275 results on '"Adriano Caixeta"'
Search Results
52. Benchmarking as a quality of care improvement tool for patients with ST-elevation myocardial infarction: an NCDR ACTION Registry experience in Latin America
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Miguel Cendoroglo Neto, Eduardo E Pesaro, Marcelo Franken, C. Michael Valentine, Pedro A. Lemos, Ivanise Gomes, Marcelo Katz, Paula Ko Yokota, Ralph G. Brindis, Adriano Caixeta, PatrÍcia V Alliegro, and Marcia Makdisse
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Adrenergic beta-Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Patient safety ,Percutaneous Coronary Intervention ,0302 clinical medicine ,St elevation myocardial infarction ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Quality of care ,Aged ,Aspirin ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Percutaneous coronary intervention ,General Medicine ,Benchmarking ,Middle Aged ,medicine.disease ,Quality Improvement ,Outcome and Process Assessment, Health Care ,Conventional PCI ,Emergency medicine ,ST Elevation Myocardial Infarction ,Female ,business ,Brazil ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
ObjectiveWe aim to examine the effect of benchmarking on quality-of-care metrics in patients presenting with ST-elevation myocardial infarction (STEMI) through the implementation of the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ACTION Registry.DesignFrom January 2005 to December 2017, 712 patients underwent primary percutaneous coronary intervention PCI—499 before NCDR ACTION Registry implementation (prior to 2013) and 213 after implementation.SettingSTEMI.Participants712 patients.Intervention(s)Primary PCI.Main Outcome Measure(s)We examined hospital performance for the quality indicators in processes and outcomes of the management of patients presenting with STEMI. Outcome measures include door-to-balloon time (DBT), antiplatelet therapy and anti-ischemic drugs prescribed at discharge from pre-NCDR ACTION Registry to post-implementation.ResultsThere was improvement in DBT, decreasing from 94 min in 2012 (before NCDR adoption) to reach a median of 47 min in 2017 (Ptrend ConclusionsThe introduction of the ACC NCDR ACTION Registry led to incremental gains in the quality in STEMI management through the benchmarking of process of care and clinical outcomes, achieving reduced DBT, improving guideline-directed medication adherence and increasing patient safety, treatment efficacy and survival.
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- 2019
53. Impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction patients
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Sergio Tufik, Laura Castro, Adriano Caixeta, Dalva Poyares, Fátima Dumas Cintra, Patrick Rademaker Burke, Fabrizio U. Maroja, Luciana J. Storti, and Angelo Amato Vincenzo de Paola
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Polysomnography ,Fibrinolytic Agents ,Risk Factors ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Sleep Apnea, Obstructive ,Ejection fraction ,medicine.diagnostic_test ,Vascular disease ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Obstructive sleep apnea ,Treatment Outcome ,Otorhinolaryngology ,Heart failure ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Neurology (clinical) ,business - Abstract
The negative association between obstructive sleep apnea (OSA) and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is well documented. However, little is known about the influence of OSA on fibrinolytic therapy. The aim of this study was to evaluate the impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction (STEMI) patients. We enrolled consecutive STEMI patients without previous vascular disease, heart failure, or OSA diagnosis. All patients underwent either a pharmacoinvasive therapy or primary PCI. Syntax score (SS) was calculated for all patients, and a full bedside polysomnography was performed in the first 72 h of admission. In-hospital events and 30 days readmissions were analyzed. The sample included 116 patients, 87 men. Patients with severe OSA were older (p = 0.01), had higher neck and abdominal circumferences (p
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- 2019
54. Spontaneous Coronary Artery Dissection
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Fernando Macaya, Peter O’Kane, Jamil Cade, Nieves Gonzalo, Fernando Alfonso, Abtehale Al-Hussaini, Robert Jackson, Ota Hlinomaz, Bernardo Cortese, Nilesh J. Samani, Thomas W Johnson, Alice Wood, Marcos García-Guimaraes, Pavel Leinveber, Gijs van Soest, Adriano Caixeta, Javier Escaned, David Adlam, and Shiju Joseph
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Pathophysiology ,030218 nuclear medicine & medical imaging ,Pathogenesis ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Optical coherence tomography ,Vasa vasorum ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Scad ,Lumen (unit) - Abstract
Objectives This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL. Background SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood. Methods A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases. Results In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. −1.9%; p Conclusions These observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing.
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- 2019
55. Pseudoaneurysm After Distal Transradial Coronary Intervention Successfully Managed by Prolonged Pneumatic Compression: Simple Solution for a Rare and Challenging Problem
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Marcos Danillo P, Oliveira, Glenda, Alves de Sá, Ednelson C, Navarro, and Adriano, Caixeta
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Percutaneous Coronary Intervention ,Treatment Outcome ,Radial Artery ,Humans ,Female ,Coronary Angiography ,Non-ST Elevated Myocardial Infarction ,Aneurysm, False ,Aged - Abstract
A 75-year-old woman with hypertension, hypothyroidism, and diabetes was referred to the catheterization laboratory due to non-ST segment elevation myocardial infarction. Urgent coronary angiography was uneventfully performed via right distal transradial access, despite lusoria subclavian artery. Left anterior descending artery was successfully treated by percutaneous coronary intervention with stenting. A TR band was left in situ for 60 minutes and completely removed after 2 hours, without bleeding. Proximal and distal radial pulses were palpable after hemostasis and at hospital discharge, 24 hours later, uneventfully. Six days after, she noticed subtle and rapidly progressive wrist, hand and fingers swelling, with pain, ecchymosis, and movement limitation.
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- 2021
56. Main differences between two highly effective lipid-lowering therapies in subclasses of lipoproteins in patients with acute myocardial infarction
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Maria Cristina de Oliveira Izar, Francisco Antonio Helfenstein Fonseca, Ana Paula de Queiroz Mello, Amanda Santoro Fonseca Bacchin, Carolina Nunes França, Antônio Martins Figueiredo Neto, Leticia C. S. Pinto, Flavio T. Moreira, Rui Póvoa, Nágila Raquel Teixeira Damasceno, Adriano Caixeta, and Henrique Tria Bianco
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Male ,medicine.medical_specialty ,Simvastatin ,RC620-627 ,Endocrinology, Diabetes and Metabolism ,Lipoproteins ,Clinical Biochemistry ,Hypercholesterolemia ,Gastroenterology ,chemistry.chemical_compound ,Endocrinology ,Ezetimibe ,Internal medicine ,medicine ,Humans ,Rosuvastatin ,Myocardial infarction ,Rosuvastatin Calcium ,Nutritional diseases. Deficiency diseases ,Aged ,medicine.diagnostic_test ,business.industry ,Cholesterol ,Research ,Biochemistry (medical) ,Cholesterol, LDL ,Middle Aged ,medicine.disease ,Atherosclerosis ,Lipids ,chemistry ,Liver ,ST Elevation Myocardial Infarction ,lipids (amino acids, peptides, and proteins) ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Lipid profile ,medicine.drug ,Lipidology ,Lipoprotein - Abstract
Background Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI). Methods Patients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test). Results The classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin. Conclusions Lipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk. Trial registration ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.
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- 2021
57. Distal Transradial Access for Primary PCI in ST-Segment Elevation Myocardial Infarction
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Marcos Danillo Oliveira and Adriano Caixeta
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Cardiology and Cardiovascular Medicine - Published
- 2022
58. In-hospital recurrent spontaneous coronary artery dissection affecting multiple arteries
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Nara Kobbaz Pereira de Almeida, Adriano Caixeta, and Marco Tulio Souza
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medicine.medical_specialty ,Myocardial ischemia ,business.industry ,Spontaneous dissection ,Coronary arteries ,medicine.anatomical_structure ,Internal medicine ,Rare case ,Cardiology ,medicine ,Lack of knowledge ,Circumflex ,Artery dissection ,business - Abstract
Spontaneous coronary artery dissection is an uncommon cause of myocardial ischemia. Although the first description dates from 1931, its diagnosis is sometimes made late and/or erroneously due to the lack of knowledge of its non-pathognomonic angiographic variations. Additionally, the proper management of this condition is not yet well established. Here we present a rare case of in-hospital recurrence of spontaneous dissection affecting both the left anterior descending and circumflex coronary arteries, with distinct clinical presentations. In-hospital recurrent spontaneous coronary [...]
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- 2020
59. Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries
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Roberto Diletti, Robert-Jan van Geuns, Alexandre Abizaid, Patrick W. Serruys, Piera Capranzano, Carlos M. Campos, Alaide Chieffo, Adriano Caixeta, Antonio L. Bartorelli, Hiroyoshi Kawamoto, Jose de Ribamar Costa, Antonio Colombo, Claudia Tamburino, Cordula Felix, Yoshinobu Onuma, and Corrado Tamburino
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medicine.medical_specialty ,Time Factors ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Coronary artery disease ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Absorbable Implants ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Adverse effect ,Aged ,business.industry ,Hazard ratio ,Cardiovascular Agents ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Thrombosis ,Confidence interval ,Treatment Outcome ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
AIMS The aim of this study was to investigate the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS We pooled patient-level databases derived from the large-scale ABSORB EXTEND study and five high-volume international centres. Between November 2011 and November 2015, 1,933 patients underwent PCI with a total of 2,372 Absorb BVS implanted. The median age was 61.0 (IQR 53.0 to 68.6) years, 24% had diabetes, and 68.2% presented with stable coronary artery disease. At a median follow-up of 616 days, MACE occurred in 93 (4.9%) patients, all-cause death in 36 (1.9%) patients, myocardial infarction in 47 (2.5%) patients, and target vessel revascularisation in 72 (3.8%) patients. Definite or probable scaffold thrombosis occurred in 26 (1.3%) patients. On multivariable logistic regression analysis, acute coronary syndromes (hazard ratio [HR] 2.79, 95% confidence interval [CI]: 1.47 to 5.29; p=0.002), dyslipidaemia (HR 1.43, 95% CI: 1.23 to 1.79; p=0.007), scaffold/reference diameter ratio >1.25 (HR 1.49, 95% CI: 1.18 to 1.88; p=0.001), and residual stenosis >15% (HR 1.67, 95% CI: 1.34 to 2.07; p
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- 2019
60. Patients with <scp>COVID</scp> ‐19 who experience a myocardial infarction have complex coronary morphology and high in‐hospital mortality: Primary results of a nationwide angiographic study
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Adriano Caixeta, Daniela Calderaro, Carlos M. Campos, Renata do Val, Cristiano Guedes Bezerra, Patrícia O. Guimarães, Fabio Sandoli de Brito, Francis R. de Souza, Roberto Kalil Filho, Alexandre Abizaid, Ludhmila Abrahão Hajjar, Fernanda Mangione, Jose de Ribamar Costa, Felipe G. Lima, Breno de Alencar Araripe Falcão, Bruno Caramelli, Henrique Barbosa Ribeiro, Ricardo Cavalcante, Pedro A. Lemos, Leandro A Côrtes, Roxana Mehran, and Natassja Huemer
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Myocardial Infarction ,Context (language use) ,Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Original Studies ,Lesion ,coronavirus disease 2019 ,03 medical and health sciences ,COVID-19 Testing ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hospital Mortality ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Thrombus ,Prospective cohort study ,SARS-CoV-2 ,business.industry ,COVID-19 ,General Medicine ,medicine.disease ,Treatment Outcome ,Concomitant ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
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- 2021
61. Use of robotic assistance to reduce proximity and air-sharing during percutaneous cardiovascular intervention
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Fredric A. P. Oliveira, Rodrigo Gobbo Garcia, Breno Oliveira Almeida, Pedro A. Lemos, Jose Mariani, Fabio G. Pitta, Adriano Caixeta, Marcelo Franken, and Gabriella Cunha-Lima
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Target lesion ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Psychological intervention ,Percutaneous coronary intervention ,Pilot Projects ,Coronary Artery Disease ,Percutaneous Coronary Intervention ,Treatment Outcome ,Robotic Surgical Procedures ,Intervention (counseling) ,Emergency medicine ,Health care ,Occlusion ,Clinical endpoint ,medicine ,Molecular Medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,business - Abstract
Lay abstract Minimally invasive therapies for cardiovascular diseases are techniques that limit the size of incisions needed and so lessen wound healing time, but traditionally require close contact between the patients and the healthcare team. This fact poses hazards that range from radiation exposure to the spread of airborne diseases. We developed a small study of ten patients to investigate whether a new method of robotic-assisted stent implantation for the treatment of a heart attack would reduce proximity between the patient and medical staff during the procedure. To evaluate the effectiveness of that strategy, we assessed the success of the procedure (by analyzing the images of the operation), the amount of time the team was positioned more than 2 meters from the patient and the occurrence of complications during the hospitalization. We concluded that this method of robotic-assisted stent implantation after a heart attack provided successful treatment while reducing proximity and shared air space between the care-delivery team and the patient.
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- 2021
62. Bilateral Distal Transradial Access for Ostial Left Anterior Descending Chronic Total Occlusion Recanalization
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Marcos Danillo P, Oliveira, Flavio G, Lyra, Valter Trigueiro C, Neto, and Adriano, Caixeta
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Percutaneous Coronary Intervention ,Radial Artery ,Humans ,Arterial Occlusive Diseases ,Hemorrhage ,Coronary Angiography - Abstract
The adoption of distal transradial access (dTRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has many advantages in terms of patient and operator comfort, access-site bleeding, faster hemostasis, and risk of radial artery occlusion. Bilateral dTRA for complex chronic total occlusion percutaneous coronary intervention by experienced operators is feasible and safe.
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- 2021
63. Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction
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Adriano Caixeta, Maria Cristina de Oliveira Izar, Ieda Maria Longo-Maugéri, Ana Carolina Carneiro Aguirre Casarotti, Iran Gonçalves, Francisco Antonio Helfenstein Fonseca, Gilberto Szarf, Henrique Tria Bianco, Daniela Teixeira, Ibraim Pinto, Flavio T. Moreira, Mayari Eika Ishimura, Maria E. R. Coste, and Amanda F Bacchin
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Adult ,Male ,0301 basic medicine ,Immunology & Inflammation ,medicine.medical_specialty ,Myocardial Infarction ,Biophysics ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Troponin T ,Antigens, CD ,Cardiac magnetic resonance imaging ,Internal medicine ,cardiac MRI ,medicine ,Humans ,ST segment ,cardiovascular diseases ,Myocardial infarction ,Prospective cohort study ,Molecular Biology ,Research Articles ,B-Lymphocytes ,Ejection fraction ,medicine.diagnostic_test ,biology ,business.industry ,Cell Biology ,medicine.disease ,Magnetic Resonance Imaging ,cytokines ,Interleukin-10 ,B-1 cell ,030104 developmental biology ,Integrin alpha M ,Cardiovascular System & Vascular Biology ,B Lymphocytes ,cardiovascular system ,Cardiology ,biology.protein ,Translational Science ,Female ,Interleukin-4 ,business - Abstract
Despite early reperfusion, patients with ST segment elevation myocardial infarction (STEMI) may present large myocardial necrosis and significant impairment of ventricular function. The present study aimed to evaluate the role of subtypes of B lymphocytes and related cytokines in the infarcted mass and left ventricular ejection fraction obtained by cardiac magnetic resonance imaging performed after 30 days of STEMI. This prospective study included 120 subjects with STEMI submitted to pharmacoinvasive strategy. Blood samples were collected in subjects in the first (D1) and 30th (D30) days post STEMI. The amount of CD11b+ B1 lymphocytes (cells/ml) at D1 were related to the infarcted mass (rho = 0.43; P=0.033), measured by cardiac MRI at D30. These B1 cells were associated with CD4+ T lymphocytes at D1 and D30, while B2 classic lymphocytes at day 30 were related to left ventricular ejection fraction (LVEF). Higher titers of circulating IL-4 and IL-10 were observed at D30 versus D1 (P=0.013 and P
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- 2021
64. Complex Coronary Intervention Via Right Distal Transradial Access With Lusoria Subclavian Artery Under Refractory Electrical Storm: A Really Challenging Case
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Marcos Danillo P, Oliveira, Ednelson Cunha, Navarro, Glenda, Alves de Sá, Giovanna Mezzalira, Santos, Maria Eduarda, Vieira Ribeiro Garcia, Rafael, Alves Banzatti Viana, and Adriano, Caixeta
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Percutaneous Coronary Intervention ,Treatment Outcome ,Radial Artery ,Subclavian Artery ,Humans ,Coronary Angiography ,Non-ST Elevated Myocardial Infarction - Abstract
The adoption of distal transradial access (TRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has advantages in terms of patient and operator comfort and risk of radial artery occlusion. We report herein a very challenging case of coronary angiography followed by complex percutaneous coronary intervention via right distal TRA, with aberrant (lusoria) subclavian artery, in the setting of non-ST segment elevation acute myocardial infarction complicated by refractory electrical storm.
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- 2021
65. Avaliação de impacto em saúde do acesso transradial distal como via de escolha preferencial para cineangiocoronariografias e intervenções coronarianas percutâneas
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Marcos Danillo P. Oliveira, Adriano Caixeta, Karina Camasmie Abe, and Simone Georges El Khouri Miraglia
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- 2021
66. Huge Cavity Spilling Coronary Perforation Management: When the Basic Works Well
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Marcos Danillo P, Oliveira, Ednelson Cunha, Navarro, and Adriano, Caixeta
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Percutaneous Coronary Intervention ,Treatment Outcome ,Heart Injuries ,Humans ,Coronary Angiography ,Coronary Vessels - Abstract
Type III cavity-spilling coronary artery perforation is an unusual but dreaded complication which can be conservatively managed with simple prolonged balloon inflation without compromising the final PCI result by anticoagulation reversal.
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- 2020
67. Alterações Precoces nas Interleucinas Circulantes e no Risco Inflamatório Residual após Infarto Agudo do Miocárdio
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Otavio Berwanger, Daniela Teixeira, Mayari Eika Ishimura, Maria E. R. Coste, Carolina Nunes França, Ieda Maria Longo-Maugéri, Henrique Tria Bianco, Amanda Santoro Fonseca Bacchin, Flavio T. Moreira, Adriano Caixeta, Iran Gonçalves, Gilberto Szarf, Francisco Antonio Helfenstein Fonseca, Maria Cristina de Oliveira Izar, and Ibraim Pinto
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medicine.medical_specialty ,Infarto do Miocárdio com Supradesnível do Segmento ST ,Magnetic Resonance Spectroscopy ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Revascularization ,Interleucina 10 ,Ventricular Function, Left ,Interleucina-6 ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,C-reactive Protein ,Diseases of the circulatory (Cardiovascular) system ,Interleukin-6, Interleukin-10, Interleukin-18 ,Humans ,In patient ,cardiovascular diseases ,Myocardial infarction ,Ventricular function ,business.industry ,Interleukins ,Artigo Original ,Stroke Volume ,Thrombolysis ,Plasma levels ,medicine.disease ,Proteína C Reativa ,RC666-701 ,Interleucina 18 ,cardiovascular system ,Cardiology ,ST Elevation Myocardial Infarction ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Espectroscopia de Ressonância Magnética ,Biomarkers - Abstract
Resumo Fundamento Pacientes com infarto agudo do miocárdio podem apresentar uma grande área infartada e disfunção ventricular mesmo com trombólise e revascularização precoces. Objetivo Investigar o comportamento das citocinas circulantes em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) e a relação delas com a função ventricular. Métodos No estudo BATTLE-AMI (Avaliação dos Linfócitos Tipos B e T no Infarto Agudo do Miocárdio), os pacientes com IAMCSST foram tratados com uma estratégia farmacoinvasiva. Os níveis de citocinas (IL-1β, IL-4, IL-6, IL-10 e IL-18) no plasma foram testados através de ensaio de imunoadsorção enzimática (ELISA) no início do estudo e após 30 dias. A massa infartada e a fração de ejeção ventricular esquerda (FEVE) foram examinadas por ressonância magnética cardíaca 3-T. Valores de p menores que 0,05 foram considerados significativos. Resultados Na comparação com o início do estudo, níveis mais baixos foram detectados para IL-1β (p = 0,028) e IL-18 (p < 0,0001) após 30 dias do IAMCSST, enquanto níveis mais altos foram observados para IL-4 (p = 0,001) e IL-10 (p < 0,0001) no mesmo momento. Em contrapartida, nenhuma mudança foi detectada nos níveis de IL-6 (p = 0,63). Os níveis da proteína C-reativa de alta sensibilidade e de IL-6 se correlacionaram no início do estudo (rho = 0,45, p < 0,0001) e 30 dias após o IAMCSST (rho = 0,29, p = 0,009). No início do estudo, a correlação entre os níveis de IL-6 e FEVE também foi observada (rho = -0,50, p = 0,004). Conclusões Durante o primeiro mês pós-infarto agudo do miocárdio, observamos uma melhora significativa no balanço das citocinas pró e anti-inflamatórias, exceto da IL-6. Esses achados sugerem risco inflamatório residual. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0) Abstract Background Patients with acute myocardial infarction may have a large infarcted area and ventricular dysfunction despite early thrombolysis and revascularization. Objective To investigate the behavior of circulating cytokines in patients with ST-segment elevation myocardial infarction (STEMI) and their relationship with ventricular function. Methods In the BATTLE-AMI (B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction) trial, patients with STEMI were treated with a pharmacoinvasive strategy. The plasma levels of cytokines (IL-1 β , IL-4, IL-6, IL-10, and IL-18) were tested using enzyme-linked immunosorbent assay (ELISA) at baseline and after 30 days. Infarcted mass and left ventricular ejection fraction (LVEF) were examined by 3-T cardiac magnetic resonance imaging. All p-values < 0.05 were considered statistically significant. Results Compared to baseline, lower levels were detected for IL-1 β (p = 0.028) and IL-18 (p < 0.0001) 30 days after STEMI, whereas higher levels were observed for IL-4 (p = 0.001) and IL-10 (p < 0.0001) at that time point. Conversely, no changes were detected for IL-6 levels (p = 0.63). The levels of high-sensitivity C-reactive protein and IL-6 correlated at baseline (rho = 0.45, p < 0.0001) and 30 days after STEMI (rho = 0.29, p = 0.009). At baseline, correlation between IL-6 levels and LVEF was also observed (rho = -0.50, p = 0.004). Conclusions During the first month post-MI, we observed a marked improvement in the balance of pro- and anti-inflammatory cytokines, except for IL-6. These findings suggest residual inflammatory risk. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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- 2020
68. Plasma Ceramides in Cardiovascular Disease Risk Stratification
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Débora L M, Junqueira, Alline, Stach, Adriano, Caixeta, Juliana, Sallum, Erika, Yasaki, Jeane, Tsutsui, Edgar, Rizatti, Carlos E, Rochitte, Ching-Jianhong, Jean-Paul, Kovalik, José E, Krieger, A Mark, Richards, Mark Y, Chan, and Leonardo P de, Carvalho
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Cardiovascular Diseases ,Risk Factors ,Humans ,Ceramides ,Risk Assessment ,Biomarkers ,Plaque, Atherosclerotic - Abstract
Ceramide production takes place throughout the body and plays a key role in the maintenance of normal physiology. However, ceramide levels are altered during disease states, particularly considering the development of diabetes and dyslipidemia. Ceramide production is also associated with atherosclerotic plaque instability. Recent studies revealed that patients with unstable coronary artery disease (CAD) presented increased plasma ceramide levels (especially C16, C18, and C24:1). These molecules are currently considered emerging biomarkers of cardiovascular diseases (CVD), being used for predicting atherosclerotic plaque instability and adverse cardiovascular events independently from traditional risk factors. With the aim of describing and discussing the role of ceramides in the stratification of cardiovascular diseases, this narrative review contextualizes the importance of this biomarker in the present cardiology scenario.A produção de ceramida ocorre em todo o corpo e desempenha um papel importante na manutenção da fisiologia normal. No entanto, os níveis de ceramidas são alterados em estados de doença, principalmente durante o desenvolvimento de diabetes e dislipidemia. A produção de ceramidas também está associada à instabilidade das placas ateroscleróticas. Estudos recentes revelam que pacientes com doença arterial coronariana instável apresentam níveis plasmáticos aumentados de ceramidas (principalmente C16, C18 e C24:1). Atualmente, são consideradas biomarcadores emergentes nas doenças cardiovasculares, sendo utilizadas na predição de instabilidade da placa aterosclerótica e eventos cardiovasculares adversos de forma independente aos fatores de risco tradicionais. Com o objetivo de descrever e discutir o papel das ceramidas na estratificação das doenças cardiovasculares, o desenvolvimento desta revisão narrativa contextualiza a importância desse biomarcador no cenário atual da cardiologia.
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- 2020
69. Primary percutaneous coronary intervention in the oldest-old age: clinical outcomes and predictors of in-hospital mortality in nonagenarians patients with ST-segment elevation myocardial infarction
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Pedro A. Lemos, B. O. Almeida, Marcelo Franken, J. Mariani Junior, Adriano Caixeta, Fábio Augusto Pinton, Guy F. A. Prado, Cristiano Guedes Bezerra, and C M Campos
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medicine.medical_specialty ,In hospital mortality ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Infarction ,medicine.disease ,Oldest old ,Reperfusion therapy ,Internal medicine ,medicine ,Cardiology ,ST segment ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Killip class - Abstract
Introduction Owing to the ageing of the population, nonagenarian patients are increasingly present in catheterization laboratories, part of them with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in patients with STEMI, provided it can be performed promptly. However, elderly patients are usually excluded from clinical trials and few data are available about nonagenarians referred for primary PCI. Purpose The aim of the present study was to evaluate clinical characteristics and in-hospital outcomes of nonagenarians STEMI patients undergoing primary PCI. Methods We retrospectively analyzed clinical, angiographic and in-hospital outcomes of death, re-infarction and stroke of primary PCI in nonagenarian STEMI patients, included in the Brazilian PCI Registry (CENIC) between June 2006 and March 2016. Predictors of in-hospital mortality of this population were determined through multivariate analysis. Results Over a period of 10 years, 847 nonagenarians were enrolled in the CENIC Registry, and 252 presented with STEMI and underwent a primary PCI. The population was predominantly female (55.2%), with a median age of 92 years (interquartile range 4 years, maximum of 105 years) and 63.9% in Killip class I at admission. Median door-to-balloon time was 90±60 minutes. Double or triple-vessel disease was found in 63%. It was used 1.3 stent per patient, 8.9% drug-eluting stents. The femoral access route was preferred in 82.1% of patients and glycoprotein IIb/IIIa inhibitors was given to 9.9%. In-hospital mortality in the period was 10.7% and re-infarction occurred in 0.5%. No cases of stroke have been reported. The only predictor of hospital mortality was Killip class (OR 7.1, 95% CI 2.7–18.5, p Conclusion In a real-world setting, primary PCI in nonagenarian STEMI patients can be performed with good clinical outcomes and acceptable in-hospital mortality rate and must be recommended even in oldest-old age patients. Killip class was the only predictor of in-hospital mortality in this population. Funding Acknowledgement Type of funding source: None
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- 2020
70. Evaluation of clinical features and metrics of care in women with st-elevation myocardial infarction treated in a pharmaco-invasive strategy network
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J.G Souza, G.M.M Coelho, P I M Moraes, A Galhardo, P.M Veloso, Adriano Caixeta, A.S Terencio, E.P Batista, M.A Moritz, E. S. Melo, L.N Gioia, J M A Souza, Iran Gonçalves, Adriano Henrique Pereira Barbosa, and A.O.S Fragoso
- Subjects
medicine.medical_specialty ,Invasive strategy ,St elevation myocardial infarction ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Despite worse cardiovascular outcomes, including higher mortality, reported in women with acute myocardial infarction, it is uncertain whether these differences can be explained by a discordant risk profile between genders. Objective To compare clinical data and metrics of care between women and men diagnosed with ST elevation myocardial infarction (STEMI). Methods We analyzed 2723 consecutive STEMI patients, of whom 29.8% (811) were women, treated in a regional network from March-2010 to December-2019, first seen in primary hospitals, where they received fibrinolysis (96% tenecteplase), and then systematically transferred to a tertiary center for cardiac catheterization (pharmaco-invasive strategy). Categorical variables were compared using chi-square test and numerical variables expressed as median and interquartile range and compared using Mann-Whitney test. A binary logistic regression model was developed to determine whether female gender was an independent predictor of mortality. Results Compared to men, women were older (60 [53–69] x 56 [49–63] years; p Conclusion After adjusting for risk variables, female gender was not related to higher in-hospital mortality in STEMI patients treated with pharmaco-invasive strategy. However, women had a higher cardiovascular risk profile compared to men and worse metrics of care, including greater delay in reperfusion therapy. Funding Acknowledgement Type of funding source: None
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- 2020
71. Distal Transradial Access (dTRA) for Coronary Angiography and Interventions: A Quality Improvement Step Forward?
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Marcos Danillo P, Oliveira and Adriano, Caixeta
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Radial Artery ,Humans ,Arterial Occlusive Diseases ,Coronary Angiography ,Quality Improvement - Abstract
Distal TRA is a novel access site in the interventional cardiology field, with current data demonstrating high success and infrequent complication rates - global procedural metrics that are comparable with historical proximal TRA. Distal TRA may conversely provide important advantages over proximal TRA, including patient comfort, shorter hemostasis time, and lower radial artery occlusion rates.
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- 2020
72. Drug-Eluting Stents for Everyone: Is the Price Worth It?
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Marcos Danillo P, Oliveira, Vanessa, Teich, and Adriano, Caixeta
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Unified Health System (SUS ,Cost-Benefit Analysis ,Artigo Original ,Myocardial Infarction ,Intervenção Coronária Percutânea ,Drug-Eluting Stents ,Reestenose Coronária ,Coronary Reestenosis ,Análise de Custo e Benefício ,Sistema Único de Saúde (SUS ,Coronary Restenosis ,Percutaneous Coronary Intervention ,Stents Farmacológicos ,Humans ,Original Article ,Public Health ,Infarto do Miocárdio ,Brazil - Abstract
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)
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- 2020
73. Prognostic role of neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing to pharmaco-invasive strategy
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Fernando Tavares, Adriano Caixeta, Iran Gonçalves, Marcos Danillo Peixoto Oliveira, P I M Moraes, Eduardo M. Santos, José Marconi Souza, Francisco Antonio Helfenstein Fonseca, Valdir Ambrósio Moisés, Carlos Vinícius A. Espírito Santo, Adriano Henrique Pereira Barbosa, Henrique Tria Bianco, and José Augusto Marcondes
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medicine.medical_specialty ,Neutrophils ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Internal medicine ,Fibrinolysis ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Lymphocytes ,Neutrophil to lymphocyte ratio ,education ,education.field_of_study ,business.industry ,fungi ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Prognosis ,Confidence interval ,Treatment Outcome ,Population study ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
OBJECTIVES We sought to determine the relationship between in-hospital mortality and the neutrophil-to-lymphocyte ratio (NLR) in patients with ST-elevation myocardial infarction (STEMI) undergoing with pharmaco-invasive strategy (PIS). BACKGROUND Increased levels of white blood cells have been associated with adverse clinical outcomes in patients with (STEMI). NLR has recently emerged as a potent and more specific prognostic marker in predicting short- and long-term mortalityin patients undergoing primary percutaneous coronary intervention. This association has never been reported in patients managed with PIS. METHODS Between March 2010 and October 2016, 1860 STEMI patients managed with PIS were consecutively included in a dedicated database. The study population was divided into tertiles based on the admission NLR values (lower
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- 2020
74. Short- and Midterm Adherence to Platelet P2Y12 Receptor Inhibitors After Percutaneous Coronary Intervention With Drug-Eluting Stents
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Marcelo Katz, Adriano Caixeta, Antonio Eduardo Pesaro, Fernando Morita, Marcelo Franken, Miguel Morita Fernandes-Silva, Mauricio Wajngarten, and Pedro A. Lemos
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Drug ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,media_common.quotation_subject ,Adhesion (medicine) ,Comorbidity ,030204 cardiovascular system & hematology ,Medication Adherence ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Platelet ,030212 general & internal medicine ,Prospective Studies ,media_common ,Aged ,Pharmacology ,Aged, 80 and over ,Smokers ,business.industry ,Coronary Thrombosis ,Smoking ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Cardiology ,Purinergic P2Y Receptor Antagonists ,Platelet aggregation inhibitor ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
Introduction/Objectives: In patients who have undergone recent percutaneous coronary intervention (PCI), poor adhesion to antiplatelet agents may increase the risk of stent thrombosis and death. We aimed to investigate the adherence to different P2Y12 receptor inhibitors after PCI with drug-eluting stent in stable and unstable patients and to evaluate the factors associated with low adherence. Method: In a prospective study conducted between 2014 and 2018, the 8-item Morisky scale was applied at 30 days and 6 months post-PCI to measure P2Y12 receptor inhibitors adherence. Also, we describe the characteristics of patients using different platelet receptor P2Y12 inhibitors. Regression models were used to identify predictors of poor adherence. Results: A total of 214 patients were included (65 ± 12 years, 81% man, 61% acute coronary syndromes). Patients in the clopidogrel group were older than those in the prasugrel (68 ± 12 vs 59 ± 11 years, P < .01, respectively) or ticagrelor group (68 ± 12 vs 62 ± 12 years, P < .01). Patients with low/moderate adherence at 30 days and 6 months represented, respectively, 19.8% and 27.5% of our sample. Current smokers and preexisting cardiovascular disease at presentation were associated with lower adherence at 30 days. Conclusions: We found substantial rates of moderate and low adherence to P2Y12 receptor inhibitors early after PCI. Current smokers and preexisting cardiovascular disease at presentation were associated with a lower likelihood of adherence. These results highlight the need of monitoring adherence to medical treatment after PCI.
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- 2020
75. Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves
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Stefano Salizzoni, Massimo Napodano, Marina Urena, Matti Adam, Ran Kornowski, Sabine Bleiziffer, Martin B. Leon, Axel Unbehaun, Lars Søndergaard, Stephan Windecker, Patrizia Presbitero, Giuseppe Bruschi, Andreas Holzamer, Elaine E. Tseng, Antonio J. Muñoz-García, Marco Barbanti, Anna Sonia Petronio, Mauricio G. Cohen, Holger Eggebrecht, John G. Webb, Alessandro Iadanza, Matjaz Bunc, Asim N. Cheema, Konstantinos Spargias, Malek Kass, Ariel Finkelstein, Jan Malte Sinning, Marco Agrifoglio, Claudia Fiorina, Vincent Auffret, Alison Duncan, Didier Champagnac, Christian Frerker, Magdalena Erlebach, Matheus Simonato, Henrik Nissen, Janarthanan Sathananthan, Piotr Chodor, Rui Campante Teles, Francesco Saia, Didier Tchetche, Robert C. Welsh, Anuj Gupta, Brian Whisenant, Josep Rodés-Cabau, Abdelhakim Allali, Danny Dvir, Vicenç Serra, Timm Ubben, Matteo Montorfano, Luis Nombela Franco, Moritz Seiffert, Won-Keun Kim, Alfredo Giuseppe Cerillo, Stefan Stortecky, Antonio Landi, Marco Ancona, Harindra C. Wijeysundera, Ole De Backer, Adriano Caixeta, David Roberts, Jan Gummert, Verena Veulemans, Antonio Dager, Luca Testa, Lars Oliver Conzelmann, Joachim Schofer, Armin Zittermann, Stephen Brecker, Mohamed Abdel-Wahab, Katia Orvin, Stéphane Noble, Tanja K. Rudolph, Philippe Pibarot, and Azeem Latib
- Subjects
Male ,medicine.medical_specialty ,Transcatheter aortic ,610 Medicine & health ,Reintervention ,TAVR ,030204 cardiovascular system & hematology ,Aortic valve-in-valve ,SAPIEN valve ,Severe prosthesis-patient mismatch ,Prosthesis Design ,Bioprosthetic valve ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Long term outcomes ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Aorta ,business.industry ,Hazard ratio ,Mean age ,Aortic Valve Stenosis ,Confidence interval ,Prosthesis Failure ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods and results A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
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- 2020
76. Contrast-Induced Nephropathy in patients submitted to percutaneous coronary intervention: an integrative review
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Cassiane Dezoti da Fonseca, Angélica Gonçalves Silva Belasco, Matheus Santos Moitinho, Dulce Aparecida Barbosa, Adriano Caixeta, and Eduesley Santana Santos
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Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,medicine.medical_treatment ,RT1-120 ,030232 urology & nephrology ,Contrast-induced nephropathy ,Contrast Media ,Nursing ,Review ,030204 cardiovascular system & hematology ,Nephropathy ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,General Nursing ,business.industry ,Incidence ,Incidence (epidemiology) ,Percutaneous coronary intervention ,Acute Kidney Injury ,Ascorbic acid ,medicine.disease ,Clinical trial ,Sodium Bicarbonate ,Balloon Coronary Angioplasty ,Kidney Diseases ,business - Abstract
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.
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- 2020
77. 1186 Three-dimensional analysis of right ventricle strain in transplanted hearts and rejection: an ongoing prospective study
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Samira Saady Morhy, TR Afonso, C G Monaco, Act Rodrigues, Rcpld Costa, Edgar Bezerra de Lira-Filho, Adriano Caixeta, Claudio Henrique Fischer, and Mlc Vieira
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Heart transplantation ,medicine.medical_specialty ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Strain (injury) ,General Medicine ,Stroke volume ,medicine.disease ,Transplant rejection ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Rejection (Psychology) ,Cardiology and Cardiovascular Medicine ,business ,Prospective cohort study - Abstract
Background The main obstacle for success after heart transplantation is graft rejection, since is mainly asymptomatic and diagnosed by endomyocardial biopsy (EMB). New echocardiographic technologies could bring benefits to that population if subtle changes in heart mechanics were related to an incipient state of rejection. Purpose To quantify echocardiographic parameters of right ventricle strain and volumes by a semi-automated offline software and to identify the presence of any relation between those findings and the histopathologic diagnose of rejection. Methods a prospective cohort of 35 postoperative heart transplant patients who were submitted to echocardiographic evaluation up to six hours after EMB, including two-dimensional chamber quantification of left ventricular (LV) volumes and ejection fraction; conventional and tissue Doppler measurements were used for flow and functional analysis. Offline assessment of the right ventricle (RV) was made by TOMTEC software, with the acquisition of RV volumes (EDV, ESV, SV) and ejection fraction, TAPSE, FAC and three-dimensional(3D) RV free wall and septal strain using speckle tracking. EMB results were classified as positive for cellular rejection if graded as 2R (two or more interstitial infiltrate spots and myocyte damage) and positive for humoral rejection if they show any response by immunofluorescence assay. Results We studied 35 patients, aged 50 ±11, 21 male (67%), totaling 58 examinations, and then we made two analysis of EMB: one in two groups regarding cellular rejection (53 negative and 5 positive) and other regarding humoral rejection (50 negative and 8 positive). RVEDV was higher in the cellular rejection group (112,5 ± 29,6 ml) compared to those with negative biopsy (86,8 ± 24,7 mL; p = 0,01). RV stroke volume showed a similar behavior (53,5 ± 22,3 mL vs. 34,5 ± 11,3 mL; p < 0,01). Regarding humoral rejection by immunofluorescence, patients who tested positive showed lower RVEDV (79,5 ± 10,5 mL vs. 90,57 ± 27,31 mL; p = 0,02) and RVESV (45,53 ± 6,33 mL vs. 53,87 ± 19,87 mL; p = 0,01). RV free wall strain was lower in the group with positive immunofluorescence (-18,35 ± 2,79% vs. -15,34 ± 5,35%; p = 0,01). Regarding 2D measurements , interventricular septal (11,5 ± 1,06 mm vs. 10,56 ± 1,38 mm; p = 0,02) and left ventricular posterior wall (10,75 ± 1,03 mm vs. 10,04 ± 1,1 mm; p = 0,05) were also thicker in the group with positive immunofluorescence for rejection. Conclusion Both cellular and humoral rejection after heart transplantation are associated to increased 3D RV volumes whereas a decrease in RV free wall strain is only observed in humoral rejection; in patients with positive immunofluorescence results a significant increase is seen for septal and posterior wall thickness.
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- 2020
78. INTERVENÇÃO PERCUTÂNEA E REVASCULARIZAÇÃO MIOCÁRDICA NO PACIENTE COM DM - ELEMENTOS QUE DEVEM SER CONSIDERADOS
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Adriano Caixeta, Epm. Setor de Cardiologia Invasiva, São Paulo, Sp, Brasil, Adriano Henrique Pereira Barbosa, and Marco Tulio Souza
- Subjects
General Earth and Planetary Sciences ,General Environmental Science - Published
- 2018
79. Stem-cell therapy in ST-segment elevation myocardial infarction with reduced ejection fraction: A multicenter, double-blind randomized trial
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Anis Rassi, Remo H.M. Furtado, João B M C Moraes, Antonio Carlos Carvalho, Carlos E. Rochitte, Edgard Quintella, Adrian P M Korman, Hélio José Castello, Costantino R Costantini, Adriano Caixeta, MiHeart, Suzana A. Silva, Marco A Mattos, Jose C. Nicolau, Hans F. Dohmann, and Ami Investigators
- Subjects
Adult ,Male ,BETA-BLOQUEADORES ,medicine.medical_specialty ,Acute coronary syndrome ,Heart Ventricles ,medicine.medical_treatment ,Clinical Investigations ,Diastole ,Magnetic Resonance Imaging, Cine ,Infarction ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Internal medicine ,Angioplasty ,medicine ,Humans ,ST segment ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Ventricular remodeling ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Stroke Volume ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,cardiovascular system ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Stem Cell Transplantation - Abstract
Background Left ventricular ejection fraction (LVEF) is a major determinant of long-term prognosis after ST-segment elevation myocardial infarction (STEMI). STEMI patients with reduced LVEF have a poor prognosis, despite successful reperfusion and the use of renin-angiotensin-aldosterone inhibitors. Hypothesis Intracoronary infusion of bone marrow-derived mononuclear cells (BMMC) may improve LVEF in STEMI patients successfully reperfused. Methods The main inclusion criteria for this double-blind, randomized, multicenter study were patient age 30 to 80 years, LVEF ≤50%, successful angioplasty of infarct-related artery, and regional dysfunction in the infarct-related area analyzed before cell injection. Cardiac magnetic resonance imaging was used to assess LVEF, left ventricular volumes, and infarct size at 7 to 9 days and 6 months post-myocardial infarction. Results One hundred and twenty-one patients were included (66 patients in the BMMC group and 55 patients in the placebo group). The primary endpoint, mean LVEF, was similar between both groups at baseline (44.63% ± 10.74% vs 42.23% ± 10.33%; P = 0.21) and at 6 months (44.74% ± 12.95 % vs 43.50 ± 12.43%; P = 0.59). The groups were also similar regarding the difference between baseline and 6 months (0.11% ± 8.5% vs 1.27% ± 8.93%; P = 0.46). Other parameters of left ventricular remodeling, such as systolic and diastolic volumes, as well as infarct size, were also similar between groups. Conclusions In this randomized, multicenter, double-blind trial, BMMC intracoronary infusion did not improve left ventricular remodeling or decrease infarct size.
- Published
- 2018
80. PLASTIA VALVAR MITRAL COM MITRACLIPMR: SELECAO DE PACIENTES, TECNICA DE IMPLANTE E RESULTADOS CLINICOS
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Fabio Sandoli de Brito Junior, C M Campos, Breno Oliveira Almeida, Pedro A. Lemos, Adriano Caixeta, Marcelo L. C. Vieira, José Mariani Junior, Leonardo Guimaraes, and Claudio Henrique Fischer
- Subjects
General Earth and Planetary Sciences ,General Environmental Science - Published
- 2017
81. P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial
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Diego Silveira, Leonardo de Freitas C. Guimarães, Bruno Robalinho C. Barbosa, Antonio Eduardo Pesaro, Adriano Caixeta, Cristiano Freitas de Souza, Gregg W. Stone, Felipe José de Andrade Falcão, Antonio Carlos de Camargo Carvalho, Francisco Antonio Helfenstein Fonseca, Claudia Maria Rodrigues Alves, and Philippe Généreux
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medicine.medical_specialty ,Prasugrel ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Clopidogrel ,Loading dose ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Randomized controlled trial ,law ,Pharmacodynamics ,Internal medicine ,Fibrinolysis ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,medicine.drug - Abstract
Background A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y 12 assay at 0, 2, 6, and 24h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively ( p =0.24). The values of PRU decreased significantly from baseline to 2h (all p p Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y 12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.
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- 2017
82. Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study
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Antonio Carlos Carvalho, Gary S. Mintz, Cristiano Freitas de Souza, Adriano Caixeta, Mitsuaki Matsumura, Akiko Maehara, and Claudia Maria Rodrigues Alves
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Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Lumen (anatomy) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Culprit ,Lesion ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Image Interpretation, Computer-Assisted ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Non-ST Elevated Myocardial Infarction ,Vascular Calcification ,Pathological ,Ultrasonography, Interventional ,Aged ,Rupture, Spontaneous ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Fibrosis ,Plaque, Atherosclerotic ,Phenotype ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives We sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP-IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high-risk acute coronary syndromes. Background There are limited data on plaque tissue characterization and phenotype classification using iMAP-IVUS. Methods In the iWonder study patients presenting with ST-elevation myocardial infarction (STEMI) or non-STEMI underwent three-vessel grayscale IVUS and iMAP-IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit (n = 100) and nonculprit (n = 285) lesions. Lesion phenotype was classified as (i) thin-cap fibroatheroma (iMAP-derived TCFA); (ii) thick-cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. Results Culprit lesions had smaller minimum lumen cross-sectional area (MLA) with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P
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- 2017
83. P2269IABP-SHOCK II risk score validation for cardiogenic shock after myocardial infarction in a cohort treated with pharmaco-invasive therapy
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Antonio Carlos Carvalho, Adriano Henrique Pereira Barbosa, G Kanhouche, Marco Tulio Souza, Adriano Caixeta, J P Cardoso, P I M Moraes, Suzi Emiko Kawakami, Iran Gonçalves, Claudia Maria Rodrigues Alves, C H Ramon, L P M Santos, J R B Arero, Antonio Celio Camargo Moreno, and A Galhardo
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medicine.medical_specialty ,Framingham Risk Score ,business.industry ,Cardiogenic shock ,medicine.disease ,Internal medicine ,Shock (circulatory) ,Cohort ,medicine ,Cardiology ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Risk stratification using scores is a valuable tool in cardiogenic shock after ST elevation myocardial infarction (STEMI). During pharmacoinvasive therapy (PIT) their use is unexplored in the literature. Objective: To validate the IABP-SHOCK II (Intra-aortic Balloon Pump in Cardiogenic Shock) score in patients treated with PIT and to analyze the influence of ischemia time on the different risk strata. Methods and results Of 2,143 STEMI patients seen between May 2010 and April 2017, 212 (9.9%) developed cardiogenic shock. Thirty-one patients (14.6%) with incomplete data were excluded from the analysis and the validation cohort included the remaining 181. Mortality rates were similar between the analyzed and excluded patients (42.5% and 45.1% respectively, p=0.77). The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62), and 76% for high-risk (n=25) (p 30-day mortality in scored strata Conclusion In patients with cardiogenic shock after STEMI treated with PIT, risk stratification using the IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterization times on the ability to the score model stratification.
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- 2019
84. Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy
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Marco Tulio Souza, Antonio Carlos Carvalho, Iran Gonçalves, Adriano Henrique Pereira Barbosa, Cláudia Rodrigues Alves, Suzi Emiko Kawakami, Adriano Caixeta, P I M Moraes, and Antonio Celio Camargo Moreno
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medicine.medical_specialty ,Framingham Risk Score ,business.industry ,Cardiogenic shock ,cardiogenic shock ,Ischemia ,Tenecteplase ,Coronary Artery Disease ,risk stratification ,medicine.disease ,reperfusion ,STEMI ,St elevation myocardial infarction ,Internal medicine ,Shock (circulatory) ,Cohort ,Risk stratification ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,thrombolytic therapy - Abstract
ObjectiveTo validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.MethodsWe analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0–2), moderate (3–4) or high (5–9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.ResultsCardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (pConclusionsIn patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.
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- 2019
85. Coronary Stent Fracture: Still a Cause of Stent Failure
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Vitor, Pazolini, Carlos, Campos, and Adriano, Caixeta
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Adult ,Coronary Restenosis ,Male ,Chest Pain ,Percutaneous Coronary Intervention ,Humans ,Drug-Eluting Stents ,Coronary Artery Disease ,Coronary Angiography ,Prosthesis Design ,Coronary Vessels ,Tomography, Optical Coherence ,Prosthesis Failure - Abstract
In the present case, multimodality images facilitated our understanding of the mechanism behind the patient's restenosis; a technique using optical coherence tomography with three-dimensional reconstruction allowed the clear identification and extent of stent fracture as well as its subsequent optimal treatment.
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- 2019
86. A Dispersão do Intervalo QT Regional como Preditor Precoce de Reperfusão em Pacientes com Infarto Agudo do Miocárdio Pós-terapia Fibrinolítica
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Maria Cristina de Oliveira Izar, Flavio T. Moreira, Antonio Carlos Carvalho, Gabriel Dotta, Luiz Fernando Muniz Pinheiro, Francisco Antonio Helfenstein Fonseca, Adriano Henrique Pereira Barbosa, Rui Póvoa, Adriano Caixeta, Marco Tulio Souza, and Henrique Tria Bianco
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Adult ,Male ,medicine.medical_specialty ,Infarto do Miocárdio com Supradesnível do Segmento ST ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Treatment outcome ,Intervenção Coronária Percutânea ,Myocardial Reperfusion ,030204 cardiovascular system & hematology ,Coronary Angiography ,QT interval ,Statistics, Nonparametric ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Fibrinolytic Agents ,Reference Values ,St elevation myocardial infarction ,medicine ,Humans ,Thrombolytic Therapy ,In patient ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Reperfusão Miocárdica ,Aged ,Gynecology ,Myocardial reperfusion ,business.industry ,Myocardial Perfusion Imaging ,Reproducibility of Results ,Eletrocardiografia ,Middle Aged ,medicine.disease ,Treatment Outcome ,Biomarcadores ,ROC Curve ,lcsh:RC666-701 ,Reference values ,Tenecteplase ,ST Elevation Myocardial Infarction ,Female ,Fibrinolytic therapy ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. Results: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis. Resumo Fundamento: Pacientes com infarto do miocárdico com elevação do segmento-ST atendidos em centros de atendimento primário e tratados de acordo com a estratégia fármaco-invasiva são submetidos à fibrinólise seguida de coronariografia em período de 2-24h. Neste cenário, o conhecimento de marcadores de reperfusão como a redução em 50% do segmento-ST é fundamental. Objetivo: Analisar o desempenho da dispersão do intervalo QT em adição aos critérios clássicos, como marcador precoce de reperfusão pós-terapia trombolítica. Métodos: Estudo observacional com a inclusão de 104 pacientes tratados com tenecteplase (TNKase) e referenciados a hospital de atendimento terciário. A análise dos eletrocardiogramas (ECG) consistiu em mensuração do intervalo QT e sua dispersão nas 12 derivações, e também apenas na região com supradesnivelamento-ST antes e 60min pós-TNKase. A angiografia foi realizada em todos os pacientes com obtenção do fluxo TIMI e Blush da artéria culpada. Foram considerados significantes valores de p < 0,05. Resultados: Observamos aumento da dispersão do intervalo QT, corrigido pela frequência cardíaca, regional (dQTcR) 60min pós-lise (p = 0,006) em infartos de parede anterior nos casos com fluxo TIMI 3 e Blush 3 [T3B3(+)]. Adicionando a dQTcR ao critério ECG (redução do ST > 50%) de reperfusão, a área sob a curva aumentou para 0,87 [(0,78-0,96), IC95%, p < 0,001] em pacientes com fluxo coronário T3B3(+). Nos pacientes com critério de ECG para reperfusão e dQTcR > 13 ms a sensibilidade e especificidade foram 93% e 71%, respectivamente, para reperfusão em T3B3(+), possibilitando reclassificar 6% dos pacientes com sucesso de reperfusão. Conclusão: Os dados sugerem a dQTcR como instrumento promissor na identificação não invasiva de reperfusão na artéria coronária culpada, 60min pós-trombólise.
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- 2019
87. Gender-related differences on short- and long-term outcomes of patients undergoing transcatheter aortic valve implantation
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Fábio Sândoli de Brito, Pedro Alves Lemos Neto, Marco Antonio Perin, Rogério Sarmento-Leite, Adriano Dias Dourado Oliveira, Alexandre C. Abizaid, Rogerio Tadeu Tumelero, Luiz Eduardo Koenig São Thiago, Flávio Tarasoutchi, Marcos Antonio Marino, Adriano Caixeta, Luiz A. Carvalho, Marcelo Katz, and Antonio Carlos Bacelar Nunes Filho
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COPD ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Proportional hazards model ,Renal function ,General Medicine ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,Gender related ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Aortic valve stenosis ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study aimed to compare gender-related differences in outcomes of patients undergoing TAVI over a long-term follow-up period. Background Transcatheter aortic valve implantation (TAVI) has been considered the standard therapy for patients with inoperable or high-risk symptomatic aortic stenosis. The influence of gender-related differences in outcomes of patients undergoing TAVI is currently on debate. Methods From January 2008 to January 2015, 819 patients (49% men) underwent TAVI and were included in a multicenter Brazilian registry. Patients were followed-up and clinical outcomes were evaluated according to the updated Valve Academic Research Consortium-2 criteria. Results Mean follow-up was 497 ± 478 days. Compared with women, men had a lower rate of major or life-threatening bleeding (12.0% vs. 20.6%; HR = 0.57 [95CI% 0.40–0.81]; P = 0.001), and major vascular complications (6% vs. 11.7%; HR = 0.50 [95CI% 0.31–0.82]; P = 0.004). At 30 days, all-cause mortality was lower in men than in women (6.5% vs. 11.5%; P = 0.013), however, cumulative all-cause mortality was similar between groups (25.9% vs. 29.7%, men and women, respectively, HR = 0.92 [95CI% 0.71–1.19]; P = 0.52) over the entire follow-up period. By adjusted Cox regression model, renal function, diabetes, peripheral artery disease, and chronic obstructive pulmonary disease (COPD) remained independently predictors of all-cause mortality. Conclusions In this large-scale study evaluating patients undergoing TAVI, 30-day mortality was higher among women than men driven by significant higher rates of major or life-threatening bleeding and major vascular complications. However, all-cause mortality on long-term follow-up was similar between groups. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
88. Diagnostic Accuracy of Several Electrocardiographic Criteria for the Prediction of Atrioventricular Nodal Reentrant Tachycardia
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Lucas Bassolli de Oliveira-Alves, Jose Marconi Almeida-de-Sousa, Ênia Lúcia-Coutinho, Ântonio Carlos-Carvalho, Juliana Filgueiras Medeiros, Adriano Caixeta, Fábio Martins Nardo-Botelho, Lucas Hollanda-Oliveira, Ângelo Amato Vicenzo-de-Paola, Cristiano de Oliveira Dietrich, Lara Cristina Felix-Bernardes, and Claudio Cirenza
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Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Adolescent ,Diagnostic accuracy ,Paroxysmal supraventricular tachycardia ,030204 cardiovascular system & hematology ,Narrow QRS complex ,Sensitivity and Specificity ,Electrocardiography ,Young Adult ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Heart Conduction System ,Internal medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Medicine ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Child ,Aged ,business.industry ,Female sex ,General Medicine ,Middle Aged ,Ecg findings ,Child, Preschool ,Multivariate Analysis ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,business - Abstract
Background and Aims Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (SVT) whose diagnosis can be strongly suspected based on the surface eletrocardiogram alone. The purpose of this study is to determine the diagnostic accuracy of several electrocardiographic (ECG) criteria for the prediction of AVNRT. Methods Between November 2010 and January 2014, a total of 256 patients who underwent electrophysiological testing (EP) with regular, paroxysmal and narrow QRS complex tachycardia were prospectively enrolled. We classified the ECG recordings during tachycardia for the presence of the following criteria: a) classical ECG findings of pseudo S wave in inferior leads and/or pseudo r′ wave in lead V1, b) notch in lead aVL, c) no retrograde P waves visible during tachycardia; d) pseudo r′ wave in lead aVR, e) notch in lead D1, f) any deflection after 100 ms of the QRS complex during tachycardia. Results On multivariate analysis, independent predictors of AVNRT diagnosis were female sex (OR 4.17; 95% CI [2.11–8.24]; p 60 years (OR 3.53; 95% CI [1.25–9.96]; p = 0.017) and the classical ECG criteria (OR 7.41; 95% CI [3.62–15.17]; p Conclusions Female, age >60 years and the classical ECG criteria were the independent predictors of AVNRT diagnosis. Although several of the ECG criteria for AVNRT diagnosis showed acceptable sensitivities and specificities, they do not improve its accuracy.
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- 2016
89. Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients
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Daniel Born, M. Santos, Marcelo José de Carvalho Cantarelli, Rosaly Gonçalves, Júlio César Machado Andréa, Fabio Sandoli de Brito, Áurea Chaves, Claudia Maria Rodrigues Alves, Hélio R. Figueira, Walter Beneduzzi Fiorotto, Maria Eduarda Menezes de Siqueira, Adriano Caixeta, Jamil Cade, Gilberto Szarf, Leandro Santini Echenique, Manuel Pereira Marques Gomes, Marco Antonio Perin, Augusto Daige, Harvey S. Hecht, Bárbara P. Freitas, and Juliana Filgueiras Medeiros
- Subjects
Adult ,medicine.medical_specialty ,Databases, Factual ,Computed Tomography Angiography ,Coronary Vessel Anomalies ,medicine.medical_treatment ,Pregnancy Complications, Cardiovascular ,Gestational Age ,030204 cardiovascular system & hematology ,Coronary Angiography ,Circumflex branch of left coronary artery ,Multimodal Imaging ,Risk Assessment ,Sampling Studies ,Tertiary Care Centers ,Coronary artery disease ,03 medical and health sciences ,Coronary artery bypass surgery ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Left coronary artery ,Pregnancy ,medicine.artery ,Internal medicine ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hospital Mortality ,Vascular Diseases ,030212 general & internal medicine ,Myocardial infarction ,Ultrasonography, Interventional ,Retrospective Studies ,medicine.diagnostic_test ,Unstable angina ,business.industry ,Postpartum Period ,Pregnancy Outcome ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. Conclusion In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
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- 2016
90. SAVEME (Myocardial Salvage After Rescue Angioplasty: Evaluation by Magnetic Resonance) Study: Rationale and Study Design
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Ana Carolina Correa de Souza, José Marconi Almeida de Sousa, Thiago Pouso Oliveira, Eryca Vanessa Santos de Jesus, Marly Uellendahl, Claudia Maria Rodrigues Alves, Adriano Caixeta, Luiz F. Ybarra, Antônio Célio Camargos Moreno, Adriano Henrique Pereira Barbosa, Marco Tulio Souza, and Antônio Carlos Camargo de Carvalho
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Mortality rate ,Percutaneous coronary intervention ,Context (language use) ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,surgical procedures, operative ,Cardiac magnetic resonance imaging ,Internal medicine ,Angioplasty ,Conventional PCI ,Cardiology ,Medicine ,cardiovascular diseases ,Myocardial infarction ,business - Abstract
Introduction Atherosclerotic disease accounts for one-third of deaths annually, as it often leads to complications such as ST-elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (PCI) is indicated in case of thrombolytic therapy failure administered in this scenario. However, the benefits regarding mortality rate reduction and the amount of myocardium that is actually salvaged are not well established. The development of new tools, including cardiac magnetic resonance imaging, to identify the myocardium at risk and the infarcted area has increased diagnostic accuracy. Differently from the context of primary PCI, little is known about the association between epicardial and microvascular coronary flow following rescue PCI and the salvaged myocardial area. The aim of this study is to evaluate whether there is an association between coronary flow and the salvaged myocardial area identified by magnetic resonance imaging. Methods This will be a prospective, open, single-center, intervention study. A total of 72 patients with STEMI who underwent rescue PCI after documented failure of the fibrinolytic therapy, and were transferred to our institution, will be selected, observing a pharmacoinvasive strategy. Conclusions At the end of this study, the authors expect to contribute to the knowledge about coronary flow and its association with the amount of salvaged cardiac muscle after rescue PCI. This type of information that can help to understand which cases can benefit the most from rescue PCI.
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- 2016
91. Estudo SAVEME (Salvamento Miocárdico Após Angioplastia de Resgate: Avaliação por Ressonância Magnética). Racional e desenho do estudo
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Claudia Maria Rodrigues Alves, Adriano Henrique Pereira Barbosa, Marco Tulio Souza, Antônio Carlos Camargo de Carvalho, Luiz F. Ybarra, Marly Uellendahl, Antônio Célio Camargos Moreno, Adriano Caixeta, Eryca Vanessa Santos de Jesus, José Marconi Almeida de Sousa, Thiago Pouso Oliveira, and Ana Carolina Correa de Souza
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03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine - Abstract
RESUMO Introducao A doenca aterosclerotica e responsavel por um terco dos obitos ocorridos anualmente, pois frequentemente leva a complicacoes como infarto do miocardio com supradesnivelamento do segmento ST (IMCST). A intervencao coronaria percutânea (ICP) de resgate e indicada caso ocorra falha da terapia trombolitica administrada neste cenario. No entanto, os beneficios, em termos de reducao da taxa de mortalidade e da quantidade de miocardio efetivamente salvo, nao sao bem estabelecidos. O desenvolvimento de novas ferramentas, entre elas a ressonância magnetica cardiaca, para identificar a area miocardica em risco e infartada, elevou a acuracia diagnostica. Diferentemente do contexto da ICP primaria, pouco se sabe sobre a relacao entre o fluxo coronario epicardico e microvascular apos a ICP de resgate e a area de miocardio salva. O objetivo deste estudo e avaliar se existe relacao entre tais fluxos e a area de miocardio salva identificada pela ressonância magnetica. Metodos Estudo prospectivo, aberto, unicentrico, de intervencao. Serao selecionados 72 pacientes com IMCST que tiverem realizado ICP de resgate apos falha documentada da terapia fibrinolitica transferidos para este servico, obedecendo uma estrategia farmaco‐invasiva. Conclusoes Ao termino desta pesquisa, esperamos contribuir para o conhecimento sobre o fluxo coronariano e sua relacao com a quantidade de musculo cardiaco salvo apos a ICP de resgate. Esta e uma informacao que pode ajudar a entender quais casos mais se beneficiam da ICP de resgate.
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- 2016
92. Midventricular type of Takotsubo (stress) cardiomyopathy concurrent to severe coronary vasospasm
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Marcos Danillo Peixoto Oliveira and Adriano Caixeta
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medicine.medical_specialty ,business.industry ,Internal medicine ,Coronary vasospasm ,medicine ,Cardiomyopathy ,Cardiology ,General Medicine ,medicine.disease ,business - Published
- 2020
93. IVUS-guided DK-crush left anterior descending-diagonal complex bifurcation PCI via redo distal transradial access
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Adriano Caixeta, Marcos Danillo Peixoto Oliveira, and Ednelson Cunha Navarro
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medicine.medical_specialty ,business.industry ,Internal medicine ,Conventional PCI ,Diagonal ,medicine ,Cardiology ,General Medicine ,business ,Bifurcation - Published
- 2020
94. Myocardial bridging mimicking Wellens’ syndrome
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Adriano Caixeta, Gustavo Lemos Pederçole, Renato Buchalla Barbar Cury, Marcela Armelin Moritz, and Marcos Danillo Peixoto Oliveira
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medicine.medical_specialty ,Myocardial bridging ,business.industry ,Internal medicine ,Wellens' syndrome ,medicine ,Cardiology ,General Medicine ,medicine.disease ,business - Published
- 2020
95. Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography
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Robert, Jackson, Abtehale, Al-Hussaini, Shiju, Joseph, Gijs, van Soest, Alice, Wood, Fernando, Macaya, Nieves, Gonzalo, Jamil, Cade, Adriano, Caixeta, Ota, Hlinomaz, Pavel, Leinveber, Peter, O'Kane, Marcos, García-Guimaraes, Bernardo, Cortese, Nilesh J, Samani, Javier, Escaned, Fernando, Alfonso, Thomas, Johnson, and David, Adlam
- Subjects
Adult ,Male ,Coronary Vessel Anomalies ,Vasa Vasorum ,Middle Aged ,Vascular Remodeling ,Prognosis ,Coronary Vessels ,Europe ,Predictive Value of Tests ,Humans ,Female ,Registries ,Vascular Diseases ,Tomography, Optical Coherence ,Retrospective Studies - Abstract
This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL.SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood.A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases.In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. -1.9%; p 0.05) and a larger FL area (73.6% vs. 53.2%, respectively; p 0.05) in dissected segments. No significant differences were found between vasa vasorum density in SCAD and those in control subjects. The FL contents were heterogeneous but attenuated less light than whole blood or thrombus (4.28 ± 0.55 mmThese observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing.
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- 2018
96. In-stent restenosis in the drug-eluting stent era
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Jaya Chandrasekhar, Adriano Caixeta, Philippe Généreux, George Dangas, and Roxana Mehran
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equipment and supplies - Abstract
Since the inception of percutaneous coronary intervention, restenosis has been considered a significant problem. Although drug-eluting stents (DES) have reduced rates of in-stent restenosis (ISR) compared with bare metal stents across all lesion subsets, ISR has not been abolished. DES efficacy has been limited by suboptimal polymer biocompatibility, efficacy of pharmacological agents, in vivo pharmacokinetic properties, and local drug resistance and toxicity. While the first two DES to be manufactured (sirolimus- and paclitaxel-eluting stents) have the longest clinical follow-up, extensive data are now also available on zotarolimus- and everolimus-eluting stents. The uptake of biolimus-eluting stents has recently increased in clinical practice. Although the low frequency of DES ISR makes it difficult to investigate this condition fully, many studies have examined the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.
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- 2018
97. P1651Elevated non-high-density lipoprotein cholesterol levels are associated with an increased inflammatory response following elective percutaneous coronary intervention
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Pedro A. Lemos, Marcelo Katz, Fabio G Pitta, Adriano Caixeta, Carlos V. Serrano, Aep Pesaro, FR Mattos, and Fabiana Rached
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Non high density lipoprotein cholesterol ,Cardiology ,medicine ,Percutaneous coronary intervention ,Increased inflammatory response ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
98. P5599Prognostic role of neutrophil to lymphocyte ratio ST-elevation acute myocardial infarction undergoing pharmacoinvasive strategy
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G F Cintra, Adriano Caixeta, Claudia Maria Rodrigues Alves, José Augusto Marcondes de Souza, Fernando Tavares, G R F Santos, Adriano Henrique Pereira Barbosa, José Marconi Almeida de Sousa, Fah Fonseca, and Acc Carvalho
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,ST elevation ,medicine ,Cardiology ,Myocardial infarction ,Neutrophil to lymphocyte ratio ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2018
99. Initial experience with the use of fractional flow reserve in the hemodynamic evaluation of transplant renal artery stenosis
- Author
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José Osmar Medina Pestana, Marcelo Costa Batista, Adriano Caixeta, Antonio Carlos Carvalho, Claudia Maria Rodrigues Alves, Manuel Pereira Marques Gomes Junior, and Adriano Henrique Pereira Barbosa
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Male ,Time Factors ,Computed Tomography Angiography ,medicine.medical_treatment ,Vasodilator Agents ,Hemodynamics ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Severity of Illness Index ,0302 clinical medicine ,Renal Artery ,Papaverine ,030212 general & internal medicine ,fractional flow reserve ,Computed tomography angiography ,medicine.diagnostic_test ,angioplasty ,renal artery obstruction ,General Medicine ,Middle Aged ,Treatment Outcome ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,Renal Artery Obstruction ,kidney transplantation ,Hyperemia ,Renal Circulation ,03 medical and health sciences ,Predictive Value of Tests ,medicine.artery ,Internal medicine ,Angioplasty ,Catheterization, Peripheral ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Renal artery ,business.industry ,Reproducibility of Results ,medicine.disease ,Kidney Transplantation ,Stenosis ,Blood pressure ,business ,Angioplasty, Balloon - Abstract
ObjectiveTo describe and standardize an original protocol for fractional flow reserve (FFR) pre and postangioplasty in an initial series of patients with clinically manifested transplant renal artery stenosis (TRAS). BackgroundThere is no data in the literature about the use of FFR in TRAS. MethodsPatients with TRAS detected in a noninvasive study were referred to diagnostic angiography and stenosis considered visually severe ( 60%) were included. After selective cannulation, a PressureWire 0.014 (CertusSt. Jude Medical) was advanced to the distal portion of the vessel. Resting Pd/Pa ratio (ratio of mean distal to lesion and mean proximal pressures) and translesional systolic pressure gradient were obtained and FFR and hyperemic translesional systolic and mean pressure gradients (HSG and HMG) were registered after papaverine induced maximum hyperemiapre and poststent implantation. Creatinine levels and office blood pressure measurements were registered at the baseline, 6 and 12months after intervention. ResultsTen consecutive patients had successful stent implantation and were included. After treatment, significant increase in FFR (0.760.09 vs. 0.96 +/- 0.04, P
- Published
- 2018
100. Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America
- Author
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Salo Vinocur Coslovsky, Renato Kawahisa Levin, Paulo Hilário Nascimento Saldiva, Marcelo Katz, Carolina Pereira, Antonio Eduardo Pesaro, Marcelo Franken, and Adriano Caixeta
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Male ,Latin Americans ,Myocardial Infarction ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Geographical locations ,0302 clinical medicine ,Medicine and Health Sciences ,Public and Occupational Health ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Prospective cohort study ,lcsh:Science ,Aged, 80 and over ,Multidisciplinary ,Age Factors ,Temperature ,Middle Aged ,Pollution ,Hospitals ,Hospitalization ,Engineering and Technology ,Female ,Seasons ,Brazil ,Research Article ,Adult ,medicine.medical_specialty ,Environmental Engineering ,HOSPITALIZAÇÃO ,Cardiology ,Young Adult ,03 medical and health sciences ,Sex Factors ,medicine ,Humans ,Decompensation ,cardiovascular diseases ,Cities ,Aged ,Retrospective Studies ,Heart Failure ,Hospitals, Public ,business.industry ,Public health ,Winter ,lcsh:R ,Retrospective cohort study ,South America ,Seasonality ,medicine.disease ,Health Care ,Health Care Facilities ,Heart failure ,Earth Sciences ,lcsh:Q ,People and places ,business ,Demography - Abstract
Background In high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America. Methods This was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates. Findings The highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p
- Published
- 2018
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