RESUMO

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

Assuntos

RESUMO

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

Assuntos

RESUMO

BACKGROUND: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. AIM: To report our experience with TAVI under conscious sedation. MATERIAL AND METHODS: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. RESULTS: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. CONCLUSIONS: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

Assuntos

RESUMO

Background: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. Aim: To report our experience with TAVI under conscious sedation. Material and Methods: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. Results: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. Conclusions: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

Assuntos

RESUMO

INTRODUCCIÓN: La valvulopatía reumática es una entidad aún frecuente en Chile, siendo la válvula mitral la más afectada. Su principal motivo de consulta es disnea progresiva. Sin tratamiento tiene mal pronóstico debido al estrechamiento progresivo de dicha válvula. En la actualidad es posible tratarla mediante cirugía abierta y valvuloplastía mitral percutánea. En este caso se revisa y discute las indicaciones actualizadas de cada una, destaca al ecocardiograma para la selección de los pacientes, y analiza las ventajas y desventajas de las diferentes técnicas. PRESENTACIÓN DEL CASO: Mujer de 44 años, con estenosis mitral, disnea progresiva en Capacidad Funcional (CF) III de 3 años de evolución. Se realiza ecocardiografía transtorácica que demuestra estenosis mitral severa de etiología reumática y se decide cirugíade reemplazo valvular. En el ecocardiograma transtorácico para evaluación preoperatorio se concluye score de Wilkins de 5 puntos por lo que se sugiere realizar valvuloplastía mitral, resultando exitosa sin complicaciones y con aumento de área mitral a 1,9 cm2. DISCUSIÓN: Inicialmente se planteó cirugía de reemplazo valvular, pero al realizar el ecocardiograma preoperatorio se decide realizar valvuloplastía mitral por sobre cirugía debido al score de Wilkins. Éste score es la herramienta más utilizada para decidir entre estas dos técnicas, y según últimos estudios puede ser mejorado con la inclusión del parámetro de calcificación comisural evitando de esta manera sus principales complicaciones.

INTRODUCTION: Rheumatic valve disease is still common entity in Chile, being mitral valve the most affected. His main complaint is progressive dyspnea. Without treatment has a poor prognosis due to progressive narrowing of the valve. It is now possible to treat by an open surgery or percutaneous mitral valvuloplasty. In this case we review and discuss the indications, highlight the echocardiogram for patient selection, and discusses the advantages and disadvantages of the different techniques. CASE PRESENTATION: 44 years old woman with mitral stenosis, progressive dyspnea Functional Capacity (CF) III of 3 years duration. Transthoracic echocardiography was performed demonstrating severe mitral stenosis of rheumatic etiology and decides valve replacement surgery. In transthoracic echocardiography for preoperative evaluation concludes Wilkins score of 5 points so it is suggested mitral valvuloplasty proving successful and uncomplicated mitral area increased to 1.9 cm2. DISCUSSION: originally was raised valve replacement surgery and because of the preoperative echocardiogram is decided to perform mitral valvuloplasty instead of surgery because of Wilkins score. This score is the most used tool for deciding between these two techniques, and according to recent studies can be improved with the inclusion of commissural calcification parameter thus avoiding its major complications.

Assuntos

RESUMO

Antecedentes: Los pacientes diabéticos tratados con angioplastía coronaria (AC) poseen un mayor riesgo de reestenosis y por lo tanto de reintervención en comparación a los no diabéticos, lo que ha derivado en una mayor utilización de stents recubiertos con drogas en este grupo de pacientes. Objetivo: Analizar la incidencia de reintervención en pacientes diabéticos no seleccionados sometidos a una AC con stent no recubierto en el Hospital Regional de Concepción e identificar los predictores de la reintervención. Método: Entre Enero 2005 y Diciembre 2006, 571 pacientes fueron sometidos AC, de los cuales 108 (19 por ciento) eran diabéticos. En este grupo estudiamos sus características clínicas, factores de riesgo y los factores angiográficos tales como el vaso tratado, diámetro, longitud y número de stents. Mediante un seguimiento telefónico y de ficha clínica se determinó la existencia o no de una reintervención coronaria. Identificado elgrupo con reintervención coronaria, comparamos las variables clínicas y angiográficas y a través de un modelo de regresión logística se buscó identificar predictores de dicha intervención. Se utilizó t de student y test exacto de Fisher. Resultados: La edad promedio fue 61±10 años, 71(66 por ciento) hombres y 25 por ciento insulinorequirientes 47(44 por ciento) pacientes tenía dislipidemia, 93(86 por ciento) hipertensión y 26(25 por ciento) eran fumadores. La AC fue en contexto de un SCA s/SDST en 56(52 por ciento) pacientes, 38 (35 por ciento) por IAM en evolución y 12(11 por ciento) por angina estable. Se implantaron 138 stents (1,3 stent/pt) y fue exitosa en el 96 por ciento. En el seguimiento de 13,7 ±7 meses la mortalidad fue 4,6 por ciento y sólo 12(11 por ciento) pacientes fueron sometidos a una nueva revascularización, 75 por ciento de las cuales fue otra AC. De las reintervenciones, sólo 4(33 por ciento) pacientes tenía reestenosis, el resto fue por lesiones en otro vaso. La distribución de los factores de riesgo...

Diabetes mellitus is associated to a more severe and extensive coronary artery disease. Coronary angioplasty (PTCA) has been demonstrated to have similar immediate results compared with patients without diabetes; however, diabetic patients exhibit a higher rate of restenosis and target lesion revascularization. Aim: to study the real incidence of a new interventional procedures in diabetics patients who were treated with bare metal stents. Methods: From January 2005 to December 2006, 571 patients were submitted to PTCA at the Hospital Regional de Concepcion. 108 patients (195) were diabetics. Clinical characteristics, risk factors, and angiographic findings were tabulated. Telephone follow up was used to determine the performance of coronary re intervention. A logistics regression model was used to identify predictors of coronary re intervention. Results: The mean average age was 61±10 years, 66 percent were men and 25 percent required insulin treatment. Dyslypidemia was present in 86 percent, hypertension in 86 percent and 25 percent were smokers. Indication for PTCA was acute coronary syndrome in 52 percent, myocardial infarction in 35 percent and stable angina in 11 percent. They received 1,3 stents/pts and immediate success rate was 96 percent. During follow up (13,7±7 months) global mortality was 4,6% and only 12 (11 percent) patients had a second revascularization procedure, 67 percent of them performed in non stentedcoronary arteries. Four revascularizations (33 percent) were due to significant in-stent restenosis, seven (58 percent) to other significant lesions and 1 to subacute stent thrombosis. In the univariate and multivariate analysis we didnot find independent clinical or angiographic factors as predictors of new revascularization. However, it wasmore frequent in patients with proximal left anterior descending artery stents and long lesions (58 percent and 50 percent, respectively). Conclusion: In our experience, need for repeat...

Assuntos

RESUMO

Antecedentes: En el infarto agudo al miocardio con supradesnivel del segmento ST (IAM c/SDST) la angioplastía primaria (AP) ha demostrado disminuir la mortalidad y el reinfarto en comparación con la trombolisis. Por esta razón, desde septiembre de 2005 instauramos la AP como el tratamiento de elección del IAM en nuestro hospital. Objetivo: Mostrar nuestra experiencia con AP en el tratamiento del IAM en el Hospital Regional de Concepción. Método: Revisamos las características clínicas, hallazgos angiográficos y los resultados de los pacientes con IAM c/SDST que fueron tratados con AP en nuestro hospital, en el periodo entre septiembre 2005 y abril de 2007. Analizamos el tiempo “puerta-balón”, los resultados angiográficos y los resultados clínicos precoces y alejados. El seguimiento ha sido a través de la visita médica y por medio de teléfono. Los valores muestran como promedio y DS. Resultados: En este periodo 147 pacientes con IAM c/SDST fueron tratados con AP, en un tiempo puerta-balón de 65 +/- 37 minutos. La edad promedio fue 61 +/- 12 años. 112 (76 por ciento) pacientes eran hombres, 36 (24 por ciento) diabéticos, 81 (55 por ciento) hipertensos, 21 (14 por ciento) tenían dislipidemia y 48 (33 por ciento) eran fumadores. El 76 por ciento se presentaron con IAM 6 horas de evolución y en el 46 por ciento el infarto fue de pared anterior. Hubo éxito angiográfico de 92 por ciento y la angioplastía fue con stent en el 93 por ciento. La mortalidad global fue 8,8 por ciento a 30 días con 2 por ciento de reinfarto. En el seguimiento alejado de 112 +/- 86 días la mortalidad fue 4,4 por ciento. El sexo femenino y la enfermedad multivaso fueron los únicos predictores independientes de mortalidad. Conclusión: Hemos logrado implementar la angioplastía primaria como método de elección en el IAM, cumpliendo con los tiempos internacionales establecidos y con una tasa de éxito superior al 90 por ciento.

Background: Compared to thrombolysis, primary coronary angioplasty (PTCA) has proven more effective to decrease mortality and re-infarction in patients with ST segment elevation myocardial infarction (STEMI). Therefore, from 2005 primary PTCA was used as the treatment of choice for patients with acute STEMI at our institution. Aim: to evaluate results obtained with primary PTCA in patients with STEMI at the Hospital Regional de Concepcion. Methods: The clinical characteristics, angiographic findings and results of primary PTCA were evaluated in consecutive patients treated from 2005 to 2007. Door to balloon time, angiographic results and early and late clinical results were evaluated. Follow up was obtained by clinical interviews and phone contact. Results are expressed as mean +/- SD. Results: 147 patients were treated. The door to balloon time was 65 +/- 37 min. Mean age was 61 +/- 12 years. 76 percent of patients were males, diabetes was present in 55 percent, hypertension in 14 percent, dyslipidemia in 33 percent and 33 percent of patients were smokers. 76 percent of patients presented 6hr after initiation of pain. An anterior wall MI was present in 46 percent. Angiographic success rate was 92 percent; stents were used in 93 percent of patients. Overall mortality rate was 8.8 percent at 30 days and reinfarction rate was 2 percent. After a mean follow up of 112 +/- 86 days, late mortality rate was 4.4 percent. Female gender and multi vessel disease were the sole predictors of mortality Conclusion: Primary PTCA at the Hospital Regional de Concepcion was performed with a success rate above 90 percent within an internationally accepted time interval following the initiation of MI.

Assuntos

RESUMO

BACKGROUND: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. AIM: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. SUBJECTS AND METHODS: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. RESULTS: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. CONCLUSIONS: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory.

Assuntos

RESUMO

Background: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. Aim: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. Subjects and methods: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. Results: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. Conclusions: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory effort.

Assuntos

RESUMO

Background : The risk of cardiovascular diseases is two to four times higher in diabetic patients. Aim: To study the severity of coronary disease and survival of patients with diabetes mellitus, compared to matched controls without diabetes. Patients and methods: A retrospective review of all coronary angiographies performed at a private hospital. All diabetic patients with coronary lesions over 50 percent were considered as the index group. Non diabetic patients with coronary artery lesions over 50 percent and with similar demographic features and risk factors to the diabetic patients group, were studied as controls. A follow up was done reviewing clinical records and by telephone interviews. Mortality was obtained reviewing death certificates. Results: Seventy seven diabetic patients (48 male, mean age 61±10 years and 129 non diabetic subjets (87 males, eman age 61±10 years) were studied. Mean follow up in diabetic and non diabetic patients was 1,270 and 1,340 days respectively. Diabetic patients had a higher frequency of multiple vessel disease than their non diabetic counterparts (69 and 52 percent respectively, p <0.003). Ejection fraction was 61 and 65 percent in diabetics and non diabetics. General mortality was 15.5 and 2.3 percent in diabetics and non diabetic respectively (p <0.01). Cardiovascular mortality was 9.1 and 0.8 percent in diabetics and non diabetics respectively (p 0.002). Conclusions: Diabetic patients with coronary artery disease have a lower survival and more extensive coronary artery lesions than non diabetic patients with similar age, sex and overall coronary risk (Rev MÚd Chile 2004; 132: 331-6).

Assuntos