195 results on '"Carlos M. Campos"'
Search Results
102. CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTIONS IN LATIN AMERICA: CHARACTERISTICS, OUTCOMES AND PREDICTORS OF UNSUCCESSFUL PROCEDURES
- Author
-
Sandra Baradel, Antônio José Muniz, Pedro Piccaro de Oliveira, Anibal P. Abelin, Cleverson N Zukowski, Antonio Carlos Botelho, Carlos M. Campos, Alexandre Schaan de Quadros, Julia Kurtz Teixeira, Lucio Padilla, Franklin Hanna, Pablo Lamelas, Mario Araya, Karlyse Belli, Daniel Weillenmann, Marcelo Leite Ribeiro, Fábio Sândoli de Brito, Luiz F. Ybarra, Joao De Paula, Marcelo José de Carvalho Cantarelli, and Ricardo Santiago-Trinidad
- Subjects
medicine.medical_specialty ,surgical procedures, operative ,Percutaneous ,Latin Americans ,business.industry ,Emergency medicine ,Conventional PCI ,medicine ,Psychological intervention ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Total occlusion - Abstract
Percutaneous coronary interventions (PCI) in chronic total occlusions (CTO) have been increasingly performed worldwide, but there is a paucity of data on procedures performed in Latin America An international multicenter registry was developed to collect data on CTO-PCI performed in experienced
- Published
- 2019
103. Bioresorbable Drug-Eluting Magnesium-Alloy Scaffold for Treatment of Coronary Artery Disease
- Author
-
Boris Warnack, Takashi Muramatsu, Yoshinobu Onuma, Carlos M. Campos, Javaid Iqbal, Yao-Jun Zhang, Hector M. Garcia-Garcia, Michael Haude, Pedro A. Lemos, Patrick W. Serruys, and Cardiology
- Subjects
Drug ,medicine.medical_specialty ,Scaffold ,Paclitaxel ,medicine.medical_treatment ,media_common.quotation_subject ,Review ,magnesium ,Catalysis ,Inorganic Chemistry ,Coronary artery disease ,lcsh:Chemistry ,Restenosis ,SDG 3 - Good Health and Well-being ,medicine ,Alloys ,drug-eluting stent ,Humans ,Physical and Theoretical Chemistry ,Magnesium alloy ,Molecular Biology ,lcsh:QH301-705.5 ,Spectroscopy ,media_common ,Sirolimus ,Antibiotics, Antineoplastic ,business.industry ,Organic Chemistry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,bioresorbable scaffold ,medicine.disease ,Computer Science Applications ,Surgery ,bioabsorbable ,lcsh:Biology (General) ,lcsh:QD1-999 ,Drug-eluting stent ,biodegradable ,business ,Bioresorbable scaffold ,coronary artery disease - Abstract
The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothelialization and healing process resulting in late persistent or acquired malapposition of the permanent metallic implant. Delayed endotheliaization and malapposition may lead to late and very late stent thrombosis. Bioresorbable scaffolds (BRS) have been introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Magnesium is an essential mineral needed for a variety of physiological functions in the human body and its bioresorbable alloy has the strength-to-weight ratio comparable with that of strong aluminum alloys and alloy steels. The aim of this review is to present the new developments in Magnesium BRS technology, to describe its clinical application and to discuss the future prospects of this innovative therapy.
- Published
- 2013
104. Extensive spontaneous coronary dissection with favorable evolution maintained under conservative treatment
- Author
-
Carlos M. Campos, Pedro A. Lemos, Breno de Alencar Araripe Falcão, Expedito E. Ribeiro, José Mariani, and Marcos Danillo Peixoto Oliveira
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Hemodynamics ,General Medicine ,Pathophysiology ,Surgery ,Conservative treatment ,Internal medicine ,medicine ,Cardiology ,Etiology ,Presentation (obstetrics) ,business ,Adverse effect ,Coronary dissection - Abstract
Spontaneous coronary dissection is a rare entity and, therefore, its etiology, pathophysiology, and treatment are not yet established. It affects mainly young women without the classic cardiovascular risk factors, commonly during the pregnancy-childbirth cycle. Several factors influence the treatment strategy, such as clinical presentation, hemodynamic status, topography, number of affected arteries, and distal coronary flow. As in the reported case, in stable patients with well-defined dissections and mainly when the coronary flow has been re-established, one can choose a conservative approach, due to the high incidence of spontaneous resolution and low incidence of long-term adverse events.
- Published
- 2015
105. Extensa dissecção coronária espontânea com boa evolução clínica mantida sob tratamento conservador
- Author
-
José Mariani, Marcos Danillo Peixoto Oliveira, Carlos M. Campos, Breno de Alencar Araripe Falcão, Expedito E. Ribeiro, and Pedro A. Lemos
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Coronary disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
RESUMO A disseccao coronaria espontânea e uma entidade rara e, por conseguinte, de etiologia, fisiopatologia e tratamento ainda nao estabelecidos. Acomete, em geral, mulheres jovens, sem os classicos fatores de risco cardiovascular, comumente ao longo do ciclo gravidico‐puerperal. Varios fatores influenciam na estrategia de tratamento, como quadro clinico, status hemodinâmico, topografia da disseccao, numero de arterias afetadas e fluxo coronario distal. Como no caso relatado, em pacientes estaveis, com disseccoes bem delimitadas e, sobremodo, quando o fluxo coronario e reestabelecido, pode‐se optar por uma abordagem conservadora, em razao da alta incidencia de resolucao espontânea e da baixa incidencia de eventos adversos a longo prazo.
- Published
- 2015
106. Transcatheter aortic valve update 2013
- Author
-
Javaid Iqbal, Osama Ibrahim Ibrahim Soliman, Carlos M. Campos, Nicolas M. Van Mieghem, Christos V. Bourantas, and Patrick W. Serruys
- Subjects
Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Aortic Valve Stenosis ,Equipment Design ,Prosthesis Failure ,Stroke ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Internal medicine ,Cardiology ,Humans ,Effective treatment ,Medicine ,Operative risk ,Cardiology and Cardiovascular Medicine ,business ,Symptomatic aortic stenosis - Abstract
Cumulative evidence has demonstrated that transcatheter aortic valve implantation (TAVI) constitutes an effective treatment option for patients with severe symptomatic aortic stenosis and a high operative risk. New valve designs and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, and broadened the applications of this treatment. The global adoption of TAVI allows us to appreciate the advantages, potentialities and caveats of the technology, identify patients who would benefit from TAVI and stratify more accurately the risk of complications. The focus of this article is to discuss the advances in this field, present the current evidence, and highlight the developments and strategies proposed to address the limitations of TAVI treatment.
- Published
- 2013
107. Long term follow-up of drug eluting versus bare metal stents in the treatment of saphenous vein graft lesions
- Author
-
Stephen G. Ellis, Antonio Helio Garcia Pozetti, Roberto Kalil-Filho, Henrique Barbosa Ribeiro, Luiz F. Ybarra, Carlos M. Campos, Expedito E. Ribeiro, Rodrigo Barbosa Esper, Augusto C. Lopes, and Pedro A. Lemos
- Subjects
Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.medical_treatment ,Hazard ratio ,Percutaneous coronary intervention ,Stent ,General Medicine ,medicine.disease ,Confidence interval ,Surgery ,Diabetes mellitus ,medicine ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Mace ,media_common - Abstract
Introduction The safety and effectiveness of drug-eluting stent (DES) compared with bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease is controversial, especially because of the lack of long-term follow-up. The aim of this study was to address the late outcome of DES versus BMS for the treatment of SVG lesions. Methods A matched, case-control study included 82 patients in each group. Patients groups were matched by gender, age, clinical presentation, and diabetes. The primary study end point was occurrence of major adverse cardiovascular events (MACE). Secondary end points included death, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). Results Clinical and angiographic characteristics were similar between the groups. At 6 months, TVR (hazard ratio [HR] 6.12, 95% confidence interval [CI] 1.39 to 26.93, P = 0.05), and MACE (HR 2.54, 95% CI 1.08 to 5.98, P = 0.04) were higher in the BMS group. At 4 years the risks of MI (P = 0.21), TVR (P = 0.99), and MACE (P = 0.21) were similar between both groups. However, the rates of death (HR 2.74, 95% CI 1.11 to 6.74, P = 0.04) and cardiac death (HR 4.26, 95% CI 1.59 to 11.35, P = 0.01) were significantly higher in the BMS group. Conclusions These results suggest that the use of DES compared with BMS in the treatment of SVG lesions reduces TVR and MACE at 6 months of follow-up, a benefit that was lost over the next 3–4 years. © 2012 Wiley Periodicals, Inc.
- Published
- 2013
108. In-hospital outcomes of patients with cardiogenic shock due to ST-elevation myocardial infarction
- Author
-
Carlos M. Campos, Francisco Hedilberto Feitosa Filho, Luciano Nunes dos Santos, Pedro Alves Lemos Neto, and Fabio Conejo
- Subjects
Choque cardiogênico ,Intervenção coronária percutânea ,Shock, cardiogenic ,Myocardial infarction ,Infarto do miocárdio ,Inta-aortic balloon pumping ,General Medicine ,Balão intra-aórtico ,Percutaneous coronary intervention - Abstract
INTRODUÇÃO: O choque cardiogênico é uma condição clínica de inadequada perfusão tecidual devido à disfunção cardíaca. A etiologia mais comum é o infarto agudo do miocárdio com elevação do segmento ST (IMCSST) levando à insuficiência ventricular esquerda, mas também pode ser causado por complicações mecânicas, como insuficiência mitral aguda, ruptura do septo interventricular ou da parede livre do ventrículo esquerdo. Apesar dos avanços terapêuticos, a mortalidade continua elevada. MÉTODOS: Estudo retrospectivo, observacional, unicêntrico, incluindo pacientes consecutivos internados com o diagnóstico de IMCSST e choque cardiogênico, tratados por intervenção coronária percutânea (ICP), em hospital terciário especializado em cardiologia. O objetivo primário foi avaliar os desfechos clínicos hospitalares. RESULTADOS: Foram incluídos 78 pacientes, a maioria do sexo masculino (67,9%), com idade de 67,5 ± 13,4 anos e 41,0% diabéticos. ICP primária foi realizada em 46,2% dos pacientes, ICP de resgate em 25,6% e ICP eletiva em 28,2% dos casos. As artérias mais frequentemente acometidas foram a descendente anterior e a coronária direita, com 44,9% cada uma. O balão intra-aórtico foi utilizado em 32,1% e os inibidores da glicoproteína IIb/IIIa em 30,8% dos casos. A incidência de insuficiência renal aguda foi de 61,5%. A necessidade de reintervenção ocorreu em 9,0%, e a taxa de trombose aguda/subaguda foi de 3,8%. Óbito, no choque cardiogênico, ocorreu em 46,2%. CONCLUSÕES: O choque cardiogênico permanece uma entidade frequente e grave, com quase 50% de mortalidade hospitalar, apesar da evolução na terapêutica instituída atualmente. BACKGROUND: Cardiogenic shock is a clinical condition of inadequate tissue perfusion due to cardiac dysfunction. The most common etiology is ST-segment elevation myocardial infarction (STEMI) leading to left ventricular failure, but it may also be caused by mechanical complications such as acute mitral regurgitation, ventricular septal rupture or rupture of the left ventricular free wall. Despite therapeutic advances, mortality rates remain high. METHODS: Retrospective, observational, single-center study, including consecutive patients admitted with a diagnosis of STEMI and cardiogenic shock treated by percutaneous coronary intervention (PCI) at a tertiary hospital specialized in cardiology. The primary objective was to evaluate in-hospital clinical outcomes. RESULTS: A total of 78 patients were included, most of them were male (67.9%), mean age was 67.5 ± 13,4 years and 41.0% were diabetic. Primary PCI was performed in 46.2% of the patients, rescue PCI in 25.6% and elective PCI in 28.2% of the cases. The most frequently involved arteries were the left anterior descending artery and the right coronary artery, with 44.9% each. Intra-aortic balloon pump was used in 32.1% of cases and glycoprotein IIb/IIIa inhibitors in 30.8% of the cases. The incidence of acute renal failure was 61.5%. The need for reintervention was observed in 9.0% and the rate of acute/subacute thrombosis was 3.8%. Death due to cardiogenic shock was observed in 46.2%. Conclusions: Cardiogenic shock remains a frequent and serious condition with almost 50% of in-hospital mortality despite the therapeutic advances.
- Published
- 2013
109. Influence of lesion location on late clinical outcomes after percutaneous coronary intervention in saphenous vein grafts
- Author
-
Carlos M. Campos, Henrique Barbosa Ribeiro, Marco Antonio Perin, Breno de Alencar Araripe Falcão, Cristiano Guedes Bezerra, Vitor de Andrade Vahle, Eduardo França Pessoa de Melo, Pedro Alves Lemos Neto, Roberto Kalil Filho, and Expedito Eustáquio Ribeiro da Silva
- Subjects
medicine.medical_specialty ,Veia safena ,medicine.medical_treatment ,Population ,Percutaneous coronary intervention ,Lesion ,Internal medicine ,medicine ,Bare metal ,Myocardial infarction ,education ,Distal anastomosis ,Intervenção coronária percutânea ,Doença das coronárias ,Coronary disease ,education.field_of_study ,business.industry ,Mortality rate ,Saphenous vein ,General Medicine ,medicine.disease ,Surgery ,Cardiology ,Stents ,medicine.symptom ,business ,Mace - Abstract
INTRODUÇÃO: A evolução tardia de pacientes submetidos à intervenção coronária percutânea em enxertos de veia safena (ICP-Saf) é pouco discutida na literatura, havendo, inclusive, controvérsias sobre a influência da localização da estenose (em posição aorto-ostial ou no corpo do enxerto). MÉTODOS: Registro unicêntrico, que incluiu pacientes submetidos à ICP-Saf, entre os anos de 2006 e 2011. A lesão aorto-ostial foi definida como aquela localizada nos primeiros 8 mm do enxerto; as lesões de corpo foram as localizadas nas porções remanescentes. Foram excluídas as intervenções que abordaram somente a anastomose distal ou o leito coronário nativo. Foram avaliadas as taxas de eventos cardíacos adversos maiores (ECAM), óbito, infarto agudo do miocárdio (IAM) ou revascularização do vaso-alvo (RVA) entre os grupos. RESULTADOS: Foram avaliados 195 pacientes, sendo 69 no Grupo Óstio e 126 no Grupo Corpo. A média de idade da população total foi de 69,6 ± 10,2 anos, 41% dela era diabética, e 65,1% apresentaram síndromes coronárias agudas, sendo a maioria tratada com stents convencionais (82,5%). Não houve diferença entre os grupos na maioria das características estudadas. No seguimento tardio, a taxa de RVA (50,8% vs. 22%; P = 0,03) foi maior no Grupo Óstio. As taxas de ECAM (67,7% vs. 63,3%; P = 0,33), morte (31,7% vs. 35,6%; P = 0,95) e IAM (55% vs. 42%; P = 0,64) foram semelhantes entre os grupos. CONCLUSÕES: Essa população compôs um subgrupo de risco elevado, com alta mortalidade tardia, independentemente da localização da lesão no enxerto. Em pacientes tratados predominantemente com stents não farmacológicos, lesões aorto-ostiais apresentaram maior taxa de reintervenção em relação às lesões de corpo. BACKGROUND: Little is known about the late clinical outcomes of patients undergoing saphenous vein graft percutaneous coronary intervention (SVG-PCI), and there are controversies regarding the role of lesion location (aorto-ostial or graft body). METHODS: Single-center registry including patients undergoing SVG-PCI between 2006 and 2011. Aorto-ostial lesion was defined as a lesion within the first 8 mm of the graft; graft body lesion was defined as a lesion located in the remaining portions of the graft. Interventions approaching only the distal anastomosis or the native coronary bed were excluded. We evaluated the rates of major adverse cardiac events (MACE), death, myocardial infarction (MI), and target vessel revascularization (TVR) between the groups. RESULTS: One hundred and ninety-five patients were evaluated, 69 in the Aorto-Ostial Group and 126 in the Graft Body Group. Mean age was 69.6 ± 10.2 years, 41% were diabetic, 65.1% had acute coronary syndromes and most of them were treated with bare metal stents (82.5%). There was no statistical difference between groups for most of the characteristics evaluated. In the late follow-up, the TVR rate (50.8% vs. 22%; P = 0.03) was greater in the Aorto-Ostial Group. The MACE rate (67.7% vs. 63.3%; P = 0.33), death (31.7% vs. 35.6%; P = 0.95) and MI (55% vs. 42%; P = 0.64) were similar between the two groups. CONCLUSIONS: This population included a high-risk subgroup, with high late mortality rates, regardless of the location of the lesion in the graft. In patients treated predominantly by bare-metal stents, aorto-ostial lesions had a higher reintervention rate when compared to graft body lesions.
- Published
- 2013
110. Clinical Outcome after Percutaneous Coronary Intervention in Patients with Prior Renal Transplantation
- Author
-
Eduardo França Pessoa de Melo, Flávio Jota de Paula, André Gasparin Spadaro, Fabio Trentin, Pedro Alves Lemos Neto, Carlos Vinicius Abreu do Espírito Santo, L.H.W. Gowdak, William C. Nahas, José Jayme Galvão de Lima, and Carlos M. Campos
- Subjects
medicine.medical_specialty ,Angioplastia ,medicine.medical_treatment ,Kidney transplantation ,Coronary artery disease ,Internal medicine ,medicine ,cardiovascular diseases ,Coronary disease ,Doença das coronárias ,business.industry ,Mortality rate ,Angioplasty ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Surgery ,Transplantation ,surgical procedures, operative ,Transplante de rim ,Conventional PCI ,Cardiology ,Stents ,business ,Cardiology and Cardiovascular Medicine ,Mace ,Kidney disease - Abstract
Background Coronary artery disease is a major cause of death in patients with chronic kidney disease. Moreover, due to the high prevalence of risk factors for atherosclerosis, many of these patients require percutaneous coronary intervention (PCI) even after renal transplantation. The aim of this study is to report the late follow-up of patients with renal transplantation treated with PCI and stenting. Methods Patients > 18 years of age, with prior kidney transplantation, and treated with PCI were included. Clinical follow-up was evaluated by medical record analysis and telephone contact. The study endpoint was the incidence of major adverse cardiac events (MACE) during follow-up. Results Twenty-nine patients were included. Mean age was 54.8 ± 8 years and the majority male (72.4%). The prevalence of hypertension was 89.7%, dyslipidemia 69% and diabetes 51.7%. Most of them had multivessel disease (2-vessel: 44.8%; 3-vessel: 41.4%). Lesion complexity was high, being 84.3% type B2 or C lesions and 27.5% bifurcation lesions. Procedural success rate was 100%. Bare metal stents were used in 96.6% of cases. The follow-up time was 1,378 ± 977 days. The mortality rate was 25.1%, target vessel revascularization rate was 15.9% and none of the patients presented nonfatal infarction. The incidence of MACE during follow-up was 34.5%. Conclusions Late follow-up after PCI in renal transplantation patients demonstrated a high probability of clinical events. However, the study population was a sample of high clinical and angiographic complexity.
- Published
- 2013
- Full Text
- View/download PDF
111. In-hospital Outcomes of Patients with Cardiogenic Shock due to ST-Segment Elevation Myocardial Infarction
- Author
-
Fabio Conejo, Luciano Nunes dos Santos, Pedro Alves Lemos Neto, Carlos M. Campos, and Francisco Hedilberto Feitosa Filho
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Percutaneous coronary intervention ,Ventricular Septal Rupture ,medicine.artery ,Internal medicine ,medicine ,cardiovascular diseases ,Myocardial infarction ,Choque cardiogênico ,Intervenção coronária percutânea ,business.industry ,Cardiogenic shock ,Mortality rate ,Infarto do miocárdio ,General Medicine ,medicine.disease ,Thrombosis ,Surgery ,Shock, cardiogenic ,Right coronary artery ,Conventional PCI ,Cardiology ,Inta-aortic balloon pumping ,Cardiology and Cardiovascular Medicine ,business ,Balão intra-aórtico - Abstract
Background Cardiogenic shock is a clinical condition of inadequate tissue perfusion due to cardiac dysfunction. The most common etiology is ST-segment elevation myocardial infarction (STEMI) leading to left ventricular failure, but it may also be caused by mechanical complications such as acute mitral regurgitation, ventricular septal rupture or rupture of the left ventricular free wall. Despite therapeutic advances, mortality rates remain high. Methods Retrospective, observational, single-center study, including consecutive patients admitted with a diagnosis of STEMI and cardiogenic shock treated by percutaneous coronary intervention (PCI) at a tertiary hospital specialized in cardiology. The primary objective was to evaluate in-hospital clinical outcomes. Results A total of 78 patients were included, most of them were male (67.9%), mean age was 67.5 ± 13,4 years and 41.0% were diabetic. Primary PCI was performed in 46.2% of the patients, rescue PCI in 25.6% and elective PCI in 28.2% of the cases. The most frequently involved arteries were the left anterior descending artery and the right coronary artery, with 44.9% each. Intra-aortic balloon pump was used in 32.1% of cases and glycoprotein IIb/ IIIa inhibitors in 30.8% of the cases. The incidence of acute renal failure was 61.5%. The need for reintervention was observed in 9.0% and the rate of acute/subacute thrombosis was 3.8%. Death due to cardiogenic shock was observed in 46.2%. Conclusions Cardiogenic shock remains a frequent and serious condition with almost 50% of in-hospital mortality despite the therapeutic advances.
- Published
- 2013
- Full Text
- View/download PDF
112. Influence of Lesion Location on Late Clinical Outcomes after Percutaneous Coronary Intervention in Saphenous Vein Grafts
- Author
-
Henrique Barbosa Ribeiro, Pedro Alves Lemos Neto, Breno de Alencar Araripe Falcão, Carlos M. Campos, Roberto Kalil Filho, Vitor de Andrade Vahle, Cristiano Guedes Bezerra, Expedito Eustáquio Ribeiro da Silva, Marco Antonio Perin, and Eduardo França Pessoa de Melo
- Subjects
medicine.medical_specialty ,Veia safena ,medicine.medical_treatment ,Population ,Vein graft ,Percutaneous coronary intervention ,Lesion ,Internal medicine ,medicine ,Bare metal ,Myocardial infarction ,education ,education.field_of_study ,Coronary disease ,Intervenção coronária percutânea ,Doença das coronárias ,business.industry ,Mortality rate ,General Medicine ,Saphenous vein ,medicine.disease ,Surgery ,Cardiology ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Background Little is known about the late clinical outcomes of patients undergoing saphenous vein graft percutaneous coronary intervention (SVG-PCI), and there are controversies regarding the role of lesion location (aorto-ostial or graft body). Methods Single-center registry including patients undergoing SVG-PCI between 2006 and 2011. Aorto-ostial lesion was defined as a lesion within the first 8 mm of the graft; graft body lesion was defined as a lesion located in the remaining portions of the graft. Interventions approaching only the distal anastomosis or the native coronary bed were excluded. We evaluated the rates of major adverse cardiac events (MACE), death, myocardial infarction (MI), and target vessel revascularization (TVR) between the groups. Results One hundred and ninety-five patients were evaluated, 69 in the Aorto-Ostial Group and 126 in the Graft Body Group. Mean age was 69.6 ± 10.2 years, 41% were diabetic, 65.1% had acute coronary syndromes and most of them were treated with bare metal stents (82.5%). There was no statistical difference between groups for most of the characteristics evaluated. In the late follow-up, the TVR rate (50.8% vs. 22%; P = 0.03) was greater in the Aorto-Ostial Group. The MACE rate (67.7% vs. 63.3%; P = 0.33), death (31.7% vs. 35.6%; P = 0.95) and MI (55% vs. 42%; P = 0.64) were similar between the two groups. Conclusions This population included a high-risk subgroup, with high late mortality rates, regardless of the location of the lesion in the graft. In patients treated predominantly by baremetal stents, aorto-ostial lesions had a higher reintervention rate when compared to graft body lesions.
- Published
- 2013
- Full Text
- View/download PDF
113. Angiographic assessment of aortic regurgitation by video-densitometry in the setting of TAVI: Echocardiographic and clinical correlates
- Author
-
Mohammad, Abdelghani, Hiroki, Tateishi, Yosuke, Miyazaki, Rafael, Cavalcante, Osama I I, Soliman, Jan G, Tijssen, Robbert J, de Winter, Jan, Baan, Yoshinobu, Onuma, Carlos M, Campos, Rogério S, Leite, José A, Mangione, Alexandre, Abizaid, Pedro A, Lemos, Fabio S, de Brito, and Patrick W, Serruys
- Subjects
Aged, 80 and over ,Male ,Aortic Valve Insufficiency ,Reproducibility of Results ,Aortography ,Severity of Illness Index ,Echocardiography, Doppler, Color ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,ROC Curve ,Predictive Value of Tests ,Aortic Valve ,Area Under Curve ,Humans ,Female ,Registries ,Brazil ,Aged ,Densitometry ,Retrospective Studies - Abstract
We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI).AR after TAVI is common but challenging to quantitate, especially in the cath-lab.In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video-densitometric analysis of aortograms. Contrast time-density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT-AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region.LVOT-AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none-trace, mild and moderate-severe post-TAVI AR as defined by echocardiography (P 0.001) and a cutpoint of0.17 corresponded to moderate-severe AR on echocardiography (area under the curve = 0.84). At follow-up (median, 496 days), patients with LVOT-AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95-148] vs. 140 [112-169] g/mLVOT-AR 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.
- Published
- 2016
114. Spatial:Frequency Approach to Fibrous Tissue Classification in Intracoronary Optical Images
- Author
-
Pedro A. Lemos, Pedro Felipe Gomes Nicz, Marco Antonio Gutierrez, Carlos M. Campos, and Maysa M. G. Macedo
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Computer science ,Fibrous cap ,02 engineering and technology ,Lateral resolution ,Fibrous tissue ,01 natural sciences ,Imaging modalities ,Visualization ,010309 optics ,medicine.anatomical_structure ,Optical coherence tomography ,0103 physical sciences ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,020201 artificial intelligence & image processing ,Arterial wall ,Spatial frequency ,Radiology ,Biomedical engineering - Abstract
Increased understanding about the mechanisms of coronary thrombosis in humans has been limited by the lack of imaging modalities with resolution sufficient to characterize fibrous cap tissue and determine its thickness in vivo. Intravascular optical coherence tomography (IOCT) provides images with micrometer axial (10–15 μm) and lateral resolution (40μm), enabling detailed visualization of micro-structural changes of the arterial wall. This article describes a fully automated method for identification and quantification of fibrous tissue in IOCT human coronary images based on spatial-frequency analysis by means Short-Time Fourier transform. Forty IOCT frames from nine IOCT in-vivo datasets were annotated by an expert and used to evaluate the proposed fibrous tissue characterization method.
- Published
- 2016
115. Rationale and design of the SYNTAX II trial evaluating the short to long-term outcomes of state-of-the-art percutaneous coronary revascularisation in patients with de novo three-vessel disease
- Author
-
Nicola Ryan, Vasim Farooq, Arie-Pieter Kappetein, Gerrit-Anne van Es, David P. Taggart, Yuki Ishibashi, Javier Escaned, Rafael Cavalcante, Bojan Stanetic, Carlos M. Campos, Yoshinobu Onuma, Patrick W. Serruys, Adrian P. Banning, Marie-Angèle Morel, Pannipa Suwannasom, Mauro Echavarria-Pinto, Cardiology, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Fractional flow reserve ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Time ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Angioplasty ,Coronary stent ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Aged ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,humanities ,Clinical trial ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims The applicability of the results of the SYNTAX trial comparing percutaneous coronary intervention (PCI) using first-generation drug-eluting stents (DES) with coronary artery bypass graft (CABG) surgery for the treatment of patients with complex coronary artery disease (CAD) has been challenged by recent major technical and procedural developments in coronary revascularisation. Functional assessment of coronary lesions has contributed to marked improvements in both safety and efficacy of DES implantation. In addition, the recent development of the SYNTAX score II, a clinical tool based on anatomical and clinical factors, allows individualised objective decision making regarding the optimal revascularisation modality in patients with complex CAD. The ongoing SYNTAX II trial is currently evaluating the effectiveness of the clinical and technological advances in the treatment of patients with complex (de novo three-vessel) CAD. Methods and results The SYNTAX II trial is a multicentre, all-comers, open-label, single-arm trial aiming to recruit 450 patients with de novo three-vessel CAD in approximately 25 European interventional cardiology centres. All patients will be selected and treated following the SYNTAX II strategy, which includes: a) establishing the appropriateness of revascularisation utilising the SYNTAX score II as a clinical tool to allow objective decision making by the Heart Team, b) ischaemia-driven revascularisation based on functional intracoronary assessment, c) implantation of the new-generation everolimus-eluting platinum chromium coronary stent with thin struts and abluminal bioabsorbable polymer coating to promote rapid vessel healing, d) intravascular ultrasound-guided DES implantation, and e) treatment at centres with expertise in CTO recanalisation. The primary endpoint is a composite of the major adverse cardiac and cerebral events (MACCE) rate at one-year follow-up compared to the historical PCI arm of the SYNTAX trial. An exploratory endpoint will be MACCE at five-year follow-up compared to the historical surgical arm of the SYNTAX trial. Conclusions The SYNTAX II trial will provide valuable information on outcomes of state-of-the-art PCI for the contemporary management of complex (de novo three-vessel) CAD. SYNTAX II will be of critical value in the design of future trials in this arena.
- Published
- 2016
116. Intravascular imaging comparison of two metallic limus-eluting stents abluminally coated with biodegradable polymers: IVUS and OCT results of the DESTINY trial
- Author
-
Alexandre Abizaid, Mauricio Prudente, Carlos M. Campos, Daniel Chamié, Expedito E. Ribeiro, J. Ribamar Costa, Pedro A. Lemos, George C. Meireles, Ricardo Costa, and Juliana P. Castro
- Subjects
medicine.medical_specialty ,Time Factors ,Polymers ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Neointima ,Absorbable Implants ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Ultrasonography, Interventional ,High rate ,Sirolimus ,business.industry ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,equipment and supplies ,Biodegradable polymer ,Coronary Vessels ,Surgery ,Treatment Outcome ,Metals ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Intravascular imaging ,Tomography, Optical Coherence - Abstract
We sought to compare, by means of IVUS and OCT imaging, the performance of a novel sirolimus-eluting drug-eluting stent (DES) with biodegradable polymer (Inspiron™) to the Biomatrix™ DES. From the DESTINY trial, a total of 70 randomized patients (2:1) were enrolled in the IVUS substudy (Inspiron™, n = 46; Biomatrix™: n = 20) while 25 patients were evaluated with OCT (Inspiron™, n = 19; Biomatrix™: n = 06) at 9-month follow-up. The main endpoints were % of neointimal tissue obstruction (IVUS) and neointimal stut coverage (OCT) at 9 months. Patients treated with both DES had very little NIH formation at 9 months either by IVUS (% of NIH obstruction of 4.9 ± 4.1 % with Inspiron™ vs. 2.7 ± 2.9 % with Biomatrix™, p = 0.03) or by OCT (neointimal thickness of 144.2 ± 72.5 µm Inspiron™ vs. 115.0 ± 53.9 µm with Biomatrix™, p = 0.45). Regarding OCT strut-level assessment, again both devices showed excellent 9-month performance, with high rates of strut coverage (99.49 ± 1.01 % with Inspiron™ vs. 97.62 ± 2.21 % with Biomatrix™, p
- Published
- 2016
117. Clinical outcomes in 995 unselected real-world patients treated with an ultrathin biodegradable polymer-coated sirolimus-eluting stent: 12-month results from the FLEX Registry
- Author
-
Jayesh Prajapati, Nikhil Parikh, Carlos M. Campos, Puneet Verma, Manjinder Singh Sandhu, Sharad R. Jain, Prakash Chandwani, Julio Flávio Meirelles Marchini, Padmakumar Ramachandran, Ashok N. Bhupali, Atul Abhyankar, Sudheer Saxena, Micheli Zanotti Galon, and Pedro A. Lemos
- Subjects
Target lesion ,Male ,medicine.medical_specialty ,Polymers ,medicine.medical_treatment ,Population ,Myocardial Infarction ,India ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,Coronary artery disease ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Neointima ,Absorbable Implants ,medicine ,Clinical endpoint ,Myocardial Revascularization ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Registries ,education ,Aged ,Sirolimus ,education.field_of_study ,Antibiotics, Antineoplastic ,business.industry ,Research ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Cardiovascular Diseases ,Female ,medicine.symptom ,business ,Tomography, Optical Coherence - Abstract
Objectives To evaluate, in the FLEX Registry, clinical outcomes of an ultrathin (60 µm) biodegradable polymer-coated Supraflex sirolimus-eluting stent (SES) for the treatment of coronary artery disease. Additionally, to determine the vascular response to the Supraflex SES through optical coherence tomography (OCT) analysis. Setting Multicentre, single-arm, all-comers, observational registry of patients who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. Participants 995 patients (1242 lesions) who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. A total of 47 participants underwent OCT analysis at 6 months’ follow-up. Interventions Percutaneous coronary intervention with Supraflex SES, Primary and secondary outcome measures The primary endpoint—the rate of major adverse cardiac events (defined as a composite of cardiac death, myocardial infarction (MI), target lesion revascularisation (TLR))—was analysed during 12 months. Results At 12 months, the primary endpoint occurred in 36 (3.7%) of 980 patients, consisting of 18 (1.8%) cardiac deaths, 16 (1.6%) MI, 7 (0.7%) TLR and 2 (0.2%) cases of non-target lesion target vessel revascularization. In a subset of 47 patients, 1227 cross-sections (9309 struts) were analysed at 6 months by OCT. Overall, a high percentage of struts was covered (98.1%), with a mean neointimal thickness of 0.13±0.06 µm. Conclusions The FLEX Registry evaluated clinical outcomes in real-world and more complex cohorts and thus provides evidence that the Supraflex SEX can be used safely and routinely in a broader percutaneous coronary intervention population. Also, the Supraflex SES showed high percentage of stent strut coverage and good stent apposition during OCT follow-up.
- Published
- 2016
118. Video densitometric assessment of aortic regurgitation after transcatheter aortic valve implantation: results from the Brazilian TAVI registry
- Author
-
Hiroki Tateishi, Lizet Bary, Marco Antonio Perin, Fabio Sandoli de Brito, José Armando Mangione, Yoshinobu Onuma, Mohammad Abdelghani, Carlos M. Campos, Osama Ibrahim Ibrahim Soliman, Pedro A. Lemos, Rogério S. Leite, Patrick W. Serruys, Ernest Spitzer, and Cardiology
- Subjects
Male ,Cardiac Catheterization ,medicine.medical_specialty ,Aortography ,Transcatheter aortic ,Aortic Valve Insufficiency ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Video densitometry ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Region of interest ,Internal medicine ,Humans ,Medicine ,Registries ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Observer Variation ,Reproducibility ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Aortic Valve Stenosis ,Ventricle outflow tract ,Treatment Outcome ,ROC Curve ,Aortic Valve ,Area Under Curve ,Heart Valve Prosthesis ,Angiography ,Cardiology ,Feasibility Studies ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Brazil ,Densitometry - Abstract
AIMS We sought to examine the feasibility and reproducibility of a new video densitometric (VD) quantification of aortic regurgitation (AR) on aortography, and its long-term clinical impact. METHODS AND RESULTS Using dedicated video densitometry software, AR after TAVI was quantified, and inter- and intra-observer reproducibility was investigated in 182 aortograms of the Brazilian TAVI registry. The aortograms were analysed using two software algorithms: 1) the quantitative regurgitation analysis (qRA) index interrogating the entire left ventricle (LV), and 2) a new method with the left ventricle outflow tract (LVOT) as a region of interest (ROI) (LVOT-AR). LVOT-AR was feasible in 64.8% vs. 29.7% of aortograms, compared with qRA index. Using the LVOT-AR, inter-observer variability was low (mean difference±standard deviation [SD]: 0.01±0.05, p=0.53), and the two observers' measurements were highly correlated (r=0.95, p 0.17 had a significantly higher one-year all-cause mortality risk compared with patients with LVOT-AR ≤0.17 (37.1% vs. 11.2%, p=0.0008). CONCLUSIONS This study proposes an alternative methodology for AR assessment after TAVI by using the LVOT method (LVOT-AR) of VD angiography. The assessment of LVOT-AR is feasible, reproducible and potentially predictive of one-year mortality.
- Published
- 2016
119. Angiogenesis between coronary grafts through the aortic wall
- Author
-
Odilson Marcos Silvestre, Carlos M. Campos, Augusto C. Lopes, Rodrigo Barbosa Esper, Fernando Bacal, Henrique Barbosa Ribeiro, Luiz F. Ybarra, and Expedito E. Ribeiro
- Subjects
medicine.medical_specialty ,Aorta ,business.industry ,medicine.disease ,Collateral circulation ,Coronary circulation ,medicine.anatomical_structure ,Coronary occlusion ,Internal medicine ,medicine.artery ,Right coronary artery ,medicine ,Cardiology ,Myocardial infarction ,Amlodipine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Artery - Abstract
Following a total coronary occlusion, residual perfusion to the myocardium persists through native coronary collateral channels. Provided that they are of adequate size, collateral circulation may protect against myocardial infarction and death [1]. However, there is tremendous individual variability in the function of those neovascularizations among patients with chronic stenosis. Thus, the detailed mechanism of collateral artery growth is still unknown in the human adult. This report describes a case of a 61-year-old man that was admitted with progressive angina (CCS III on admission) for the last 3 months. He had a previous history of hypertension, dyslipidemia and insulindependent diabetes and two surgical myocardial revascularizations performed 14 and 8 years prior to admission. Medications taken on a daily basis included atenolol, amlodipine, trimetazidine, propatylnitrate, atorvastatin, metformin and insulin. Tc-Sestamibi Scintigraphy demonstrated irreversible defect of basal-inferior wall and moderate reversible defect of anterior-apical wall, along with reduced ventricular function during exercise. Coronary angiography showed occlusion of native vessels, pervious left internal mammary graft to a marginal branch and collateral circulation (CC) grade III to right coronary artery. Moreover, there was an ostial occlusion of a free right internal thoracic artery graft (RITA) to left anterior descending artery, which had a delayed filling through CC from a saphenous vein graft (SVG) to a
- Published
- 2012
120. TCT-232 Late clinical outcomes of diabetic patients treated with a novel third-generation drug-eluting stent: Highlights from Inspiron registry
- Author
-
Expedito E. Ribeiro, Silvio Zalc, Paulo R. Soares, Celso Kiyochi Takimura, Marcus Nogueira da Gama, Antonio Euzébios Filho, Luiz J. Kajita, Pedro E. Horta, Gilberto Guilherme Ajjar Marchiori, Pedro A. Lemos, Nelson Henrique Fantin Fundão, Vinicius Seleme, José Mariani, Carlos M. Campos, and Guy F. A. Prado
- Subjects
medicine.medical_specialty ,education.field_of_study ,Clinical events ,business.industry ,medicine.medical_treatment ,Population ,Clinical performance ,Stent ,Percutaneous coronary intervention ,Third generation ,surgical procedures, operative ,Drug-eluting stent ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
Percutaneous coronary intervention (PCI) treatment is closely related to worse clinical events in diabetic patients. This study aims to evaluate the safety and efficacy clinical performance of a new drug-eluting stent (DES) in this population. Long-term evaluation of comparative results between
- Published
- 2017
121. TCT-394 Impact of Creating a Telemedicine-Guided, Population-Based, ST Elevation Myocardial Infarction (STEMI) Network on Revascularization Strategy, Cost and Mortality
- Author
-
Roberto Botelho, Cesar Dusilek, Marco Antonio Perin, Carlos M. Campos, Adam Yoculan, Rodolfo Vega, Sameer Mehta, Alex Au-Yeung, Francisco J. Fernández, Rodolfo Cardoso, Daniel A. Rodriguez, Juan Carlos Perez Alva, Mario Torres, Marco Alcocer-Gamba, and Isaac Yepes
- Subjects
medicine.medical_specialty ,Telemedicine ,business.industry ,medicine.medical_treatment ,Network on ,Developing country ,Population based ,Revascularization ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,St elevation myocardial infarction ,parasitic diseases ,Emergency medicine ,medicine ,030212 general & internal medicine ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
A telemedicine-guided strategy increases access to care and efficiency of STEMI networks. It also reduces disparities of care between developed and developing countries. Whether telemedicine modifies reperfusion rates, costs and outcomes is uncertain. Regions in Brazil, Colombia and Mexico, lacking
- Published
- 2017
122. TCT-317 Propensity Score-Matched Analysis of Operator Radiation Exposure in Percutaneous Coronary Intervention with Radial versus Femoral Approach
- Author
-
Paula Fernanda Gomes, Pedro A. Lemos, Breno Almeida, Adriano Caixeta, Ivanise Gomes, Stella Marinelli Pedrini, Fabio Sandoli de Brito, Marco Tulio Souza, Marcelo Franken, José Mariani, Ana Leoncio, and Carlos M. Campos
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Radiation exposure ,surgical procedures, operative ,Operator (computer programming) ,Femoral access ,Internal medicine ,Propensity score matching ,Conventional PCI ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Data regarding operator radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study sought to compare operator and patient radiation exposure during PCI with radial versus femoral access. This
- Published
- 2017
123. Evolução hospitalar de pacientes submetidos a assistência circulatória com balão intra-aórtico durante intervenção coronária percutânea de alto risco: registro InCor
- Author
-
Paulo R. Soares, Rodrigo Barbosa Esper, Henrique Barbosa Ribeiro, Augusto C. Lopes, Carlos M. Campos, Fabio Conejo, Marco Antonio Perin, Luciano Nunes dos Santos, Gilberto Guilherme Ajjar Marchiori, Antonio Helio Garcia Pozetti, Andre G. Spadaro, Antonio Esteves Filho, and Expedito E. Ribeiro
- Subjects
medicine.medical_specialty ,Angioplastia ,medicine.medical_treatment ,Population ,Single Center ,cardiogenic ,medicine ,education ,Choque cardiogênico ,Gynecology ,education.field_of_study ,Ejection fraction ,business.industry ,Cardiogenic shock ,Angioplasty ,Percutaneous coronary intervention ,Shock ,General Medicine ,medicine.disease ,Surgery ,Conventional PCI ,Intra-aortic balloon ,business ,Balão intra-aórtico ,Mace ,TIMI - Abstract
INSTRODUÇÃO: O balão intra-aórtico (BIA) é utilizado há décadas como dispositivo de assistência circulatória, sendo recomendado na maioria das diretrizes, apesar da fraca evidência em relação à redução da mortalidade. O objetivo deste estudo foi avaliar o uso do BIA como ferramenta adjunta na intervenção coronária percutânea (ICP). MÉTODOS: Registro unicêntrico que analisou a evolução hospitalar de 134 pacientes consecutivos que utilizaram BIA durante ICP de alto risco ou na vigência de choque cardiogênico. RESULTADOS: A média de idade foi de 64,7 + 12,5 anos e 67,9% eram do sexo masculino. A população apresentou características de alto risco, com 33,5% de diabéticos, 73,1% tratados na vigência de infarto do miocárdio, 68,6% com padrão triarterial, e fração de ejeção do ventrículo esquerdo de 38,6 + 16,1%. Fluxo TIMI 2/3 foi obtido em 86,4% dos casos, sendo tratada 1,6 + 0,6 lesão/paciente. Ocorreram 18 (13,4%) reinfartos, dos quais 9 (6,7%) por trombose do stent, sendo 2 (1,4%) pacientes encaminhados para cirurgia de revascularização miocárdica e 16 (11,9%), para nova ICP. A mortalidade hospitalar foi de 61,2% e a taxa de eventos cardíacos adversos maiores (ECAM) foi de 67,2%. Por análise multivariada, foram preditores de mortalidade: idade > 65 anos, ICP prévia, necessidade de diálise e padrão triarterial. Os preditores de sobrevida foram: função ventricular normal, fluxo TIMI 2/3 ao final do procedimento e permanência do BIA > 72 horas. CONCLUSÕES: Os pacientes que utilizaram BIA durante ICP apresentaram perfil clínico de risco muito alto, que se refletiu em elevada taxa de óbito. Fatores clínicos, angiográficos e do procedimento podem identificar variáveis que interferem independentemente na mortalidade. BACKGROUND: The intra-aortic balloon pump (IABP) has been used for decades as a circulatory support device, being recommended in most guidelines, despite poor evidence of mortality reduction. The purpose of this study was to evaluate the use of IABP as an adjunct therapy in percutaneous coronary intervention (PCI). METHODS: Single center registry analyzing in-hospital outcomes of 134 consecutive patients submitted to IABP during high risk PCI or in the presence of cardiogenic shock. RESULTS: Mean age was 64.7 + 12.5 years and 67.9% were males. The population presented high-risk features, with 33.5% of diabetic patients, 73.1% treated in the presence of myocardial infarction, 68.6% with three-vessel disease and left ventricular ejection fraction of 38.6 + 16.1%. TIMI 2/3 flow was obtained in 86.4% of the cases and 1.6 + 0.6 lesion/patient was treated. There were 18 (13.4%) reinfarctions, of which 9 (6.7%) were due to stent thrombosis, 2 (1.4%) patients were referred for CABG and 16 (11.9%) for a new PCI. Hospital mortality was 61.2% and the major adverse cardiac events (MACE) rate was 67.2%. By multivariate analysis, predictors of mortality were: age > 65 years, prior PCI, need of dialysis and three-vessel disease. Predictors of survival were: normal ventricular function, TIMI 2/3 flow at the end of the procedure and IABP utilization > 72 hours. CONCLUSIONS: Patients undergoing PCI with IABP support have a very high risk clinical profile, which led to high mortality rates. Clinical, angiographic and procedure-related factors can identify independent variables for mortality.
- Published
- 2011
124. Infarto agudo do miocárdio complicado por choque cardiogênico: efeito da circulação colateral nos resultados da intervenção coronária percutânea primária - dados do registro InCor
- Author
-
Marco Antonio Perin, Augusto C. Lopes, Carlos M. Campos, Pedro A. Lemos, José Antonio Franchini Ramires, Expedito E. Ribeiro, Silvio Zalc, Igor Ribeiro de Castro Bienert, Rodrigo Barbosa Esper, Leandro Richa Valim, and Henrique Barbosa Ribeiro
- Subjects
Choque cardiogênico ,Angioplastia ,Circulação colateral ,Infarto do miocárdio ,General Medicine - Abstract
INTRODUÇÃO: A presença de circulação colateral no contexto do infarto agudo do miocárdio (IAM) pode exercer um fator de proteção, levando a menor área de infarto e melhor função ventricular. Este trabalho procurou examinar as características clínicas dos pacientes com diferentes graus de circulação colateral e a influência desta na evolução do IAM com supradesnivelamento de segmento ST (IAMCSST) complicado com choque cardiogênico à admissão hospitalar e tratados com intervenção coronária percutânea (ICP) primária. MÉTODOS: Registro unicêntrico que realizou seguimento prospectivo no período de 2001 a 2009, incluindo 105 pacientes divididos em dois grupos, de acordo com o grau de circulação colateral: grupo 1, circulação colateral graus 0/1 (n = 83); e grupo 2, circulação colateral graus 2/3 (n = 22). As características clínicas e angiográficas e os desfechos hospitalares foram comparados entre os grupos. RESULTADOS: Ambos os grupos foram semelhantes em relação às características clínicas, exceto pela menor média de idade (65,9 anos vs. 57,8 anos; P = 0,015) e maior tendência ao tabagismo atual no grupo com colateral graus 2/3 (15,7% vs. 31,8%; P = 0,08). Quanto às características angiográficas, nos indivíduos com colateral graus 2/3 houve maior frequência de lesões/paciente (1,3 lesão vs. 1,8 lesão; P = 0,02) e maior acometimento de bifurcação coronária (18,5% vs. 36,4%; P = 0,03). Na evolução intra-hospitalar ficou evidenciada menor mortalidade nos pacientes com circulação colateral exuberante (49,4% vs. 27,3%, risco relativo de 0,55; P = 0,05). CONCLUSÕES: Em pacientes com IAMCSST e choque cardiogênico tratados com ICP primária a presença de circulação colateral pode favorecer um melhor prognóstico na evolução intra-hospitalar.
- Published
- 2011
125. Stents convencionais de aço inoxidável vs. cromo-cobalto: impacto clínico da liga metálica no cenário atual - registro InCor
- Author
-
Marco Antonio Perin, Augusto C. Lopes, Rodrigo Barbosa Esper, Pedro A. Lemos, Paulo R. Soares, Silvio Zalc, Andre G. Spadaro, Pedro E. Horta, Luiz J. Kajita, Expedito E. Ribeiro, Carlos M. Campos, and Henrique Barbosa Ribeiro
- Subjects
medicine.medical_specialty ,business.industry ,technology, industry, and agriculture ,Target vessel revascularization ,General Medicine ,equipment and supplies ,medicine.disease ,Single Center ,Surgery ,surgical procedures, operative ,Restenosis ,Conventional PCI ,Clinical endpoint ,Bare metal ,Medicine ,cardiovascular diseases ,business ,Mace - Abstract
Stainless Steel versus Cobalt-ChromiumBare Metal Stents: Clinical Impact of theMetal Alloy in a “Real World” Scenario –InCor Registry Background: Years ago studies demonstrated that the use ofcobalt-chromium stents with thinner struts significantly reducedcoronary restenosis when compared to conventional stainlesssteel stents available at the time. Since then, stents with struts< 100 µm and different metal alloys are available for clinicaluse. The objective of this study was to assess differences inthe clinical outcomes of patients undergoing percutaneouscoronary intervention (PCI) with thin strut stents and differentmetal alloys. Methods: Single center registry comparing theresults of patients undergoing PCI with stainless steel stents(n = 135) vs. cobalt-chromium bare metal stents (n = 181).The primary endpoint was the occurrence of major adversecardiac events (MACE), defined by death, acute myocardialinfarction (AMI) or target vessel revascularization (TVR) in thelate follow-up.
- Published
- 2011
126. TCT-440 Revascularization Outcomes, Financial Impact and Mortality Reduction – Effects of a Telemedicine-guided Strategy on Population-based AMI management
- Author
-
Roberto Botelho, Marco Alcocer-Gamba, Mario Torres, Lucas Lauar Cortizo Vidal, Francisco J. Fernández, Sameer Mehta, Carlos M. Campos, Alfredo Estrada, Ricardo Cavalcanti, Daniel A. Rodriguez, Mauricio Prudente, Haytham Aboushi, Adam Yoculan, Cesar Dusilek, Jamil Cade, and Fausto Feres
- Subjects
medicine.medical_specialty ,Telemedicine ,Financial impact ,business.industry ,medicine.medical_treatment ,Mortality reduction ,Developing country ,Population based ,Revascularization ,parasitic diseases ,Emergency medicine ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
A telemedicine-guided strategy increases access to care and efficiency of STEMI networks. It also reduces disparities of care between developed and developing countries. Whether telemedicine modifies reperfusion rates, costs and outcomes is uncertain? Regions in Brazil, Colombia, and Mexico
- Published
- 2018
127. Associação entre renda, características clínicas e angiográficas de pacientes submetidos a intervenção coronária percutânea
- Author
-
Carlos M. Campos, Carlos A. M. Gottschall, Fernanda O. Camozzatto, Dulce Welter, Alexandre Schaan de Quadros, Denise Rovinski, and Rogério Sarmento-Leite
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Distribution (economics) ,Percutaneous coronary intervention ,General Medicine ,Anthropometry ,Surgery ,Quartile ,Male patient ,Internal medicine ,Medicine ,Medical history ,business ,Socioeconomic status ,Body mass index - Abstract
BACKGROUND: There is great scientific interest with respect to socioeconomic status and population health, and several studies have shown the influence of these variables on clinical outcome of patients. The present study assesses the influence of income on the distribution of risk factors, clinical and angiographic characteristics in patients undergoing percutaneous coronary intervention. METHOD: Patients undergoing percutaneous coronary intervention in a tertiary center from December 2007 to March 2008 were prospectively included. The information on income was directly collected from the patient by one of the investigators. In this analysis, subjects were divided into quartiles according to their respective monthly income. RESULTS: Four hundred patients with mean age of 61.01 ± 10.36 years, 64.7% males and 24.6% diabetics were included. A majority had stable angina (54.9%), and there were no differences between groups regarding comorbidities. Income was associated with the percentage of male patients (48% in the first quartile vs. 81.3% in the last quartile; P < 0.001), the weight and height (P < 0.05), but there was no association with mean body mass index. We also observed a significant association between income and use of drug-eluting stents with the following rates from first to fourth quartile: 0, 1%, 1.9% and 7.7% (P = 0.003). CONCLUSION: In this study, there was an association between income and gender, anthropometric characteristics and use of drug-eluting stents. There was no association between income and risk factors, medical history and angiographic characteristics of patients.
- Published
- 2010
128. TCT-368 Natural history of coronary calcification: A 5-year serial optical coherence tomography study
- Author
-
Bojan Stanetic, Hector M. Garcia-Garcia, Carlos M. Campos, Patrick W. Serruys, Susan Veldhof, and Marcos Nato
- Subjects
Natural history ,medicine.medical_specialty ,Optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Coronary artery calcification ,medicine ,Radiology ,medicine.disease ,business ,Cardiology and Cardiovascular Medicine ,Calcification - Published
- 2015
- Full Text
- View/download PDF
129. Superdominant Right Coronary Artery with Absence of Left Circumflex and Anomalous Origin of the Left Anterior Descending Coronary from the Right Sinus: An Unheard Coronary Anomaly Circulation
- Author
-
Luiz J. Kajita, Expedito E. Ribeiro, Fernando Roberto de Fazzio, José Mariani Junior, Marcos Danillo Peixoto Oliveira, Carlos M. Campos, and Pedro A. Lemos
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,business.industry ,Case Report ,Coronary angiogram ,Coronary Anomaly ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,lcsh:RC666-701 ,Right coronary artery ,medicine.artery ,Internal medicine ,Cardiology ,cardiovascular system ,Medicine ,Circumflex ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Sinus (anatomy) ,Artery - Abstract
Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. We present herein the case of a 70-year-old man with symptomatic severe aortic valvar stenosis whose preoperative coronary angiogram revealed a so far unreported coronary anomaly circulation pattern.
- Published
- 2015
130. Four-year clinical follow-up of the first-in-man randomized comparison of a novel sirolimus eluting stent with abluminal biodegradable polymer and ultra-thin strut cobalt-chromium alloy: the INSPIRON-I trial
- Author
-
Marcos Danillo Peixoto, Oliveira, Expedito E, Ribeiro, Carlos M, Campos, Henrique B, Ribeiro, Bruno L R, Faillace, Augusto C, Lopes, Rodrigo B, Esper, George X, Meirelles, Marco A, Perin, Alexandre, Abizaid, and Pedro A, Lemos
- Subjects
Original Article - Abstract
The Inspiron™ sirolimus-eluting stent (SES) is a low-dose, ultra-thin-strut cobalt-chromium stent abluminally coated with biodegradable polymers (BP). Previous results from the INSPIRON-I trial, a first-in-man study, have proven the efficacy of the novel stent in reducing neointimal proliferation. The present report aims at evaluating the long-term clinical outcomes of patients enrolled into the INSPIRON-I trial (Clinical Trials Gov. identifier: NCT01093391).A total of 57 patients (60 lesions) were randomly allocated in a 2:1 ratio to treatment with the Inspiron™ SES vs. its equivalent Cronus™ bare metal stent (BMS, both by Scitech Medical™, Aparecida de Goiânia, Goiás, Brazil), in four tertiary centers. The primary endpoint of the present analysis was the occurrence of major adverse cardiac events (MACE) [death, myocardial infarction (MI), target vessel revascularization (TVR) and/or target lesion revascularization (TLR)] at 4 years.Baseline clinical and angiographic characteristics of both groups were similar. After 4 years, the primary endpoint occurred in 7.9% vs. 23.5% of patients in Inspiron and control groups respectively (P=0.11). The rate of death/MI was similar between the groups, but there was a significant decrease in the risk of repeat revascularization in the Inspiron group compared to the control arm TLR (0.0% vs. 23.5% respectively, P=0.02). There were no stent thromboses in the study population.The novel Inspiron™ SES showed a sustained safe and effective clinical profile after 4-year of follow-up, with very low adverse events and null stent thrombosis (ST) occurrence.
- Published
- 2015
131. The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation
- Author
-
Patrick W. Serruys, Carlos M. Campos, Evald Høj Christiansen, and Gregg W. Stone
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Antineoplastic Agents ,Revascularization ,Coronary artery disease ,Coronary artery bypass surgery ,Percutaneous Coronary Intervention ,Internal medicine ,Angioplasty ,medicine ,Humans ,cardiovascular diseases ,Everolimus ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Randomized Controlled Trials as Topic ,Sirolimus ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,Drug-Eluting Stents ,medicine.disease ,Surgery ,Stenosis ,surgical procedures, operative ,Treatment Outcome ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Unprotected left main coronary artery (ULMCA) stenosis has relatively high prevalence and exposes patients to a high risk for adverse cardiovascular events. The optimal revascularisation strategy (coronary artery bypass surgery [CABG] or percutaneous coronary intervention [PCI]) for patients with complex coronary artery disease is a topic of continuing debate. The introduction of the newer-generation drug-eluting stents (DES) -with documented improvements in both safety and efficacy- has prompted the interventional community to design two new dedicated randomised trials comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials. The aims of the present review are to describe the similarities and contrasts between these two trials as well to explore their future implications in ULMCA treatment.
- Published
- 2015
132. Impact of the Orbital Atherectomy System on a Peripheral Calcified Lesion: Quantitative Analysis by Intravascular Echogenicity
- Author
-
Yohei, Sotomi, Nicolas W, Shammas, Pannipa, Suwannasom, Carlos M, Campos, Joanna J, Wykrzykowska, Robbert J, de Winter, Jouke, Dijkstra, Patrick W, Serruys, and Yoshinobu, Onuma
- Subjects
Male ,Peripheral Vascular Diseases ,Leg ,Atherectomy ,Arteries ,Arteriosclerosis Obliterans ,Constriction, Pathologic ,Equipment Design ,Treatment Outcome ,Predictive Value of Tests ,Humans ,Vascular Calcification ,Angioplasty, Balloon ,Ultrasonography, Interventional ,Aged - Published
- 2015
133. Anatomic characteristics and clinical implications of angiographic coronary thrombus: insights from a patient-level pooled analysis of SYNTAX, RESOLUTE, and LEADERS Trials
- Author
-
Pannipa Suwannasom, Stephan Windecker, Patrick W. Serruys, Christos V Bourantas, Francesco Costa, Marco Valgimigli, Marie-Angèle Morel, Carlos M. Campos, Hector M. Garcia-Garcia, and Cardiology
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,610 Medicine & health ,Coronary Artery Disease ,Coronary artery disease ,Angina ,Percutaneous Coronary Intervention ,Postoperative Complications ,Population Groups ,Predictive Value of Tests ,Internal medicine ,Coronary stent ,medicine ,Humans ,Myocardial infarction ,Aged ,Netherlands ,Ultrasonography ,Clinical Trials as Topic ,business.industry ,Academies and Institutes ,Percutaneous coronary intervention ,Thrombosis ,Middle Aged ,medicine.disease ,Prognosis ,Coronary Vessels ,Survival Analysis ,Coronary arteries ,medicine.anatomical_structure ,Treatment Outcome ,Drug-eluting stent ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— The distribution of thrombus-containing lesions (TCLs) in an all-comer population admitted with a heterogeneous clinical presentation (stable, ustable angina, or an acute coronary syndrome) and treated with percutaneous coronary intervention is yet unclear, and the long-term prognostic implications are still disputed. This study sought to assess the distribution and prognostic implications of coronary thrombus, detected by coronary angiography, in a population recruited in all-comer percutaneous coronary intervention trials. Methods and Results— Patient-level data from 3 contemporary coronary stent trials were pooled by an independent academic research organization (Cardialysis, Rotterdam, the Netherlands). Clinical outcomes in terms of major adverse cardiac events (major adverse cardiac events, a composite of death, myocardial infarction, and repeat revascularization), death, myocardial infarction, and repeated revascularization were compared between patients with and without angiographic TCL. Preprocedural TCL was present in 257 patients (5.8%) and absent in 4193 (94.2%) patients. At 3-year follow-up, there was no difference for major adverse cardiac events (25.3 versus 25.4%; P =0.683); all-cause death (7.4 versus 6.8%; P =0.683); myocardial infarction (5.8 versus 6.0%; P =0.962), and any revascularizations (17.5 versus 17.7%; P =0.822) between patients with and without TCL. The comparison of outcomes in groups weighing the jeopardized myocardial by TCL also did not show a significant difference. TCL were seen more often in the first 2 segments of the right (43.6%) and left anterior descending (36.8%) coronary arteries. The association of TCL and bifurcation lesions was present in 40.1% of the prespecified segments. Conclusions— TCL involved mainly the proximal coronary segments and did not have any effect on clinical outcomes. A more detailed thrombus burden quantification is required to investigate its prognostic implications. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT00114972, NCT01443104, NCT00617084.
- Published
- 2015
134. Impact of the Everolimus-eluting Bioresorbable Scaffold in Coronary Atherosclerosis
- Author
-
Pieter H. Kitslaar, Koen Nieman, Pedro de Araújo Gonçalves, Takashi Muramatsu, Johan H. C. Reiber, Yoshinobu Onuma, Mark Webster, Dariusz Dudek, Hector M. Garcia-Garcia, Leif Thuesen, Susan Veldhof, John A. Ormiston, Patrick W. Serruys, Carlos M. Campos, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Absorb ,Computed tomography coronary angiography ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Absorbable Implants ,Multidetector Computed Tomography ,medicine ,Humans ,030212 general & internal medicine ,Everolimus ,Prospective Studies ,Prospective cohort study ,Coronary atherosclerosis ,Computed tomography angiography ,Disease progression ,medicine.diagnostic_test ,Tissue Scaffolds ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Atherosclerosis ,Atheroma ,Treatment Outcome ,Cardiology ,Female ,business ,Coronary plaque ,Bioresorbable scaffold ,Immunosuppressive Agents ,medicine.drug - Abstract
The Absorb bioresorbable vascular scaffold has been shown to decrease total plaque areas in the treated segment. However, it is unknown whether plaque size is modified in scaffolded segments only or whether the modification extends to other coronary segments.Absorb Cohort A is a single-arm, prospective study, with safety and imaging endpoints, in which 30 patients underwent percutaneous coronary intervention with the first generation Absorb bioresorbable vascular scaffold. Noninvasive multislice computed tomography imaging was performed in 18 patients at 18 months and 5 years of follow-up. The present study was an intrapatient comparison of matched segments (normalized by the segment length) of the scaffolded region with nonintervened segments for lumen volume, vessel volume, plaque volume, plaque burden, and percent change in plaque atheroma volume.All 18 scaffolded segments could be analyzed. In the nonintervened segments, 1 of 72 segments had a motion artifact and was excluded. Serial comparison showed that the scaffolded segments showed no significant change in the mean plaque burden, total atheroma volume, total lumen volume, or vessel volume between 18 months and 5 years. Conversely, the untreated segments showed a significant increase in plaque burden (2.7 ± 6.5%; P.01) and normalized plaque volumes (8.0 ± 22.8mm(3); P.01). This resulted in a significant difference in plaque burden between scaffolded and nonintervened segments (P = .03).In this small series, the Absorb bioresorbable vascular scaffold showed the potential to provide an additional benefit to pharmacological therapy in locally reducing progression of percent plaque burden. These findings need to be confirmed in larger studies.
- Published
- 2015
135. Long-Term Prognostic Effect of Coronary Atherosclerotic Burden
- Author
-
Saima Mushtaq, Carlos M. Campos, Pedro de Araújo Gonçalves, Patrick W. Serruys, Gianluca Pontone, Daniele Andreini, Erika Bertella, Mauro Pepi, Antonio L. Bartorelli, Hector M. Garcia-Garcia, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Centro de Estudos de Doenças Crónicas (CEDOC), and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Computed tomography ,CAD ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Coronary Angiography ,Severity of Illness Index ,Coronary artery disease ,Stenosis degree ,Disease-Free Survival ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Chi-Square Distribution ,medicine.diagnostic_test ,Proportional hazards model ,business.industry ,Hazard ratio ,Coronary Stenosis ,Reproducibility of Results ,Middle Aged ,Prognosis ,medicine.disease ,Coronary Vessels ,Plaque, Atherosclerotic ,Stenosis ,Radiology Nuclear Medicine and imaging ,Multivariate Analysis ,Cardiology ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— Computed tomography–adapted Leaman score (CT-LeSc) was developed to quantify coronary CT angiography information about atherosclerotic burden (lesion localization, stenosis degree, and plaque composition). The objective of the study is to evaluate CT-LeSc long-term prognostic value in patients with suspected coronary artery disease (CAD). Methods and Results— Single-center prospective registry including 1304 consecutive patients undergoing coronary CT angiography for suspected CAD. High CT-LeSc was defined by upper tertile (score, >5) cutoff. Segment involvement score and segment stenosis score were also evaluated. Hard cardiac events (cardiac death and nonfatal acute coronary syndromes) were considered for analysis. Different Cox regression models were used to identify independent event predictors. Kaplan–Meier event-free survival was evaluated in 4 patient subgroups stratified by obstructive (≥50% stenosis) versus nonobstructive CAD and a high (>5) versus a low (≤5) CT-LeSc. Of 1196 patients included in the final analysis (mean follow-up of 52±22 months), 125 patients experienced 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarction). All atherosclerotic burden scores were independent predictors of cardiac events (hazard ratios of 3.09 for segment involvement score, 4.42 for segment stenosis score, and 5.39 for CT-LeSc). Cumulative event-free survival was 76.8% with a high CT-LeSc and 96.0% with a low CT-LeSc. Event-free survival in nonobstructive CAD with high CT-LeSc (78.6%) was similar to obstructive CAD with high CT-LeSc (76.5%) but lower than obstructive CAD with low CT-LeSc (80.7%). Conclusions— CT-LeSc is an independent long-term predictor of hard cardiac events. Patients with nonobstructive CAD and high CT-LeSc had hard event-free survival similar to patients with obstructive CAD.
- Published
- 2015
136. Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective
- Author
-
Patrick W. Serruys, Vasim Farooq, Keith D. Dawkins, Haiyan Li, Mouin Abdallah, A. Pieter Kappetein, Marie-Claude Morice, Ruben L. Osnabrugge, Carlos M. Campos, David J. Cohen, Friedrich W. Mohr, Katherine Vilain, Ewout W. Steyerberg, Kaijun Wang, David van Klaveren, Elizabeth A. Magnuson, Cardiothoracic Surgery, Cardiology, and Public Health
- Subjects
medicine.medical_specialty ,Time Factors ,Cost effectiveness ,medicine.medical_treatment ,Cost-Benefit Analysis ,Health Status ,Population ,Coronary Artery Disease ,Patient Readmission ,Decision Support Techniques ,Coronary artery disease ,Percutaneous Coronary Intervention ,SDG 3 - Good Health and Well-being ,Internal medicine ,Surveys and Questionnaires ,medicine ,Humans ,Computer Simulation ,Myocardial infarction ,cardiovascular diseases ,Coronary Artery Bypass ,Hospital Costs ,education ,Netherlands ,education.field_of_study ,business.industry ,Patient Selection ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Length of Stay ,medicine.disease ,Quality-adjusted life year ,surgical procedures, operative ,Models, Economic ,Treatment Outcome ,Bypass surgery ,Emergency medicine ,Conventional PCI ,Retreatment ,Cardiology ,Quality of Life ,Quality-Adjusted Life Years ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Recent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective. We, therefore, used individual patient-level data from the SYNTAX trial to evaluate the cost-effectiveness of PCI versus CABG from a European (Dutch) perspective. Methods and results Between 2005 and 2007, 1800 patients with three-vessel or left main coronary artery disease were randomised to either CABG (n=897) or PCI with drug-eluting stents (DES; n=903). Costs were estimated for all patients based on observed healthcare resource usage over 5 years of follow-up. Health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on Dutch life-tables was used to extrapolate the 5-year in-trial data to a lifetime horizon. Although initial procedural costs were lower for CABG, total initial hospitalisation costs per patient were higher (.17 506 vs .14 037, p >0.001). PCI was more costly during the next 5 years of follow-up, due to more frequent hospitalisations, repeat revascularisation procedures and higher medication costs. Nevertheless, total 5-year costs remained .2465/patient higher with CABG. When the in-trial results were extrapolated to a lifetime horizon, CABG was projected to be economically attractive relative to DES-PCI, with gains in both life expectancy and quality-adjusted life expectancy. The incremental cost-effectiveness ratio (ICER) (.5390/quality-adjusted life year (QALY) gained) was favourable and remained >.80 000/QALY in
- Published
- 2015
137. Ex vivo validation of 45 MHz intravascular ultrasound backscatter tissue characterization
- Author
-
Gregg W. Stone, M. Pauliina Margolis, Patrick W. Serruys, Pedro A. Lemos, D. Geoffrey Vince, Anuja Nair, Carlos M. Campos, Hector M. Garcia-Garcia, Russell J. Fedewa, and Cardiology
- Subjects
medicine.medical_specialty ,Rotation ,Backscatter ,In Vitro Techniques ,medicine.disease_cause ,Cardiac Catheters ,Intravascular ultrasound ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Reproducibility ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Histology ,General Medicine ,Gold standard (test) ,Coronary Vessels ,Vulnerable plaque ,Plaque, Atherosclerotic ,Coronary arteries ,medicine.anatomical_structure ,Autopsy ,Radiology ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Algorithms ,Ex vivo - Abstract
Aims: The objectives of the present study are to describe the algorithm for VHw IVUS using the 45-MHz rotational IVUS catheter and the associated ex vivo validation in comparison to the gold standard histology. Methods and results: The first phase of the present study was to construct the 45 MHz VH IVUS algorithm by using a total of 55 human coronary artery specimens [111 independent coronary lesions and 510 homogenous regions of interest (ROIs)], obtained at autopsy. Regions were selected from histology and matched with their corresponding IVUS data to build the plaque classification system using spectral analysis and statistical random forests. In the second phase, the ex vivo validation of the VH IVUS algorithm assessed a total of 1060 ROIs (120 lesions from 60 coronary arteries) in comparison with histology. In an independent manner, two interventional cardiologists also classified a randomly selected subset of the ROIs for assessment of inter- and intra-observer reproducibility of VH IVUS image interpretation. When including all ROIs, the predictive accuracies were 90.8% for fibrous tissue, 85.8% for fibro fatty tissue, 88.3% for necrotic core, and 88.0% for dense calcium. The exclusion of ROIs in the acoustically attenuated areas improved the predictive accuracies, ranging from 91.9 to 96.8%. The independent analysis of randomly selected 253 ROIs showed substantial agreement for inter-observer (k = 0.66) and intra-observer (k = 0.88) reproducibility. Conclusion: Tissue classification by 45 MHzVHIVUS technology, when not influenced by calcium-induced acoustic attenuation, provided combined tissue accuracy >88% to identify tissue types compared with the gold standard histologic assessment, with high inter- and intra-observer reproducibility.
- Published
- 2015
138. Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAX II trial
- Author
-
Carlos M, Campos, Bojan M, Stanetic, Vasim, Farooq, Simon, Walsh, Yuki, Ishibashi, Yoshinobu, Onuma, Hector M, Garcia-Garcia, Javier, Escaned, Adrian, Banning, and Patrick W, Serruys
- Subjects
Adult ,Male ,Patient Care Team ,Time Factors ,Patient Selection ,Decision Making ,Drug-Eluting Stents ,Coronary Artery Disease ,Middle Aged ,Coronary Angiography ,Risk Assessment ,Severity of Illness Index ,Coronary Restenosis ,Survival Rate ,Treatment Outcome ,Predictive Value of Tests ,Humans ,Female ,Single-Blind Method ,Prospective Studies ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Decision Making, Computer-Assisted ,Aged ,Follow-Up Studies - Abstract
Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial.The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI.A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial.The SYNTAX score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
- Published
- 2014
139. Comparison between two- and three-dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: A subanalysis of the TRYTON pivotal IDE coronary bifurcation trial
- Author
-
Takashi, Muramatsu, Maik J, Grundeken, Yuki, Ishibashi, Shimpei, Nakatani, Chrysafios, Girasis, Carlos M, Campos, Marie-Angèle, Morel, Hans, Jonker, Robbert J, de Winter, Joanna J, Wykrzykowska, Hector M, García-García, Martin B, Leon, Patrick W, Serruys, and Yoshinobu, Onuma
- Subjects
Imaging, Three-Dimensional ,Treatment Outcome ,Humans ,Radiographic Image Interpretation, Computer-Assisted ,Coronary Artery Disease ,Coronary Angiography ,Software - Abstract
Three-dimensional (3D) quantitative coronary angiography (QCA) provides more accurate measurements by minimizing inherent limitations of two-dimensional (2D) QCA. The aim of this study was to compare the measurements between 2D and 3D QCA analyses in bifurcation lesions.A total of 114 cases with non-left main bifurcation lesions in the TRYTON pivotal IDE Coronary Bifurcation Trial (ClinicalTrials.gov: NCT01258972) were analyzed using a validated bifurcation QCA software (CAAS 5.10, Pie Medical Imaging, Maastricht, the Netherlands). All cases were analyzed in matched projections between pre- and post-procedure. The 2D analysis was performed using one of two angiographic images used for 3D reconstruction showing a larger distal bifurcation angle. In the treated segments (stent and balloon), there were no differences in minimal luminal diameter (MLD) between 2D and 3D, while diameter stenosis (DS) was significantly higher in 2D compared to 3D both pre-procedure and post-procedure (53.9% for 2D vs. 52.1% for 3D pre-procedure, P 0.01; 23.2% for 2D vs. 20.9% for 3D post-procedure, P = 0.01). In the sub-segment level analysis, lengths of proximal main branch, distal main branch, and side branch were consistently shorter in 2D compared to 3D both pre-procedure and post-procedure. Using 3D QCA, the anatomic location of the smallest MLD or the highest DS was relocated to a different bifurcation sub-segment in a considerable proportion of the patients compared to when 2D-QCA was used (kappa values: 0.50 for MLD, 0.55 for DS).Our data showed differences in addressing anatomical severity and location of coronary bifurcation lesions between in vivo 2D and 3D QCA analyses. More studies are needed to investigate potential clinical benefits in using 3D approach over 2D QCA for the assessment of bifurcation lesions.
- Published
- 2014
140. Transcoronary sinus administration of autologous bone marrow in patients with chronic refractory stable angina
- Author
-
Jose Vicario, R. Milesi, N. Perez Baliño, J R Piva, L. Gerardo, Fernando Faccio, R. Novero, C. Lofeudo, H. Pfeiffer, Carlos M. Campos, Carlos Becker, I. Fendrich, Ahmad Amin, A. Pierini, Hugo Hector Ortega, A. Licheri, A. Monti, and E. De Giovanni
- Subjects
medicine.medical_specialty ,business.industry ,Canadian Cardiovascular Society ,medicine.disease ,Transplantation ,Angina ,Coronary circulation ,medicine.anatomical_structure ,Internal medicine ,Occlusion ,Inclusion and exclusion criteria ,Cardiology ,Molecular Medicine ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Prospective cohort study ,Coronary sinus - Abstract
Purpose Based on our preclinic studies with autologous unfractionated bone marrow (AUBM) via coronary sinus with transitory occlusion, a clinic study in patients with chronic stable angina was designed. The objectives were to evaluate safety, tolerance and feasibility. Methods and materials A multicenter prospective study with inclusion and exclusion criteria defined by an Independent Clinical Committee was carried out. Fourteen patients underwent transcoronary sinus administration of freshly aspirated and filtered AUBM (60–120 ml). Safety and tolerance were evaluated. Feasibility was evaluated with Seattle Angina Questionnaire (SAQ), Canadian Cardiovascular Society (CCS) angina classification (baseline–Day 180), myocardial perfusion (baseline–Day 90) with independent core laboratory and coronary angiography (baseline and Day 30). Results There were no changes in the safety and tolerance parameters. Preliminary clinical efficacy at Day 180 disclosed a significant improvement of 38%, evaluated by the SAQ. The CCS angina classification shows that the mean angina class was 3.0±0.55 at baseline and improved to 2.0±0.00 at Day 180 ( P P P Conclusions We can conclude that AUBM via coronary sinus with transitory occlusion is tolerable and safe. Significant improvement in the myocardial perfusion at Day 90 and in the quality of life at Day 180 was observed.
- Published
- 2004
141. Transcoronary sinus delivery of autologous bone marrow and angiogenesis in pig models with myocardial injury
- Author
-
H. Pfeiffer, Carlos M. Campos, J R Piva, I. Fendrich, L. Gerardo, Ana M. Canal, A. Pierini, Jose Vicario, Hugo Hector Ortega, A. Monti, and R. Novero
- Subjects
Cardiac Catheterization ,Pathology ,medicine.medical_specialty ,Time Factors ,Swine ,Angiogenesis ,medicine.medical_treatment ,H&E stain ,Neovascularization, Physiologic ,Transplantation, Autologous ,Random Allocation ,Coronary Circulation ,Occlusion ,medicine ,Animals ,Saline ,Sinus (anatomy) ,Coronary sinus ,Bone Marrow Transplantation ,business.industry ,Coronary Stenosis ,Sinus of Valsalva ,Collateral circulation ,Disease Models, Animal ,medicine.anatomical_structure ,Heart Injuries ,Feasibility Studies ,Molecular Medicine ,Surgery ,Bone marrow ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: The aim of the investigation is to study myocardial injury on pig model with two objectives: (1) feasibility of stimulating angiogenesis with fresh autologous bone marrow; (2) administration of the same fresh autologous bone marrow via coronary sinus with transitory occlusion. Methods: A controlled study was done in animal model with three phases, in a study group of 12 pigs (bone marrow administration) as well as in control group of 4 pigs (saline administration). Phase 1—production of coronary stenosis and myocardial injury; Phase 2—two weeks later, administration of bone marrow through coronary sinus with 10 min occlusion in the study group and saline solution in the control group. Phase 3—two weeks later, histological staining with hematoxylin–eosin and inmunohistochemical staining with monoclonal antibody for smooth muscle α-actin were conducted on both study and control groups. Results: The percentage of angionenesis observed in the study group was 91% and 0% in control group. Counting of positive actin in affected and control areas showed statistically significant differences in relation to both groups: study group (1.37 vs. 0.79) and control group (0.47 vs. 0.51). The percentage of mononuclear immature cells observed in the myocardium in the study group was 25% and in the control group was 0%. There was no increment in the coronary collateral circulation when comparing coronary angiography. Conclusions: Autologous bone marrow in animal model with experimental myocardial injury enhances angiogenesis, as well as vessels with smooth muscles. The transitory occlusion of the coronary sinus might be an effective way to administer cells as those from the bone marrow.
- Published
- 2002
142. TCT-202 Evaluation of Renal Function Improvement After Transcatheter Aortic Valve Replacement
- Author
-
Marcelo Franken, José Mariani, Carolina Pereira, Breno Almeida, Henrique Barbosa Ribeiro, Adriano Caixeta, Pedro A. Lemos, Flávio Tarasoutchi, Antonio Carlos Bacelar Nunes Filho, Natalia Esteves, Michel V. Lemes da Silva, Rogério Ruscitto Prado, Carlos M. Campos, and Fabio Sandoli de Brito
- Subjects
medicine.medical_specialty ,Valve replacement ,Transcatheter aortic ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,Medicine ,Renal function ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
143. Pseudoaneurisma: rara complicação do acesso radial
- Author
-
Luciano Nunes dos Santos, Rodrigo Barbosa Esper, Luiz F. Ybarra, Augusto C. Lopes, Carlos M. Campos, Henrique Barbosa Ribeiro, and Expedito E. Ribeiro
- Subjects
General Medicine - Abstract
A via radial apresenta menores taxas de complicacoes vasculares para realizacao de cinecoronariografia. O pseudoaneurisma da arteria radial e uma complicacao rara desse procedimento. O diagnostico precoce e essencial para evitar complicacoes como ruptura espontânea, isquemia e sindrome compartimental. Neste relato e descrito um caso de pseudoaneurisma da arteria radial direita apos realizacao de cinecoronariografia eletiva. O diagnostico foi confirmado por ultrassonografia com Doppler, que evidenciou pseudoaneurisma da arteria radial na face anteromedial do antebraco, medindo 3,7 x 2,5 cm, com colo de 0,7 cm. O tratamento foi feito com curativo compressivo local e nova ultrassonografia com Doppler, realizada 12 horas apos, demonstrou resolucao do pseudoaneurisma.
- Published
- 2011
144. Reasonable incomplete revascularisation after percutaneous coronary intervention: the SYNTAX Revascularisation Index
- Author
-
Adriano Caixeta, Tullio Palmerini, George Dangas, Dominic P. Francese, Gregg W. Stone, Philippe Généreux, Ke Xu, Martin B. Leon, Patrick W. Serruys, Mayank Yadav, Roxana Mehran, Carlos M. Campos, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Coronary Angiography ,Risk Assessment ,Decision Support Techniques ,Coronary artery disease ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Aged ,Proportional Hazards Models ,Chi-Square Distribution ,Proportional hazards model ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Treatment Outcome ,ROC Curve ,Predictive value of tests ,Area Under Curve ,Conventional PCI ,Multivariate Analysis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Chi-squared distribution - Abstract
Aims: Incomplete revascularisation is Common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI). Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from 2,618 angiograms of patients enrolled in the prospective ACUITY trial. The SRI was then calculated for each patient using the following formula: SRI=(1-[rSS/bSS]) x 100. Outcomes were examined according to three SRI groups (SRI=100% [complete revascularisation], 50-99%, and = 80% representing a reasonable goal. However, the rSS showed superior predictive capability for one-year mortality.
- Published
- 2014
145. Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II
- Author
-
David van Klaveren, Ewout W. Steyerberg, Carlos M. Campos, Vasim Farooq, Joseph F. Sabik, Gregg W. Stone, Patrick W. Serruys, Charles A. Simonton, Arie Pieter Kappetein, Cardiology, Public Health, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Revascularization ,Severity of Illness Index ,Coronary artery bypass surgery ,Pulmonary Disease, Chronic Obstructive ,Percutaneous Coronary Intervention ,Internal medicine ,Multicenter trial ,medicine ,Myocardial Revascularization ,Humans ,cardiovascular diseases ,Everolimus ,Prospective Studies ,Coronary Artery Bypass ,Prospective cohort study ,Aged ,Peripheral Vascular Diseases ,Ejection fraction ,business.industry ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,Middle Aged ,Decision Support Systems, Clinical ,humanities ,Surgery ,surgical procedures, operative ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents - Abstract
Aims To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Methods and results Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (
- Published
- 2014
146. Smoking is associated with adverse clinical outcomes in patients undergoing revascularization with PCI or CABG: the SYNTAX trial at 5-year follow-up
- Author
-
Yao-Jun, Zhang, Javaid, Iqbal, David, van Klaveren, Carlos M, Campos, David R, Holmes, Arie Pieter, Kappetein, Marie-Claude, Morice, Adrian P, Banning, Ever D, Grech, Christos V, Bourantas, Yoshinobu, Onuma, Hector M, Garcia-Garcia, Michael J, Mack, Antonio, Colombo, Friedrich W, Mohr, Ewout W, Steyerberg, and Patrick W, Serruys
- Subjects
Male ,Paclitaxel ,Incidence ,Smoking ,Myocardial Infarction ,Drug-Eluting Stents ,Coronary Artery Disease ,Stroke ,Percutaneous Coronary Intervention ,Treatment Outcome ,Humans ,Female ,Coronary Artery Bypass ,Follow-Up Studies ,Proportional Hazards Models - Abstract
Cigarette smoking is a well-known risk factor for development of coronary artery disease (CAD). However, some studies have suggested a "smoker's paradox," meaning neutral or favorable outcomes in smokers who have developed CAD, especially myocardial infarction (MI).The study aimed to examine the association of smoking status with clinical outcomes in the randomized controlled SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial at 5-year follow-up.Detailed smoking history was collected at baseline, 6-month, 1-year, 3-year, and 5-year follow-up. The composite endpoints included death/MI/stroke (primary endpoint) plus major adverse cardiac and cerebrovascular events (MACCE) (combination of death/MI/stroke and target lesion revascularization) according to patient smoking status. The comparison of 5-year clinical outcomes between the groups according to smoking status was performed with Cox regression using smoking status at baseline or smoking as a time-dependent covariate.A sizeable proportion (n = 322, 17.9%) of patients had changing smoking status during 5-year follow-up. One in 5 patients with complex CAD was smoking at baseline. However, 60% stopped after revascularization while others continued to smoke. Smokers had worse clinical outcomes due to a higher incidence of recurrent MI in both revascularization arms. Smoking was an independent predictor of the composite endpoint of death/MI/stroke (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.3 to 2.5; p = 0.001) and MACCE (HR: 1.4; 95% CI: 1.1 to 1.7; p = 0.02).Smoking is associated with poor clinical outcomes after revascularization in patients with complex CAD. This places further emphasis on efforts at smoking cessation to improve revascularization benefits. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972).
- Published
- 2014
147. Development of a closed‐artery catheter‐based myocardial infarction in pigs using sponge and lidocaine hydrochloride infusion to prevent irreversible ventricular fibrillation
- Author
-
Celso Kiyochi Takimura, Rafael Dariolli, Carlos M. Campos, José Eduardo Krieger, and Pedro A. Lemos
- Subjects
Fibrillation ,medicine.medical_specialty ,Troponin T ,Physiology ,business.industry ,catheter ,medicine.disease ,embolism ,Catheter ,medicine.anatomical_structure ,myocardial infarction ,Physiology (medical) ,Internal medicine ,Heart failure ,Ventricular fibrillation ,Cardiology ,Medicine ,Myocardial infarction ,medicine.symptom ,fibrillation ,business ,Perfusion ,Balloon ,Artery ,Original Research - Abstract
The objectives of this study were to develop a robust, homogeneous, viable and inexpensive model of closed‐artery catheter‐based model of myocardial infarction (MI) in pigs without major cardiac dysfunction. Suitable animal models that mimic human cardiovascular conditions are of paramount importance to understand the effects of novel therapeutic strategies to improve tissue perfusion and prevent cardiac deterioration post‐MI. Pigs (N = 21, BW = 17 ± 1 kg) receiving continuous iv lidocaine hydrochloride were subjected to percutaneous intracoronary implant of foam sponge into the proximal left circumflex coronary artery. Intraprocedure mortality was 23.8%. ST segment elevation and increased serum Troponin T and CK‐MB were documented in all animals. Thirty days after occlusion, echocardiography (95% IC [9.3–12.4%]) and anatomopathological (95% CI [9.3–12.6%]) analyses confirmed a significant and reproducible MI. Taken together, we provide evidence for a suitable closed‐artery catheter‐based method to produce MI in pigs accompanied by tissue hypoperfusion and absence of overt heart failure., We provide evidence that an inexpensive and easily available material can be used to produce a robust and homogenous percutaneous closed‐artery model of MI in pigs, when associated with lidocaine hydrochloride use. Thirty days after occlusion, anatomopathological (95% IC [9.3–12.6%]) analyses confirmed a significant and reproducible MI accompanied by hypoperfusion and absence of overt heart failure.
- Published
- 2014
148. Precise vessel sizing: a trivial but crucial issue during left main stenting
- Author
-
Carlos M. Campos and Pedro A. Lemos
- Subjects
Male ,Sirolimus ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Drug-Eluting Stents ,General Medicine ,Coronary Artery Disease ,medicine.disease ,Balloon ,Coronary Vessels ,Sizing ,Coronary artery disease ,Angioplasty ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Radiology ,Ultrasonography ,Angioplasty, Balloon, Coronary ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography, Interventional - Published
- 2014
149. Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease-analysis of CREDO-Kyoto registry
- Author
-
Yoshihisa Nakagawa, Pedro A. Lemos, Takeshi Kimura, Patrick W. Serruys, David van Klaveren, Carlos M. Campos, Vasim Farooq, Yoshinobu Onuma, Yao-Jun Zhang, Hector M. Garcia-Garcia, Javaid Iqbal, Marie-Angèle Morel, Ewout W. Steyerberg, Yutaka Furukawa, Kazushige Kadota, Hiroki Shiomi, Cardiology, and Public Health
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Coronary Artery Disease ,Revascularization ,Coronary artery disease ,Percutaneous Coronary Intervention ,Japan ,Predictive Value of Tests ,Internal medicine ,Epidemiology ,Medicine ,Humans ,cardiovascular diseases ,Registries ,Coronary Artery Bypass ,education ,Aged ,education.field_of_study ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Clinical trial ,surgical procedures, operative ,Predictive value of tests ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background:SYNTAX score II (SSII) provides individualized estimates of 4-year mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in order to facilitate decision-making between these revascularization methods. The purpose of the present study was to assess SSII in a real-world multicenter registry with distinct regional and epidemiological characteristics.Methods and Results:Long-term mortality was analyzed in 3,896 patients undergoing PCI (n=2,190) or CABG (n=1,796) from the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry cohort-2. SSII discriminated well in both CABG and PCI patient groups (concordance index [c-index], 0.70; 95% CI: 0.68–0.72; and 0.75, 95% CI: 0.72–0.78) surpassing anatomical SYNTAX score (SS; c-index, 0.50; 95% CI: 0.47–0.53; and 0.59, 95% CI: 0.57–0.61). SSII had the best discriminative ability to separate low-, medium- and high-risk tertiles, and calibration plots showed good predictive performance for CABG and PCI groups. Use of anatomical SS as a reference improved the overall reclassification provided by SSII, with a net reclassification index of 0.5 (P
- Published
- 2014
150. Temporal evolution of strut light intensity after implantation of bioresorbable polymeric intracoronary scaffolds in the ABSORB cohort B trial-an application of a new quantitative method based on optical coherence tomography
- Author
-
Shimpei, Nakatani, Yoshinobu, Onuma, Yuki, Ishibashi, Jeroen, Eggermont, Yao-Jun, Zhang, Carlos M, Campos, Yun Kyeong, Cho, Shengnan, Liu, Jouke, Dijkstra, Johan H C, Reiber, Laura, Perkins, Alexander, Sheehy, Susan, Veldhof, Richard, Rapoza, Gerrit-Anne, van Es, Hector M, Garcia-Garcia, Robert-Jan, van Geuns, Patrick W, Serruys, and Robert, Whitbourn
- Subjects
Male ,Case-Control Studies ,Absorbable Implants ,Humans ,Female ,Coronary Artery Disease ,Tomography, Optical Coherence ,Blood Vessel Prosthesis ,Follow-Up Studies ,Monitoring, Physiologic - Abstract
Quantitative light intensity analysis of the strut core by optical coherence tomography (OCT) may enable assessment of changes in the light reflectivity of the bioresorbable polymeric scaffold from polymer to provisional matrix and connective tissues, with full disappearance and integration of the scaffold into the vessel wall. The aim of this report was to describe the methodology and to apply it to serial human OCT images post procedure and at 6, 12, 24 and 36 months in the ABSORB cohort B trial.In serial frequency-domain OCT pullbacks, corresponding struts at different time points were identified by 3-dimensional foldout view. The peak and median values of light intensity were measured in the strut core by dedicated software. A total of 303 corresponding struts were serially analyzed at 3 time points. In the sequential analysis, peak light intensity increased gradually in the first 24 months after implantation and reached a plateau (relative difference with respect to baseline [%Dif]: 61.4% at 12 months, 115.0% at 24 months, 110.7% at 36 months), while the median intensity kept increasing at 36 months (%Dif: 14.3% at 12 months, 75.0% at 24 months, 93.1% at 36 months).Quantitative light intensity analysis by OCT was capable of detecting subtle changes in the bioresorbable strut appearance over time, and could be used to monitor the bioresorption and integration process of polylactide struts.
- Published
- 2014
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.