For patients with complex CAD treated by PCI, the combination of baseline clinical and angiographic factors provided better risk assessment. The SSII demonstrated the most precise predictive performance for long-term mortality.

Background: In ST-segment elevation myocardial infarction, the need for early recanalization of the culprit artery, associated to the difficult access of the general population to medical services that provide such treatment, contribute to increased mortality in such patients. This is the rationale for implementing the LATIN project, acronym for Latin America Telemedicine Infarct Network, in areas characterized by high demographic density and difficult access to healthcare services. The objective of the present study was to analyze the first year results of this project. Methods: The sample included six centers with telemedicine systems participating in the LATIN registry. In cases of acute myocardial infarction, the electrocardiogram and clinical summary were sent to the mobile phones of the interventional cardiologists at the reference hospital. Clinical and angiographic characteristics, intervals between care delivered and hospital outcomes were analyzed. Results: From June 2014 to June 2015, a total of 125 patients were enrolled, mean age of 58.3±11.1 years, 66.4% males, 30.4% suffering from diabetes mellitus and 28.8% smokers. A total of 85 primary percutaneous coronary interventions were performed with a mean door-to-balloon time of 46.4±25.0 minutes. The pharmaco-invasive strategy was adopted in 20.0% of patients. In-hospital mortality was 5.6%. Conclusions: The telemedicine system was a valuable partner in early diagnosis and rapid initiation of the gold standard treatment for acute myocardial infarction in the region analyzed, with possible impact in survival, cost reduction and morbimortality. RESUMO -Introdução:No infarto agudo do miocárdio com supradesnivelamento do segmento ST, a necessidade de recanalização precoce da artéria culpada, associada às dificuldades de acesso da população em geral aos serviços médicos que realizam esta modalidade de tratamento, contribui para o aumento da mortalidade nesse perfil de paciente. Diante do exposto, encontra-se o racional de implementação do projeto denominado LATIN, acrônimo para Latin America Telemedicine Infarct Network, em áreas caracterizadas por concentração demográfica densa e dificuldades de acesso à saúde. O objetivo do presente estudo foi analisar os resultados do primeiro ano deste projeto. Métodos: A amostra compreendeu seis centros dotados de telemedicina participantes do registro LATIN. Nos casos de infarto agudo do miocárdio, eletrocardiograma e resumo clínico eram encaminhados por mensagem para os celulares dos cardiologistas intervencionistas do hospital de referência. Foram analisadas as características clínicas, angiográficas, os intervalos de atendimento e os desfechos hospitalares. Resultados: De junho de 2014 a junho de 2015, foram incluídos 125 pacientes, com média de idade de 58,3±11,1 anos, 66,4% do sexo masculino, 30,4% portadores de diabetes melito e 28,8% tabagistas. Foram realizadas 85 intervenções coronárias percutâneas primárias, com tempo porta-balão médio de 46,4±25,0 minutos. A estratégia fármaco-invasiva foi realizada em 20,0...

Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access.

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Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.