Luiz Carlos Corsetti Bergoli

Perfil da intervenção coronária percutânea no infarto agudo do miocárdio com supradesnivelamento do segmento ST no Brasil de 2006 a 2010: registro CENIC

BACKGROUND: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality. This study aims to outline the national profile of percutaneous coronary intervention (PCI) in the setting of AMI, analyzing different time periods and geographic regions, with focus on primary PCI and adjunctive pharmacological and mechanical treatments. METHODS: Data from 20,004 patients with ST elevation myocardial infarction (STEMI) undergoing PCI and included in the CENIC Registry (National Center of Cardiovascular Interventions) from January 2006 to December 2010 were included in this study. Data were obtained from 252 centers located in 22 states from five different geographic regions in the country. RESULTS: Primary PCI accounted for 57.8% of PCI performed in the setting of AMI, followed by elective PCI after STEMI (35.7%), rescue PCI (6.1%) and facilitated PCI (0.4%). The evolution over time showed a progressive increase in the number of primary PCIs in Brazil, from 56.7% in 2006 to 71.6% in 2010. The mean door-to-balloon time of primary PCI in Brazil during this period was 2 hours. Thrombus aspiration increased from 0.4% in 2006 to 8.2% of cases in 2010. Procedural success rate was 93.8%, while in-hospital mortality was only 2.8%. CONCLUSIONS: PCI in the setting of STEMI has improved from 2006 to 2010, although heterogeneously in the different regions of Brazil, due to increased primary PCI rates and higher use of thrombus aspiration devices, which have not been incorporated in the routine practice. Investments in staff training and implementation of clinical protocols are essential to optimize the door-to-balloon time and improve clinical outcomes.

Gastrointestinal bleeding due to angiodysplasia in a patient with severe aortic stenosis: Heyde's syndrome

ABSTRACT There is a frequent association between aortic valve stenosis and gastrointestinal bleeding, also known as Heyde’s syndrome. The pathophysiologic basis for this syndrome seems to be an acquired von Willebrand factor deficiency, leading to bleeding of angiodysplastic arteriovenous malformations. Treatment options include the location and cauterization of bleeding points, which is associated to high recurrence rates. Valve replacement appears to offer the best hope of long-term resolution of bleeding, and should be considered in most cases. We report a 79 year-old patient with aortic stenosis and gastrointestinal bleeding due to duodenal angiodysplasia treated by transcatheter aortic valve implantation.

An Overview of Care Changes in the Last 6 Year in Primary PCI in ST-Elevation Myocardial Infarction in a Tertiary University Brazilian Hospital

Mailing Address: Guilherme Pinheiro Machado Rua Domingos Crescencio, 545. Postal Code: Santana, Porto Alegre, RS Brazil. E-mail: gpmachado89@gmail.com, guimachado@hcpa.edu.br An Overview of Care Changes in the Last 6 Year in Primary PCI in ST-Elevation Myocardial Infarction in a Tertiary University Brazilian Hospital Guilherme Pinheiro Machado,1,2 Fernando Pivatto Junior,2 Rodrigo Wainstein,2 Gustavo Neves de Araujo,2 Christian Kunde Carpes,1,2 Mateus Correa Lech,1,2 Felipe Homem Valle,2 Luiz Carlos Corsetti Bergoli,2 Sandro Cadaval Gonçalves,2 Marco Vugman Wainstein1,2 Faculdade de Medicina, Universidade Federal do Rio Grande do Sul,1 RS Brazil Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre,2 RS Brazil

On- vs. off-hours admission of patients with ST-elevation acute myocardial infarction undergoing percutaneous coronary interventions: data from a tertiary university Brazilian hospital

Introduction: Early reperfusion therapy is crucial in patients with ST-elevation myocardial infarction (STEMI). Off-hours hospital presentation may increase the time from pain to coronary reperfusion, and it may be responsible for increased cardiovascular outcomes. The aim of this study was to compare the effect of different times of presentation (on- and off-hours) on early mortality and major cardiovascular outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Methods: We have included consecutive patients with STEMI who underwent primary PCI between April 2011 and November 2016 in a tertiary university hospital in southern Brazil. Patients were divided into on- and off-hours admission. In-hospital and 30-day outcomes were evaluated. Results: A total of 301 patients (57.4%) were admitted during off-hours, and 223 (42.5%) during on-hours. Baseline characteristics were well balanced between the two groups. Median door-to-balloon time was higher in the off-hours group than in the on-hours group: 75 min (IQR 60-95) vs. 60 min (IQR 50-73.7) respectively (p < 0.001). In-hospital mortality was similar between groups (odds ratio [OR] = 0.56; 95% confidence interval [95%CI] 0.31-1.03; p = 0.06) and at 30-day follow-up (OR = 0.2; 95%CI 0.02-1.72 p = 0.14). In the matched cohort, no difference was found in the rates of in-hospital mortality (OR = 2.0; 95%CI 0.75-5.32; p = 0.16) and 30-day MACE (OR= 0.9; 95%CI 0.49-1.66; p = 0.75). Conclusions: In our center with PCI available 24/7 – without in-house staff – we did not observe any difference in patient characteristics, management, and outcomes, although a significant longer door-to-balloon time was found in patients treated during night shifts. Our results are consistent with those of other trials. Keywords: Myocardial infarction; percutaneous coronary intervention; system delay

Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

BACKGROUND AND AIMS Elevated neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are indirect inflammatory markers. There is some evidence that both are associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The aim of the present study was to compare the capacity of NLR and MPV to predict adverse events after primary PCI. METHODS In a prospective cohort study, 625 consecutive patients with STEMI, who underwent primary PCI, were followed. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for the occurrence of procedural complications, mortality and major adverse cardiovascular events (MACE). RESULTS Mean age was 60.7 (±12.1) years, 67.5% were male. The median of NLR was 6.17 (3.8-9.4) and MPV was 10.7 (10.0-11.3). In multivariate analysis, both NLR and MPV remained independent predictors of no-reflow (relative risk [RR] = 2.26; 95%confidence interval [95%CI] = 1.16-4.32; p = 0.01 and RR = 2.68; 95%CI = 1.40-5.10; p < 0.01, respectively), but only NLR remained an independent predictor of in-hospital MACE (RR = 1.01; 95%CI = 1.00-1.06; p = 0.02). The AUC for in-hospital MACE was 0.57 for NLR (95%CI = 0.53-0.60; p = 0.03) and 0.56 for MPV (95%CI = 0.52-0.60; p = 0.07). However, when AUC were compared with DeLong test, there was no statistically significant difference for these outcomes (p > 0.05). NLR had an excellent negative predictive value (NPV) of 96.7 for no-reflow and 89.0 for in-hospital MACE. CONCLUSIONS Despite no difference in the ROC curve comparison with MPV, only NLR remained an independent predictor for in-hospital MACE. A low NLR has an excellent NPV for no-reflow and in-hospital MACE, and this could be of clinical relevance in the management of low-risk patients.

Guidewire Self-Extrusion After Entrapment of Distal Protection Device During Saphenous Vein Graft Angioplasty

A 66-year-old man with previous coronary artery bypass graft surgery was referred to cardiac catheterization due to a non–ST-segment elevation acute myocardial infarction. On arrival he was hemodynamically stable and complaining of mild chest discomfort. Coronary angiography showed a patent

Comparison of Anatomical and Clinical Scores in Predicting Outcomes in Primary Percutaneous Coronary Intervention

Fundamento: Diferentes escores baseados em variaveis anatomicas e/ou clinicas tem sido desenvolvidos para estratificacao de risco em pacientes submetidos a intervencao coronariana percutânea (ICP). Estudos comparando a capacidade desses modelos na predicao de eventos cardiacos e cerebrovasculares adversos maiores (ECCAM) em pacientes submetidos a ICP primaria sao escassos. Objetivo: O objetivo desse estudo foi o de comparar os escores SYNTAX (SS), Clinical SYNTAX (CSS), ACEF e ACEF modificado (ACEFMod) na predicao de ECCAM em pacientes com infarto agudo do miocardico com supradesnivelamento do segmento ST (IAMCSST) submetidos a ICP primaria. Metodos: Foram analisados 311 pacientes consecutivos com IAMCSST submetidos a ICP primaria entre abril/2011 e dezembro/2015. As areas sob a curva caracteristica de operacao do receptor (ROC) foram calculadas para avaliar a habilidade desses escores em predizer ECCAM. O nivel de significância adotado em todos os testes foi de 5%. Resultados: Os pacientes apresentaram idade media de 60,2 ± 12,0 anos, 35,4% eram do sexo feminino e 22,5% eram diabeticos. A ocorrencia de ECCAM foi observada em 23,8% dos participantes. A area sob a curva ROC foi 0,586 (p = 0,028) para ACEF, 0,616 (p = 0,003) para SS, 0,623 (p = 0,002) para ACEFMod e 0,658 (p < 0,001) para CSS. Na analise multivariada, apenas SS (p = 0,011) e CSS (p = 0,002) foram preditores independentes de ECCAM. Conclusoes: SS e CSS elevados foram preditores independentes de ECCAM. Em nossa coorte de pacientes com IAMCSST submetidos a ICP primaria, o SS calculado a cineangiocoronariografia inicial mostrou-se uma ferramenta util para predizer ECCAM. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

Síndrome coronariana aguda como apresentação atípica do fenômeno de roubo subclávio

Roubo coronariano da subclavia (RCS) e um fenomeno raro que ocorre em pacientes submetidos a cirurgia de revascularizacao miocardica com enxerto de arteria toracica interna esquerda (ATIE) e que causa estenose da arteria subclavia ipsilateral e proximal a origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atipico de sindrome do RCS, manifestando-se como sindrome coronariana aguda no pos-operatorio de cirurgia vascular. Palavras-chave: Sindrome coronariana aguda; angioplastia; sindrome do roubo coronario-subclavio

Volume Plaquetário Médio Como Preditor de Desfechos Cardiovasculares Maiores e Fluxo Coronariano Final em Pacientes Submetidos à Intervenção Coronária Percutânea Primária

Introducao: As plaquetas desempenham papel fundamental na fisiopatologia do infarto agudo do miocardio. Existem evidencias de que plaquetas de maior volume apresentem potencial pro- -trombotico aumentado. O objetivo deste estudo foi avaliar se o volume plaquetario medio pode predizer o fluxo coronariano do vaso tratado e os desfechos cardiovasculares adversos em pacientes com infarto do miocardio com supradesnivelamento do segmento ST submetidos a intervencao coronaria percutânea primaria. Metodos: Desfecho primario foi considerado como a ocorrencia de eventos cardiovasculares adversos (morte, acidente vascular cerebral, infarto agudo do miocardio, trombose de stent, angina e insuficiencia cardiaca classes 3 ou 4) em 30 dias. Desfecho secundario foi avaliado por meio da analise angiografica do fluxo TIMI pos-procedimento. Resultados: Dos 215 pacientes incluidos no registro de intervencao coronaria percutânea primaria, 168 (78,6%) tiveram volume plaquetario medio calculado antes do procedimento e foram analisados no presente estudo. Valores do volume plaquetario medio foram estratificados em tercis, sendo considerado um valor elevado > 11 fentolitros (fl). Volume plaquetario medio > 11 fl foi preditor independente de eventos cardiovasculares em 30 dias (p = 0,02). Observou-se que pacientes com fluxo final TIMI zero ou 1 demonstraram tendencia a apresentar volume plaquetario medio maior em relacao aqueles com fluxo final TIMI 2 ou 3 (11,3 ± 0,9 fl vs. 10,5 ± 1,3 fl; p = 0,06). Conclusoes: O volume plaquetario medio basal e um marcador simples, de facil afericao e util para predizer risco de eventos cardiovasculares em 30 dias em pacientes com infarto do miocardio com supradesnivelamento do segmento ST submetidos a intervencao coronaria percutânea primaria. Estudos futuros podem responder se a terapia antitrombotica mais agressiva resulta em melhores desfechos angiograficos e/ou clinicos nos pacientes com plaquetas maiores e mais ativas.

Sangramento gastrintestinal por angiodisplasia e estenose aórtica: síndrome de Heyde

There is a frequent association between aortic valve stenosis and gastrointestinal bleeding, also known as Heydes syndrome. The pathophysiologic basis for this syndrome seems to be an acquired von Willebrand factor deficiency, leading to bleeding of angiodysplastic arteriovenous malformations. Treatment options include the location and cauterization of bleeding points, which is associated to high recurrence rates. Valve replacement appears to offer the best hope of long-term resolution of bleeding, and should be considered in most cases. We report a 79 year-old patient with aortic stenosis and gastrointestinal bleeding due to duodenal angiodysplasia treated by transcatheter aortic valve implantation.