Patricia Teixeira da Silva

Resultados da intervenção coronária percutânea primária em pacientes do Sistema Único de Saúde e da saúde suplementar

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the most effective reperfusion technique in acute myocardial infarction (AMI) and its success rate depends on many factors. This study aimed to assess the profile and to compare in-hospital outcomes of primary PCI among patients from the Public Healthcare System (PuHS) versus those from the Private Healthcare System (PrHS). METHODS: From 2006 to 2010, 493 patients were submitted to primary PCI, of which 220 were treated by the PuHS and 273 by the PrHS. Procedure technique and materials were left to the operators discretion. RESULTS: The PuHS group had a larger number of Killip > 1 patients. Multivessel coronary disease, pre-procedure coronary flow TIMI 0/1 and the presence of collaterals for the treated vessel did not differ between groups. The PrHS group used more thromboaspiration catheters (10% vs. 20.8%; P < 0.01) and glycoprotein IIb/IIIa inhibitors (24.1% vs. 36.6%; P < 0.01). There was no difference for door-to-balloon times (62.3 minutes vs. 64.2 minutes; P = 0.91). For patients referred from other hospitals, however, transportation times were higher for PuHS patients (400.8 minutes vs. 262.4 minutes; P < 0.01). PCI success rates and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) did not differ between groups (6.3% vs. 6.2%; P = 0.1). Age, Killip III/IV and transportation time were the variables that best explained the occurrence of MACCE. CONCLUSIONS: Differences in the clinical, angiographic and procedure profile of patients undergoing primary PCI treated by the PuHS and the PrHS did not have an impact on MACCE. Transportation times, however, high in both groups and higher in the PuHS group, proved to be an independent predictor of adverse events.

Impacto do tabagismo nos resultados da intervenção coronária percutânea

BACKGROUND: Smoking is an important atherothrombotic risk factor, observed in one third of patients undergoing per-cutaneous coronary intervention (PCI) at our service. The objective of the present study was to analyze the clinical angiographic profile and the results of the procedure in this population. METHOD: From January 2002 to October 2009, 5,466 PCI procedures were carried out, of which 1,745 in smokers and 3,721 in non-smokers. All data were prospectively obtained and patients were followed-up during hospitalization. RESULTS: In the group of smokers, there was prevalence of males (75.2% vs. 62.1%; P < 0.001), younger patients (56.4 years vs. 64.5 years; P < 0.001), acute myocardial infarction (AMI) with ST-segment elevation (37.5% vs. 19.5%; P < 0.001), single-vessel disease (56.5% vs. 47%; P < 0.001), long lesions (14.7% vs. 12%; P < 0.001), bifurcations (5.6% vs. 3.9%; P = 0.002), thrombotic lesions (15.4% vs. 9%; P < 0.001), total occlusions (18.2% vs. 11.2%; P < 0.001) and greater use of IIb/IIIa inhibitors (2.5% vs. 1.6%; P = 0.04). Clinical success (96.5% vs. 96.1%; P = 0.5) as well as the need of emergency surgical revascularization (0.06% vs. 0.05%; P = 0.22), AMI (0.74% vs. 1.02%; P = 0.32) or death (0.63% vs. 0.73%; P = 0.69) were similar in both groups. Smokers, however, showed a trend towards a greater number of strokes during hospitalization (0.11% vs. 0.05%; P = 0.07). CONCLUSION: Smokers undergoing coronary angioplasty are eight years younger than non-smokers, present AMI with ST-segment elevation more frequently and have greater angiographic complexity. The use of modern technological resources allowed comparable in-hospital results, with the exception of stroke, whose incidence tends to be twice as high in smokers.

Perfil de pacientes tratados com cateteres de aspiração de trombos durante intervenção coronária percutânea primária

BACKGROUND: The benefits of using thrombus aspiration catheters during primary percutaneous coronary intervention (PCI), to obtain better coronary flow and myocardial perfusion and reducing late mortality are established in the literature. However, in the clinical practice it does not seem to be used for all patients. We tried to determine what clinical and angiographic variables have led to the indication of these devices in primary PCI at our institution. METHODS: From August 2006 to November 2010, 558 patients were consecutively submitted to primary PCI. Thrombus aspiration catheters were used in 79 patients (group 1), who were compared to 479 patients who did not use these devices (group 2). RESULTS: Group 1 showed a prevalence of males, smokers, large acute myocardial infarctions (AMI) and thrombotic lesions. The use of glycoprotein IIb/IIIa inhibitors, direct stenting and larger diameter stents and the presence of transient coronary flow disturbances were also more frequent in group 1. Procedure success rate was high (93.7% vs. 92.3%; P = 0.4) and it was similar between groups. At hospital discharge, the incidence of major adverse cardiac and cerebrovascular events (6.3% vs. 6.5%; P = 0.6), death (5.1% vs. 3.8%; P = 0.58), stroke (1.3% vs. 0.4%; P = 0.09), reinfarction (0 vs. 2.3%; P = 0.17) was not different between groups. CONCLUSIONS: Thrombus aspiration catheters have been used in 15% of primary PCIs, usually in AMIs with greater extension and thrombotic burden. Despite the more severe clinical-angiographic profile of these patients the success rate is high and similar to that of low-risk patients.

Resultados hospitalares da intervenção coronária percutânea primária no infarto agudo do miocárdio em pacientes com mais de 80 anos

ABSTRACT In-hospital Results of Primary PercutaneousCoronary Intervention in PatientsAbove 80 Years of Age Background: Improvements in life expectancy of the overallpopulation and the risk of bleeding with thrombolytics haveenabled very elderly patients with acute myocardial infarctionto be treated by primary percutaneous coronary intervention(PCI). We analyzed the primary PCI in-hospital results inpatients > 80 years of age. Method: From January 2002 toOctober 2008, 4,788 PCIs were performed, of which 428were primary PCIs. Of these, 34 were performed in patients> 80 years of age and 394 in patients 0.99), but patients > 80 years oldhad a higher mortality rate (11.8% vs. 2.3%; P = 0.014).Reinfarction, stroke, major vascular complications and acuterenal failure were similar between groups.

Resultados hospitalares da intervenção coronária percutânea primária em mulheres

ABSTRACT In-Hospital Outcomes of Primary PercutaneousCoronary Intervention in Women Background: Women with acute myocardial infarction (AMI)have higher mortality rates than men. Primary percutaneouscoronary intervention (PCI) plays a major role in reducingAMI mortality rates. We tried to identify whether there aredifferences in in-hospital outcomes of primary PCI betweenwomen and men. Methods: From January 2002 and October2008, 428 primary PCIs were performed, 125 (29.2%) infemale patients. The technique and device selection wereat the operator’s discretion. All of the patients received dualantiplatelet therapy before the procedure. Results: Femalepatients were older (65.1 years vs. 59.2 years; P < 0.001),and more frequently presented Killip III/IV (11.2% vs.3.3%; P = 0.002). Stent diameter was smaller in women(3.1 + 0.4 mm vs. 3.3 + 0.5 mm; P < 0.001), but there wereno differences in stent length (19.1 + 6.5 mm vs. 18.7 +6.2 mm; P = 0.55), door-to-balloon time (159.4 + 110.1minutes vs. 138.9 + 138.3 minutes; P = 0.19), use of gly-coprotein IIb/IIIa inhibitors (32% vs. 31%; P = 0.58) orthrombus aspiration catheters (10.4% vs. 9.9%; P = 0.65).Procedure success was similar (97.1% vs. 96.7%) and womenhad a higher likelihood of death (5.6% vs. 2%; P = 0.06)and stroke (0.8% vs. 0.3%; P = 0.09). Major vascular com-plications (6.4% vs. 5.6%; P = 0.49) were similar in bothgenders.

Resultados hospitalares da intervenção coronária percutânea em diabéticos

BACKGROUND: There are few reports available in the literature assessing in-hospital outcomes of diabetic patients undergoing contemporary percutaneous coronary intervention (PCI). Our objective was to assess the acute post-PCI outcomes of a large series of diabetic and non-diabetic patients treated consecutively. METHODS: From August 2006 to February 2012, 6,011 patients were submitted to PCI and were included in Hospital Bandeirantes Registry. The technique and devices for the procedure were chosen by the operators. Clinical outcomes were recorded at the time of hospital discharge. RESULTS: Diabetic patients were older and more often female, with a higher prevalence of comorbidities and risk factors for coronary artery disease, except for smoking. However, most of the characteristics related to lesion complexity did not differ between groups. In diabetics, the number of treated vessels (1.6 ± 0.8 vs. 1.4 ± 0.7; P < 0.01) was higher and the use of smaller stents (2.9 ± 0.5 mm vs. 3 ± 0.5 mm; P < 0,01) was more frequent. Procedural success rate of 95.5% was achieved in both groups. In-hospital outcomes did not differ regarding the incidence of major adverse cardiac and cerebrovascular events (3.3% vs. 2.8%; P = 0.79), death (1% vs. 1.1%; P = 0.90), acute myocardial infarction (2% vs. 2.4%; P = 0.35), stroke (0.1% in both groups), and emergency revascularization (0.3% in both groups). Hypertension was the variable that best explained the occurrence of major adverse cardiac and cerebrovascular events [odds ratio (OR) 2.68, 95% confidence interval (95% CI) 1.13-6.38; P = 0.026). CONCLUSIONS: Diabetes adds more clinical complexity to PCI, but has no significant impact on in-hospital outcomes.

Resultados da intervenção coronária percutânea de pacientes tratados pelo sistema único de saúde e pela saúde suplementar

BACKGROUND: The main healthcare funding systems in Brazil, the public and the private healthcare systems (PuHS and PrHS, respectively), have peculiar characteristics and cover almost all patients referred for percutaneous coronary intervention (PCI). Our objective was to identify population differences and PCI hospital outcomes in patients using both systems. METHODS: From August 2006 to November 2010, 4,957 consecutive patients were submitted to PCI, 2,802 (56.5%) were from the PuHS and 2,155 from the PrHS. RESULTS: Patients from the PuHS were younger, had less education, greater incidence of smoking, prior myocardial infarction (MI), single-vessel disease, left ventricular dysfunction, and received more direct stenting. In the PrHS group, there was more diabetes, dyslipidemia, prior coronary bypass graft surgery (CABG) and PCI, prior stroke, chronic renal failure, ST-segment elevation and non-ST segment elevation acute coronary syndromes, restenotic lesions, long lesions, primary PCIs, use of glycoprotein IIb/IIIa inhibitors and drug-eluting stents. PCI success (96% vs. 96,1%; P = 0.87), MI (1.7% vs. 1.8%; P = 0.72), CABG (0.1% vs. 0.2%; P = 0.85), stroke (0.1% vs. 0.1%; P > 0.99) and death (1% vs. 1.2%; P = 0.48) were not different between groups. CONCLUSIONS: Patients from the PrHS had greater clinical and angiographic complexity than those from the PuHS. However, these differences did not affect the success of the procedure and the rate of in-hospital major adverse cardiovascular and cerebrovascular events.

Resultados hospitalares da intervenção coronária percutânea Ad Hoc vs. eletiva

BACKGROUND: Ad hoc percutaneous coronary intervention (PCI) has proven to be safe in certain subsets of patients and the number of procedures has grown steadily over the years. In face of the scarcity of literature publications, we performed a comparative analysis of in-hospital outcomes of ad hoc and elective PCIs. METHODS: From 2006 to 2010, 4,957 consecutive patients were submitted to PCI and were included in the Hospital Bandeirantes Registry. Patients undergoing primary or rescue PCI were excluded and of the remaining 4,048 patients, 1,510 (37.3%) were submitted to ad hoc PCI and 2,538 to elective PCI. RESULTS: The ad hoc PCI group was younger, had a lower prevalence of comorbidities and a greater number of patients were treated in the presence of acute coronary syndrome. They exhibited less complex coronary lesions, used larger diameter stents and had more transient flow impairments during PCI. Procedure success was similar between groups (97% vs. 96.8%; P = 0.70) as well as the occurrence of death (0.5% vs. 0.3%; P = 0.19), myocardial infarction (1.3% vs. 1.8%; P = 0.17), emergency coronary artery bypass graft surgery (0.4% vs. 0.2%; P = 0.36), stroke (0.1% vs. 0; P = 0.71) and major vascular complications (0.3% vs. 0.4%; P = 0.64). CONCLUSIONS: Ad hoc PCI is performed in lower risk patients and the outcomes demonstrate it is a safe procedure for most of the selected patients.

Impacto do sexo feminino nos resultados da intervenção coronária percutânea contemporânea

BACKGROUND: Prior studies have shown there are differences in the clinical outcomes of percutaneous coronary intervention (PCI) between men and women. We tried to assess gender differences in clinical and angiographic presentation as well as in the in-hospital outcomes of patients undergoing contemporary PCI. METHODS: From 2002 to 2009, 6,067 consecutive patients were submitted to PCI, of these, 2,021 (33.3%) were women. The interventional strategy, including the type of stent implanted, was conducted at the operators discretion. RESULTS: The female gender was older and had a greater incidence of risk factors for atherosclerosis, except for smoking. Acute coronary syndrome without ST segment elevation was the most prevalent presentation in women. Women had a higher number of single vessel lesions and a lower prevalence of B2/C lesions, thrombi, bifurcation lesions and moderate to severe ventricular dysfunction. Patients were predominantly treated with bare metal stents and no differences were observed for the diameter and length of the stents. No differences were observed for the in-hospital incidence of major adverse cardiac and cerebrovascular events (1.5% vs. 1.4%; P = 0.76), death (0.9% vs. 0.6%; P = 0.15), stroke (0.05% vs. 0.05%; P > 0.99), acute myocardial infarction (0.7% vs. 1.1%; P = 0.16) and emergency myocardial revascularization surgery (0.1% vs. 0; P = 0.62). Diabetes, multivessel coronary artery disease, B2/C type lesions and total occlusions were the variables that best explained the occurrence of in-hospital events. CONCLUSIONS: Women correspond to one third of the patients undergoing PCI at our service and have a more severe clinical profile, but lower anatomic complexity than men. In our study, the female gender was not a predictor of in-hospital adverse clinical events.