Roberto Botelho

Relative and absolute changes in urinary neutrophil gelatinase-associated lipocalin and correlation with small increases in serum creatinine levels after coronary angiography: an observational study.

Introduction/Aims: The Acute Kidney Injury Network classification is based on small increases in serum creatinine (sCr) for stage 1. This study investigated whether changes in the urinary concentration of neutrophil gelatinase-associated lipocalin (uNGAL) could predict small increases in sCr in patients undergoing coronary angiography. Methods: The uNGAL was measured before contrast infusion and 2 and 4 h afterwards. Patients were divided into 2 subgroups: G1 (n = 103), where sCr increased by <0.3 mg/dl, and G2 (n = 22), where sCr increased by ≥0.3 mg/dl 48 h after the angiography. To determine the sensitivity and specificity for the absolute and relative variations of uNGAL, a receiver operating characteristic curve analysis was performed. Results: In G2, the uNGAL concentration increased over baseline values (15.9 vs. 9.2 ng/dl; p < 0.05), and it was also 2-fold higher in G2 versus G1 (15.9 vs. 8.0 ng/dl; p < 0.001). The uNGAL remains an independent predictor of the small increases in sCr, and, for an increase of 50% over baseline levels, it showed 60% sensitivity and 81% specificity. Conclusion: Changes in uNGAL concentration 2 h after the infusion of contrast media showed marginal sensitivity to predict small increases in sCr.

TCT-438 Telemedicine Increases the Access to Primary Percutaneous Coronary Intervention Saving Costs and Lives in ST-Elevation Myocardial Infarction (STEMI). Three-year Analysis of the Latin America Telemedicine Network (LATIN) Program in Sao Paulo East Zone.

The STEMI remains with high mortality in underserved areas. Patient’s transportation, logistics and treatment to PCI centers require high use of resources. Telemedicine (TM) favors early referral reducing the time to revascularization with the potential to improve outcomes. However the impact of

TCT-49 Transformational Pathways for AMI Management in Developing Countries - Rolling 600,000 Remote Patient Encounters to D2B Interventions

Major disparities exist between developed and developing countries in the outcomes of patients presenting with AMI. Telemedicine has emerged as a powerful, cost-efficient, and scalable tool for population-based AMI management. We propose efficient telemedicine protocols as frontline AMI strategies

TCT-439 Long-term Savings with Telemedicine STEMI Networks

Despite proven benefits of a telemedicine-guided AMI strategy, insurance rebuffs are prodigious reasons for denial of Primary PCI (>50%). Our previous work has demonstrated augmented access, accuracy, and cost-effectiveness of a population-based AMI program. Latin Telemedicine Infarct Network (LATIN

A Specific Angiographic View of Left Coronary Artery Bifurcation in the Left Main Percutaneous Coronary Intervention Era

OBJECTIVES We propose a right lateral (90-120° RAO) with 30° cranial angiographic view to expose the bifurcation of the left main coronary artery (LMCA) when previously used routine projections were inefficient at clearly showing this region. BACKGROUND Little has been published in the medical literature regarding angiographic projections dedicated to special anatomies. METHODS A total of 84 patients were subjected to the proposed projections. A reproducibility study, conducted with the participation of 2 independent observers, judged the effectiveness of the proposed projection. The Prevalence and Bias Adjusted Kappa (PABAK) index, with a 95% confidence interval (CI), was used to demonstrate the intensity of intra/inter-observer agreement. RESULTS The proposed projection was efficient in 79% of the angiograms, with agreement of 0.76 (0.6-0.9; P ≤ 0.001). The origins and the proximal segments of: the anterior descending coronary artery were exposed in 89% of the angiograms, agreement of 0.86 (0.7-1.0; P ≤ 0.001); the circumflex artery were exposed in 83% of the angiograms, with agreement of 0.72 (0.5-1.0; P ≤ 0.001); and the intermediate branch, when present, were exposed in 89% of the angiograms, agreement of 0.79 (0.6-1.0; P ≤ 0.001). CONCLUSION The right lateral (90-120° RAO) with 30° cranial projection is effective, safe, and reproducible. In special situations where routine projections fail, this proposed projection can reveal important details of the anatomy of the bifurcation of the LMCA during conventional coronary angiography or be the working projection during coronary angioplasty. (J Interven Cardiol 2016;29:293-299).

Systolic Heart Function, Kidney Filtration and the Number of Coronary Atherosclerotic Plaques in Lean and Overweight Patients

The objective of this study was to quantify the number of vessels with stenotic points in the coronary circulation of lean and overweight individuals submitted to coronary angiography and ventriculography to verify the possible associations with glomerular filtration and the systolic ventricular function. Eighty-six patients with a previous history of myocardial ischemia were studied. Two groups were formed: non-elderly (G1), n = 38, 52.8 ± 1.2 years old, and elderly (G2), n = 48, 70.1 ± 1.2 years old. Both groups were divided into 2 subgroups according to the estimated glomerular filtration rate (eGFR): ≥60 and <60 ml/min/m2. The results showed that G1 had 0.36 ± 0.11 versus 1.25 ± 0.45 stenoses/patient (≥60 vs. <60 ml/min/m2; p < 0.05, respectively) and G2 had 0.91 ± 0.28 versus 1.83 ± 0.33 stenoses/patient (≥60 vs. <60 ml/min/m2, respectively). The other variables, such as central and brachial arterial blood pressures, did not manifest significant differences in relation to the eGFR. The following significant correlations were observed: between the quantity of coronary stenotic points and the eGFR (R2 = 11.2%; r = -0.33; p < 0.001), and between eGFR and the ventricular ejection fraction (R2 = 5.1%; r = 0.57; p < 0.0001). The ejection fraction correlated significantly with the number of vessels with stenoses in the coronary bed (R2 = 13.4%; r = -0.36; p < 0.008). In conclusion, although the correlations are considered weak, interrelationships between heart and kidney were demonstrated in this study.

Combined repair of extensive aneurysm of the ascending aorta, arch, and descending aorta

A 50-year-old man with an extensive aneurysm of the ascending aorta with extension through the transverse arch and of the descending thoracic aorta had this segment repaired by insertion of multiple stent grafts and, 2 days later, of the arch and ascending segment by an open-surgical procedure. The stents covered the segment from the takeoff of the left subclavian artery to the thoracoabdominal transition. The procedure consisted of insertion of a Dacron tube graft that covered the segment from the proximal edge of the first stent to the aortic root. The patient has had an event-free recovery.