Rodrigo Vugman Wainstein

Erectile Dysfunction and Coronary Artery Disease: An Association of Higher Risk in Younger Men

INTRODUCTION The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM To investigate the interaction of age in the association between ED and CAD. METHODS This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results.  Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

Association between myeloperoxidase polymorphisms and its plasma levels with severity of coronary artery disease.

OBJECTIVES Myeloperoxidase (MPO) polymorphism -463 has been related to higher cardiovascular risk. This study was conducted to test whether the MPO promoter polymorphism -463A/G and MPO plasma levels are associated with coronary artery disease (CAD) severity. DESIGN AND METHODS Patients submitted to elective coronariography were enrolled, CAD severity was assessed and blood samples collected to identify the MPO polymorphism and its plasma levels. RESULTS Genotypes were determined in 118 patients. Among these patients, 12 (10%) were homozygous for AA, 69 (58%) for GG and 37 (32%) were heterozygous. Mean MPO plasma levels were 8.6+/-4.7 ng/mL for AA, 8.6+/-7.0 ng/mL for AG and 9.4+/-5.6 ng/mL for GG genotypes. The CAD severity was not associated with MPO genotypes (p=0.43), however, patients with higher CAD score presented higher MPO levels (p=0.02). CONCLUSION We found no association between MPO polymorphism and CAD severity, although a relation was observed for MPO plasma levels and extension of CAD.

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.

Two HEmostasis Methods After TransradIal Catheterization: THEMATIC - protocol for a randomized clinical trial.

OBJECTIVE Randomized clinical trial protocol to evaluate the incidence of radial artery occlusion with two different arterial compression devices after transradial procedures. METHODS Barbeaus test will be performed in adults scheduled to undergo transradial interventional procedures. Those with A, B, or C plethysmographic patterns will be selected. At the end of the procedure, patients will be randomly assigned (1:1) to receive patent haemostasis with TR Band™ device or conventional haemostasis with an elastic adhesive bandage. The primary outcome is the incidence of radial artery occlusion. Secondary outcomes are Barbeaus test curve change, additional time to achieve haemostasis, incidence of bleeding at the puncture site, pain severity, development of arteriovenous fistula, radial pseudo aneurysm, any access-site complication requiring vascular surgery intervention and costs between the two devices. DISCUSSION The results of this trial should provide valuable additional information on the best approach for haemostasis after transradial percutaneous cardiovascular interventions.

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