53 research outputs found
Effect of oral sirolimus therapy on inflammatory biomarkers following coronary stenting
We studied the effect of oral sirolimus, administered to prevent and treat in-stent restenosis (ISR), on the variation of serum levels of inflammatory markers following coronary stenting with bare metal stents. The mean age of the patients was 56 ± 13 years, 65% were males and all had clinically manifested ischemia. Serum levels of high sensitivity C-reactive protein (hs-CRP) concentration were determined by chemiluminescence and serum levels of all other biomarkers by ELISA. One group of patients at high risk for ISR received a loading oral dose of 15 mg sirolimus and 5 mg daily thereafter for 28 days after stenting (SIR-G). A control group (CONT-G) was submitted to stenting without sirolimus therapy. The increase in hs-CRP concentration was highest at 24 h after stenting in both groups. A significant difference between SIR-G and CONT-G was observed at 4 weeks (-1.50 ± 5.0 vs -0.19 ± 0.4, P = 0.008) and lost significance 1 month after sirolimus discontinuation (-1.73 ± 4.3 vs -0.01 ± 0.7, P = 0.0975). A continuous fall in MMP-9 concentration was observed in SIR-G, with the greatest reduction at 4 weeks (-352.9 ± 455 vs +395.2 ± 377, P = 0.0004), while a positive variation was noted 4 weeks after sirolimus discontinuation (227 ± 708 vs 406.2 ± 472.1, P = 0.0958). SIR-G exhibited a higher increase in P-selectin after sirolimus discontinuation at week 8 (46.1 ± 67.9 vs 5.8 ± 23.7, P = 0.0025). These findings suggest that the anti-restenotic actions of systemic sirolimus include anti-proliferative effects and modulation of the inflammatory response with inhibition of adhesion molecule expression.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Hospital São Paulo and Hospital do Rim e Hipertensão Disciplinas de Cardiologia e NefrologiaUniversidade Federal do EspÃrito Santo Hospital Universitário Cassiano Antonio de Morais Disciplina de CardiologiaUNIFESP, Hospital São Paulo and Hospital do Rim e Hipertensão Disciplinas de Cardiologia e NefrologiaFAPESP: 03/02946-7SciEL
Impact analysis of drug-eluting stent in the unified health system budget
BACKGROUND: Drug-eluting stents represent an additional option to treat coronary artery disease. This technology represents a major breakthrough that may require additional funding in the short-term to enable its inclusion in procedures of the Unified Health System. OBJECTIVE: To estimate the impact on the Unified Health System budget in the first year of use of drug-eluting stents. METHODS: A Budget Impact Model was designed to predict the economic impact of the inclusion of drug-eluting stents in the Unified Health System budget. Data about costs and local procedures were collected in multiple sources, specifically procedure volume data, hospital costs, cost of stents, drug costs and number of stents used in single and multi-vessel procedures. RESULTS: The results in the first year indicate that the impact on the Unified Health System is of 12.8% in the best scenario and 24.4% in the worst scenario, representing an increase by R 24 milhões a R$ 44 milhões no orçamento total projetado. CONCLUSÃO: O uso de stent farmacológico tem custo adicional comparativamente ao uso de stent convencional, no primeiro ano de utilização, no Sistema Único de Saúde.Universidade Federal de São Paulo (UNIFESP) EPMUNIFESP, EPMSciEL
Resistencia a la aspirina: realidad o ficción?
A meta-analysis of clinical studies of patients with cardiovascular disease demonstrated that the use of aspirin was associated with a 22% decrease in death rates and relevant ischemic vascular events. However, clinical studies demonstrated that patients that regularly took aspirin presented recurrence of cardiovascular events. Such observation led to the question whether, in some patients, the aspirin was not effective in blocking platelet aggregation and these patients were called unresponsive to aspirin or aspirin-resistant. The clinical aspirin resistance is characterized as the occurrence of cardiovascular events in patients during treatment with aspirin, whereas the laboratory resistance is defined as the persistence of platelet aggregation, documented by laboratory test, in patients regularly taking aspirin. Patients that are aspirin-resistant presented, according to laboratory tests, on average 3.8 times more cardiovascular events when compared to non-resistant ones.Un metanálisis de estudios clÃnicos de pacientes con enfermedad cardiovascular demostró que el uso de aspirina estaba asociado a la reducción de 22% de muertes y a eventos vasculares isquémicos relevantes. Entre tanto, estudios clÃnicos revelaron que pacientes tomando regularmente aspirina presentaban recurrencia de eventos cardiovasculares. Tal constatación llevó a un cuestionamiento: si, en algunos pacientes, la aspirina no era eficaz en bloquear la agregación plaquetaria, siendo estos pacientes llamados de no responsivos o resistentes a la aspirina. Se conceptúa resistencia clÃnica a la aspirina por la ocurrencia de eventos cardiovasculares en pacientes en la vigencia del tratamiento con aspirina, mientras que la resistencia de laboratorio es definida como la persistencia de la agregación plaquetaria, documentada por test de laboratorio, en pacientes tomando regularmente aspirina. Pacientes resistentes a la aspirina tuvieron, de acuerdo con tests de laboratorio, en media, 3,8 veces más eventos cardiovasculares cuando fueron comparados a los no resistentes.Uma metanálise de estudos clÃnicos de pacientes com doença cardiovascular demonstrou que o uso de aspirina estava associado à redução de 22% de mortes e a eventos vasculares isquêmicos relevantes. Entretanto, estudos clÃnicos revelaram que pacientes tomando regularmente aspirina apresentavam recorrência de eventos cardiovasculares. Tal constatação levou a um questionamento: se, em alguns pacientes, a aspirina não era eficaz em bloquear a agregação plaquetária, sendo estes pacientes chamados de não responsivos ou resistentes à aspirina. Conceitua-se resistência clÃnica à aspirina pela ocorrência de eventos cardiovasculares em pacientes na vigência de tratamento com aspirina, enquanto a resistência laboratorial é definida como a persistência da agregação plaquetária, documentada por teste laboratorial, em pacientes tomando regularmente aspirina. Pacientes resistentes à aspirina tiveram, de acordo com testes laboratoriais, em média, 3,8 vezes mais eventos cardiovasculares quando comparados aos não resistentes.Associação do Sanatório SÃrio Hospital do CoraçãoUniversidade Federal de São Paulo (UNIFESP) Hospital São PauloUniversidade Federal de Pernambuco Hospital das ClÃnicasUNIFESP, Hospital São PauloSciEL
Mesenchymal stem cells: are they appropriate for cardiac regeneration?
Mesenchymal stem cells represent a rare subpopulation of bone marrow stem cells (< 0.01% of mononuclear cells originated from bone marrow) with capacity for in vitro mitotic expansion. Because they split and proliferate easily, mesenchymal stem cells are believed to be responsible for the maintenance and renovation of adult mesenchymal tissues, including the cardiac muscle. One of the virtues of this type of cell is their immunosuppressive activity, avoiding therefore the adverse events related to graft rejection by the host (graft versus host disease). Mesenchymal stem cells have been extensively studied, both in pre-clinical and clinical trials. We believe that once some challenges regarding their isolation, preparation and mode of delivery are overcome, these cells may, in the near future, represent the ideal cell type for cardiac regeneration.As células-tronco mesenquimais representam uma rara subpopulação das células-tronco da medula óssea (< 0,01% das células mononucleares da medula óssea) com capacidade de expansão mitótica in vitro. Em decorrência da facilidade em se dividir e proliferar, concluiu-se que as células-tronco mesenquimais seriam as células responsáveis pela manutenção e renovação dos tecidos mesenquimais adultos, incluindo o músculo cardÃaco. Esse tipo celular apresenta como uma de suas virtudes considerável atividade imunossupressora, evitando assim efeitos adversos relacionados a rejeição entre o material infundido e o hospedeiro. As célulastronco mesenquimais vêm sendo cada vez mais estudadas, tanto em ensaios pré-clÃnicos como clÃnicos. Acreditamos que, superados alguns desafios em seu isolamento, preparo e modo de infusão, essas células poderão, em futuro próximo, representar o tipo celular ideal para a regeneração cardÃaca.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL
‘Mother and Child’ Technique with a New Catheter: Initial Experience
ABSTRACTThe our initial experience in this hospital with the GuideLiner™, a ‘child’ type rapid exchange guide catheter extension, designed to facilitate stent and balloon delivery in complex percutaneous coronary interventions, is reported. This guide catheter extension was used in one case of a complex coronary lesion, in another case of complex anatomy and in a third case with dissection of the left internal thoracic artery graft. All of the procedures were performed successfully. The GuideLiner™ can be used to treat complex artery lesions and to treat complications during the procedure
Concomitant Use of Glycoprotein IIb/IIIa Inhibitor and Streptokinase after Unsuccessful Rescue Angioplasty
A 38-year-old man with acute myocardial infarction in the lower wall affecting the right ventricle underwent thrombolytic treatment with streptokinase. Approximately 2 hours after the thrombolytic treatment started, he presented with signs of coronary reocclusion. He underwent emergency cineangiocoronariography that revealed that his right coronary artery was completely occluded by a clot. He unsuccessfully underwent angioplasty and stent implantation. After the concomitant use of glycoprotein IIb/IIIa inhibitor, coronary TIMI III flow was achieved without additional dilations, and he was discharged from the hospital 5 days later with no further complications.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL
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