Endothelial function in patients with slow coronary flow and normal coronary angiography

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Prevalence, etiology, and characteristics of patients with type-2 acute myocardial infarction

AbstractBackgroundIn clinical practice, type-1 (coronary thrombosis) and type-2 (imbalance between oxygen demand and supply) acute myocardial infarction (AMI) are not clearly differentiated. The aim of this study was to evaluate the prevalence and etiology of type-2 AMI and compare its profile with that of type-1 AMI.MethodsPatients admitted with ST-segment elevation AMI (STEMI)<12hours of symptom onset, and referred for coronary angiography, from 2009 to 2013, were analyzed.ResultsThere were 1,960 patients included; 1,817 were analyzed, of whom 1,786 (98.3%) had type-1 AMI, and 31 (1.7%), type-2. All patients with type-2 AMI showed no significant coronary lesions, and 36% of the cases had apical dyskinesia. Type-2 AMI patients had, in general, a clinical and laboratory profile that was similar to those with type-1, except for the younger age, lower levels of myocardial necrosis markers, higher probability of having pre-TIMI 3 flow and higher left ventricular ejection fraction. At 30 days, mortality (3.2 vs. 9.0%; p=0.23) and the occurrence of death, reinfarction, or need for target-vessel revascularization (3.2 vs. 13.0%; p=0.09) were numerically lower in type-2 AMI.ConclusionsFew patients with STEMI were classified as type-2; they had structural abnormalities, isolated or associated with the absence of significant lesions; showed little difference regarding the clinical and laboratory profile, and similar clinical outcomes at 30 days, when compared to patients with type-1 AMI

RIAM – Multicentre, Interoperable, Clinical Registry of Acute Myocardial Infarction

Introduction: Ischemic heart disease is the leading cause of death in the world. In Brazil, in 2013, acute myocardial infarction (AMI) was the main cause of mortality due to heart disease. A better identification of the patients will serve as a tool to improve the treatment of this pathology. Objective: To expand the database of patients with ST elevation myocardial infarction (STEMI) of the Cardiology Institute (Porto Alegre-RS, Brazil). Methods and Results: The following steps were taken: (1) data elements standardisation in accordance with standard variables, including all applicable standardized data elements published by the American Heart Association / American College of Cardiology, and Brazilian national datasets standards; (2) Development of electronic case reports (CRF) using REDCap (Research Electronic Data Capture) and in accordance with the HIPAA (Health Insurance Portability and Accountability Act) privacy rule ; And (3) expansion of registration to other referral centers. The participating institutions are distributed in the regions of Santa Maria, Passo Fundo, Caxias do Sul all of Rio Grande do Sul, as well as the regions of Santa Catarina and the Distrito Federal in Brasília. The data collected will be stored according to the Health Insurance Portability and Accountability Act. Conclusion: The enhancement and expansion of the RIAM Registry to other referral centers is generating data directly into the REDCap CRF, is a tool with results the treatment of AMI in our environment, which contributes to clinical practice, health services management and policies

Clinical profile and outcomes of primary percutaneous coronary intervention in young patients

AbstractBackgroundThe epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low

Valvuloplastia pulmonar percutânea em síndrome de Noonan

Os autores descrevem o casa de uma menina de 14 anos portadora de Syndrome de Noonan e estenose pulmonar severa submetida a valvuloplastia pulmonar percutanea com cateter-balgo House melhora sintomftica importante ap6s o procedimento, que transcorreu sem complicag6es. No entanto, permaneceu obstrugao residual na via de saida do ventrfculo direito por hipertrofia infundibular, que regrediu apes um ano e meio de acompanhamento O faso 6 ilustrativo de alguns pontos controversos do uso da valvuloplastia pulmonar percutanea, coma seu emprego em pacientes com vflvulas displasicas e estenose importante, o tempo correta da indicagao, o uso de betabloqueadores após o procedimento, a técnica utilizada e o tamanho do balio a ser empregado e suas repercussões a médio e longo prazo.The authors report the case of a fourteen years-old girl with Noonan's Syndrome and severe pulmonary stenosis who underwent a percutaneous pulmonary balloon valvuloplasty. There was symptomatic improvement after the procedure and no complications. However, moderate residual stenosis remained due to infundibular obstruction, which decreased significantly in one and a half years of follow up. This case illustrates some controversial issues of percutaneous pulmonary balloon valvuloplasty: its application on dysplasic valves with severe stenosis, the correct timing of intervention, the use of betablockers after the procedure, technical aspects and the size of the balloon used and medium to long term result

Estudo comparativo entre extensão da aterosclerose coronária com os fatores de risco e as alterações na artéria da retina

Objetivo - Estudar a possível relação entre extensão da aterosclerose coronária com os fatores de risco e com as alterações nas artérias da retina. Métodos - Foram estudados 96 pacientes, 66 do sexo masculino, com idades de 36 a 72 anos, por meio da cinecoronariografia seletiva, quantificação dos fatores de risco (dislipidemia, hipertensão arterial sistêmica (HAS), sexo, tabagismo, obesidade, alcoolismo e história familiar e com alterações no exame de fundo de olho, divididos em 2 grupos: sem obstruções significativas nas artérias coronárias e com lesão de 75% ou mais em uma ou mais artéria coronárias e, posteriormente, subdivididos em 4 grupos: grupo 1 (n:42) - pacientes sem obstrução significativa das coronárias; grupo 2 (n:15) - com obstrução igual ou superior a 75% em uma coronária; grupo 3 (n:27) - com obstrução em 2 coronárias e grupo 4 (n:12) - com obstrução em 3 coronárias. Resultados - Constatou-se relação entre a extensão da aterosclerose coronária com sexo masculino (p<0,001) e tabagismo (p<0,01). Não se encontrou relação entre extensão da aterosclerose coronária com obesidade, HAS, colesterol e triglicerídeos, alcoolismo e história familiar, bem como entre as alterações do reflexo axial, cruzamento A-V, exsudato, hemorragia, mácula e relação A-V dos ramos da artéria da retina. Conclusão - Existe relação entre extensão da aterosclerose coronária com o sexo masculino e tabagismo. Esta relação não foi encontrada nos demais fatores de risco analisados e nem com as alterações da artéria central da retina.Purpose - To identify a possible relationship of the extent of coronary artery disease, with risk factors for coronary artery disease and the retinal arteriolar changes (evaluated by fundoscopic examination). Methods - We studied 96 patients (66 males), 36 to 72 years of age. All patients were studied by selective cinecoronaryarteriography, fundoscopic examination, as well as evaluated for the common risk factors, cigarrete smoking, diabetes, dislipidemia, systemic hypertension, age, alcoholism, male sex, family history and obesity. Results - Male (p<0,001) and smoking (p<0,01) were the statistically significant associations with the extent of coronary artery disease. No significant relationship with the extent of coronary artery disease was present for the other risk factor nor for changes in retinal arteriolar branches. Conclusion - A relationship between extent of coronary artery disease with male sex and a cigarrette smoker is occured. No relationship with other risk factors, nor with retinal arteriolar changes were present

Histopathological evaluation of coronary thrombi in patients with ST-segment elevation myocardial infarction

ABSTRACTBackgroundPrimary percutaneous coronary intervention (primary PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates.MethodsConsecutive patients undergoing primary PCI were enrolled from December 2009 to June 2011. Clinical, laboratory and angiographic data were prospectively collected and entered in a dedicated database. The decision to perform thromboaspiration was left to the discretion of the operators. One hundred and twelve samples of thrombi were collected, stored in 10% formalin-fixed paraffin, stained with hematoxylin-eosin and analyzed by light microscopy. On histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organized thrombi.ResultsRecent thrombi were identified in 68 patients (61%) and lysed/organized thrombi in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P=0.03). There were no other statistically significant differences identified for clinical, angiographic, laboratory or clinical outcomes between the two study groups.ConclusionsIn patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates showed histopathological features of recent thrombi. There were no significant associations between these characteristics and clinical, laboratory and angiographic data in this contemporary sample representative of the real world