Elective and primary angioplasty at hospitals without on-site surgery versus with on-site surgery: results from a national registry

INTRODUCTION: Current European clinical guidelines do not restrict interventional cardiology at centers without on-site surgical backup, but disagreement still exists whether hospitals with cardiac catheterization laboratories, but without on-site cardiac surgery, should develop percutaneous coronary intervention (PCI) programs. Technical improvements in equipment and pharmacologic adjunctive therapy have increased the safety margins of diagnostic and therapeutic cardiac catheterization and more than half of the patients treated by PCI in Portugal are treated at hospitals without on-site cardiac surgery. OBJECTIVES: We set out to compare clinical outcomes of elective and primary PCI for ST-segment elevation myocardial infarction at centers without on-site cardiac surgery with those at centers with on-site cardiac surgery. METHODS: Based on the Portuguese Registry of Interventional Cardiology, we retrospectively reviewed a total of 13,235 PCI procedures performed from January 2002 to June 2006 and compared the results for 7,112 patients treated at hospitals without on-site cardiac surgery with 6,123 patients treated at hospitals with on-site cardiac surgery. RESULTS: Demographic data were similar, with a mean age of 64 (55-72) vs. 63 (54-71) years, 75% vs. 76% male and 25.0% vs. 24.2% with diabetes respectively at centers without and with on-site surgical backup. Hospital mortality at centers without and with on-site surgical backup respectively was: chronic angina: 0.3% vs. 0.3% (NS); acute coronary syndromes: 1.5% vs. 1.0% (NS); acute myocardial infarction with ST elevation and without cardiogenic shock: 4.0% vs. 5.0% (NS); cardiogenic shock: 50.9% vs. 53.4% (NS). CONCLUSIONS: Similar clinical outcomes for interventional cardiology were achieved at hospitals without on-site cardiac surgery and those with on-site cardiac surgery. In the era of coronary stents, adjunctive therapy and experienced operators, elective and primary PCI can safely be performed without on-site surgical backup

A Multifunctional Integrated Circuit Router for Body Area Network Wearable Systems

A multifunctional router IC to be included in the nodes of a wearable body sensor network is described and evaluated. The router targets different application scenarios, especially those including tens of sensors, embedded into textile materials and with high data-rate communication demands. The router IC supports two different functionality sets, one for sensor nodes and another for the base node, both based on the same circuit module. The nodes are connected to each other by means of woven thick conductive yarns forming a mesh topology with the base node at the center. From the standpoint of the network, each sensor node is a four port router capable of handling packets from destination nodes to the base node, with sufficient redundant paths. The adopted hybrid circuit and packet switching scheme significantly improve network performance in terms of end-to-end delay, throughput and power consumption. The IC also implements a highly precise, sub-microsecond one-way time synchronization protocol which is used for time stamping the acquired data. The communication module was implemented in a 4-metal, 0.35 μm CMOS technology. The maximum data rate of the system is 35 Mbps while supporting up to 250 sensors, which exceeds current BAN applications scenarios.This work was supported in part by the Fundação para a Ciéncia e a Tecnologia (FCT) (Portuguese Foundation for Science and Technology) under Project PROLIMB PTDC/EEAELC/103683/2008 and through the Ph.D. Grant SFRH/BD/75324/2010, and in part by the CREaTION, FCT/MEC through national funds and co-funded by the FEDER-PT2020 partnership agreement under Project UIDB/EEA/50008/2020, Project CONQUEST (CMU/ECE/030/2017), Project COST CA15104, and ORCIP. (Corresponding author: Fardin Derogarian Miyandoab.)info:eu-repo/semantics/publishedVersio

Safety of etanercept in the treatment of rheumatic disease patients with Hepatitis C virus infection

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Exequibilidade, segurança e utilidade da biópsia endomiocárdica ventricular esquerda por acesso transradial : experiência inicial de um centro universitário terciário

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).Introduction and objectives: Over the last decade, several studies have suggested that left ventricular endomyocardial biopsy is safer and has a higher diagnostic yield than transvenous right ventricular biopsy. In addition, recent publications indicate that the transradial approach is a feasible and safe alternative to the transfemoral approach for sampling the left ventricle. We report our initial experience with transradial endomyocardial biopsy with regards to feasibility, safety and usefulness. Methods: Single-center registry of consecutive patients undergoing intended transradial left endomyocardial biopsy. Clinical and technical data were collected prospectively, with a particular focus on success rate and complications. Results: Twenty-seven patients were screened for left ventricle biopsy. Twenty (25) were selected for an intended transradial approach (mean age 51±18 years old, 22 male). Success rate was 100% with no crossover to femoral approach. There were no major complications. Two patients experienced mild radial spasm. One of them also had a run of non-sustained ventricular tachycardia. Indication for biopsy was either myocarditis or cardiomyopathy of unknown etiology. The final diagnosis was acute lymphocytic myocarditis in five patients, chronic myocarditis in one patient, amyloid light-chain amyloidosis in four patients and transthyretin amyloidosis in six patients. Myocarditis was ruled out in eight patients and amyloidosis in one patient. Conclusions: Transradial left ventricle endomyocardial biopsy is a very safe and feasible method of sampling the myocardium for histopathological analysis, with a good diagnostic yield and clinically meaningful results in properly selected patients.info:eu-repo/semantics/publishedVersio

Efficacy and safety of percutaneous left atrial appendage closure in chronic kidney disease patients with atrial fibrillation : results of a 7-year registry

© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.INTRODUCTION AND AIMS: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, the most devastating complication being thromboembolism leading to fatal or disabling stroke. Although oral anticoagulation (OAC) is the mainstay of prevention therapy in the general population, its benefit in chronic kidney disease (CKD) patients is less well defined. End-stage renal disease patients treated with vitamin K antagonists present increased risk of bleeding, accelerated cardiovascular calcification and increased risk of calciphylaxis. Left atrial appendage closure (LAAC) is performed to prevent complications in high-risk AF patients with contraindications to OAC and in AF patients with events despite OAC.info:eu-repo/semantics/publishedVersio

Can we rely on iFR for avoiding FFR? Conclusions of a 5-year experience

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017Background: Recently, the instantaneous wave free ratio (iFR), has been proposed an alternative or complementary method to fractional flow reserve (FFR). This new method does not require the use of adenosine and may expedite the speed of functional assessment. The iFR “hybrid strategy” relies on values 0,93 as definitive results which would not require the use of FFR. However, this strategy is much less consensual than FFR alone. Purpose: We aimed to assess the concordance of FFR and iFR results using the principle of the “hybrid strategy”, based on the 5-year experience of a single center. We also aimed to analyse the effect of iFR in the operator's decision to proceed to FFR, and its impact on procedure duration and radiation time/dosage. Methods: Single-center registry of all patients undergoing functional coronary lesion assessment during 5 years. FFR was used as a gold standard (with a cut-off point for intervention ≤0,80) for assessing the diagnostic accuracy of iFR in every patient who underwent measurements with both techniques. For analysis purposes, an iFR value 0,93 was considered negative (i.e. defer intervention). Values in between were deemed inconclusive. For statistical analysis we used the T student and Chi-Square tests. Results: Functional testing was undertaken in 326 patients (67±11 years, 65,6% male), encompassing 402 lesions. 154 lesions underwent assessment with both techniques, 222 by FFR only and 26 cases iFR only. The average iFR was 0,9±0,1. 60 lesions had an iFR >0,93 and 21 an iFR <0,86. An iFR value between 0,86 and 0,93 was strongly associated with the decision to proceed to FFR (χ2=30,1; p0,93 (71,4% vs 68%; p=0,792). In these cases, there was a statistically significant concordance of 87% between the iFR and FFR results (χ2=22,43; p<0,001). Notwithstanding, there were 4 out of 13 cases (30,7%) of positive iFR with negative FFR and 3 out of 42 (7,1%) cases of negative iFR and positive FFR. This difference was statistically significant (p=0,026). Regarding procedural time, radiation time and radiation dose, there were no statistically significant differences between patients who only underwent iFR, FFR only, or both techniques. Conclusions: The iFR results were inconclusive (i.e. between 0,86 and 0,93) in most cases. There was a high degree of concordance between the iFR and FFR values. However, a significant proportion of patients, particularly in cases of positive iFR (<0,86), were classified as negative by FFR. The use of iFR had no impact on procedural time, radiation time and radiation dose.info:eu-repo/semantics/publishedVersio

Portuguese multidisciplinary recommendations for non-pharmacological and non-surgical interventions in patients with rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis (RA) report significant levels of disease impact, which are improved, but not fully abrogated by immunosuppressive therapy, even when remission is achieved. This imposes the need for adjuvant interventions targeting the uncontrolled domains of disease impact. Non-pharmacological interventions are widely used for this purpose, but they have not been the object of professional recommendations or guidelines. OBJECTIVE: To propose multidisciplinary recommendations to inform clinical care providers regarding the employment of non-pharmacological and non-surgical interventions in the management of patients with RA. METHODS: The EULAR standardized operating procedures for the development of recommendations were followed. First, a systematic literature review was performed. Then, a multidisciplinary Technical Expert Panel (TEP) met to develop and discuss the recommendations and research agenda. For each developed recommendation i) the level of evidence and grade of recommendation were determined, and ii) the level of agreement among TEP members was set. A recommendation was adopted if approved by ≥75% of the TEP members, and the level of agreement was considered high when ≥8. All relevant national societies were included in this construction process to attain their endorsement. RESULTS: Based on evidence and expert opinion, the TEP developed and agreed on five overarching principles and 12 recommendations for non-pharmacological and non-surgical interventions in patients with RA. The mean level of agreement between the TEP members ranged between 8.5 and 9.9. The recommendations include a broad spectrum of intervention areas, such as exercise, hydrokinesiotherapy, psychological interventions, orthoses, education, general management of comorbidities, among others; and they set the requirements for their application. CONCLUSIONS: These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines and patients' representatives from Portugal. Given the evidence for effectiveness, feasibility and safety, non-pharmacological and non-surgical interventions should be an integral part of standard care for people with RA. It is hoped that these recommendations should be widely implemented in clinical practice. The target audience for these recommendations includes all health professionals involved in the care of patients with RA. The target patient population includes adult Portuguese people with RA.publishersversionpublishe

Score CTo-aBCDE : um novo score preditor de sucesso nas CTOs

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction: Patient selection for percutaneous coronary intervention (PCI) in chronic total occlusions (CTOs) is crucial to procedural success. Our aim was to identify independent predictors of success in CTO PCI in order to create an accurate score. Methods: In a single-center observational registry of CTO PCI, demographic and clinical data and anatomical characteristics of coronary lesions were recorded. Linear and logistic regression analysis were used to identify predictors of success. A score to predict success was created and its accuracy was measured by receiver operating curve analysis. Results: A total of 377 interventions were performed (334 patients, age 68±11 years, 75% male). The success rate was 65% per patient and 60% per procedure. Predictors of success in univariate analysis were absence of active smoking (OR 2.02, 95% CI 1.243-3.29; p=0.005), presence of tapered stump (OR 5.2, 95% CI 2.7-10.2; p8 with high probability (95%). Conclusion: In our sample only anatomical characteristics were predictors of success. The creation of a score to predict success, with good accuracy, may enable selection of cases that can be treated by any operator, those in which a dedicated operator will be desirable, and those with an extremely low probability of success, which should be considered individually for conservative management, surgical revascularization or PCI by a team experienced in CTO.info:eu-repo/semantics/publishedVersio

Economic considerations and patients’ preferences affect treatment selection for rheumatoid arthritis patients : A discrete choice experiment among European rheumatologists

Peer reviewedPostprin

description of the methodological approach

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