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Objective: to demonstrate scientific evidence on incidence and factors associated with contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. Methods: an integrative review carried out in the VHL, PubMed, VHL Regional Portal and SciELO databases, of articles published between 2014 and 2019. Results: the sample consisted of five original articles, two cohorts, two control cases and a clinical trial. The incidence of contrast-induced nephropathy ranged from 6% to 24%. It stands out among patients with advanced age, male gender, diabetes mellitus, systemic arterial hypertension, volume of contrast infused and osmolarity. Intravenous hydration, sodium bicarbonate, ascorbic acid and statin were important prophylactic agents. Conclusion: this study envisioned the main risk factors for contrast-induced nephropathy in patients undergoing percutaneous coronary intervention and elucidated preventive measures that guide multidisciplinary health care aiming at a quality and safe care.

Introducao: Atualmente, existe grande debate acerca da fisiopatologia do infarto agudo do miocardio e da composicao tecidual e morfologica das lesoes responsaveis por eventos isquemicos. Entretanto, poucos estudos investigaram a aplicabilidade da tecnologia iMAP® na caracterizacao tecidual desses pacientes. Avaliamos pacientes com infarto agudo do miocardio com supradesnivelamento do segmento ST pos-fibrinolitico com ultrassom intravascular em escala de cinzas e com a tecnologia iMAP®, a fim de descrever a composicao tecidual das lesoes culpadas pelo infarto agudo do miocardio. Metodos: Foram avaliadas tres arterias coronarias epicardicas com ultrassom intravascular em escala de cinzas e com a tecnologia iMAP® de 25 pacientes com infarto agudo do miocardio com supradesnivelamento do segmento ST pos-trombolise, com criterios de reperfusao. Resultados: A media de idade foi de 51 ± 11,5 anos, com predominio do sexo masculino (72%). A arteria mais frequentemente envolvida foi a coronaria direita (48%). O ultrassom intravascular mostrou que as lesoes culpadas eram longas (extensao de 31,0 ± 17,2 mm) e com elevado porcentual de volume de placa (58,5 ± 5,1%). No ponto de maior obstrucao, ou seja, na area luminal minima, a carga de placa foi de 82,5 ± 7,5%. Alem disso, o indice de remodelamento medio foi de 1,4 ± 1,0, denotando remodelamento positivo. As analises pelo iMAP®, tanto da lesao, quanto da area luminal minima, mostraram predominio em termos porcentuais de componentes fibrotico e necrotico, quando comparados aos demais. Conclusoes: As lesoes ateroscleroticas culpadas pelo infarto agudo do miocardio com supradesnivelamento do segmento ST apresentaram predominio de remodelamento arterial positivo e do componente necrotico na composicao da placa culpada, o que corrobora, in vivo, a principal fisiopatologia da doenca aterosclerotica aguda.

PURPOSE: To evaluate the early luminal diameter loss in the first 15 min after percutaneous transluminal coronary angioplasty (PTCA) and its influence on coronary restenosis. METHODS: In a prospective study, we evaluated 86 patients. The patients were divided in two groups based on the presence or absence of coronary restenosis. Thirty one lesions developed restenosis and 55 lesions did not. RESULTS: Univariate analysis showed that balloon/artery ratio was lower in the group of restenosis (0.92 +/- 0.01 vs 1.00 +/- 0.11, P = .003). Absolute and relative elastic recoil at 1 min was greater in the group that developed restenosis (0.79 +/- 0.54 vs 0.68 +/- 0.59 mm; P = .007 and 32.04 +/- 14.27 vs 22.15 +/- 16.65%; P = .006). Similarly, absolute and relative elastic recoil at 15 min were greater in the group with restenosis (1.25 +/- 0.59 vs 0.90 +/- 0.65 mm, P = .017 e 46.75 +/- 15.69 vs 29.18 +/- 17.84%, P < .00001). Minimal luminal diameter (MLD) at 1 min was lower in the group with restenosis (2.15 +/- 0.42 vs 2.43 +/- 0.58 mm; P = .022). The very early loss was greater in the group with restenosis (0.46 +/- 0.34 vs 0.22 +/- 0.35 mm, P = .004). MLD at 15 min was lower in the group of restenosis than in the group without restenosis (1.69 +/- 0.48 vs 2.20 +/- 0.61; P = .0001). Multivariate analysis revealed balloon/artery ratio and MLD at 15 min as independent correlates of the late outcome. CONCLUSION: The late outcome of PTCA is influenced by elastic recoil and the early MLD loss after PTCA. However, the strongest and most important predictors of late outcome by multivariate analysis were balloon/artery ratio and MLD at 15 min.

Achados de microscopia eletronica de varredura de trombo em enxerto de veia safena em paciente com infarto agudo do miocardio