Fábio Salerno Rinaldi

Comparison of a vascular closure device versus the radial approach to reduce access site complications in non-ST-segment elevation acute coronary syndrome patients: The angio-seal versus the radial approach in acute coronary syndrome trial

To compare the radial versus femoral approach using Angio‐Seal for the incidence of access site complications among non‐ST‐segment elevation acute coronary syndrome patients undergoing invasive strategy.

Impacto da transferência inter-hospitalar nos resultados da intervenção coronária percutânea primária

BACKGROUND: Delays resulting from the transfer to perform primary percutaneous coronary intervention (PCI) have a negative impact on the benefits of the procedure. METHODS: Prospective registry aimed at comparing the results of primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) admitted or transferred to an interventional cath lab equipped hospital. RESULTS: Between February 2009 and December 2011, 319 patients were included in the study with mean age of 59.8 ± 12 years, 28.5% were female and 22.3% were diabetics. Patients transferred for primary PCI (n = 201) had longer door-to-balloon time (86.4 ± 26.6 min vs 69 ± 22.6 min; P < 0.0001), a non-significant decrease in ST-segment elevation resolution (83.5% vs 90.4%; P = 0.18), final TIMI 3 flow (90.1% vs 94.1%; P = 0.30), myocardial blush grade 3 (74.3% vs 78.8%; P = 0.22) and angiographic success (90.1% vs 94.1%; P = 0.30), and a non-significant increase in major bleeding (2% vs 0.9%; P = 0.20) and hospital mortality (6.5% vs 4%; P = 0.29). CONCLUSIONS: The referral of patients with STEMI directly to an interventional cath lab equipped hospital is associated with shorter door-to-balloon time and non-significant improvement of reperfusion markers and mortality.

Infarto agudo do miocárdio por dissecção espontânea de artérias coronárias: série de cinco casos

We report a series of five patients hospitalized due to acute coronary syndrome, from 2008 to 2010, in whom coronary angiography showed spontaneous coronary dissection. Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction, most commonly seen in young individuals with no history of cardiovascular disease. The optimal management is uncertain, especially due to the limited clinical experience with this entity. Intravascular ultrasound is a useful tool to diagnose spontaneous coronary artery dissection as well as to guide percutaneous therapy.

Resolução do segmento ST após intervenção coronária percutânea primária: características, preditores de insucesso e impacto na mortalidade

BACKGROUND: ST-segment resolution is an important predictor of infarct-related artery patency and effective microcirculatory perfusion. The aim of this study was to compare patients with and without ST-segment elevation resolution and identify variables that are associated with failure of ST-segment resolution. METHODS: Between March 2012 and July 2013, 61 patients with ST-segment elevation acute myocardial infarction underwent primary percutaneous coronary intervention (PCI) and were included in a prospective registry. To compare the groups with and without ST-segment resolution, the chi-square test or Fishers exact test were used for qualitative variables and Students t test or Mann-Whitneys test for quantitative variables. Simple and multiple logistic regression models were used to identify variables associated with failure of ST-segment resolution. RESULTS: The group of patients without ST-segment resolution had higher heart rate, higher prevalence of diabetes mellitus, chronic renal failure and a trend towards longer ischemia time. There was a higher mortality rate in patients who did not achieve ST-segment elevation resolution. In the univariate analysis, heart rate, diabetes mellitus, chronic renal failure and ischemia time were associated with increased odds of not obtaining ST-segment resolution, losing significance in the multivariate model. CONCLUSIONS: Failure of ST-segment resolution is observed in up to one-third of patients undergoing primary PCI and requires new pharmacologic strategies or interventions to minimize it.

Insucesso da Técnica Radial em Centro com Alto Volume de Procedimentos

Failure of the Transradial Approach in a High-Volume Center background: The mechanisms and predictors of failed transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5%, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, failure rate was < 2% and variables associated with technical failure were female gender, advanced age and peripheral arterial disease. DesCRIPToRs: Radial artery. Percutaneous coronary intervention. Hemorrhage. Ischemia.

Utilização de Pulseira Compressora Seletiva na Prevenção da Oclusão da Artéria Radial Após Procedimento Coronário Invasivo

ABSTRACT Use of a Selective Radial Compression Device to Prevent Radial Artery Occlusion After Coronary Invasive Procedure Background: In addition to providing greater comfort and convenience for the patient, the radial approach is associated to lower rates of vascular complications and major bleeding, with potential impact on morbidity and mortality. Thus, the adoption of strategies that reduce the risk of arterial occlusion after invasive procedures, enabling it to be reused, is desirable. Methods: Controlled prospective registry evaluating the impact of routine adoption of a selective radial compression device in patients with acute coronary syndrome without ST-segment-elevation undergoing early invasive stratification through the radial access. Arterial patency was assessed by the Barbeau test at hospital discharge and at the 30-day follow-up. Results: Fifty-nine patients were evaluated, of which 83% underwent ad hoc percutaneous coronary intervention. Mean age was 64 ± 12.2, 66.1% were male and 28.8% had diabetes melli-tus. The right radial access was used in 98.3% of cases, the number of catheters was 2.4 ± 0.6, with a diameter of 6 F in all cases, and the duration of the procedure was 32.4 ± 12.7 minutes. Spasm was reported in 10.2% of cases, hematoma > 5 cm in 3.4% and occlusion of the radial artery after the procedure and at 30 days in 6.8% and 3.4% of the cases, respectively.

Temporal Evaluation of Coronary Revascularization Procedures Performed through the Unified Health System (SUS) in Brazil: a 20-year overview

Fundamento: As taxas de mortalidade relacionadas a doenca aterosclerotica coronariana (DAC) vem reduzindo nas ultimas decadas devido, em parte, aos avancos nas tecnicas de revascularizacao. Objetivos: O objetivo deste estudo foi apresentar um visao dos ultimos 20 anos do tratamento da DAC pelo Sistema Unico de Saude (SUS) no Brasil. Metodos: Os dados foram obtidos atraves dos sistemas TABNET e SIGTAP do SUS e atraves do IBGE. Os procedimentos foram agrupados nas categorias de revascularizacao percutânea, cirurgica e percutânea primaria. Foram analisados o numero de autorizacoes de internacao hospitalar (AIH), duracao media de permanencia hospitalar, mortalidade hospitalar, valor do repasse total por procedimento e valores medios da AIH e dos servicos profissional e hospitalar. Resultados: Entre 1995 e 2015, houve aumento no numero de revascularizacoes cirurgicas (de 13.198 a 22.559) e percutâneas (de 10.522 a 66.345). De modo semelhante, o numero de angioplastias primarias apresentaram aumento entre 2004 e 2015 (de 1.901 a 8.524). Houve uma queda no tempo medio de permanencia hospitalar (de 14,4 a 12,8 dias) e da mortalidade hospitalar (de 7,6% a 5,9%) nas revascularizacoes cirurgicas e queda da permanencia hospitalar (de 5,3 dias a 3,7 dias) mas manutencao da taxa de mortalidade (2,2%) nas revascularizacoes percutâneas. Nas angioplastias primarias, o tempo medio de permanencia hospitalar variou de 5,3 a 5,6 dias e a taxa de mortalidade variou de 7,94% a 7,43% entre 2004 e 2015, respectivamente. O valor medio do repasse total para as revascularizacao cirurgicas variou de R

12-Month Clinical Follow-Up of Patients Undergoing Early Invasive Strategy by the Transradial or Transfemoral Approach with Vascular Closure Device

4.327,57 para R

Segurança e Factibilidade do Acesso Ulnar Após Falha do Acesso Radial Ipsilateral

12.839,13 e para as revascularizacoes percutâneas de R

Safety and Feasibility of Ulnar Access After Failure of Ipsilateral Radial Access

2.615,81 a R