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Background: The use of the radial approach for diagnostic cardiac catheterization and percutaneous coronary interventions varies among different interventional cardiology centers in the world. We describe the trends in the use of this approach over the past 14 years at a tertiary hospital.Methods: Consecutive coronary procedures performed from 1999 to 2013 at a single center, in patients aged ≥ 35 years were identified. Age, gender, resource provider (Public or Private Healthcare System) and the complexity of the procedure (diagnostic or therapeutic) were retrospectively analyzed.Results: 103,253 procedures were included. The Brazilian Public Healthcare Service (SUS – Sistema Único de Saúde) was the resource provider in 77% of the cases. Mean age of patients was 62.2 ± 11.3 years and 58% were male. The radial approach was used in 6,402 (6.2%) procedures, showing a significant rise over time, which was more evident when analyzed comparatively for the six timepoints of service experience: 0.2%; 0.6%; 3.1%; 2.1%; 6.9%, and 24.4% respectively (p < 0.01). Even larger percentages of radial approach were observed when only the procedures performed by the SUS and diagnostic cardiac catheterizations were taken into account. There were also changes in the profile of vascular access, even though smaller, in the Private Healthcare System.Conclusions: We demonstrated progressive changes in the profile of the use of access routes for diagnostic cardiac catheterization and percutaneous coronary interventions at a large center over time. These data are consistent with the global trend and are significantly robust, especially when the last sextile is analyzed.RESUMOTendências da Utilização da Via de Acesso Transradiai em Mais de Uma Década: A Experiência do InCorIntroduco: A utilização da via radial para a realização de cateterismo cardíaco diagnóstico e intervenção coronária percutânea varia entre os diversos centros de hemodinâmica. Descrevemos as tendências do uso dessa via de acesso ao longo dos últimos 14 anos num serviço terciário.Métodos: Foram identificados procedimentos coronarianos consecutivos realizados de 1999 a 2013, em um único centro, em pacientes com idade ≥ 35 anos. Dados como idade, sexo, fonte provedora de recursos (Sistema de Saúde Público ou Saúde Suplementar/Privado) e complexidade do procedimento (diagnòstico ou terapêutico) foram retrospectivamente analisados.Resultados: Foram incluídos 103.253 procedimentos, dos quais o Sistema Único de Saúde (SUS) foi o provedor de recursos em 77% dos casos. A média de idades dos pacientes foi 62,2 ± 11,3 e 58,8% eram do sexo masculino. A via radial foi utilizada em 6.402 (6,2%) dos procedimentos, apresentando ascenSão significativa ao longo do tempo, mais evidente quando analisada comparativamente nos seis períodos de experiência do serviço: 0,2%, 0,6%, 3,1%, 2,1%, 6,9% e 24,4%, respectivamente (p < 0,01). Porcentuais ainda maiores do uso da via radial foram encontrados, restringindo-se aos procedimentos realizados pelo SUS e quando apenas os cateterismos cardíacos diagnósticos foram contabilizados. Houve também mudança no perfil da via de acesso, ainda que de menor monta, no setor de Saúde Suplementar/Privado.Conclusões: Demonstramos a progressiva modificação do perfil de utilização das vias de acesso para a realização de cateterismo cardíaco diagnòstico e intervenção coronària percutânea de um centro de grande porte ao longo do tempo. Esses dados são condizentes com a tendência mundial e de significativa robustez, principalmente quando analisado o último sextil.

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.

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.

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.

Background: Cardiogenic shock is the leading cause of death in patients with ST-segment elevation myocardial infarction (STEMI). The present study evaluated patients with STEMI and cardiogenic shock undergoing primary percutaneous coronary intervention, in order to establish their profile and predictors of in-hospital mortality. Methods: A single centre registry, including 100 patients evaluated from 2001 to 2009, was used to compile clinical, angiographic and procedure-related characteristics and in-hospital outcomes. The independent predictors of in-hospital mortality were determined by multivariate analysis. Results: A high prevalence of risk factors was observed. The angiographic success rate was 92%, despite the lesion complexity (83.1% were type B2/C). The left anterior descending artery was the most affected artery (45%), and 73% of the patients had multivessel disease. The mortality rate was 45%, and its independent predictors were multivessel disease (odds ratio [OR] 2.62; 95% confidence interval [95% CI] 1.16–5.90) and TIMI flow < 3 at the end of the procedure (OR 2.11; 95% CI 1.48–3.02). Conclusions: Patients with STEMI complicated by cardiogenic shock presented high-risk clinical and angiographic characteristics, and despite the high angiographic success rate of the procedure, mortality rates were high. The presence of multivessel disease and TIMI flow < 3 at the end of the procedure were independent predictors of mortality.

BackgroundAcute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI).MethodsSingle-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated.ResultsMean age was 60.7±12.6years and 67% were male. The populaton had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion.ConclusionsAcute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.