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Introduction The left atrial appendage occlusion (LAAO) procedure is a therapeutic option for stroke prevention in patients with atrial fibrillation (AF) which have contraindication to oral anticoagulants or still develop embolic events despite therapeutic anticoagulation. Transesophageal echocardiography (TEE) has been the gold standard to guide this procedure, with the intracardiac echocardiography (ICE) emerging as an alternative because of the advantage of reducing the general anesthesia burden compared to TEE. Objectives This study aims to compare the safety, procedure-related parameters and outcomes between TEE-guided LAAO and ICE-guided LAAO. Methods In a tertiary center, patients who underwent TEE-guided LAAO and ICE-guided LAAO were compared retrospectively regarding technical success, procedure-related events, procedure-related parameters (fluoroscopy time, dose of radiation and contrast volume), 45 days-transthoracic echocardiography (TTE) and 1-year outcomes (mortality, stroke and major bleeding). Results 88 patients underwent LAAO between 2009 and 2020 (n=43 with TEE, n=45 with ICE). Baseline characteristics were similar. Success was achieved in 95.3% (n=41) and 95.6% (n=43) of the patients in the TEE and ICE groups, respectively (OR 0.95, p=0.96). Procedure-related complications (major vascular complications, perforation, device embolization) didn't show significant differences (14.0% vs 8.9%, OR 1.66, p=0.46) in the TEE and ICE groups, respectively. Fluoroscopy time was inferior in the TEE group (29.1±13.6 vs 44.1±17.4 minutes, p=0.001), while radiation dose (2761±1555 vs 3397±2118 mGy, p=0.113) and contrast volume (220.3±104.1 vs 204.0±100.9mL, p=0.469) showed no significant differences. 45 days-TTE showed no significant differences between the TEE and ICE groups regarding peri-device leaks (14.0% vs 24.4%, p=0.212), device thrombus (2.3% vs 0%, p=0.990) and iatrogenic atrial septal defects, all mild (4.7% vs 13.3%, p=0.174). 1-year outcomes showed no significant differences regarding stroke (9.3% vs 4.4%, p=0.186), major bleeding (9.3% vs 2.2%, p=0.78) and all-cause mortality (9.3% vs 11.1%, p=0.38) between the TEE and ICE groups, respectively. Conclusions ICE-guided LAAO is associated with similar results, procedure-related events, procedure related-parameters (fluoroscopy time being the only exception) and 1-year outcomes, compared with TEE-guided LAAO. Funding Acknowledgement Type of funding sources: None.

Introduction: Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal. Methods: A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized. Results: A total of 118706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C-type or bifurcated coronary lesions, and in-stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery. Conclusion: Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery. Resumo: Introdução: A ecografia intravascular coronária tem ganho importância nos laboratórios de hemodinâmica pela evidência de impacto prognóstico positivo para os doentes. Este trabalho tem como objetivo caraterizar a utilização de ecografia intravascular em intervenções coronárias percutâneas em Portugal. Métodos: Estudo observacional retrospetivo com base no Registo Nacional de Cardiologia de Intervenção da Sociedade Portuguesa de Cardiologia. De 2002 a 2016 caraterizou-se o perfil clínico e angiográficos dos doentes submetidos a intervenção coronária percutânea, a percentagem de utilização de ecografia intravascular e as artérias coronárias avaliadas. Resultados: Foram incluídas 118 706 intervenções coronárias percutâneas, com utilização de ecografia intravascular em 2266 (19%). A evolução temporal caraterizou-se por ausência em 2002 e uma utilização maioritariamente crescente de 2003 (0.1%) a 2016 (2.4%). O grupo de doentes com utilização de ecografia intravascular coronária tinham idade semelhante ao grupo de doentes sem utilização de ecografia intravascular coronária, com uma menor prevalência de doentes do sexo masculino e uma maior prevalência de fatores de risco cardiovasculares (hipertensão arterial, hipercolesterolemia, diabetes), enfarte agudo do miocárdio prévio, intervenção coronária percutânea prévia, doença coronária multivaso, lesões coronárias do tipo C ou em bifurcação e reestenose intra-stent. A ecografia intravascular foi utilizada em 54.8% em intervenções coronárias percutâneas eletivas e em 19.15% das intervenções coronárias percutâneas do tronco comum. Conclusão: A ecografia intravascular coronária teve uma utilização crescente em Portugal desde 2003, ocorre preferencialmente em intervenções coronárias percutâneas eletivas, de doentes com maior risco cardiovascular, com lesões coronárias mais complexas e lesões do tronco comum. Keywords: Intravascular ultrasound, Percutaneous coronary intervention, Coronary disease, Cardiology, Palavras-chave: Ecografia intravascular, Intervenção coronária percutânea, Doença coronária, Cardiologia

Introduction: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. Methods: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. Results: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker.The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. Conclusion: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause. Resumo: Introdução: Na miocardiopatia hipertrófica obstrutiva (MCHO), ablação septal alcoólica (ASA) pode levar a redução do gradiente e melhoria sintomática. O objetivo foi avaliar a eficácia e segurança da ASA no desfecho a longo prazo. Métodos: Análise de doentes submetidos a ASA, durante sete anos, num centro terciário. Endpoint primário ecocardiográfico: redução >50% do gradiente na câmara de saída do ventrículo esquerdo (CSVE) durante o primeiro ano após o procedimento. Endpoints primários clínicos: a) melhoria da capacidade funcional; b) endpoint combinado: morte de causa cardíaca+hospitalização de causa cardíaca. Tempo de seguimento 4,17±2,13 anos. Resultados: Oitenta doentes, idade média de 63,9±12,3 anos, 30,0% homens. De base, o gradiente na CSVE era 96,3±34,6 mmHg, espessura do septo interventricular 21,6±3,1 mm. Complicações minor foram verificadas em 6,3%, complicações major em 2,5% e 8,8% receberam um pacemaker definitivo. O endpoint primário ecocardiográfico foi atingido em 85,7%. Aos três meses, o gradiente na CSVE foi de 25,8±26,0 mmHg no grupo com sucesso no procedimento contrastando com 69,2±35,6 mmHg nos restantes doentes (p=0,001). Aos seis meses, os gradientes na CSVE foram 27,1±27,4 versus 58,2±16,6 mmHg (p=0,024).De entre os 74 doentes em classe NYHA III/IV antes do procedimento, 57 (77%) melhoraram para classe NYHA I/II. O endpoint primário combinado (morte de causa cardíaca+hospitalização de causa cardíaca) verificou-se em 27,5% (n=22). No grupo sem sucesso, o endpoint primário composto verificou-se em 54,5%, contrastando com apenas 22,7% no grupo com sucesso. Apenas dois doentes apresentaram morte de causa cardíaca. Conclusão: A ASA é um procedimento seguro com elevada taxa de sucesso. Doentes que atingiram redução significativa do gradiente na CSVE apresentam menor morte de causa cardíaca e hospitalização de causa cardíaca. Keywords: Obstructive hypertrophic cardiomyopathy, Alcohol septal ablation, Left ventricular outflow tract gradient, Palavras chave: Miocardiopatia hipertrófica obstrutiva, Ablação septal alcoólica, Gradiente na câmara de saída do ventrículo esquerdo

Aims: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. Methods and results: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3,603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). Inhospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs 3.0%, p=0.09). Conclusions: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication. © Europa Edition. All rights reserved.

Resumo: Introdução: A ablação septal alcoólica (ASA) é a forma percutânea de tratamento invasivo da cardiomiopatia hipertrófica obstrutiva (CMHO). A propósito da descrição da experiência no nosso centro, procurar-se-á rever as indicações, os aspetos técnicos e práticos e os resultados da ASA, assim como a sua posição atual em comparação com a miectomia cirúrgica. Objetivo: Avaliar os resultados da ASA numa série de doentes consecutivos tratados nos primeiros quatro anos de atividade. Métodos: Estudo retrospetivo de todos os doentes, consecutivos e não selecionados, com CMHO, tratados por ASA, entre janeiro de 2009 e fevereiro de 2013. Resultados: Durante o período de quatro anos foram tratados com ASA 40 doentes. Em três doentes (7,5%) repetiu-se o procedimento. A taxa de sucesso foi de 84%. A taxa de complicações minor foi de 7,5%. Foi necessário implantar pacemaker definitivo por bloqueio auriculoventricular em dois doentes (6%, do subgrupo sem pacemaker prévio). A taxa de complicações major foi de 5%. Não houve mortalidade intra-hospitalar nesta população. Durante o seguimento clínico (22 ± 14 meses) a mortalidade cardiovascular foi de 2,5%. A mortalidade total foi de 5%. Discussão e conclusão: Os resultados apresentados refletem a experiência inicial do tratamento com ASA no nosso centro. O procedimento foi bem-sucedido na maioria dos doentes, sendo a taxa de sucesso semelhante à descrita em outras séries, mas ainda com possibilidade de beneficiar de uma melhor seleção dos doentes. A intervenção também se revelou segura, com uma baixa ocorrência de complicações e sem mortalidade associada. A ASA é uma alternativa percutânea no tratamento invasivo dos doentes com CMHO refratária à terapêutica médica. Abstract: Introduction: We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. Objective: To assess the results of ASA in all patients treated in the first four years of activity at our center. Methods: We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. Results: In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in-hospital deaths; during clinical follow-up (22±14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. Discussion and Conclusion: The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure-related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment. Palavras-chave: Cardiomiopatia hipertrófica obstrutiva, Tratamento percutâneo, Ablação septal alcoólica, Keywords: Obstructive hypertrophic cardiomyopathy, Percutaneous treatment, Alcohol septal ablation

BACKGROUND: In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI. PATIENTS AND METHODS: From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS: Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods. CONCLUSION: Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.

Background: Non-invasive Ischemia Testing (NIST) is recommended for most patients suspected to have stable coronary artery disease (CAD) before invasive cardiac angiography (ICA). We sought to assess the diagnostic predictive ability of NIST over clinical risk profiling in a contemporary sample of patients undergoing the currently recommended diagnostic triage strategy. Methods and results: From 2006 - 2011, 2600 consecutive patients without known CAD undergoing elective ICA in a single tertiary - care centre were retrospectively identified and the prevalence of obstructive CAD determined. To understand the incremental value of frequently used clinical parameters in predicting obstructive CAD, receiver - operating - characteristic curves were plotted for six sequential models starting with Framingham risk score and then progressively adding multiple clinical factors and finally NIST results. At ICA 1268 patients (48.8%) had obstructive. The vast majority (85%) were classified in an intermediate clinical pre - test probability of CAD and NIST prior to ICA was used in 86% of the cohort. The most powerful correlate of obstructive CAD was the presence of severe angina (OR = 9.1, 95% confidence interval (CI), 4.3 - 19.1). Accordingly, the incorporation of NIST in a sequential model had no significant effect on the predictive ability over that achieved by clinical and symptomatic status model (C - statistic 0.754; 95% CI, 0.732 - 0.776, p = 0.28). Conclusions: Less than half the patients with suspect stable obstructive CAD referred to a tertiary level centre for elective ICA had the diagnosis confirmed. In this clinical setting, the results of NIST may not have the power to change the discriminative ability over clinical judgment alone.

Introduction: We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. Objective: To assess the results of ASA in all patients treated in the first four years of activity at our center. Methods: We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. Results: In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in‐hospital deaths; during clinical follow‐up (22±14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. Discussion and Conclusion: The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure‐related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment. Resumo: Introdução: A ablação septal alcoólica (ASA) é a forma percutânea de tratamento invasivo da cardiomiopatia hipertrófica obstrutiva (CMHO). A propósito da descrição da experiência no nosso centro, procurar‐se‐á rever as indicações, os aspetos técnicos e práticos e os resultados da ASA, assim como a sua posição atual em comparação com a miectomia cirúrgica. Objetivo: Avaliar os resultados da ASA numa série de doentes consecutivos tratados nos primeiros quatro anos de atividade. Métodos: Estudo retrospetivo de todos os doentes, consecutivos e não selecionados, com CMHO, tratados por ASA, entre janeiro de 2009 e fevereiro de 2013. Resultados: Durante o período de quatro anos foram tratados com ASA 40 doentes. Em três doentes (7,5%) repetiu‐se o procedimento. A taxa de sucesso foi de 84%. A taxa de complicações minor foi de 7,5%. Foi necessário implantar pacemaker definitivo por bloqueio‐auriculoventricular em dois doentes (6%, do subgrupo sem pacemaker prévio). A taxa de complicações major foi de 5%. Não houve mortalidade intra‐hospitalar nesta população. Durante o seguimento clínico (22 ± 14 meses) a mortalidade cardiovascular foi de 2,5%. A mortalidade total foi de 5%. Discussão e conclusão: Os resultados apresentados refletem a experiência inicial do tratamento com ASA no nosso centro. O procedimento foi bem‐sucedido na maioria dos doentes, sendo a taxa de sucesso semelhante à descrita em outras séries, mas ainda com possibilidade de beneficiar de uma melhor seleção dos doentes. A intervenção também se revelou segura, com uma baixa ocorrência de complicações e sem mortalidade associada. A ASA é uma alternativa percutânea no tratamento invasivo dos doentes com CMHO refratária à terapêutica médica. Keywords: Obstructive hypertrophic cardiomyopathy, Percutaneous treatment, Alcohol septal ablation, Palavras‐chave: Cardiomiopatia hipertrófica obstrutiva, Tratamento percutâneo, Ablação septal alcoólica

Purpose The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. Methods and Materials All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12 months. Results In the cohort of 109 patients (73.4% male, 59 ± 12 years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00 mm (2.50–4.00) and median length of 15 mm (9–33). Cumulative MACEs were 2.8% at one month and 6.4% at 12 months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12 months, 33.9% of patients were not on dual antiplatelet therapy. Conclusions GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. Summary We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction.

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Apresentamos o caso de um doente, previamente submetido a angioplastia coronária com um stent revestido com fármaco, com enfarte agudo do miocárdio (EAM) provocado por trombose tardia do stent, tendo sido detectada fractura do mesmo. Este caso vem reforçar o reconhecimento crescente da fractura como potencial mecanismo para a trombose tardia de stent, na era dos stents revestidos com fármaco. A propósito deste caso clínico, apresentamos uma revisão da literatura sobre fractura de stent, nomeadamente sobre a sua incidência, mecanismos subjacentes e complicações clínicas.

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INTRODUCTION: The use of drug-eluting stents in the context of mechanical reperfusion following ST-segment elevation myocardial infarction (MI) was initially viewed with concern. The main fear was that the drugs' action in unstable lesions could increase the risk of thrombotic stent occlusion. Furthermore, there was no evidence that the proven benefit of reduced instent restenosis could be extended to such patients, since they were excluded from the initial clinical trials. OBJECTIVES: To assess the safety and long-term clinical outcomes of the use of drug-eluting stents in primary angioplasty. METHODS: The first 100 consecutive and non-selected patients admitted for MI and treated by primary angioplasty with drug-eluting stent implantation in the target lesion were analyzed retrospectively. The efficacy and safety of the procedure, in-hospital clinical evolution and the occurrence of major adverse cardiac events in the first year were assessed. RESULTS: Patients' mean age was 58.2 +/- 11.5 years, and 78 were male. The success rate of primary angioplasty was 99%. Stents coated with sirolimus were used in 67 patients, paclitaxel in 19 and dexamethasone in 16. In-hospital mortality was 3%. The follow-up rate at 12 months was 98%. During this period, the rate of target vessel revascularization was 1% (with no patient requiring target lesion revascularization), MI 2%, and overall mortality 3.9%. Fourteen patients had clinical indication for repeat coronary angiography, which showed no significant in-stent restenosis. One event was considered to be due to acute stent thrombosis. The incidence of major adverse events was 5.9%. CONCLUSION: The use of drug-eluting stents in MI patients undergoing primary mechanical revascularization is safe and is associated with a reduced incidence of major adverse events, thrombosis and clinical restenosis at one year.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2011-09-02T16:35:01Z No. of bitstreams: 1 RPC 2007 211.pdf: 113072 bytes, checksum: 52737f86b817daac82fcdcc0f6f9d84a (MD5) Made available in DSpace on 2011-09-02T16:35:01Z (GMT). No. of bitstreams: 1 RPC 2007 211.pdf: 113072 bytes, checksum: 52737f86b817daac82fcdcc0f6f9d84a (MD5) Previous issue date: 2007

Objective: This study sought to assess long term incidence, timing and prognostic of stent thrombosis (ST) after drug-eluting stent (DES) or bare-metal stent (BMS) implantation in patients undergoing primary percutaneous coronary intervention (PPCI). Background: Although DES remarkably reduced the incidence of stent-restenosis and the need for target lesion revascularization (TLR) compared to BMS, its widespread use has raised concerns regarding the occurrence of very late ST (>1 year). The incidence and timing of ST remain unsettled, with consequent uncertainty about risk stratification and long-term recommendations for antiplatelet medications. Methods: From 2001 to 2007 consecutive patients undergoing PPCI single tertiary-care center were included and prospectively followed up for at least 5 years. We analyzed ST occurrence as defined by the Academic Research Consortium (ARC) and also assessed the cumulative incidence of major adverse cardiac events (MACE) defined as death, reinfarction or TLR at 5-year follow up. Results: There were 1156 STEMI patients undergoing PPCI in study period. Patients not receiving a stent (92, 7.9%) were excluded from the analysis. Forty patients (3.8%) were lost to follow up. Mean follow up time was 64.3 months. DES was used in 417 (39.2%). Patients receiving DES were more likely to be younger (61±10 vs 69±11, p=0.03) and have single vessel disease (56 vs 48%, p= 0.02). No other baseline characteristics were found to differ between the 2 groups (Diabetes 18.3%, Severe LV dysfunction 10.2%). Five-year definite ST was found in 6 patients (1.44%) in the DES group and in 4 (0.75%) in BMS group. Considering definite or probable ST the total events number raised to 11 (2.6%) in the DES group and to 22 (4.1%) in BMS group. There was also no difference in the timing of ST (very late ST for BMS 1.1% vs 1.4% for DES, p=ns). Interestingly, ST was associated with an increase in 5-year MACE as compared to pts with reinfarction not due to ST (33 vs 19.8%, p=ns). This was not driven by a mortality difference. Conclusion: Stent thrombosis is an infrequent event (3,38%) after PPCI at 5-year follow up. DES use in this setting was not associated with an increases risk of ST. Although ST is linked with dismal prognosis, this does not seem to be worse than a reinfartion unrelated to ST.

The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HCM): 1. The relation of rate corrected QT interval (QTc) and of QTc interlead variability (QTc dispersion) to complex ventricular arrhythmias (CVA); 2. The effects of amiodarone (Am), beta-blockers (beta B) and calcium antagonists (CA) on QTc and on QTc dispersion. Surface 12 leads ECG was analysed in 55 patients with HCM (39 +/- 12 years, 32 males). All patients were in sinus rhythm, without bundle branch block. Maximum (max), minimum (min) and mean QTc values were considered. QTc dispersion was calculated as: a) max QTc - min QTc (max-min); b) dispersion index (DI) = standard deviation of QTc/mean QTcx100. Patients groups were defined accordingly to: 1--the absence (group A1-35 patients) or the presence (group A2-20 patients) of CVA on 24 hours Holter monitoring; II--absence of cardioactive medication (group B1-20 patients) versus monotherapy with Am (group B3-10 patients), or beta B (group B4-15 patients), or CA (group B5-10 patients). Age, gender, type of HCM (asymmetric versus concentric) and echocardiographic fractional shortening were not different in the studied groups.[table: see text]1. Maximum QTc interlead QTc dispersion are increased in patients with HCM that show CVA on Holter monitoring; 2. Amiodarone prolongs QTc but reduces QTc dispersion, while beta-blockers and calcium antagonists do not significantly change neither the duration nor the dispersion of ventricular repolarization.