Florencia Rolandi

Prosthetic Valve Thrombosis in Pregnancy A Promising Treatment for a Rare and Mostly Preventable Complication

Prosthetic heart valve thrombosis (PVT) is a rare complication, with an estimated incidence of 0.1% to 5.7% per patient-year.1 However, during pregnancy, changes in the hemostatic system lead to a procoagulant state that increases the risk of PVT up to 10%.2 This maternal and fetal life-threatening complication is mostly preventable with long-term adequate anticoagulation therapy. When anticoagulation fails, treatment focuses on choosing between cardiac surgery and thrombolysis, 2 therapeutic strategies with risks and benefits for the mother and fetus that are difficult to assess. Article see p 532 The study by Ozkan et al3 in this issue of Circulation is the largest series of pregnant patients with prosthetic mitral valve thrombosis reported to date and offers interesting results in a scenario in which randomized, clinical trials are not feasible. A protocol of low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed that was guided by transesophageal echocardiography was associated with a successful thrombolysis in all episodes, with no maternal deaths and a fetal mortality rate of 20%, results that seem to be better than those obtained with other thrombolytic strategies reported. The authors’ conclusions on the superiority of thrombolysis over surgery and the redefinition of the lytic option as a first-line therapy in pregnant patients with PVT require careful evaluation. Previous studies of cardiac surgery showing maternal and fetal mortality rates of 6% and 30%, respectively, were published a decade ago and were based mostly on coronary revascularization procedures. Since then, some recommendations have been included, such as appointing the procedure during the second …

Avaliação do stent coronário eluidor de everolimus XIENCE TM V na cpopulação feminina latino-americana do estudo de braço único SPIRIT Women: acompanhamento clínico de um ano

BACKGROUND: Drug-eluting stent trials have predominantly examined male populations of European descent. SPIRIT Women single-arm study evaluates the XIENCETM V everolimus-eluting stent in complex de novo lesions in a real world female population, including Latin American patients. This analysis provides an insight into how this population responds to stenting when compared to non-Latin American patients. METHODS: Of the 1,572 patients enrolled from 73 non-US sites, 138 (9%) were recruited from Argentina, Brazil and Venezuela. RESULTS: Target lesions had reference vessel diameter ranging between 2.25 mm and 4 mm and lesion length ≤ 28 mm. Baseline characteristics were similar between the groups, with exception to a higher prevalence of hypertension, anterior myocardial infarction (MI) and family history of coronary artery disease in the Latin American cohort. Lesions tended to be more complex in Latin American women with a smaller reference vessel diameter, longer lesion length, increased eccentricity and angulation, and more type B2/C lesions. Events were adjudicated according to the guidelines of the Academic Research Consortium. At 1 year, the composite endpoint of death, MI and target vessel revascularization (TVR) was 12.1% in the non-Latin American population and 10.1% in the Latin American population (P = 0.58). CONCLUSIONS: At 1 year, the low rates of adverse cardiac events, including stent thrombosis, target lesion failure, cardiac death, MI and TVR in Latin American women were comparable to those of the non-Latin American women, despite the higher complexity of lesions. These results demonstrate the safety and efficacy of the XIENCETM V stent in this small cohort of Latin American patients, in line with what is observed in larger and more varied populations.

La calcificación coronaria detectada por fluoroscopia es capaz de predecir la mortalidad a largo plazo

Introduction: Coronary artery calcification is a marker of atherosclerosis. Fluoroscopy is a simple and accessible method to detect coronary artery calcification. Objective: The aim of this study was to evaluate the value of fluoroscopic detection of coronary artery calcification as an independent predictor of all-cause mortality and cardiovascular mortality in the long-term. Methods: A prospective cohort of persons ≥45 years without documented cardiovascular disease underwent fluoroscopic examination to identify the presence of coronary artery calcification. A Cox regression model was used to evaluate the independent effect of calcification as a predictor of mortality in the long-term. Results: A total of 857 persons were included. Follow-up was completed in 98.7% of cases with an average of 14.4 ± 4.3 years (range: 34 days to 20.8 years). Mean age was 61.3 ± 9.7 years, 88.9% had hypertension, 19.6% had high cholesterol levels, 1.8% were diabetics and 52.7% were men. Coronary artery calcification was detected in 264 patients (32%). The presence of coronary artery calcification was associated with age, male sex and high cholesterol levels. All-cause long-term mortality was 28.3% and cardiovascular mortality was 14.9%. The presence of coronary artery calcification was an independent predictor of all-cause mortality (HR 1.6, 95% CI 1.2-2.0; p = 0.002) and of cardiovascular mortality (HR 2.5, 95% CI 1.6-3.9; p = 0.002). All-cause mortality without calcification was 1.35 per 100 patient-years and 3.39 per 100 patient-years with calcification [p (log rank test) < 0.0001]. Conclusion: Fluoroscopic detection of coronary artery calcification may predict all-cause mortality and cardiovascular mortality in the long-term in a population without documented cardiovascular disease.

TCT-473 Genetic Polymorphisms of Platelet and Endothelial Nitric Oxide Synthase and their relationship with Stent Restenosis and Coronary Events at Long Term Follow Up.

Platelets and nitric oxide system play an important role in coronary disease. Platelet and eNOS polymorphism could be asociated with stent restenosis and coronary events. We included 92 patients (pts) with previous PCI referred to cath lab. We consider cases pts with confirmed angiographic