BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the domina... more BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. METHODS: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. RESULTS: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical tech...
INTRODUÇÃO: O uso da técnica radial na realização de procedimentos coronários reduz a incidência ... more INTRODUÇÃO: O uso da técnica radial na realização de procedimentos coronários reduz a incidência de complicações vasculares no sítio de punção, os custos e o tempo de permanência hospitalar, além de propiciar maior conforto ao paciente. No entanto, seu emprego encontra-se prejudicado em 5% a 15% dos casos por variações anatômicas da artéria radial, vasoespasmo e teste de Allen negativo. O objetivo do trabalho é avaliar a segurança e a eficácia do acesso ulnar como via alternativa na realização dos procedimentos coronários. MÉTODO: Pacientes submetidos a procedimento coronário pela via ulnar foram incluídos em um registro prospectivo. Foram avaliados: o sucesso da técnica, definido como realização de coronariografia com adequada opacificação arterial e intervenção coronária percutânea (ICP) com estenose residual < 30%, sem necessidade de mudança da via de acesso; os tempos de procedimento e de fluoroscopia; e as complicações intra-hospitalares e aos 30 dias de seguimento. RESULTAD...
Background: The mechanisms and predictors of failed transradial approach in centers dedicated to ... more Background: The mechanisms and predictors of failed transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. Methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5%, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, failure rate was < 2% and variables associated with technical failure were female gender, advanc...
Radial access, besides providing greater comfort to the patient and reduction of hospital costs, ... more Radial access, besides providing greater comfort to the patient and reduction of hospital costs, promotes unequivocal reduction of vascular complications, with possible prognosis implication. A series of cases has shown that when its use is not suitable, ulnar access presents itself as a viable and effective alternative. To evaluate the safety and effectiveness of ulnar approach in the performance of coronary procedures after failed attempt in obtaining radial access. From May 2007 to February 2009, 115 patients underwent 122 coronary procedures via ulnar access and were included in a prospective registry. The average age was 61.3 +/- 11.1 years, 67 (58%) were female and 36 (31%) were diabetic. Procedure success was achieved in 116 (95%) cases. There were no cases of major bleeding, transfusions or vascular repair surgery among the complications. There were hematomas in 4.9% of the cases, though mostly superficial, light to moderate spasms in 4% and asymptomatic ulnar artery occlusi...
Treatment of acute coronary syndrome has been based on the prevention of ischemic complications b... more Treatment of acute coronary syndrome has been based on the prevention of ischemic complications by means of antithrombotic therapy and invasive strategies. The desired reduction reached in the recurrence of ischemic events reveals its price, an increase in the occurrence of major bleeding. Initially tolerated as a benign complication, it is now shown to be an important predictor of mortality. Greater attention dedicated to the prognostic impact of bleeding is recent, motivated by the development of new antithrombotic agents. Detailed analysis of the risk factors for myocardial infarction or bleeding is an important issue and allows institution of individualized approach.
The current recommendation is for at least 12 months of dual antiplatelet therapy after implantat... more The current recommendation is for at least 12 months of dual antiplatelet therapy after implantation of a drug-eluting stent. However, the optimal duration of dual antiplatelet therapy with specific types of drug-eluting stents remains unknown. To assess the clinical noninferiority of 3 months (short-term) vs 12 months (long-term) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) with zotarolimus-eluting stents. The OPTIMIZE trial was an open-label, active-controlled, 1:1 randomized noninferiority study including 3119 patients in 33 sites in Brazil between April 2010 and March 2012. Clinical follow-up was performed at 1, 3, 6, and 12 months. Eligible patients were those with stable coronary artery disease or history of low-risk acute coronary syndrome (ACS) undergoing PCI with zotarolimus-eluting stents. After PCI with zotarolimus-eluting stents, patients were prescribed aspirin (100-200 mg daily) and clopidogrel (75 mg daily) for 3 months ...
BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the domina... more BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. METHODS: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. RESULTS: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical tech...
INTRODUÇÃO: O uso da técnica radial na realização de procedimentos coronários reduz a incidência ... more INTRODUÇÃO: O uso da técnica radial na realização de procedimentos coronários reduz a incidência de complicações vasculares no sítio de punção, os custos e o tempo de permanência hospitalar, além de propiciar maior conforto ao paciente. No entanto, seu emprego encontra-se prejudicado em 5% a 15% dos casos por variações anatômicas da artéria radial, vasoespasmo e teste de Allen negativo. O objetivo do trabalho é avaliar a segurança e a eficácia do acesso ulnar como via alternativa na realização dos procedimentos coronários. MÉTODO: Pacientes submetidos a procedimento coronário pela via ulnar foram incluídos em um registro prospectivo. Foram avaliados: o sucesso da técnica, definido como realização de coronariografia com adequada opacificação arterial e intervenção coronária percutânea (ICP) com estenose residual < 30%, sem necessidade de mudança da via de acesso; os tempos de procedimento e de fluoroscopia; e as complicações intra-hospitalares e aos 30 dias de seguimento. RESULTAD...
Background: The mechanisms and predictors of failed transradial approach in centers dedicated to ... more Background: The mechanisms and predictors of failed transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. Methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5%, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, failure rate was < 2% and variables associated with technical failure were female gender, advanc...
Radial access, besides providing greater comfort to the patient and reduction of hospital costs, ... more Radial access, besides providing greater comfort to the patient and reduction of hospital costs, promotes unequivocal reduction of vascular complications, with possible prognosis implication. A series of cases has shown that when its use is not suitable, ulnar access presents itself as a viable and effective alternative. To evaluate the safety and effectiveness of ulnar approach in the performance of coronary procedures after failed attempt in obtaining radial access. From May 2007 to February 2009, 115 patients underwent 122 coronary procedures via ulnar access and were included in a prospective registry. The average age was 61.3 +/- 11.1 years, 67 (58%) were female and 36 (31%) were diabetic. Procedure success was achieved in 116 (95%) cases. There were no cases of major bleeding, transfusions or vascular repair surgery among the complications. There were hematomas in 4.9% of the cases, though mostly superficial, light to moderate spasms in 4% and asymptomatic ulnar artery occlusi...
Treatment of acute coronary syndrome has been based on the prevention of ischemic complications b... more Treatment of acute coronary syndrome has been based on the prevention of ischemic complications by means of antithrombotic therapy and invasive strategies. The desired reduction reached in the recurrence of ischemic events reveals its price, an increase in the occurrence of major bleeding. Initially tolerated as a benign complication, it is now shown to be an important predictor of mortality. Greater attention dedicated to the prognostic impact of bleeding is recent, motivated by the development of new antithrombotic agents. Detailed analysis of the risk factors for myocardial infarction or bleeding is an important issue and allows institution of individualized approach.
The current recommendation is for at least 12 months of dual antiplatelet therapy after implantat... more The current recommendation is for at least 12 months of dual antiplatelet therapy after implantation of a drug-eluting stent. However, the optimal duration of dual antiplatelet therapy with specific types of drug-eluting stents remains unknown. To assess the clinical noninferiority of 3 months (short-term) vs 12 months (long-term) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) with zotarolimus-eluting stents. The OPTIMIZE trial was an open-label, active-controlled, 1:1 randomized noninferiority study including 3119 patients in 33 sites in Brazil between April 2010 and March 2012. Clinical follow-up was performed at 1, 3, 6, and 12 months. Eligible patients were those with stable coronary artery disease or history of low-risk acute coronary syndrome (ACS) undergoing PCI with zotarolimus-eluting stents. After PCI with zotarolimus-eluting stents, patients were prescribed aspirin (100-200 mg daily) and clopidogrel (75 mg daily) for 3 months ...
Uploads
Papers