpoint was the occurrence of major adverse cardiovascular events at 1 year.</p></div><div><h3>Results</h3><p>Clinical, angiographic and procedure-related characteristics of the patients did not show differences between groups. Most patients in the Titan-2® group were male (70%), mean age was 68.4 ± 12.9 years and 25% were diabetic. Stable symptomatic patients were prevalent (68%), 51% had three-vessel disease and ventricular function was preserved (55.6 ± 12.7%). The incidence of major adverse cardiovascular events at 1 year in the Titan-2® group was 21% (vs. 17%; <em>p</em> = 0.59), death was observed in 3% (vs. 2%; <em>p</em> > 0.99) of the patients, acute myocardial infarction in 5% (vs. 4%; <em>p</em> > 0.99) and a new revascularization procedure in 13% (vs. 11%; <em>p</em> = 0.83). Definitive stent thrombosis was not observed in either group.</p></div><div><h3>Conclusions</h3><p>The Titan-2® stent showed similar results to those of the second-generation drug-eluting stents, which makes it attractive for use in the complex scenario of patients with multivessel coronary artery disease.</p></div><div><h3>RESUMO</h3><p>Desempenho do Stent Recoberto por Titânio-Óxido Nítrico em Pacientes com Doença Coronária Multiarterial</p></div><div><h3>Introdção</h3><p>Até o momento, nenhum estudo avaliou o stent recoberto por titânio-óxido nítrico em pacientes com doença arterial coronariana multiarterial. Comparamos o desempenho do stent Titan-2® ao stents farmacológicos de segunda geragao nesse cenário.</p></div><div><h3>Métodos</h3><p>No período de 2011 a 2012, 284 pacientes foram tratados com o stent Titan-2®, dos quais 100 (35,2%) eram portadores de doença arterial coronariana multiarterial. Esse grupo foi comparado a 100 pacientes, de um grupo de 304 (38,9%), com doença arterial coronariana multiarterial, tratados com o stent farmacológico de segunda geração com polímeros duráveis ou biodegradáveis. O desfecho primário foi a ocorrência de eventos cardíacos adversos maiores em 1 ano.</p></div><div><h3>Resultados</h3><p>Características clínicas, angiográficas e do procedimento não apresentaram diferenças entre os grupos. A maioria dos pacientes do grupo Titan-2® era do sexo masculino (70%), com idade de 68,4 ± 12,9 anos e 25% eram diabéticos. Predominaram os quadros clínicos ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 143-148"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30008-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86523196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30012-0
Rodrigo Nieckel da Costa , Marcelo Silva Ribeiro , André Ferreira da Silva , Rodrigo Antonini Ribeiro , Otavio Berwanger , Alexandre Biasi , Helio Penna , Carisi Anne Polanczyk , Marcelo Queiroga , Carlos Augusto Cardoso Pedra
Background
Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System (Sistema Único de Saúde –SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies.
Methods
Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of Amplatzer™ Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved.
Results
Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS.
Conclusions
Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result in a aceptable ICER threshold for possible incorporation by the SUS.
Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática
Introdução
A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias.
Métodos
Revisão sistemática em relação a desfechos clínicos e criaçã
背景:动脉导管未闭(PDA)是一种较为常见的先天性心脏病及其治疗方案。2.5 mm为手术或经皮堵塞。后者虽然被认为是一种选择方法，但巴西国家卫生系统(Sistema Único de Saúde -SUS)不提供。我们的目的是比较两种策略的增量成本-效果比(ICER)。方法系统回顾临床结果并开发决策算法，以评估Amplatzer™导管闭塞器(ADO)与手术治疗关闭PDA的ICER。这两种方法的成本都是根据2010年SUS支付的报销数字计算的，经皮套件(器械+支持材料)的成本估计为10,000雷亚尔。我们使用支付相当于巴西国内生产总值三倍的意愿作为阈值，即每年挽救生命57,000雷亚尔。结果两种方法均安全有效，并发症少，住院时间短。两组的调整后预期寿命相似，ADO组稍微好一些。手术总费用为8,507雷亚尔，ADO费用为11,000雷亚尔。ICER计算为每年挽救生命71,380雷亚尔。阈值分析表明，ADO套件的成本降低492.65雷币，将使ICER降低到SUS可接受的值，以纳入该技术。结论与手术治疗相比，经皮闭塞术的发病率较低，住院时间较短，且增量效果相似。考虑到本研究中使用的直接成本，并考虑到所有PDA患者都使用ADO治疗，经皮闭塞术的成本效益较低。然而，经皮试剂盒成本的略微降低将导致可接受的ICER阈值，从而可能被SUS纳入。动脉导管，未闭，心脏缺陷，先天性，手术，假体和植入物，成本效益分析。自定义-有效性-渐进式治疗Cirúrgico vs.经动脉治疗Persistência与Amplatzer®导管闭塞器(cma):修正 SistemáticaIntroduçãoA persistência与动脉治疗(PCA) 心脏疾病(PCA) congênita相对治疗(relative comcome)作为治疗的替代方案;2,5 mm ssi o a cirurgia o a ocluso percut com próteses do tipo rolha。Essas últimas, escolha， 系统评估，系统预测Único de Saúde (SUS)。本研究的目的是将其与传统的顾客有效增值(RCEI)模式进行比较。m修正 o sistemática em relao a desfeechos clínicos e criao de modelo de decis o para avalio da RCEI do Amplatzer®管道闭塞器(ADO) em comparao o atamento cirúrgico, para o fecda PCA。从2010年起，美国海关已向美国海关提供了10万美元的电子邮件和电子邮件服务，其中，海关提供的电子邮件服务(电子邮件+电子邮件)估计为10万美元。在此基础上，我们考虑了一个类似于três的类似于巴西布鲁莱罗的项目，结果为5700 000雷亚尔，这是一个非常重要的项目。结果:3例病例中，有3例病例与其他病例相比，有3例病例与其他病例相比，有3例病例与其他病例相比，无3例病例与其他病例相比。一种预期的生活方式的调整，以类似的方式进行分组，如在ADO中进行分组和分组。根据统计，总金额为8507万雷亚尔，而根据统计，总金额为11000万雷亚尔。据估计，一项RCEI的费用为7138万雷亚尔。Uma análise de linear demonstration que a redudur R o do valor do conjunto conconto completo do do ADO em R$ 492,65 traria a RCEI para o linear aceitável para合并para o o SUS nos dias de hoje。ConclusõesO治疗过痛症:目前存在的疾病，如内源性疾病，治疗前疾病，治疗前疾病，治疗前疾病，áquela治疗cirúrgico。《联合国宪章》和《联合国宪章》以及《联合国宪章》和《联合国宪章》的共同作用，以及《联合国宪章》、《联合国宪章》、《联合国宪章》、《联合国宪章》、《联合国宪章》和《联合国宪章》的共同作用。Entretanto, com pequena reducao nos英勇conjunto, o procedimento percutaneo estaria dentro de嗯limiar aceitavel da RCEI对位possivel incorporacao。动脉管，心脏病congênitas，神经痛，Próteses e植入物，Análise custo-benefício。
{"title":"Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the Amplatzer™ Duct Occluder in Children: A Systematic Review","authors":"Rodrigo Nieckel da Costa , Marcelo Silva Ribeiro , André Ferreira da Silva , Rodrigo Antonini Ribeiro , Otavio Berwanger , Alexandre Biasi , Helio Penna , Carisi Anne Polanczyk , Marcelo Queiroga , Carlos Augusto Cardoso Pedra","doi":"10.1016/S2214-1235(15)30012-0","DOIUrl":"10.1016/S2214-1235(15)30012-0","url":null,"abstract":"<div><h3>Background</h3><p>Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System <em>(Sistema Único de Saúde –</em>SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies.</p></div><div><h3>Methods</h3><p>Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of Amplatzer™ Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved.</p></div><div><h3>Results</h3><p>Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS.</p></div><div><h3>Conclusions</h3><p>Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result in a aceptable ICER threshold for possible incorporation by the SUS.</p></div><div><h3>DESCRIPTORS</h3><p>Ductus arteriosus, patent, Heart defects, congenital, Surgery, Prostheses and implants, Cost-benefit analysis.</p></div><div><p>Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática</p></div><div><h3>Introdução</h3><p>A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias.</p></div><div><h3>Métodos</h3><p>Revisão sistemática em relação a desfechos clínicos e criaçã","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 168-179"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30012-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84713099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-06-01DOI: 10.1016/S2214-1235(15)30005-3
Cleverson Neves Zukowski , láscara Wozniak , Newton Fernando Stadler de Souza Filho , Emile Alencar Cordeiro , Alessandro Rell , Marisa Leal , Jackson Stadler , José Augusto Ribas Fortes , Rodrigo Cerci
Background
Studies demonstrate that radial artery access reduces the risk of vascular and bleeding complications associated to percutaneous coronary intervention. Our objective was to evaluate in-hospital results of the transradial approach in elderly patients undergoing percutaneous coronary intervention.
Methods
Prospective registry including patient’s ≥ 70 years of age; safety and efficacy endpoints were compared for the radial and femoral artery access groups.
Results
We included 255 patients, 117 (52%) treated using the radial approach and 108 using the femoral approach. Except for age, the remaining clinical characteristics did not show differences between groups. Male patients prevailed (60%), 36.7% were diabetic and over one third were diagnosed with acute coronary syndrome. Angiographic and procedure-related variables did not show differences between groups. When vascular complication rates were compared only hematomas < 5 cm (5.1% vs. 17.6%; p < 0.01) were more prevalent with the femoral access. Major bleedings, according to the ACUITY criteria (zero vs. 5.6%; p = 0.01) and minor bleedings, according to the TIMI criteria (zero vs. 7.4%; p < 0.01), were also more frequent in the femoral group. In-hospital clinical endpoints, death (0.9% vs. 5.6%; p = 0.06) and non-fatal infarction (zero vs. 3.7%; p = 0.05) were more frequent in patients treated by the femoral access.
Conclusions
In a non-selected patient population ≥ 70 years of age, percutaneous coronary intervention by radial access was associated to a lower incidence of in-hospital clinical endpoints, especially of bleeding events related to the vascular access route.
RESUMO
Acesso Radial vs. Acesso Femoral em Pacientes com Idade Avançada Submetidos à Intervenção Coronária Percutânea
Introdução
Estudos demonstram que o acesso via artéria radial diminui o risco de complicações vasculares e hemorrágicas associadas à intervenção coronária percutânea. Nosso objetivo foi avaliar os resultados hospitalares da utilização da via radial em pacientes idosos submetidos à intervenção coronária percutânea.
Métodos
Registro prospectivo, que incluiu pacientes ≥ 70 anos, tendo sido comparados os desfechos de segurança e de eficácia entre os grupos tratados pelas vias radial e femoral.
Resultados
Incluímos 225 pacientes, sendo 117 (52%) tratados por via radial e 108 por via femoral. À exceção da idade, as demais características clínicas não mostraram diferençãs entre os grupos. Predominaram os pacientes do sexo masculino (60%); 36,7% eram diabéticos e mais de um terço foi tratado na vigência de quad
研究表明，桡动脉通路可降低经皮冠状动脉介入治疗相关血管和出血并发症的风险。我们的目的是评估经桡动脉入路在接受经皮冠状动脉介入治疗的老年患者中的住院效果。方法前瞻性登记:患者年龄≥70岁;比较桡动脉组和股动脉组的安全性和有效性终点。结果纳入255例患者，其中117例(52%)采用桡骨入路，108例采用股骨入路。除年龄外，其余临床特征组间无差异。男性患者占60%，糖尿病患者占36.7%，超过三分之一的患者被诊断为急性冠状动脉综合征。血管造影和手术相关的变量在两组之间没有差异。当血管并发症发生率比较时，只有血肿<5 cm (5.1% vs. 17.6%;p & lt;0.01)在股骨通路中更为常见。严重出血，根据ACUITY标准(0 vs. 5.6%;p = 0.01)和轻度出血，根据TIMI标准(0比7.4%;p & lt;0.01)，股骨组发生率更高。院内临床终点:死亡(0.9% vs. 5.6%;P = 0.06)和非致死性梗死(0比3.7%;P = 0.05)。结论:在年龄≥70岁的非选择性患者群体中，经皮冠状动脉介入治疗桡动脉通路与较低的院内临床终点发生率相关，尤其是与血管通路相关的出血事件。resumo桡动脉通路与股骨动脉通路的对比:经动脉导管导管导管导管与经动脉导管导管导管的对比:经动脉导管导管导管导管与经动脉导管导管导管导管的对比:经动脉导管导管导管与经动脉导管导管导管的对比:经动脉导管导管导管与经动脉导管导管的对比:complicações血管导管导管与hemorrágicas血管导管导管联合:coronária经动脉导管导管导管。目的:探讨医院数据利用经桡骨动脉(radiem)的数据利用经桡骨动脉(radiem)的数据利用(submetidos intermestidos)或coronária percut的数据利用。前瞻性登记包括年龄≥70岁的患者，经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨和股骨经桡骨。ResultadosIncluímos 225例，经桡骨骨折117例(52%)，经股骨骨折108例。À excel。绝大多数患者表现为男性化(60%);36.7%的美国人认为，美国人的薪金薪金主要来自于美国人的薪金薪金和vigência美国人的薪金薪金。如variáveis angiográficas，我们将程序转到n9o . o . o . o . o . o . o . o . o。没有比较复杂血管的分类，有些是血肿;5 cm (5.1% vs. 17.6%;p & lt;[0,01]有孔窝的主要是没有进入股骨。sanggramentos maires, pelo crit; ACUITY (0 vs. 5.6%;p = 0.01)， 5个指标，1个指标，1个指标，3个指标(0比7.4%;p & lt;2001)， tambsamam foram主要的频率没有群股。Os desfechos clínicos hospitalares óbito(0,9%对5,6%;P = 0.06)死亡率为0(0比3.7%;P = 0.05)，经股动脉栓塞患者的发生率最高。ConclusõesEm uma populada。
{"title":"Radial vs. Femoral Artery Access in Elderly Patients Undergoing Percutaneous Coronary Intervention","authors":"Cleverson Neves Zukowski , láscara Wozniak , Newton Fernando Stadler de Souza Filho , Emile Alencar Cordeiro , Alessandro Rell , Marisa Leal , Jackson Stadler , José Augusto Ribas Fortes , Rodrigo Cerci","doi":"10.1016/S2214-1235(15)30005-3","DOIUrl":"10.1016/S2214-1235(15)30005-3","url":null,"abstract":"<div><h3>Background</h3><p>Studies demonstrate that radial artery access reduces the risk of vascular and bleeding complications associated to percutaneous coronary intervention. Our objective was to evaluate in-hospital results of the transradial approach in elderly patients undergoing percutaneous coronary intervention.</p></div><div><h3>Methods</h3><p>Prospective registry including patient’s<!--> <!-->≥<!--> <!-->70 years of age; safety and efficacy endpoints were compared for the radial and femoral artery access groups.</p></div><div><h3>Results</h3><p>We included 255 patients, 117 (52%) treated using the radial approach and 108 using the femoral approach. Except for age, the remaining clinical characteristics did not show differences between groups. Male patients prevailed (60%), 36.7% were diabetic and over one third were diagnosed with acute coronary syndrome. Angiographic and procedure-related variables did not show differences between groups. When vascular complication rates were compared only hematomas<!--> <!--><<!--> <!-->5<!--> <!-->cm (5.1% vs. 17.6%; <em>p</em> <!--><<!--> <!-->0.01) were more prevalent with the femoral access. Major bleedings, according to the ACUITY criteria (zero vs. 5.6%; <em>p</em> <!-->=<!--> <!-->0.01) and minor bleedings, according to the TIMI criteria (zero vs. 7.4%; <em>p</em> <!--><<!--> <!-->0.01), were also more frequent in the femoral group. In-hospital clinical endpoints, death (0.9% vs. 5.6%; <em>p</em> <!-->=<!--> <!-->0.06) and non-fatal infarction (zero vs. 3.7%; <em>p</em> <!-->=<!--> <!-->0.05) were more frequent in patients treated by the femoral access.</p></div><div><h3>Conclusions</h3><p>In a non-selected patient population<!--> <!-->≥<!--> <!-->70 years of age, percutaneous coronary intervention by radial access was associated to a lower incidence of in-hospital clinical endpoints, especially of bleeding events related to the vascular access route.</p></div><div><h3>RESUMO</h3><p>Acesso Radial vs. Acesso Femoral em Pacientes com Idade Avançada Submetidos à Intervenção Coronária Percutânea</p></div><div><h3>Introdução</h3><p>Estudos demonstram que o acesso via artéria radial diminui o risco de complicações vasculares e hemorrágicas associadas à intervenção coronária percutânea. Nosso objetivo foi avaliar os resultados hospitalares da utilização da via radial em pacientes idosos submetidos à intervenção coronária percutânea.</p></div><div><h3>Métodos</h3><p>Registro prospectivo, que incluiu pacientes<!--> <!-->≥<!--> <!-->70 anos, tendo sido comparados os desfechos de segurança e de eficácia entre os grupos tratados pelas vias radial e femoral.</p></div><div><h3>Resultados</h3><p>Incluímos 225 pacientes, sendo 117 (52%) tratados por via radial e 108 por via femoral. À exceção da idade, as demais características clínicas não mostraram diferençãs entre os grupos. Predominaram os pacientes do sexo masculino (60%); 36,7% eram diabéticos e mais de um terço foi tratado na vigência de quad","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"22 2","pages":"Pages 125-130"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2214-1235(15)30005-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79554403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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