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EL GENOTIPO D/D DEL GEN DE LA ENZIMA CONVERSIVA DE LA ANGIOTENSINA COMO FACTOR DE RIESGO DE REESTENOSIS POST-STENT CORONARIO

Introduccion Un numero significativo de los pacientes en quienes se implanta un stent coronario experimentan reestenosis, la cual es secundaria a proliferacion tisular. El sistema renina-angiotensina esta muy involucrado en la hiperplasia neointimal. Se conoce que la enzima conversiva de la angiotensina esta regulada en parte por el polimorfismo I/D del gen de esta enzima y sus concentraciones plasmaticas son mayores en los pacientes homozigotos D/D. En este trabajo se estudio la posibilidad de que el polimorfismo I/D pudiera estar relacionado con la reestenosis intra-stent. Metodos Estudiamos el polimorfismo I/D del gen de la enzima conversiva de la angiotensina en 48 pacientes consecutivos en quienes se implanto un stent en forma electiva, en arterias nativas y que tuvieran un reestudio angiografico a los 6 meses. Encontramos reestenosis (definida como estenosis > 50% respecto del lumen del vaso de referencia) en 23 de los 48 pacientes. Los grupos con y sin reestenosis no diferian en variables como diabetes, colesterol plasmatico o resultados inmediatos de la angioplastia. Resultados Encontramos que el 22,9% de los pacientes presentaba genotipo D/D; el 14,5% de los pacientes fueron I/I y el 62,5% de los pacientes eran heterozigotos I/D. Se pudo establecer que el 81,8% de los pacientes D/D desarrollo reestenosis intra-stent, mientras que solo el 40,0% de los pacientes heterozigotos I/D presentaron reestenosis. Los homozigotos I/I presentaron reestenosis muy raramente (14,2%). La diferencia de incidencia de reestenosis entre los grupos fue estadisticamente significativa (p Conclusiones De acuerdo con estos resultados, el polimorfismo D/D del gen de la enzima conversiva de la angiotensina puede ser un factor de riesgo de reestenosis intra-stent, mientras que los individuos con genotipo I/I practicamente no desarrollaron reestenosis.

Effect of primary coronary angioplasty on left ventricular function and myocardial perfusion as determined by Tc-99m sestamibi scintigraphy☆

There is little information available regarding the changes in the size of acute myocardial infarction (AMI) and the evolution of left ventricular (LV) function over time after primary angioplasty. 1 The evaluation of these parameters could give additional insight into the mechanisms of myocardial recovery and the possible additional benefits of adjunctive therapy to primary angioplasty. The size of the AMI can be quantified by using single-photon emission computed tomographic imaging (SPECT) scintigraphy with technetium-99m (Tc-99m) sestamibi. 2‐ 4 In this study, we evaluated the changes in LV function and in the size of the AMI with SPECT scintigraphy in patients with AMI treated with primary angioplasty. To accomplish this, SPECT was performed at the time of admission, at 72 hours, and at 3 months after primary angioplasty. ••• We studied 24 consecutive patients with AMI who were admitted to the emergency room at our institution, in whom primary angioplasty was indicated. A signed informed consent was obtained in all cases. Diagnosis of AMI was based on the classic criteria of chest pain and ST-segment elevation

Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent☆ MICAMI-MGUARD

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Perfil demográfico e resultados imediatos dos pacientes submetidos a angioplastia primária no Registro SOLACI

2 contiguous electrocardiographic leads. We studied patients with a first AMI who came to the emergency room within 6 hours of the onset of chest pain. Patients with prior infarction, cardiogenic shock, and those in whom coronary angiography revealed patency of the infarct-related artery (Thrombolysis In Myocardial Infarction 3 flow) were excluded. Primary angioplasty was considered to be successful when grade 3 Thrombolysis In Myocardial Infarction flow was obtained with a residual stenosis ,30%. All patients were given aspirin, and those who had stent implantation received ticlopidine or clopidogrel. Intravenous heparin in a bolus of 10,000 IU was given before angioplasty, with subsequent dosing as needed to maintain an activated coagulation time of about 300 seconds. Before primary angioplasty and during the chest

Experiencia preliminar: STENT MGUARD en angioplastía coronaria con alta carga trombótica, ¿una nueva alternativa en protección embólica?

BACKGROUND Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). OBJECTIVE Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). METHODS Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). RESULTS At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30days follow up, but no clinical events at 6 months follow up. CONCLUSIONS In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

Cierre percutáneo de orejuela izquierda para prevención de fenómenos embólicos en fibrilación auricular: experiencia preliminar

ABSTRACT Patient Demographics and Immediate Resultsof Primary Angioplasty in the SOLACI Registry Introduction: The superiority of primary angioplasty com-pared to fibrinolytic agents has been broadly demonstratedin different studies, but due to logistic issues we haveobserved a delay in the implementation of the recom-mendations in real world scenarios. We compared primaryangioplasty results at three different timepoints in theSOLACI Registry. Methods: The SOLACI Registry includeddata of 43,725 primary angioplasties carried out from1995-97 (n = 6,793), 2000-03 (n = 23,007) and 2007-08(n = 13,925). Results: An increasing complexity of treatedpatients was observed, with an increment in the percentageof women, diabetics, patients with prior myocardial in-farction and patients with moderate to severe ventriculardysfunction. Procedural success remained high (> 91%) atall timepoints, regardless of the device used. In addition,we observed a significant decrease of door-to-balloontime, increased use of stents and a 45% decrease in the useof glycoprotein IIb/IIIa inhibitors. Regarding in-hospitaloutcomes, a decreased mortality (9.1% vs. 5.3% vs. 4.5%),reinfarction (4.1% vs. 2.6% vs. 2.7%) and target vesselrevascularization procedures (3.5% vs. 0.7% vs. 0.7%)was observed.

Oral rapamycin to prevent human coronary stent restenosis: A pilot study

Resumen: Introduccion: La microembolizacion se asocia a mas eventos cardiovasculares adversos (MACE) especial-mente en angioplastia (PTCA) de puentes venosos aorto-coronarios (PAC) o en sindrome coronario agudo (SCA). El stent MGuard evitaria la embolizacion distal. Nuestro objetivo: evaluar el stent con micromalla de dacron como alternativa de proteccion embolica. Metodos: Registro prospectivo de PTCA con stent MGuard en de SCA de PAC y vasos nativos. Resultados: 15 angioplastias, de ellas 53% con infarto agudo miocardico con supradesnivel de ST (IAM con SDST). PTCA en vasos nativos: 60% y PAC: 40% (anti-guedad: 13 ± 3 anos). El 53% tuvo flujo inicial TIMI 0-1, alto contenido trombotico (66%: 4-5 en escala de trom-bos TIMI). Se predilato la lesion en 73% de los casos, se empleo Reopro en 2 casos, no se uso filtros de protec-cion ni aspirador de trombos. Las dimensiones del stent MGuard: 22.2 ± 4.4 mm de largo por 3.7 ± 0.44 mm de diametro. El 100% con flujo TIMI 3 final, 93% con im-pregnacion miocardica grado 3. Subgrupo de IAM con SDST: 71% obtuvo < 23 cuadros TIMI/segundo, 100% con regresion del SDST mayor de 50% a 90 minutos de PTCA. Subgrupo de PTCA de PAC: (excepto caso de PTCA de PAC en IAM c/SDST) no se registro elevacion de la CK total o MB post PTCA. Seguimiento: un caso de trombosis al mes. Conclusion: El MGuard stent parece ser efectivo en la proteccion de la microcirculacion. Se requieren estudios para evaluar la seguridad clinica y eficacia en proteccion embolica.

Riesgo de presentar un evento cardiovascular a 10 años en personas sanas: proyecto RICAR (estudio de prevención de riesgo cardiovascular de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular)

ResumenIntroduccion: Dentro de las complicaciones mas importantes de la fibrilacion auricular (FA) se encuentra el accidente vascular encefalico embolico (AVE), siendo la terapia anticoagulante oral (TACO) la principal herramienta para su prevencion. Cerca de un 20% de los pacientes con FA presentan condiciones clinicas que impiden su uso. Como la orejuela izquierda (OI) ha sido identificada como el principal sitio de formacion de trombos en la FA no valvular, se ha postulado que su oclusion podria disminuir la incidencia de eventos embolicos en este tipo de pacientes. Con este objetivo se han desarrollado multiples tecnicas, tanto quirurgicas como dispositivos percutaneos para el cierre de esta estructura. En esta publicacion se presenta la experiencia del cierre percutaneo de la OI en tres pacientes, con el uso del dispositivo Amplatzer Cardiac Plug (ACP). Metodos: Los tres pacientes tenian alto riesgo embolico y contraindicacion para uso de TACO. El procedimiento se realizo en el laboratorio de hemodinamia, bajo guia radioscopica y ecocardiografica, con anestesia