Roberto Muniz Ferreira

Troponin I elevation and all-cause mortality after elective percutaneous coronary interventions

BACKGROUND/PURPOSE Although troponin I (TnI) elevation and myocardial injury after percutaneous coronary interventions (PCI) are frequent findings, their prognoses remain controversial. We aimed to determine the association between any or ≥5 times TnI elevation after elective PCI and subsequent one year mortality rates and long term survival. METHODS Consecutive patients admitted for elective PCI between January 2013 and December 2014 were retrospectively analyzed by chart review in two hospitals in Rio de Janeiro. Only patients with post-PCI TnI measurements were included. Clinical, angiographic and procedural characteristics were correlated with any or ≥5 times TnI elevation, as well as 1year mortality and long term survival. RESULTS A total of 407 interventions were included in the analysis. Post-PCI TnI elevation was observed in 74.7% of cases and ≥5 times elevations occurred in 41.3%. Age≥70years, female gender and multistenting were predictors of enzyme elevation. Prior aspirin or hypoglycemic therapy were protective factors. One year mortality was significantly associated with any TnI elevation (6.6% vs 1.05%, p=0.035) and values ≥5 times above the normal limit predicted the highest mortality rates (8.13% vs 3.14%, p=0.031). Survival of patients with single vessel disease was also adversely affected by ≥5 times enzyme elevation (log-rank: p=0.039). CONCLUSION Troponin I elevation after elective PCI is frequent and associated with progressively higher mortality rates at 1year. A cutoff value ≥5 times the 99th percentile, currently defined as myocardial injury, appears to be an even more significant predictor of this outcome, even in lower risk subgroups.

Allergic recurrent coronary stent thrombosis: A mini-review of Kounis syndrome

Kounis syndrome (KS) consists of an association between hypersensitivity reactions triggered by various environmental and pharmacological factors and acute coronary syndromes. Blood supply may be compromised by either vasospasm (type I), native plaque destabilization (type II) or stent thrombosis (type III). Although the prognosis is generally favorable, treatment should include aggressive anti-thrombotic and anti-allergic therapies. A case compatible with type III KS, manifested as a macular rash followed by two episodes of stent thrombosis after primary angioplasty (PCI) of the right coronary artery is presented, and complemented by a review on the topic.

Contrast-induced thrombocytopenia following percutaneous coronary intervention

Contrast-induced thrombocytopenia is a rare complication distinguished by acute and severe platelet consumption, with spontaneous recovery within days. We describe a case of acute thrombocytopenia 6 hours after coronary angioplasty in a patient with a negative antiplatelet factor 4 test. The count reached 1 × 103/µL, but improved spontaneously to 210 × 103/µL after 8 days. In conclusion, physicians should be aware of this complication, particularly when dual antiplatelet therapy is being considered.

Troponin I elevation after elective percutaneous coronary interventions: Prevalence and risk factors

Troponin elevation after coronary angioplasty is a prognostic marker associated with significant morbidity and mortality, although its prevalence varies according to clinical and procedural characteristics. We analyzed the frequency of post-procedural enzyme elevation among 112 elective interventions between 2013 and 2014 in a private hospital in Brazil. Troponin increase was observed in 62.5% of the procedures, and was related to age, female sex, low pre-procedural hemoglobin, prior angiotensin converting enzyme inhibitor or angiotensin receptor blocker use and multivessel angioplasty. PCI is not a risk free procedure and these results underscore the importance of a careful clinical assessment before its utilization.

Complications after elective percutaneous coronary interventions: A comparison between public and private hospitals

Objective Complications after percutaneous coronary interventions (PCI) are associated with significant morbidity and mortality, although institutional discrepancies can occur when public and private hospitals coexist within the healthcare system. The aim of this study was to compare the in-hospital complication rates and mortality in addition to long-term survival following elective PCI in two reference public and private cardiology hospitals in Rio de Janeiro, Brazil. Methods From January 1st 2013 to December 31st 2014, a total of 440 procedures were identified in both hospitals (public: 328 vs. private: 112) and retrospectively analyzed by chart review. Results There were no significant differences between the two hospitals regarding the total number of procedures with at least one complication (public: 23.8 vs. private: 17.9%, p = 0.2) or in-hospital mortality rates (public: 0.6% vs. private: 0%, p = 0.5). Post-procedural renal insufficiency was more frequent in the private hospital, whereas coronary-related complications were more prevalent in the public hospital. After a mean follow up of 30.3 months (SD ± 9.2), the survival rate was also similar. Conclusions Clinical complications after elective PCI are common both in public and private hospitals. Meticulous pre-procedural clinical assessment and patient selection as well as adherence to guideline-based practices could minimize the risk of PCI-related adverse events.