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Methods In this prospective study conducted during the COVID-19 pandemic, 105 SUS patients with CCS undergoing elective coronary angiography at a teaching hospital between March and May 2020 were evaluated. Four patients were excluded for not attending the test on the scheduled date. All patients were previously evaluated by a cardiologist in a medical appointment, including data on each patient’s clinical profile. During the appointment and when signing the informed consent form, patients were advised to make social isolation, and [...]

Resumo Fundamento O uso do stent farmacológico (SF) comparado ao stent não farmacológico (SNF) na intervenção coronariana percutânea (ICP) reduziu o percentual de reestenose, porém sem impacto na mortalidade, com aumento no custo. A literatura carece de estudos randomizados que comparem economicamente esses dois grupos de stents na realidade do Sistema Único de Saúde (SUS). Objetivo Estimar a razão custo-efetividade incremental (RCEI) entre SF e SNF na coronariopatia uniarterial em pacientes do SUS Métodos Pacientes com coronariopatia uniarterial sintomática foram randomizados em 3 anos para uso de SF ou SNF durante a ICP, na proporção de 1:2, com seguimento clínico de 12 meses. Foram avaliados reestenose intrastent (RIS), revascularização da lesão-alvo (RLA), eventos adversos maiores e custo-efetividade (CE) de cada grupo. Os valores de p < 0,05 foram considerados significativos. Resultados No grupo SF, dos 74 pacientes (96,1%) que completaram o acompanhamento, ocorreu RIS em 1(1,4%), RLA em 1 (1,4%), óbito em 1 (1,4%), sem trombose. No grupo SNF, dos 141 pacientes (91,5%),ocorreu RIS em 14 (10,1%), RLA em 10 (7,3%), óbito em 3 (2,1%) e trombose em 1 (0,74%). Na análise econômica, o custo do procedimento foi de R$ 5.722,21 no grupo SF e de R$4.085,21 no grupo SNF. A diferença de efetividade a favor do grupo SF por RIS e RLA foi 8,7% e 5,9%, respectivamente, com RCEI de R$ 18.816,09 e R$ 27.745,76. Conclusões No SUS, o SF foi custo-efetivo, em concordância com o limiar de CE preconizado pela Organização Mundial da Saúde. (Arq Bras Cardiol. 2020; 115(1):80-89) Abstract Background The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with single-vessel coronary artery disease. Methods Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included in-stent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values

Patient: Male, 60-year-old Final Diagnosis: Thromboembolic ischemia of the upper limb Symptoms: Pain and paresthesia in the right arm Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Rare coexistence of disease or pathology Background: A left atrial septal pouch (LASP) was first described in 2010 as a new anatomical entity with potential for embolic events. The prevalences of left, right, and double septal pouches are 40.8%, 5.1%, and 3.7%, respectively. There is a concern about the risk of embolic events due to formation of thrombi in a LASP (especially stroke). Case Report: A 60-year-old man presented with sudden onset of right arm pain associated with sweating and neck pain radiating to his left upper extremity. On physical examination, his right arm was cyanotic and he had pain, pares-thesia, and no radial pulse. The patient was diagnosed with acute arterial occlusion of his right upper extremity. An arterial embolectomy was performed with a Fogarty catheter at the level of the brachial artery, which resulted in immediate reperfusion. The patient had an embolic event and after efforts to identify the possible etiology, only an LASP was found. Therefore, we hypothesized that he experienced an embolic event in which a thrombus had formed at the site of the LASP. Conclusions: The present case report is designed to raise awareness of the thrombogenic potential of LASP and the possibility of an embolic event to the upper limb of patients with it. LASP can be the source of a thrombus in a patient with a non-stroke embolic event.

Introduction: Interleukin L-17 is produced by Th 17 cells and other cells. There is a debate if IL 17 is atherogenic or atheroprotective. The true role of this interleukin during the development and progression of the coronary artery disease is not known. Objective: To evaluate if there are differences between the IL17 A serum levels according to clinical presentation of the coronary artery disease. Methods: This is a cross sectional study which enrolled 101 patients with acute coronary syndrome (ACS), 100 patients with chronic coronary syndrome (CCS) and 100 healthy volunteers. Blood samples were taken from patients ( at admission) and controls to analysis the level of IL17A. Clinical characteristics were collected through questionnaires. This research was approved by ethical committee. Results: Comparisons of the clinical characteristics between patients with ACS and CCS revealed: mean age ( 62 ± 12.4 vs 63.3 ± 9.8, p = 0.4 ), male (63.4% vs 58%, p = 0.4) hypertension (85.1% vs 79%, p = 0.1) , disyipidemia (48% vs 31%, p =0.01), Diabetes Mellitus (47.5% vs 41%, p = 0.3), previous myocardial infarction (57.4% vs 40%, p = 0,01), smoking (29.7% vs 38%, p = 1). The peripheral concentrations of IL17A according to ACS, CCS and controls were: 5.36 ± 8.83 vs 6.69 ± 17.92 vs 6.26 ± 11.13, p = 0.6. Besides, the comparison between ACS and CCS showed: 5.36 ± 8.83 vs 6.69 ± 17.92, p = 0.3. Conclusion: The main finding os this study was that the circulating IL 17 concentrations were similar in patients with ACS, CCS and healthy volunteers). Besides, there was no difference between patients with ACS and CCS. Therefore, our hypothesis is that in patients with ACS and CCS the circulating IL 17 A concentrations are low or undetectable.

Introduction Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks. – Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions [...]

Microcirculation influences peripheral vascular resistance and therefore contributes to arterial blood pressure. The aim of this study was to investigate the correlation between serum markers of inflammation and microcirculatory parameters observed by nailfold videocapillaroscopy (NVC) in patients with resistant (RH, 58 [50–63] years, n = 25) or mild-to-moderate hypertension (MMH, 56 [47–64] years, n = 25) compared to normotensive patients (control group (CG), 33 [27–52] years, n = 25). C-reactive protein (CRP), endothelin, adiponectin, I-CAM and V-CAM levels were obtained by laboratory analysis. Functional capillary density (FCD; the number of capillaries with flowing red blood cells by unit tissue area), capillary diameters, maximum red blood cell velocity (RBCVmax) during the reactive hyperemia response/RBCVbaseline after 1 min of arterial occlusion at the finger base and time to reach RBCVmax were determined by NVC. A sub-analysis was also conducted on hypertensive patients not taking statins, with controlled/uncontrolled blood pressure. The RH group showed lower RBCV and RBCVmax values and longer TRBCVmax compared to MMH and CG patients, with worse values in those with uncontrolled blood pressure. FCD and diameters showed no significant differences among the three groups, with higher CRP values in the RH and MMH groups. An increase in endothelin was observed only in patients not taking statins in both hypertensive groups. Patients with severe hypertension and uncontrolled blood pressure levels presented more pronounced microvascular dysfunction, as well as higher serum values for CRP and endothelin (without statin treatment), suggesting that the use of statins decreases endothelin release.

Background: In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS). Objectives: To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS. Methods: Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE. Results: We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%. Conclusion: FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography. Resumo Fundamentos: Em pacientes multiarteriais e lesões moderadas, a reserva de fluxo fracionada (FFR) avalia cada lesão e direciona o tratamento, podendo ser útil no custo-efetividade (CE) de implante de stents não farmacológicos (SNF). Objetivos: Avaliar CE e impacto clínico da angioplastia + FFR versus angioplastia + angiografia (ANGIO), em multiarteriais, utilizando SNF. Métodos: pacientes com doença multiarteriais foram randomizados prospectivamente durante ±5 anos para FFR ou ANGIO, e acompanhados por até 12 meses. Foram avaliados eventos cardíacos maiores (ECAM), reestenose e CE. Resultados: foram incluídos 69 pacientes, 47(68,1%) homens, 34(49,2%) no FFR e 35(50,7%) no ANGIO, idade 62,0 ± 9,0 anos, com angina estável e Síndrome Coronariana Aguda estabilizada. No FFR, havia 26 com doença (76,5%) biarterial e 8 (23,5%) triarterial, e no grupo ANGIO, 24(68,6%) biarteriais e 11(31,4%) triarteriais. Ocorreram 12(17,3%) ECAM – 3(4,3%) óbitos: 2(5,8%) no FFR e 1(2,8%) no ANGIO, 9(13,0%) anginas, 4(11,7%) no FFR e 5(14,2%) no ANGIO, 6 reestenoses: 2(5,8%) no FFR e 4 (11,4%) no ANGIO. Angiografia detectou 87(53,0%) lesões no FFR, 39(23,7%) com ICP e 48(29,3%) com tratamento clínico; e 77(47,0%) lesões no ANGIO, todas submetidas à angioplastia. Quanto aos stents, registrou-se 39(33,3%) (0,45 ± 0,50 stents/lesão) no FFR e 78(66,6%) (1,05 ± 0,22 stents/lesão) no ANGIO (p = 0,0001); ANGIO utilizou 51,4% a mais que o FFR. Análise de CE revelou um custo de R$5045,97 e R$5.430,60 nos grupos ANGIO e FFR, respectivamente. A diferença de efetividade foi 1,82%. Conclusões: FFR diminuiu o número de lesões tratadas e de stents e necessidade de revascularização do vaso-alvo, com CE comparável ao da angiografia.

Background: Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke. Objective: To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF. Methods: This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex). Results: The mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%). Conclusion: There was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0) Resumo Fundamento: Fibrilação atrial (FA) é uma arritmia cardíaca que submete os pacientes a alto risco de eventos tromboembólicos, particularmente o acidente vascular encefálico. Objetivo: Avaliar a segurança da oclusão do apêndice atrial esquerdo (OAAE) com o dispositivo Amplatzer Cardiac Plug na prevenção de fenômenos embólicos em pacientes com FA de origem não valvar. Métodos: Este estudo de OAAE incluiu 15 pacientes, sendo 6 (40%) acima de 75 anos (idade média, 69,4 ± 9,3 anos; 60% do sexo masculino). Resultados: A média do escore CHADS2 foi 3,4 ± 0,1. Quando se aplicou o CHA2DS2VASc, a média foi de 4,8 ± 1,8, mostrando alto risco de eventos tromboembólicos. Todos os pacientes tinham o escore HAS-BLED > 3 (média 4,5 ± 1,2) com alto risco de sangramentos maiores em 1 ano. Houve sucesso no implante do dispositivo em todos os pacientes, com posicionamento correto na primeira tentativa na maioria deles (n = 11; 73,3%). Conclusão: Não houve complicações periprocedimento, como migração do dispositivo, tamponamento pericárdico, complicações vasculares e hemorragias maiores. Na fase intra-hospitalar, os pacientes evoluíram favoravelmente, obtendo alta em até 2 dias. Nas avaliações ecocardiográficas do seguimento em 6 e 12 meses, não houve migração do dispositivo, presença de trombos e nem vazamentos peridispositivo. Na evolução clínica aos 12 meses, nenhum dos pacientes apresentou eventos tromboembólicos ou sangramentos relacionados aos fatores de risco ou ao dispositivo. Nesta pequena série, a OAAE mostrou-se segura, com uma alta taxa de sucesso do procedimento e evolução favorável dos pacientes aos 12 meses. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Hypertension is associated with microcirculatory impairment. Our objectives were to evaluate endothelial function and inflammatory biomarkers in patients with resistant (RH) and mild to moderate (MMH) arterial hypertension in comparison to normotensives (control group-CG). Three groups, 25 patients each, have been investigated, by anamnesis, venous occlusion plethysmography (VOP) and serum determination of adhesion molecules (VCAM, ICAM), adiponectin, endothelin and C-reactive protein (CRP). Patients not using statins and with or without blood pressure control were also analyzed. RH group showed smaller percentage increase of maximum forearm blood flow (FBF) (endothelial-dependent vasodilatation) than controls (p

BACKGROUNDDrug-eluting stents have been used since 2002 in different patient populations aiming to achieve high success rates with low clinical and angiographic restenosis rates. With the late thrombosis adverse events associated to the first generation sirolimus and paclitaxel-eluting stents, second-generation everolimus and zotarolimus-eluting stents has been recently developed.METHODSThe POLAR registry is a prospective, non-randomized, multicenter study, which included 988 patients, totaling 1,362 lesions treated with the everolimus-eluting stent Promus®. In order to represent the clinical practice, almost all subtypes of patients and lesions were included in this registry. Clinical follow-up was planned to be performed 1, 6, 12 and 24 months after the procedure.RESULTSMost patients were male (69.8%), with mean age of 64.9±9.4years, 35.2% were diabetics and 55% had been treated for acute coronary syndrome. Vessel diameter was 2.95±0.43mm and lesion extension was 20.5±5.6mm. A total of 1.14±0.38 stent/patient were implanted and the procedural success rate was 96.6%. Major adverse cardiac events occurred in 4.5% of patients, and stent thrombosis was observed in 5 patients (0.5%) after a clinical follow-up of 12 months.CONCLUSIONSThe present registry suggests that everolimus-eluting stents are safe and effective in daily clinical practice patients, with a low rate of major adverse cardiac events at the end of the first year of follow-up.

BACKGROUNDStudies on the cost-effectiveness ratio of drug-eluting stents (DES) are rare. Our objective was to evaluate the results and compare costs (incremental cost-effectiveness ratio – ICER) per restenosis avoided between DES and bare metal stents (BMS) using the propensity score.METHODSTwo hundred and twenty consecutive patients were included in the study, of which 111 were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention, by means of matching, stratification and weighing.RESULTSMost patients were male (67.7% vs. 66.9%; P = 0.53), with a mean age of 65.9 years. Patients treated with the DES had a higher rate of diabetes (54% vs. 17.4%; P < 0.001), three-vessel disease (18.9% vs. 10.1%; P = 0.029) and poor ventricular function (54.1% vs. 22%; P < 0.0001). The diameter of stents was 2.76 ± 0.35mm vs. 2.91 ± 0.47mm (P = 0.006) and the sum of the lengths of stents was 37.6 ± 23mm vs. 24.8 ± 15.8mm (P < 0.0001). Restenosis was observed on 6.3% vs. 12.8% of the patients (P = 0.099) and in 4.1% vs. 9.8% of the lesions (P = 0.048). There was an incremental cost of R$ 9,500.00 and the ICER was R$ 147,538.00 per restenosis avoided (above the World Health Organization threshold). However, when the propensity score was used, the variables that best classified patients for DES and had a maximum ICER of R$ 4,776.96 were age > 72 years, diabetes and lesions with diameter < 3.2mm and length > 18mm.CONCLUSIONSAlthough DES were not cost-effective in the overall population, the propensity score showed that in elderly patients, diabetics and patients with long lesions or small vessels, the use of DES was cost-effective.

Male patient with unstable angina and critical calcified lesion in the left main coronary artery (LMCA). Background: coronary artery bypass grafting and anemia. The intention to treat was angioplasty with drugeluting stents (DES) in the LMCA. The patient presented gastrointestinal bleeding and worsening of anemia, which were treated. Angina was refractory to medical therapy. Because of antiplatelet therapy limitation, bioresorbable vascular support (BVS) was implanted in the LMCA. This case report discusses the use of BVS in complex lesion, enabling absorption of the device and better management of antiplatelet therapy and future follow-up of the obstruction treated using by non-invasive imaging methods.

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):61-73 doi:10.12957/rhupe.2013.7084 Pulmonary arterial hypertension (PAH) is a rare disease characterized by a progressive increase in pulmonary vascular resistance, leading to right heart failure and premature death. Over the last decades, a better understanding of the pathogenesis of PAH has led to the approval of several targeted therapies that confer improvements in patients’ clinical and haemodynamic status, quality of life and survival. The clinical manifestations are non-specific but progressive, with the majority of patients presenting with worsening dyspnea, the most common symptom, that has usually been attributed to other cardiorespiratory disorders. As a consequence, diagnostic delay is usual, with 75% of patients reporting New York Heart Association functional class (NYHA-FC) III or IV symptoms by the time the diagnosis is established. Brazil has until March 2013 indexed in the database PUBMED 52 articles on this topic since the early twentieth century. In fact, the disease was forgotten until the early 1990s, when it was found that their frequency was greater than previously thought and that it could be approached together or separately, in cases of idiopathic etiology, improving quality of life and increasing survival in years. In Brazil, despite advances in therapeutic and diagnostic approach, there are few reference centers for diagnosis and treatment, which hinders the capillarization of knowledge. This review presents the current scenario of the diagnosis of PAH and its broad perspective for treatment. Keywords: Pulmonary arterial hypertension; Therapy ; Review.

INTRODUÇÃO: Os estudos sobre a razão de custo-efetividade dos stents farmacológicos (SFs) são escassos. Nosso objetivo foi avaliar os resultados e comparar os custos (razão custo-efetividade incremental - RCEI) por reestenose evitada entre SFs e stents não-farmacológicos (SNFs) utilizando o escore de propensão. MÉTODOS: Incluímos na análise 220 pacientes tratados consecutivamente, dos quais 111 com SFs e 109 com SNFs. O escore de propensão foi usado para ajustar o efeito da intervenção por meio de pareamento, estratificação e ponderação. RESULTADOS: Predominaram pacientes do sexo masculino (67,7% vs. 66,9%; P = 0,53), com média de idade de 65,9 anos. Pacientes tratados com SFs apresentaram maior frequência de diabetes (54% vs. 17,4%; P < 0,001) e doença triarterial (18,9% vs. 10,1%; P = 0,029) e pior função ventricular (54,1% vs. 22%; P < 0,0001). O diâmetro dos stents foi de 2,76 ± 0,35 mm vs. 2,91 ± 0,47 mm (P = 0,006) e a soma do comprimento dos stents foi de 37,6 ± 23 mm vs. 24,8 ± 15,8 mm (P < 0,0001). Reestenose ocorreu em 6,3% vs. 12,8% dos pacientes (P = 0,099) e em 4,1% vs. 9,8% das lesões (P = 0,048). Houve incremento de custo de R$ 9.590,00 e a RCEI foi de R$ 147.538,00 por reestenose evitada (acima do limiar da Organização Mundial da Saúde). Entretanto, utilizando o escore de propensão, as variáveis que melhor classificaram os pacientes para SFs e apresentam RCEI máxima de R$ 4.776,96 foram idade > 72 anos, diabetes e lesões com diâmetro < 3,2 mm e comprimento > 18 mm. CONCLUSÕES: Apesar de os SFs não terem sido custo-efetivos na população em geral, o escore de propensão demonstrou que em idosos, diabéticos e pacientes com lesões longas ou vasos de fino calibre o uso de SFs foi custo-efetivo. BACKGROUND: Studies on the cost-effectiveness ratio of drug-eluting stents (DES) are rare. Our objective was to evaluate the results and compare costs (incremental cost-effectiveness ratio - ICER) per restenosis avoided between DES and bare metal stents (BMS) using the propensity score. METHODS: Two hundred and twenty consecutive patients were included in the study, of which 111 were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention, by means of matching, stratification and weighing. RESULTS: Most patients were male (67.7% vs. 66.9%; P = 0.53), with a mean age of 65.9 years. Patients treated with the DES had a higher rate of diabetes (54% vs. 17.4%; P < 0.001), three-vessel disease (18.9% vs. 10.1%; P = 0.029) and poor ventricular function (54.1% vs. 22%; P < 0.0001). The diameter of stents was 2.76 ± 0.35 mm vs. 2.91 ± 0.47 mm (P = 0.006) and the sum of the lengths of stents was 37.6 ± 23 mm vs. 24.8 ± 15.8 mm (P < 0.0001). Restenosis was observed on 6.3% vs. 12.8% of the patients (P = 0.099) and in 4.1% vs. 9.8% of the lesions (P = 0.048). There was an incremental cost of R$ 9,500.00 and the ICER was R$ 147,538.00 per restenosis avoided (above the World Health Organization threshold). However, when the propensity score was used, the variables that best classified patients for DES and had a maximum ICER of R$ 4,776.96 were age > 72 years, diabetes and lesions with diameter < 3.2 mm and length > 18 mm. CONCLUSIONS: Although DES were not cost-effective in the overall population, the propensity score showed that in elderly patients, diabetics and patients with long lesions or small vessels, the use of DES was cost-effective.

INTRODUÇÃO: Desde 2002, os stents farmacológicos são utilizados em diversas populações de pacientes objetivando alcançar elevados índices de sucesso, com baixas taxas de reestenose angiográfica e clínica. Com os resultados adversos em relação à trombose tardia associados aos stents farmacológicos de primeira geração eluidores de sirolimus e paclitaxel, surgiram recentemente os stents farmacológicos de segunda geração eluidores de zotarolimus e everolimus. MÉTODOS: O registro POLAR é um registro prospectivo, não-randomizado, multicêntrico, que incluiu 988 pacientes totalizando 1.362 lesões tratadas com o stent Promus®. Objetivando representar a prática clínica, praticamente todos os subtipos de pacientes e lesões foram incluídos neste registro. O seguimento clínico foi planejado para ser realizado 1 mês, 6 meses, 12 meses e 24 meses após o procedimento. RESULTADOS: A maioria dos pacientes era do sexo masculino (69,8%), com média de idade de 64,9 ± 9,4 anos, 35,2% eram diabéticos e 55% tinham sido tratados na vigência de síndrome coronária aguda. O diâmetro do vaso foi de 2,95 ± 0,43 mm e a extensão da lesão, de 20,5 ± 5,6 mm. Foi implantado 1,14 ± 0,38 stent/paciente e o sucesso do procedimento foi alcançado em 96,6% dos casos. Eventos cardíacos adversos maiores ocorreram em 4,1% dos pacientes, e trombose de stent esteve presente em 5 pacientes (0,5%) após o seguimento clínico de 12 meses. CONCLUSÕES: O presente registro sugere que os stents farmacológicos eluidores de everolimus são seguros e eficazes em pacientes da prática clínica diária, com baixas taxas de eventos cardíacos adversos maiores ao término do primeiro ano de seguimento. BACKGROUND: Drug-eluting stents have been used since 2002 in different patient populations aiming to achieve high success rates with low clinical and angiographic restenosis rates. With the late thrombosis adverse events associated to the first generation sirolimus and paclitaxel-eluting stents, second-generation everolimus and zotarolimus-eluting stents has been recently developed. METHODS: The POLAR registry is a prospective, non-randomized, multicenter study, which included 988 patients, totaling 1,362 lesions treated with the everolimus-eluting stent Promus®. In order to represent the clinical practice, almost all subtypes of patients and lesions were included in this registry. Clinical follow-up was planned to be performed 1, 6, 12 and 24 months after the procedure. RESULTS: Most patients were male (69.8%), with mean age of 64.9 ± 9.4 years, 35.2% were diabetics and 55% had been treated for acute coronary syndrome. Vessel diameter was 2.95 ± 0.43 mm and lesion extension was 20.5 ± 5.6 mm. A total of 1.14 ± 0.38 stent/patient were implanted and the procedural success rate was 96.6%. Major adverse cardiac events occurred in 4.5% of patients, and stent thrombosis was observed in 5 patients (0.5%) after a clinical follow-up of 12 months. CONCLUSIONS: The present registry suggests that everolimus-eluting stents are safe and effective in daily clinical practice patients, with a low rate of major adverse cardiac events at the end of the first year of follow-up.

FUNDAMENTO: Na literatura nacional há escassez de análises de custo-efetividade, comparando stents farmacológicos (SF) versus não farmacológicos (SNF), no seguimento tardio. OBJETIVO: Estimar a Razão de Custo-Efetividade Incremental (RCEI) entre SF e SNF na coronariopatia uniarterial. MÉTODOS: 217 pacientes (130 SF e 87 SNF), com 48 meses de seguimento (média=26). Desfecho primário: custo por re-estenose evitada, sendo efetividade definida como redução de eventos maiores. O modelo analítico de decisão foi baseado no estudo de Polanczyk et al. Os custos diretos foram aqueles utilizados diretamente nas intervenções. RESULTADOS: A amostra foi homogênea para idade e sexo. O SF foi mais utilizado em diabéticos: 59 (45,4%) vs 16 (18,4%)(p

OBJETIVO: Avaliar retrospectivamente, implante de stent (IS) em paciente com doença arterial coronária (DAC), realizado em 7 hospitais do Rio de Janeiro. MÉTODOS: De junho/94 a dezembro/96, foram realizados 2.220 procedimentos, e desses, analisados 783 IS em 660 (29,7%) pacientes, através da coronariografia sem subtração digital. Os diversos tipos de stent, mais freqüentemente, usados foram: Palmaz-Schatz (40,9%), Gianturco-Roubin (29,1%) e NIR (22,0%). As indicações para o IS foram: lesão de novo, 67,9%; lesão reestenótica, 16,0%; lesão com resultado subótimo da angioplastia transluminal coronária (ATC), 8,2%; oclusão aguda ou provável pós-ATC, 4,9%; oclusão crônica, 3,0%. Todos os stents foram implantados com alta pressão, sem controle pelo ultra-som intracoronário. A prevenção da trombose subaguda, na maioria dos pacientes (87,8%), foi feita com o uso de ticlopidina e ácido acetil-salicílico. RESULTADOS: Evolução imediata: a) sucesso no IS em 770 lesões: 98,0% em 646 (97,9%) pacientes; b) sucesso clínico em 634 (96,0%) casos; c) complicações maiores: infarto agudo do miocárdio (IAM) - 1,1%; cirurgia de revascularização miocárdica (CRM) - 1,4% e óbito - 0,8%; d) complicações vasculares com correção cirúrgica e/ou sangramento - 3,0%. Evolução tardia: a) dos 399 (60,4%) pacientes acompanhados clinicamente, a coronariografia de 121 (30,3%) mostrou retorno da lesão no IS em 79 (19,8%) casos; b) freqüência de outros eventos: IAM - 1,5%; CRM - 2,3%; óbito -1,0% e outra ATC ou procedimento similar - 12,5%. CONCLUSÃO: O estudo multicêntrico mostrou que o IS na DAC pode ser realizado com segurança, alto índice de sucesso imediato, poucas complicações e baixa taxa de eventos cardíacos na evolução tardia. PURPOSE: To evaluate retrospectively stent implantation (SI) in patients with coronary artery disease (CAD) performed in 7 hospitals in Rio de Janeiro. METHODS: From June/94 to December/96 2,220 procedures were performed among which we analyzed 783 SI in 660 (29.7%) patients using coronary angiography without digital subtraction. Several types of stents were used: Palmaz-Schatz (40.9%), Gianturco-Roubin (29.1%) e NIR (22.0%). Indications for SI: 1- de novo lesion (67.9%); 2) restenotic lesion (16.0%); 3) sub-optimal results after PTCA (8.2%); 4) abrupt or threatened closure after PTCA (4.9%); 5) chronic occlusion (3.0%). All stents were implanted using high pressure balloon inflation without intracoronary ultrasound guidance. Sub-acute stent thrombosis prevention, in the majority of patients (87.8%) was done with ticlopidine and aspirin. RESULTS: Early outcome: a) the success rate of SI in 770 lesions was 98.0% in 646 (97.9%) patients; b) the clinical success rate in 634 patients was 96.0%; c) the major complications were acute myocardial infarction (1.1%); coronary artery bypass graft (1.4%) and death (0.8%); d) vascular complications with surgical correction and/or bleeding occurred in 3.0%. Late outcome: a) the clinical follow-up of 399 (60.4%) and the coronary angiographies of 121 patients (30.3%) showed in-stent lesion in 79 (19.8%); b) other event rates: myocardial infarction (1.5%); coronary bypass (2.3%); death: 1.0% and other PTCA or similar procedure (12.5%). CONCLUSION: This multicentric study showed that SI for CAD can be performed with safety, high early success rate, few complications and low rate of cardiac events during the late follow-up.