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Background: The debate on percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has been constant over time., Objective: To investigate the clinical and procedural characteristics and cardiovascular outcomes of PCI of unprotected LMCA., Material and Methods: Observational study which included patients with unprotected LMCA disease undergoing PCI; patients with cardiogenic shock prior to the procedure were excluded. We describe the clinical and angiographic characteristics, as well as the major adverse cardiac and cerebrovascular events (MACCE) according to the year of the procedure., Results: We included 73 patients, with a SYNTAX I score of 31.2 ± 9.1, mostly with ST-elevation acute coronary syndrome (35%). There was a higher frequency of triple vessel coronary disease (63%) and distal LMCA lesions (35%). The provisional stent technique was the most used for distal lesions (58%) and the 2-stent technique for bifurcation lesions (78%), supported by intravascular ultrasound (IVUS) in 38%. During follow-up, 19 presented MACCE (26%), out of which cardiac death occurred in 13%, non-cardiovascular death in 5%, non-fatal acute myocardial infarction in 1%, cerebrovascular event in 2%, and revascularization of the treated vessel in 4%., Conclusions: It was observed a similar frequency to the one appearing in other studies of cardiovascular events, mainly in patients with intermediate risk, which supports the increasing use of percutaneous intervention in this population., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: Complex calcified coronary lesions are a frequent finding during percutaneous coronary intervention, representing for decades a challenge and limitation in patients with indication of revascularization, due to suboptimal angiographic results, high incidence of perioperative complications and long-term adverse events despite the multiple strategies employed, such as the use of cutting balloon, high-pressure balloons or rotational or orbital atherectomy, interventions with limitations that have hindered its routine use, recently a new plaque modification technique known as coronary intravascular lithotripsy has burst into the treatment of this complex entity, which consists in the use of a specially modified balloon for the emission of pulsatile mechanical energy (sonic pressure waves) that allows modifying the calcified plate., Clinical Case: By presenting a series of clinical cases and reviewing the literature, our initial experience is presented, key elements are summarized and discussed in the understanding of this new intervention technique necessary for decision making., Conclusion: Coronary intravascular lithotripsy is projected as a promising technique for the modification and preparation of superficial and deep calcified coronary lesions, through microfractures that allow the apposition and effective expansion of the stent, strategy that according to different trials (Disrupt CAD series, SOLSTICE assay) and records presents a high efficiency and good safety profile, data consistent with our initial experience., (Licencia CC 4.0 (BY-NC-ND) © 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Objective: To determine the relation between epicardial fat thickness and coronary in-stent restenosis in patients with acute myocardial infarction and percutaneous coronary intervention., Methods: A prospective study was conducted, which included 129 patients (67.3% male, mean age 62.9±10 years) with ST segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention with bare metal stent. Patients were divided in two groups according to the presence (n=21) or not (n=108) of in-stent restenosis during one year follow-up., Results: Epicardial fat was significantly thicker in patients with coronary in-stent restenosis (5.51±1.6 vs 4.14±2.0mm, p=0.006). A proportionally and significantly thicker epicardial fat was found according to the increase in coronary disease severity (3.3±0.9mm vs 4.3±1.8mm vs 4.7±2.3mm vs 6.7±2.2mm, for type A, B1, B2 and C lesions, respectively, p=0.001) and number of vessels (3.07±1.2mm vs 4.92±1.8mm vs 5.43±2.2mm, for one, two and three vessels disease, respectively, p<0.0001). Epicardial fat thickness ≥4.7mm had 75.0% sensibility and 69.0% specificity for predicting restenosis (AUC=0.737)., Conclusions: Echocardiographic evaluation of epicardial fat thickness could identify those patients with acute myocardial infarction with greater probabilities of in-stent restenosis after percutaneous coronary intervention., (Copyright © 2018 Sociedad Española de Arteriosclerosis. All rights reserved.)

Introduction and Objectives: Recent animal studies have shown metformin (MF) to impair endothelialization of drug-eluting stents (DES). The aim of this study was to evaluate the effect of MF on the healing of DES in human coronary arteries of patients with diabetes mellitus by optical coherence tomography (OCT)., Methods: The RESERVOIR trial randomized 116 lesions in 112 patients with diabetes mellitus to amphilimus- or everolimus-eluting stents and included mandatory OCT at 9 months of follow-up. Patients were divided in 3 groups according to the glucose-lowering agents received: a) no MF; b) MF in noninsulin treated patients, and c) MF in insulin-treated patients. The primary safety endpoint was the rate of uncovered stents., Results: Seventeen patients with 19 lesions did not receive MF, whereas MF was administered to 53 noninsulin treated patients (54 lesions) and 28 insulin-treated patients (28 lesions). Baseline characteristics were comparable, although noninsulin treated patients who received MF had better glycemic control (P < .01). By OCT, rates of uncovered struts were comparable between groups (3.07±4.80% vs 2.23±4.73% vs 3.43±6.69%, respectively; P = .48). Multivariate models confirmed that MF had no effect on the healing of DES (OR, 1.49, 95%CI, 0.71-3.08; P = .29). Similarly, quantitative angiography showed no effect of MF on late lumen loss, whereas patients treated with exogenous insulin had greater late lumen loss (P = .02)., Conclusions: Metformin use does not impair endothelial healing of DES in patients with both insulin- and noninsulin-treated diabetes mellitus. According to these results, MF should not be discouraged in these patients., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in 2015., Methods: All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and analyzed mostly by an independent company., Results: In 2015, 106 centers participated in the national register; 73 of these centers are public. A total of 145 836 diagnostic studies were conducted, among which 128 669 were coronary angiograms. These figures are higher than in previous years. The Spanish average of total diagnoses per million population was 3127. The number of coronary interventional procedures was very similar (67 671), although there was a slight increase in the complexity of coronary interventions: 7% in multivessel treatment and 8% in unprotected left main trunk treatment. A total of 98 043 stents were implanted, of which 74 684 were drug-eluting stents. A total of 18 418 interventional procedures were performed in the acute myocardial infarction setting, of which 81.9% were primary angioplasties. The radial approach was used in 73.3% of the diagnostic procedures and in 76.1% of interventional ones. The number of transcatheter aortic valve implantations continued to increase (1586), as well as the number of left atrial appendage closures (331)., Conclusions: An increase in diagnostic and therapeutic procedures in acute myocardial infarction was reported in 2015. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The progressive increase in structural procedures seen in previous years continued., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Percutaneous coronary intervention (PCI)is currently a basic therapeutic option in patients with coronary artery disease. To carry this out specialists must be trained and accredited. It is known that the number of procedures performed each year influences results. We suggest that some low volume centres may also get good results., Methods: Prospective analysis of clinical features and immediate results obtained in our centre following PCI performed between 2006 and 2012 and retrospective analysis of overall survival, outcome-free survival and restenosis in patients treated between 2006 and 2009.The clinical features, acute and long-term events (complications,survival and mortality) of our group were compared with other published studies., Results: In our centre the likelihood of complications ina PCI was 9% with an overall mortality of 2%. PCI mortality in stable coronary disease was 0.43% and in acute coronary syndrome 6.25%. Complications at the vascular access site was 1.44% and restenosis at nine months, inpatients undergoing PCI for the first time, was 5.2%., Conclusions: Although a high interventionist volume has been shown to reduce the rate of complications and improve long-term evolution, some low volume interventional centres can obtain similar results to those of high volume interventional centres.

Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously., (Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.)

Unlabelled: Elderly patients present testosterone deficit syndrome (TDS) in a prevalent manner. TDS is defined as a clinical and biochemical syndrome with total fasting testosterone below normal levels in two consecutive measurements. A significant relationship with comorbidities such as diabetes mellitus, obesity or metabolic syndrome has been observed in these patients. These latter are recognized risk factors of coronary artery disease (CAD) and arteriosclerosis. It seems logical to think that CAD is more frequent in patients with TDS, and it is supported on multiple works demonstrating the correlation of theses two pathologies. We intend to illustrate the management of patients with TDS and CAD presenting a clinical case and the recommended diagnostic and therapeutic approach. A Sixty-four year old male with hypertension, non-insulin dependent diabetes mellitus and obesity consulted for erectile dysfunction and diminished sexual desire. Fasting total testosterone and glycosylate hemoglobin were determined. IIEF-5 was 12, Erection hardness Score was 2 and IIEF item 12 1 point over 5. His total testosterone was 150 ng/dl, which was confirmed in a second test; HDL cholesterol level was 30 mg/dl. Interrogated again, the patient referred oppressive chest pain appearing after running 50 meters for the last three months that never happened in rest or with minor efforts., Approach: It is a patient with high cardiovascular risk and atypical chest pain so recommendation was given to consult a cardiologist. Stress test was performed. It was a submaximal, evaluable test (reached 80% of his maximum theoretical heart rate) stopped due to angina. Clinically and electrically it was positive at medium charge. Coronary angiogram was indicated showing a severe (85%percnt;%) lesion at the medial third of anterior descendant artery. Balloon angioplasty was performed and a 3.0 x 24 mm drug-coated stent was placed. Cardiologic treatment was prescribed as well as combination therapy for his erectile dysfunction and diminished libido with testosterone and a PDE 5 inhibitor.

Ventricular arrhythmias are important contributors to morbidity and mortality in patients with coronary artery disease. Ventricular fibrillation accounts for the majority of deaths occurring in the acute phase of ischemia, whereas sustained, monomorphic ventricular tachycardia due to reentry generated in the scar tissue develops most often in the setting of healed myocardial infarction, especially in patients with lower left ventricular ejection fraction. Despite determinant advances in population education and myocardial infarction management, the ventricular tachycardia risk in the overall population with coronary artery disease continues to be a major problem in clinical practice. The initial evaluation of a patient presenting with ventricular tachycardia requires a 12-lead electrocardiogram, which can be helpful to confirm the diagnosis, suggest the presence of potential underlying heart disease, and identify the location of the ventricular tachycardia circuit. An invasive electrophysiologic study is usually crucial to determine the mechanism of the arrhythmia once induced and to provide guidance for ablation. The approach for ventricular tachycardia ablation depends on several factors, including inducibility, sustainability, and clinical tolerance of ventricular tachycardia. The paper also reviews other therapeutic options for patients with ventricular tachycardia associated with coronary artery disease, including antiarrhythmic drug therapy, surgical ablation, and current implantable cardioverter-defibrillator indications., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background and Objective: To assess whether there are differences in the rate of restenosis between bare metal stents (BMS) and drug eluting stents (DES) implanted for the treatment of cardiac allograft vasculopathy (CAV)., Patients and Methods: This retrospective study describes the baseline characteristics, clinical and angiographic evolution of a sample of heart transplant patients treated with coronary stent implantation due to CAV., Results: We analyzed the follow-up of 40 stents (17 BMS and 23 DES). Mean follow-up was 28 ± 18 months (range 12 to 84). The DES group had a lower rate of active smoking, a higher percentage of residual stenosis and an increased use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Control angiography was performed in 33 stents (82%). In the BMS group (n=15), 8 restenosis were identified (53%) whereas 2 (11%) were seen in the DES group (n=18) (P=.02)., Conclusion: In this series a lower rate of restenosis was observed in the DES group, attributable to the effect of the drug released locally by the stent., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: Coronary angiography is the gold standard for the study of coronary artery disease. This technique requires several orthogonal projections. Rotational angiography is a new technique which involves pre-set rotation of the X-ray tube around the patient and allows visualization of each coronary artery in different views, using a single contrast injection. The purpose of this study was to compare conventional coronary angiography (A) vs rotational angiography (B), focusing on radiation dose, amount of contrast administered, and total procedure time for both diagnostic and therapeutic percutaneous coronary interventions., Methods: Prospective study of 104 consecutive patients undergoing coronary angiography who were randomized to one of these techniques., Results: We found a significant reduction in the amount of contrast administered (A vs B, 93.1 [41.7] vs 50.9 [14.7] mL; P<.0001) and radiation exposure (27.6 [11.5] vs 18 [6.4] mGycm(2); P<.0001). A significant increase in total procedure time was noted in the rotational angiography arm. However, when only the last 50 patients were analyzed, we found no difference in procedure time between the groups, probably related to the learning curve of the operators. Angioplasty was performed in 29 patients in group A and 28 patients in group B. Contrast reduction was maintained in the rotational angiography group compared to the conventional technique (A vs B, 335.1 [192.1] vs 238.5 [114.4] mL; P=.02)., Conclusions: The rotational angiography technique leads to a significant decrease in radiation exposure and contrast dose administered for diagnostic procedures when compared to conventional coronary angiography. In patients who undergo percutaneous coronary intervention, contrast reduction remains significant., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background: Diabetic patients are a group of primary interest in the study of myocardial revascularization., Aim: To compare coronary artery bypass grafting surgery (CABG) and percutaneous angioplasty with stents (PCI-S) in diabetic patients with coronary three-vessel or left main coronary artery disease., Material and Methods: Meta-analysis of MEDLINE randomized controlled studies comparing CABG and PCI-S in diabetic patients. The primary outcome measure was major adverse cardiovascular events (MACCE), death, myocardial infarction, cerebrovascular accident (CVA) and coronary re-intervention. Secondary outcomes were the individual components of MACCE., Results: Three studies comparing CABG and PCI-S met the inclusion criteria. One thousand sixty two patients were studied: 565 in the CABG group and 597 in the PCI-S group. At one year follow up MACCE occurred in 24.9 and 12.7% of patients in PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confidence intervals (CI) 1.66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, 95% CI0.09-0.68) and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, 95% CI 3.27-8.67)., Conclusions: In diabetic patients with three-vessel coronary disease or left main coronary artery, revascularization with CABG had significantly less MACCE at one year than those treated with PCI-S. Stroke frequency was higher in CABG, coronary re-intervention was higher in PCI-S. These results must be interpreted cautiously.

This article contains a review of the main developments in the field of geriatric cardiology reported during 2011. The principle focus is on research into the characteristics of elderly patients with heart failure, arrhythmias (e.g. into atrial fibrillation and implantable cardioverter-defibrillators), ischemic heart disease and percutaneous interventions., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

This article contains a review of the main developments reported in 2011 on the pathophysiology, prevention, prognosis and treatment of chronic coronary artery disease and acute coronary syndrome, with or without ST-segment elevation. It also discusses the recommendations of the latest clinical practice guidelines., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background: Differences between geographic regions in patient characteristics and outcomes, particularly for acute coronary syndromes, have been demonstrated in clinical trials. Clinical outcomes after percutaneous coronary interventions with the Zotarolimus-eluting stent in a real-world population were assessed over time., Objectives: The influence of geographic location on clinical outcomes with the Zotarolimus-eluting stent was assessed in 3 regions: Asia Pacific, Europe, and Latin America., Methods: A total of 8,314 patients (6,572 Europe, 1,522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2,116 of these (1,613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions., Results: Patients in Latin America had the highest proportions of risk factors and prior myocardial infarction. Dual antiplatelet therapy usage rapidly declined in Latin America, from 44.9% at 6 months to 22.5% at 1 year and 7.8% at 2 years (Europe: 87.4%, 61.5%, 19.7%; Asia Pacific: 82.4%, 67.0%, 45.7%). There were no significant differences between Latin America and Europe or Asia Pacific for any outcome at either time point. The incidence of Academic Research Consortium definite and probable stent thrombosis was low (<1.2%) among all patients at 1 year and 2 years., Conclusion: Clinical outcomes were comparable between patients in Latin America and Europe, and Latin America and Asia Pacific, despite less favorable clinical subsets in Latin America, a higher risk profile, and markedly lower use of dual antiplatelet therapy over time.

Background: The Brazilian Public Health System (SUS) holds approximately 80% of percutaneous coronary interventions (PCI) in Brazil. Being aware of these data will enable to design a proper plan for the treatment of coronary artery disease (CAD)., Objective: To review and discuss the results of PCIs performed by the SUS., Methods: We reviewed data from SIH/DATASUS available for public consultation., Results: From 2005 to 2008, 166,514 procedures were performed in 180 hospitals. Average hospital mortality was 2.33%, ranging from 0% to 11.35%, being lower in the Southeast, 2.03% and higher in the northern region, 3.64% (p < 0.001). The mortality rate was 2.33% in 45 (25%) higher-volume hospitals, accounting for 101,218 (60.8%) of the PCIs, 2.29% in 90 (50%) medium-volume hospitals with 50,067 (34.9%) PCIs and 2.52% in 45 (25%) small-volume hospitals with 7,229 (4.3%) PCIs (p > 0.05). Mortality was higher in females (p < 0.0001) and at ages > 65 to = (p < 0.001). In the diagnosis of angina (79,324, 47.64%) mortality was 1.03%, and AMI (33,286, 32.30%) 6.35% (p < 0.0000001). In the single stent implantation, the most common (102,165, 61.36%), mortality was 1.20%, and primary PCI (27,125, 16.29%), 6.96%., Conclusion: Although it is growing, the number of PCIs in Brazil is still low. High-volume hospitals, in smaller numbers, accounted for most procedures. Single stent implantation through hospital admission was reported to be most commonly used procedure. Mortality rates were highly variable among the hospitals. Primary PCI was responsible for the highest mortality rate.

Introduction and Objectives: The development of second-generation optical coherence tomography (i.e. Fourier domain optical coherence tomography, FD-OCT) has made it possible to perform high speed pullbacks during image acquisition without the need for transient occlusion of the coronary artery. The objective of this study was to assess the reproducibility of FD-OCT systems for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention., Methods: The study included 45 patients scheduled for percutaneous coronary intervention who were enrolled between May and December 2008. Image acquisition was performed by FD-OCT using a non-occlusive technique and employing pullback speeds ranging from 5 to 20 mm/s. Interstudy, interobserver and intraobserver reproducibility of plaque characterization and stent analysis were assessed., Results: Fourier domain imaging was successfully performed in all patients (n=45). The average flush rate was 3+/-0.4 mL/s and the contrast volume per pullback was 16.1+/-3.5 mL. The mean pullback duration and length were 3.2+/-1.2 s and 53.3+/-12.4 mm, respectively. The interstudy reproducibility for visualizing edge dissection, tissue prolapse, intrastent dissection and malapposition was excellent (k=1). The kappa values for interstudy, interobserver and intraobserver agreement on plaque characterization were 0.92, 0.82 and 0.95, respectively., Conclusions: A second-generation OCT system (i.e. FD-OCT) involving high-speed data acquisition demonstrated good interstudy, interobserver and intraobserver reproducibility for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention.

Introduction and Objectives: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI., Methods: The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically., Results: Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs. 45%; P=1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%., Conclusions: Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of ST-segment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved.

Introduction and Objectives: Provisional stenting has been shown to be effective in the treatment of bifurcated coronary lesions. The aim of this study was to evaluate changes in the geometry of the main vessel stent following side branch (SB) dilatation and kissing balloon (KB) inflation., Methods: The study involved 23 patients with a bifurcated coronary lesion. A first intravascular ultrasound (IVUS) study was performed after drug-eluting stent implantation in the main vessel. Subsequently, angioplasty of the SB was carried out, and a second IVUS was performed to evaluate its effect. Finally, KB inflation was carried out, followed by a third IVUS study of the main vessel. The cross-sectional area of the implanted stent at different points was compared in the three IVUS studies., Results: The cross-sectional area of the proximal segment of the recently implanted stent was 7.3+/-1.9 mm2 and increased to 9.6+/-2.9 mm2 after KB inflation (P< .05). Dilatation of the SB resulted in a reduction in the cross-sectional area under the SB origin from 5.9+/-1.2 mm2 initially to 5.2+/-1.2 mm2 (P< .05). After KB inflation, the cross-sectional area partially recovered (to 5.6+/-1.2 mm2)., Conclusions: After angioplasty of the SB, a reduction was observed in the cross-sectional area of the stent immediately distal to the SB origin. The area did not return to its initial value after KB inflation. However, KB inflation increased the cross-sectional area of the proximal segment of the stent and changed stent geometry.

We report a 56 years-old man presenting with chest pain with exercise, seven years after an orthotopic heart transplant. A coronary angiography showed an atherosclerotic lesion in the common left main coronary artery with more than 90% obstruction. The lesion was successfully treated with a transluminal angioplasty with stenting. A 131-1 metaiodobenylguanidine (MIBG) scan demonstrated sympathetic reinnervation. Sixteen months later, due to progression of allograft vasculopathy, coronary artery bypass was required.

Advances in the understanding of the role of vulnerable plaque coupled with novel diagnostic and therapeutic approaches create a unique opportunity for cardiovascular events prevention due to rupture of vulnerable plaques. Currently, non-invasive methods do not have enough resolution to identify vulnerable plaques, on the other hand, some invasive methods can define the morphological and anatomic characteristics of vulnerable plaques. These invasive methods include intravascular ultrasound and three dimensional intravascular ultrasound, virtual histology, optical coherence tomography, intravascular magnetic resonance and intracoronary angioscopy. Atherosclerotic plaques causing symptoms require local treatment but the systemic nature of the atherosclerotic process requires global therapeutic approach for the prevention of cardiovascular events.

Background: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere., Aim: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines., Material and Methods: Prospective registry of 5.000 patients aged 60+/-11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications., Results: The indications for 80% of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62%, mainly one vessel disease. These were two deaths due to the procedure (0.04%), three patients (0.06%) had an acute myocardial infarction or a stroke. These figures are lower than referential values., Conclusions: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values.

Contemporary clinical and laboratory data have challenged our classical concepts of the pathogenesis of the acute coronary syndromes [ACS]. Indeed, several independent lines of clinical evidence have supported that the critical stenoses cause only a fraction of the ACS. Acute myocardial infarction is believed to be caused by rupture of a vulnerable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and therefore result in multiple unstable lesions. Recent studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some ACS patients. It has also been reported that a ruptured plaque at the culprit lesion is associated with elevated C- reactive protein and other inflammatory markers, which indeed indicate a poor prognosis in patients with ACS. Also, multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Therefore some ACS patients [20-40%] may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. It should be accepted that this ACS population represent a part of the spectrum of the ACS, and in particular in this group of patients treatment should focus not only on the stabilization of the culprit site but also warrants a broader approach to systemic stabilization of the arteries. However, recurrent cardiovascular events in this population still remain unacceptably high, indicating that plaque rupture or vulnerability of multiple plaques is a current challenge in the management of ACS patients.

Introduction and Objectives: In vitro studies show that stents deform when dilated laterally to access a side branch. This phenomenon may be avoided by use of a kissing balloon at the end of the procedure. However, to date, no in vivo data are available. Our objectives were to investigate the main vessel stent using intravascular ultrasound (IVUS) at six-month follow-up in 55 patients with bifurcation lesions treated using rapamycin-eluting stents and to examine the effect of technical factors., Patients and Method: All patients were treated using provisional or T stents. At 6 months, IVUS measurements were made in the main vessel at both proximal and distal ends of the stent, in reference segments, immediately below the side branch ostium, and at the points where the lumen was smallest and where stent expansion was greatest., Results: The lumen area immediately below the side branch ostium was significantly smaller than that at the point of maximum stent expansion (6.7 [1.8] vs 5.1 [1.3] mm2; P<.05). Underexpansion was not influenced by use of a kissing balloon (stent area immediately under the side branch ostium: 5.5 [0.9] vs 5.6 [1.6] mm2; P=NS) and only one patient experienced restenosis at this point. The lumen areas at the proximal and distal edges of the stent were almost identical in patients who did or did not undergo balloon dilation beyond the ends of the stent., Conclusions: Stent underexpansion below the side branch ostium was frequently found following provisional or T stenting of bifurcation lesions. This minor stent deformity was not prevented by use of a kissing balloon nor by any specific side branch treatment and had no significant impact on the restenosis rate.

Coronary artery fistulas are one of the most common congenital anomalies of the coronary arteries. Most fistulas are small and of no clinical significance, although larger or multiple fistulas can be symptomatic and produce complications. Early percutaneous occlusion is now always recommended, and surgical closure is restricted to use for multiple or large fistulas. Here we report four cases of coronary fistula draining from the coronary arteries to the pulmonary vascular bed, which were treated with percutaneous occlusion by coils.

We describe a patient with obstruction of the dominant circumflex artery after surgical repair of the mitral valve, repaired successfully with percutaneous coronary intervention during the immediate postoperative period. We discuss the etiology, prevention and management of this complication with special emphasis on percutaneous intervention.

Contrast angiography has been used for nearly five decades to evaluate the severity of coronary lesions. However, when attempting to distinguish between intermediate coronary lesions able or unable to produce ischemia, the technique has several limitations. A large number of patients undergo cardiac catheterization without prior evaluation of coronary perfusion by non-invasive tests. This number is likely to increase in the coming years, because current recommendations favor the invasive treatment of acute coronary syndromes. This has triggered marked interest in new diagnostic techniques capable of assessing the physiological significance of intermediate lesions in the catheterization room. This paper reviews the different techniques currently available for scientifically assessing the significance of such lesions. The advantages and limitations of each are discussed.

Coronary artery fistula is a rare condition in which a communication exists between a coronary artery an a cardiac chamber or systemic vein. It causes an obligatory shunt from the high-pressure coronary artery to a lower-pressure cardiac chamber. We report a case of right coronary artery fistula draining into the right ventricle, echocardiographic features and interventional catheterization.

Percutaneous coronary interventions have been growing rapidly in recent years for their favorable outcome. Coronary artery disease, however, is caused by a diffuse atherosclerotic process involving the whole coronary artery tree and commonly other vascular territories. In recent years, evidence has accumulated that several classes of secondary preventive drugs are clinically effective. The statins are the cornerstone for lipid-lowering therapy and reduce morbidity and mortality in patients with ACS and treated with interventional cardiology. The highest risk of a recurrent event in patients with acute coronary syndromes (ACS) occurs in the first month, with the rates of reported events ranging from 10-25%. More recent data from several trials show that statin therapy can reduce cardiovascular risk in unstable disease. In the MIRACL trial, early initiation of atorvastatin after an episode of unstable angina or non-Q-MI reduced events along the ensuing 16 weeks. The Third Report of the Expert Panel Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) recommends that lipid lowering drug therapy be initiated at hospital discharge in patients with acute coronary syndromes and patients treated with percutaneous coronary interventions.

Percutaneous coronary intervention procedures are currently preferred for the treatment of Acute Coronary Syndromes. Given the relevance of platelets and fibrin formation in the physiopathology of these clinical syndromes and in the genesis of possible complications caused by interventionist procedures, their association with the use of drugs to control the thrombogenic and clotting response has led to a significant reduction of recurring infarcts, deaths, and re-interventions of the treated vessel or emergency surgery. Due to their synergic effects with percutaneous coronary interventions, aspirin, clopidogrel, heparins (fractionated and non-fractionated), and platelet receptor IIb/IIIa blockers have become an important part of the therapeutics in Ischemic Coronary Syndromes.

We report the results obtained of 23 patients in whom 25 intracoronary stents (SAQ) were placed. All had atherosclerotic coronary artery disease with different clinical types of presentation, such as stable angina, unstable angina, myocardial infarction. In others cases the reason for the procedure was postangioplasty complications. The majority of cases had complex lesions: total occlusion, long plaques and patients in critical and unstable state. The immediate results were considered satisfactory due to the fact that there was angiographic improvement compared to just conventional angioplasty, the final flow was TIMI-3 in 23 and TIMI-2 en two others, in these cases the initial flow was TIMI-0. The arterial diameter improved compared to prior angioplasty. Acute thrombosis occurred in one case and was resolved with repeated dilatation, in two cases the atherosclerotic plaque protruded within the stent, in both cases the occlusion was considered non significant, without modifications in the flow. All patients had a 3 months follow up with treadmill test. In 10 cases angiography was indicated, in 4 due to positive treadmill. Restenosis was resolved in three cases, in another coronary arterial by-pass was necessary. In all other cases angiographic findings were normal, included one patient with two stents.

Atherosclerotic aortic aneurysm, is frequently associated to coronary atherosclerosis. When myocardial ischemia is asymptomatic, aortic surgery commonly is deferred because unexpected ischemic cardiopathy. To diminish the risk of aortic surgery, aortocoronary bypass must be installed before the aortic graft. Percutaneous transluminal coronary angioplasty is an alternative treatment of coronary atherosclerosis, principally in elderly patients. We present the case of a male patient with an abdominal aortic aneurysm and myocardial silent ischemia secondary to right coronary artery stenosis treated by mean the percutaneous transluminal coronary angioplasty (PTCA) before aortic surgery, with the objective of decreasing surgical risk and its possible complications (myocardial infarction, cardiogenic shock, death, etc.). Nine months after the PTCA, the patient is asymptomatic and stress test on treadmill is negative.