Jorge Marques

Trends in primary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional Cardiology

INTRODUCTION AND OBJECTIVESnThe aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal.nnnMETHODSnProspective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013.nnnRESULTSnIn 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013.nnnCONCLUSIONnDuring the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach.

Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient

Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stress-induced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.

Arcada coronária – uma anomalia rara da circulação coronária

Intercoronary communication or coronary arcade is a rare congenital coronary anomaly. We present the case of a 65-year-old man with atypical chest pain for four months. The 12-lead ECG and echocardiogram were normal. Treadmill exercise testing was interrupted at peak exercise due to consecutive salvos of ventricular premature beats, without significant ST-T changes. Coronary angiography showed no significant coronary stenosis, but a connection between the right coronary and circumflex arteries was observed, consistent with coronary arcade. The functional importance of this variant is not clear, but it may cause myocardial ischemia by coronary steal or function as a natural bypass, in which case it may play a protective role in the myocardium if significant atherosclerosis develops.

Severe coronary milking in obstructive hypertrophic cardiomyopathy

Cardiomyopathy, hypertrophic; coronary disease.A 65 year old woman with recent onset angina was admitted for acute coronary syndrome without ST elevation. EKG show deep T wave inversion on the anterior and lateral leads.At angiography no coronary stenosis were found, but severe “milking” of the midleft anterior descending coronary artery, up to 100% systolic narrowing was observed (fig. 1, 2, 3 and 4). Intraventricular gradient could be elicited at rest by multipurpose catheter during left ventricle pullback (fig. 5). Two dimensional (cross sectional) echocardiography disclosed asymmetric septal hypertrophy (anterior septum 22 mm, posterior wall 10 mm) with severe and diffuse involvement of the entire interventricular septum and anterolateral wall and left intraventricular gradient at rest was confirmed.

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology

BackgroundWe aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in ‘real-world’ settings.MethodsWe performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006–2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI).ResultsWe assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54–1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35–0.98; 3500 patients).ConclusionsThe whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.

The ominous side of a coronary fistula

Coronary artery fistulas are rare and estimated to occur in 0.002% of the overall population.1 Most patients remain asymptomatic, but angina, dyspnoea, arrhythmias or sudden death may arise.2nnWe report the case of a 65-year-old man with previous hypertension, angina and obesity, who presented to accident and emergency department with oppressive central chest pain initiated whilst driving. During initial observation he had a cardiac arrest in ventricular fibrillation, which was promptly treated. His cardiovascular physical examination did not show any abnormal signs. The 12 lead ECG showed sinus rhythm, Q waves in III and aVF, and T-wave inversion in I, aVL and V4–V6 …

Original ArticleStent for Life in Portugal: This initiative is here to stayStent for Life em Portugal: uma iniciativa para ficar

Aims nPortugal has one of the lowest rates of primary percutaneous coronary intervention (p-PCI) in Western Europe. This study assessed the progress of Portuguese p-PCI performance indicators one year after Portugal joined the Stent for Life (SFL) initiative.

Seguimento clínico a longo prazo de doentes com intervenção coronária diferida guiada pela medição da fração de fluxo de reserva coronária

INTRODUCTION AND AIMSnThe functional significance of coronary lesions can be assessed in the cardiac catheterization laboratory by determination of fractional flow reserve (FFR), thus overcoming one of the major limitations of conventional angiography. The aim of this study was to analyze the long-term clinical course of patients with intermediate coronary stenosis (50-70%) deferred for intervention based on FFR <0.80.nnnMETHODSnBetween May 1999 and December 2009, 300 lesions in 231 patients (mean age 65 ± 10 years, 68% male and 75.3% with multivessel disease) were studied by FFR. Intervention was deferred in 282 (94%) lesions and 18 were treated based on FFR <0.80. We assessed the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal acute coronary syndrome and target lesion revascularization (TLR).nnnRESULTSnDuring a median follow-up of 637 days (interquartile range 455-1160), there were 15 (6.5%) MACE in the subgroup of patients with target lesion intervention deferred based on FFR: one cardiovascular death, four hospitalizations for acute coronary syndrome and 14 TLR (12 patients were treated percutaneously and two underwent coronary artery bypass grafting). MACE-free survival at one year follow-up was 97.8%.nnnCONCLUSIONnThese results, in a real-world population, support the current trend to base the decision to treat on functional rather than purely anatomical criteria, in order to improve safety and efficiency.