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Evolu??o tardia após interven??o coronária percutanea com stents farmacológicos em pacientes diabéticos do Registro DESIRE (Drug-Eluting Stents In the REal world)
Moreira, Adriana Costa;Sousa, Amanda G. M. R.;Costa Jr., José de Ribamar;Costa, Ricardo A.;Maldonado, Galo A.;Cano, Manuel N.;Pavanello, Ricardo;Berwanger, Otavio;Liguori, Ieda M.;Egito, Enilton S. T.;Abib, Maria Helena;Sousa, J. Eduardo M. R.;
Revista Brasileira de Cardiologia Invasiva , 2008, DOI: 10.1590/S2179-83972008000200012
Abstract: background: diabetes mellitus is related to the occurrence of unfavorable outcomes after percutaneous coronary interventions. drug-eluting stents can confer a better late evolution to this subgroup. the aim of this study was to assess the performance of these devices in diabetic patients. methods: the desire is a single-center, prospective registry that included 2,365 consecutive patients treated with drug-eluting stents between may 2002 and january 2008. for the present analysis, patients with a diagnosis of acute myocardial infarction, those with saphenous vein grafts lesions and those within 6 months of the index procedure, were excluded. results: therefore, 1,705 patients were divided into two groups: non-diabetics (n = 1,211 p/71.1%) and diabetics (n = 494 p/28.9%), of which 109 p (6.4%) were insulin-dependent. among the diabetics there was a higher number of older people (64.8 ± 9.8 years old vs. 63.4 ± 11.7 years old; p = 0.025), females (28.9 vs. 22.5%; p = 0.005), patients with obesity (35.2 vs. 23.5%; p < 0.001), hypertension (86.6 vs. 73.7%; p < 0.001), multi-vessel disease (63.4 vs. 54.4%; p = 0.001), small-vessel disease (2.70 ± 0.51 mm vs. 2.75 ± 0.42 mm; p < 0.001) and calcified lesions (32.3 vs. 27.1%; p = 0.009). in the late clinical follow up (2.2 ± 1.1 years), the combined cardiac events occurred more frequently in the diabetic patients (9.8 vs. 7.0%; p = 0.048). the multivariate analysis showed that diabetes mellitus (or = 1.45; 95% confidence interval 1.0 to 2.1) and the presence of a calcified lesion (or = 3.06; 95% ci 1.47 to 6.34) were independent predictors of major adverse cardiac events. conclusion: the use of drug-eluting stents in diabetics showed to be a safe and efficient approach. the major adverse cardiac events, although in very low rates, occurred more frequently in the diabetics.
Stents farmacológicos para o tratamento de coronárias de fino calibre: experiência muito tardia (até 7 anos) do Registro DESIRE
Nogueira, Ederlon Ferreira;Sousa, Amanda G. M. R.;Costa Jr., J. Ribamar;Moreira, Adriana;Costa, Ricardo;Maldonado, Galo;Campos, Cantídio;Cano, Manuel;Sousa, J. Eduardo;
Revista Brasileira de Cardiologia Invasiva , 2010, DOI: 10.1590/S2179-83972010000300010
Abstract: background: in this study, we sought to evaluate the clinical outcomes of patients with coronary lesions in small vessels in a cohort of real world patients undergoing percutaneous coronary intervention (pci) with drug-eluting stents (des). methods: between may 2002 and december 2009, 1,380 consecutive patients from the desire registry (drug eluting stents in the real world), with 1,683 lesions in small vessels (< 2.5 mm in diameter) were consecutively submitted to elective or emergency pci, with 1,818 des (cyphertm, 89%; taxustm, 7.5%; xience vtm/promustm, 3%; endeavor, 0.33%; biomatrixtm, 0.2%) and included in this study. the clinical follow-up of up to 7 years (median, 2.8 years) was completed for 98%, and was obtained at 1, 6, 12 months and then annually. our objective was to determine the rates of major cardiac events (mace) during clinical follow-up. results: mean age was 64.5 ± 11.7 years, with a prevalence of male patients (76.7%). diabetes mellitus was observed in 31.6% of the cases and 9.8% had chronic renal failure. left anterior descending artery was the most frequent vessel treated (43.4%) and two-thirds of the lesions were complex lesions (b2/c). angiographic success was obtained in 98.8% of the cases. the rate of mace was 12.8% during follow-up with 4.5% of cardiac death, 4.2% of acute myocardial infarction, 4.5% of repeat target lesion revascularization and 1.5% of stent thrombosis. conclusions: in the desire registry, the use of des to treat small vessels in non-selected patients was associated with excellent early and late outcomes and low thrombosis rates.
Evolu??o tardia de pacientes com infarto agudo do miocárdio tratados com stents farmacológicos na prática diária do mundo real: subanálise do Registro DESIRE (Drug-Eluting Stent In the REal World)
Costa, Ricardo A.;Sousa, Amanda G. M. R.;Costa Jr., J. Ribamar;Moreira, Adriana;Maldonado, Galo;Cano, Manuel N.;Feres, Fausto;Jardim, César;Liguori, Ieda M.;Barbosa, Marco A.;Romano, Edson R.;Sousa, J. Eduardo;
Revista Brasileira de Cardiologia Invasiva , 2011, DOI: 10.1590/S2179-83972011000300005
Abstract: background: previous studies comparing drug-eluting stents (des) and bare-metal stents suggest efficacy and safety of the des in the treatment of patients with myocardial infarction (mi). however, the late evolution of patients with mi treated with des in the daily practice remains unknown. our goal was to investigate the late follow-up of patients with mi recently treated with des in the real world. methods: between may 2002 and june 2009, 3,018 non-selected patients with indication for elective or urgent percutaneous coronary intervention have been consecutively treated with des in a clinical institution. the 7-year follow-up was performed in 98% of these patients, with a median of 3.4 years. the patients were divided in two groups: patients with recent mi (< 30 days) and patients without recent mi. results: patients with recent mi had less co-morbidities, but more multiarterial disease (68.1% vs. 60.7%; p < 0.001), lesions with thrombus (13.6% vs. 1.3%; p < 0.001), timi flow 0/1 (8.3% vs. 1.1%; p < 0.001), and moderate/severe lv dysfunction (23.2% vs. 10.9%; p < 0.001) when compared with patients without mi. the recent mi group received 1.6 ± 0.8 stents/patient and more glycoprotein iib/iiia inhibitors (19.6% vs. 2%; p < 0.001), but the angiographic success (> 99%) was similar between groups. in the late follow-up, the incidence of cardiac death (6.4% vs. 2.7%; p < 0.001) and stent thrombosis (3.6% vs. 1.3%; p < 0.001) was significantly greater in the recent mi group. recent mi remained an independent predictor of stent thrombosis in multivariate analysis (hr 2.96, 95% ci 1.62-5.41; p < 0,001). conclusions: patients with mi < 30 days treated with des had a worse prognosis when compared with patients without recent mi, including a higher incidence of cardiac death and a 2.5 times greater occurrence of stent thrombosis rate up to 7-year follow-up.
Impacto do diabetes melito na eficácia e na seguran?a dos stents farmacológicos: registro com até cinco anos de seguimento
Smidt, Luis Felipe;Bodanese, Rodrigo;Gomes, Vitor;Lasevitch, Ricardo;Barcellos, Christiano;Oliveira, Denise;Morais, Marina;Hickmann, Patrícia;Krepsky, Ana;Arndt, Marcelo;Polanczyk, Carisi;Bodanese, Luiz Carlos;Caramori, Paulo;
Revista Brasileira de Cardiologia Invasiva , 2009, DOI: 10.1590/S2179-83972009000400014
Abstract: background: diabetic patients are at high risk of recurrent coronary events. drug eluting stents (des) reduce restenosis and target lesion revascularization in both diabetic and non-diabetic patients. however, there are limited data on the long-term safety and efficacy of des in diabetic patients. the objective of this study was to evaluate the long-term clinical outcome in this high risk population. method: from may 2002 to april 2007, all patients undergoing coronary intervention with des in two hospitals were included in the study and were followed-up for up to 5 years. results: a total of 611 patients with mean age of 63.5 ± 11.2 years were included in the registry. diabetic patients (n = 204, 33.4%) included a smaller proportion of males, greater prevalence of hypertension, chronic renal failure, and smaller coronary reference diameter when compared to non-diabetic patients. during the follow-up, diabetics had a higher probability of combined adverse cardiac events (19.7% vs. 13.4%; p = 0.04), as a result of death (7.4% vs. 2.3%; p = 0.003), acute myocardial infarction (5.9% vs. 3.1%; p = 0.10) and definitive/probable stent thrombosis (3.9% vs. 1.3%; p = 0.04). target vessel and target lesion revascularization, however, were not different between the groups (10.9% vs. 9.8%; p = 0.68 and 3.4% vs. 5.1%; p= 0.35, respectively). the presence of diabetes mellitus was an independent predictor of death [odds ratio (or) 2.41; 95% confidence interval (95% ci) 1.02-5.78; p = 0.05) but not of stent thrombosis (or 2.41; 95% ci 0.76-7.61; p = 0.13) in our patients. conclusions: the outcomes of this study show that in patients undergoing des implantation, the presence of diabetes was associated to higher mortality rates, acute myocardial infarction and stent thrombosis when compared to non-diabetics. the finding of similar target lesion revascularization rates in diabetic and non-diabetic patients is promising and suggests the efficacy of percutaneous revascularization with
Trombose coronariana tardia secundária a implante de stent com paclitaxel sem reestenose dos stents convencionais
Abreu, Luciano Maurício de;Meireles, George César Ximenes;Sumita, Marcos Kiyoshi;Forte, Antonio Artur da Cruz;Aliaga, Jose Del Carmen Solano;Hayashi, Jorge;
Arquivos Brasileiros de Cardiologia , 2007, DOI: 10.1590/S0066-782X2007000500023
Abstract: a male 39 year-old patient with post-infarction angina. the coronary angiography showed total proximal obstruction of right coronary artery (rca), obstructive lesions of 95% of the anterior descending artery (ada), 80% of the second left marginal branch (lm2), and 95% of the circumflex artery (cxa). the patient was successfully implanted with a taxus 3.0 x 24 mm stent and an express 2.75 x 24 mm stent in the proximal and distal thirds of the rca, respectively, and with an infinnium 3.0 x 24 mm stent in the ada. after seven months, the patient had an anterior acute myocardial infarct (ami) due to thrombosis of the infinnium stent and restenosis of the taxus stent, with no loss of results in the conventional stents.
Análise volumétrica tardia após implante de stents eluidores de sirolimus versus biolimus A9
Missel, Eduardo;Abizaid, Alexandre;Cesar, Felipe;Centemero, Marinella P.;Mattos, Luiz A.;Feres, Fausto;Staico, Rodolfo;Tanajura, Luis F.;Chaves, áurea;Beraldo, Pedro;Abizaid, Andrea;Sousa, Amanda;Grube, Eberhard;Sousa, J. Eduardo;
Revista Brasileira de Cardiologia Invasiva , 2008, DOI: 10.1590/S2179-83972008000100009
Abstract: introduction: sirolimus-eluting stents (ses) significantly reduce restenosis and major adverse cardiac events (mace) compared to bare metal stents (bms). the novel sirolimus analog, biolimus a9t (ba9), presented similar safety and efficacy in the randomized, controlled stealth i trial. this study compared the efficacy of a ba9-eluting stent versus sirolimus-eluting and bare metal control stents. methods: forty-five patients with de novo coronary lesions were randomly assigned in a 2:1 basis to receive either ba9-eluting (n = 30) or bare metal (n=15) s-stents. quantitative coronary angiography (qca) and intravascular ultrasound (ivus), at 6 months, were then compared to a matched series of patients who received either sirolimuseluting (n = 30) or bare metal (n = 15) bx velocity stents. baseline clinical and angiographic characteristics were similar among all groups, except for a significantly higher percentage of females and class c lesions in the ba9eluting stent group. results: at 6 month follow-up, there was no significant difference in clinical outcomes between any of the groups. qca revealed significantly lower late loss in both drug-eluting stents (des) groups compared to bare metal controls, but no significant difference between ba9 and ses groups was observed (0.24 ± 0.39mm vs. 0.15 ± 0.38mm, p = ns). obstruction volume measured by 3d ivus was significantly reduced in both des groups compared to bare metal controls, but did not differ between the ba9 and ses groups (2.23% vs. 3.30%, ba9 vs. ses, p=ns). conclusions: ba9-eluting stents reduce neointimal hyperplasia, safely and effectively, compared to bms, and the magnitude of this inhibition is similar to that of ses.
Incidência de aposi??o incompleta persistente e tardia após implante de stents com sirolimus e zotarolimus
Siqueira, Dimytri Alexandre de Alvim;Feres, Fausto;Abizaid, Alexandre A. C.;Costa Jr., José Ribamar da;Andrade, Pedro B. de;Lasave, Leandro I.;Maia, Julio de Paiva;Mattos, Luiz A.;Staico, Rodolfo;Costa, Ricardo A.;Tanajura, Luiz Fernando;Chaves, áurea J.;Centemero, Marinella P.;Abizaid, Andrea S.;Sousa, Amanda G. M. R.;Sousa, J. Eduardo M. R.;
Revista Brasileira de Cardiologia Invasiva , 2007, DOI: 10.1590/S2179-83972007000400010
Abstract: background: incomplete stent apposition (isa) has been documented after drug-eluting stents (des) and could be related to stent thrombosis. because des differ in metal platform, polymer and pharmacological agent, differences in performance and safety are expected. objective: we sought to investigate the frequency and clinical consequences of isa after implantation of sirolimus- (ses) and zotarolimuseluting stents (zes). methods: 242 patients (pts) who underwent des placement (175 pts with cypher? and 67 pts with endeavortm stents) had serial intravascular ultrasound (ivus) performed (at index procedure and after 6-months). results: 7 pts (4%) had late-acquired isa after ses. another 12 (6.8%) pts treated with ses had persistent isa. among pts treated with zes, none had late isa and 4 had isa observed after stent implantation that completely resolved at 6-months. there was an increase in vessel (377.2 ± 148.9 to 431.9 ± 155.1 mm3, p = 0.51) and in plaque volume (206.1 ± 51.53 to 236.91 ± 68.4 mm3, p=0.36) in pts with late isa. amount of neointimal hyperplasia was significantly higher in zes than ses (16.6 ± 5.8 mm3 vs 5.1 ± 5.5 mm3, p < 0.0001). after 9 months, no adverse clinical event was observed in pts with isa. conclusion: overall incidence of ivus-detected late incomplete des apposition was 2.9%, all after ses. the presence of isa was not related to clinical adverse events during mid term follow-up.
Efetividade e seguran?a dos stents farmacológicos em um servi?o de cardiologia em Curitiba-PR
Braga, Chiu Yun Yu;Rivetti, Luiz Antonio;Stella, Francisco de Paula;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010005000081
Abstract: background: the effectiveness and safety of drug-eluting stents (des) have still been questioned. objective: the objective of this study was to evaluate the effectiveness and safety of these stents, as well as the incidence of target lesion revascularization (tlr), in addition to identifying possible variables influencing the need for tlr. methods: a total of 203 patients from hospital costantini who were clinically followed up for one to 3 years were selected. results: the sample characteristics were as follows: 470 lesions; 171 (84.24%) male patients; 54 (26.6%) had diabetes; 131 (64.35%) had hypertension; 127 (62.56%), dyslipidemia; 40 (19.70%) were smokers; and 79 (38.92%) had a family history of coronary artery disease. also: 49 (24.14%) patients presented with stable angina; 58 (28.57%), unstable angina; and 6 (2.96%), myocardial infarction. eighty five (41.87%) patients were asymptomatic, and 146 (71.92%), had multivessel disease. as for the characteristics of the lesions, 77.45% were b2/c (aha/acc). taxus was implanted in 73.62% of the patients. stents with diameter > 2.5 mm were used in 381 (81.96%) patients. the stent length was < 30 mm in 67.87% of the lesions, with a mean of 2.3 stents per patient. after follow-up, 19 patients (9.3%) underwent tlr. four patients died (1.97%), two of them of mi (0.98%), one of stroke (0.49%), and one of abdominal aneurysm (0.49%). also, one patient died of late thrombosis (0.49%), and one of reinfarction (0.49%). in the statistical analysis carried out, only the bifurcation lesions variable reached values close to the statistical significance level, with p < 0.06. conclusion: in conclusion, drug-eluting stents have good effectiveness and safety profiles; the incidence of tlr was 9.3%, and we did not identify a variable correlated with the need for tlr.
Inibi??o da prolifera??o neointimal após o implante de stents eluidores de Biolimus A9: análise volumétrica tardia com ultra-som intracoronário
Missel, Eduardo;Beraldo, Pedro;Abizaid, Alexandre;Mattos, Luiz Alberto P.;Feres, Fausto;Staico, Rodolfo;Costa, José de Ribamar;Cesar, Felipe;Centemero, Marinella;Chaves, áurea;Abizaid, Andrea;Sousa, Amanda;Grube, Eberhard;Sousa, J. Eduardo;
Revista Brasileira de Cardiologia Invasiva , 2007, DOI: 10.1590/S2179-83972007000300008
Abstract: background: biolimus a9 (ba9) is a novel sirolimus analog with similar antiproliferative properties. ba9-eluting stents reduce angiographic late-loss compared to bare metal stents (bms), with a low incidence of major adverse cardiac events (mace), as reported in the randomized, controlled stealth i trial. we describe the intravascular ultrasound (ivus) volumetric findings of patients enrolled at our institution. methods and results: forty-five patients presenting a single, de novo coronary lesion (2.5-4.0 mm vessels; lesion length <24 mm) were randomly assigned in a 2:1 basis to receive either ba9-eluting (n=30) or bare metal stents (n=15). mean age was 58 years, with 16% diabetics and 62% men. baseline clinical and angiographic characteristics were similar between groups. at 6 month follow-up, there was no statistical difference in clinical outcomes between groups. in-stent intimal hyperplasia index measured by ivus was 0.19+/-0.08 mm3/ mm3 for the ba9 group vs. 2.71+/-0.50 mm3/mm3 for bms controls. the percentage of stent obstruction was also significantly lower for the ba9 group when compared to bms (2.2+/-0.80% vs. 19.9+/-4.67%, p<0.0001). no stent thrombosis, aneurysm formation or incomplete stent apposition was observed in any group. conclusions: using ivus volumetric analysis, we showed that ba9-eluting stents have a potent inhibitory effect on neointimal proliferation when compared to bms at 6-month follow-up.
Perfil de seguran?a dos stents farmacológicos nas síndromes coronárias agudas: dados do Registro INCOR
Campos, Carlos Augusto Homem de Magalh?es;Ribeiro, Expedito E.;Lemos, Pedro A.;Falc?o, Jo?o L.;Spadaro, Andre G.;Kajita, Luiz J.;Esteves Filho, Antonio;Perin, Marco A.;Horta, Pedro E.;Gama, Marcus N.;Marchiori, Gilberto;Martinez, Eulógio;
Revista Brasileira de Cardiologia Invasiva , 2008, DOI: 10.1590/S2179-83972008000300008
Abstract: background: drug-eluting stents are a great advance in the treatment of coronary disease. however, their use in patients with acute coronary syndromes has been the subject of intense scientific debate. methods: 910 consecutive patients treated with at least one drug-eluting stent between may 2002 and september 2006 were enrolled in the present analysis. the patients were assigned to 2 groups according to their clinical condition at the time of admission: 1) stable group (635 patients with stable angina) and 2) acute group (275 patients with nstemi). we analyzed the clinical and angiographic characteristics as well as the occurrence of late adverse events. results: the clinical characteristics of the groups were similar, except for the highest incidence of smokers in the acute group and previous percutaneous intervention in the stable group. after 588 days (median follow-up period), the stable and acute groups had similar rates of re-infarction (2.8 vs. 5.0%; p = 0.1), target vessel revascularization (6.0 vs. 7.7%; p = 0.4), death (4.5 vs. 6.5%; p = 0.2) and composite major adverse cardiac events (9.9 vs. 11.9%; p = 0.4), respectively. however, the occurrence of in-stent thrombosis was more frequent in patients with acute coronary diseases (1.4 vs. 4.4%; p = 0.02), mainly due to the occurrence of thrombosis within the first year after implantation (1.1 vs. 4.4%; p = 0.01). conclusion: drug-eluting stents have shown a good safety profile in patients with acute coronary syndromes compared to those with chronic coronary disease, despite the higher incidence of late in-stent thrombosis.
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