background: Although the transradial approach had significantly reduced vascular complications, studies have demonstrated that it may be related to higher radiation exposure. The objective of this study is to compare radiation exposure in invasive cardiologic procedures using the transradial and transfemoral approaches. Methods: Prospective cohort study including patients undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI) between August 2010 and December 2011. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patients were analyzed according to the access route: femoral or radial. Results: Of the 1,197 patients included in the study, 782 were submitted to procedures using the femoral access and 415 using the radial access. There was a lower prevalence of females (36.2% vs. 45.6%; P < 0.01), previous coronary artery bypass graft surgery (4% vs. 12.7%; P < 0.01) and severe valvular heart disease (0.3% vs. 1.4%; P = 0.07) in the radial group. The median radiation dose received by the patients was higher with the radial approach, both for diagnostic (621.6 mGy vs 445.7 mGy; P < 0.01) and therapeutic procedures (1,241.6 mGy vs 990.9 mGy; P < 0.01). Less experienced operators in the radial approach exposed patients to higher radiation doses (1,463 mGy vs 1,196 mGy; P = 0.02), which did not occur with the more experienced operators (1,311 mGy vs 1,449 mGy; P = 0.84). Conclusions: Patients undergoing invasive cardiologic procedures are exposed to higher radiation levels when the

RESUMOIntrodução: Estudos demonstram que a intervenção coronária percutânea primária realizada fora do horário de rotina está relacionada a pior prognóstico. Nosso objetivo foi avaliar os desfechos da intervenção coronária percutânea primária realizada nos períodos diurno e noturno em um centro cardiológico de referência. Métodos: Estudo de coorte prospectivo, que incluiu 1.108 pacientes consecutivamente atendidos por infarto agudo do miocárdio com supradesnivelamento do segmento ST, divididos nos grupos intervenção coronária percutânea primária diurna (se realizada entre 8 e 20 horas) e intervenção coronária percutânea primária noturna (se realizada entre 20 e 8 horas). Resultados: Incluímos 680 pacientes no grupo diurno e 428 no grupo noturno. As características basais referentes ao perfil demográfico, fatores de risco e classificação Killip foram semelhantes em ambos os grupos, porém o tempo porta-balão foi significativamente maior no grupo noturno (84 ± 66 minutos vs. 102 ± 98 minutos; p < 0,01). Vasos culpados, e fluxos TIMI pré e pós-procedimento não foram diferentes entre os grupos. Não encontramos diferenças significantes em relação à mortalidade hospitalar (7,6% vs. 10,2%; p = 0,16), trombose de stent (2,8% vs. 2,4%; p = 0,69) ou presença de sangramento maior (1,9% vs. 2,1%; p = 0,50). Em 1 ano, a mortalidade também foi semelhante (9,5% vs. 12,6%; p = 0,12). O principal preditor de mortalidade em 1 ano foi a classe III/IV de Killip (OR = 10,02; IC 95% 5,8-17,1; p < 0,01). Conclusões: Pacientes com infarto agudo do miocárdio apresentam taxas de desfechos clínicos semelhantes, independentemente do horário de realização da intervenção coronária percutânea primária. No entanto, o tempo porta-balão é significativamente maior nos pacientes tratados entre 20 e 8 horas. DESCRITORES:Infarto do miocárdio. Intervenção coronária per cutânea. Reperfusão miocárdica. ABSTRACT Results of Primary Percutaneous Coronary Interventions Performed During On-and Off-HoursBackground: Previous studies have shown that off-hours primary percutaneous coronary interventions are related to a worse prognosis. The objective of this study was to evaluate the outcomes of patients undergoing on-and off-hours primary percutaneous coronary interventions performed at a reference cardiology center. Methods: Prospective cohort study, including 1,108 consecutive patients with ST elevation myocardial infarction divided into primary percutaneous coronary intervention performed during regular working hours group (on-hours: 8:00 am to 8:00 pm) and primary percutaneous coronary intervention during nonregular working hours group (off-hours: 8:00 pm to 8:00 am). Results: The sample included 680 patients in the on-hours group and 428 in the off-hours group. Baseline demographic data, risk factors and Killip classification were similar in both groups, however door-to-balloon time was significantly longer in the off-hours group (84 ± 66 minutes vs. 102 ± 98 minutes; p < 0.01). Culprit vessels, pre-and post-procedure TIMI flows were not different between ...

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background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates. Methods: Consecutive patients undergoing primary PCI were enrolled from December of 2009 to June of 2011. Clinical, laboratory, and angiographic data were prospectively collected and entered into a dedicated database. The decision to perform thrombus aspiration was left to the discretion of the surgeons. One hundred and twelve samples of thrombi were collected, stored in 10% formalin fixed paraffin, stained with hematoxylineosin, and analysed by light microscopy. Upon histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organised thrombi. results: Recent thrombi were identified in 68 patients (61%), and lysed/organised thrombi were found in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P = 0.03). There were no other statistically significant differences regarding clinical, angiographic, laboratory, or clinical outcomes between the two study groups. Conclusions: In patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates presented the histopathological features of recent thrombi. There were no significant associations among these characteristics and the clinical, laboratory, and angiographic data in this

Cardiovascular disease is the leading cause of mortality in Brazil and worldwide, and ischemic heart disease accounts for a large portion of this concerning scenario. 1 Among its forms of presentation, acute coronary syndrome (ACS) has a wide range of severity. 2 However, the use of validated mathematical models of clinical prediction is essential and recommended in national and international guidelines for the management of patients with ACS. 3,4 With this stratification, high-risk patients may receive more aggressive antiplatelet and antithrombotic therapy and early invasive intervention, whereas lower-risk patients may receive less aggressive treatments. 3,5 Based on the Global Registry of Acute Coronary Events (GRACE) report, the GRACE score was designed with 8 variables analyzed on patient's admission, 6 5 semiquantitative ones (age range, heart rate, systolic blood pressure, plasma creatinine, and Killip class) and 3