50% em 88,5%, com taxa de crossover de 1,5%. A mortalidade hospitalar foi de 4,5% e a taxa de sangramento grave foi de 1%, sendo um episódio de hemorragia digestiva alta e uma queda de hemoglobina de 5 g/dl. As complicações vasculares relacionadas ao sítio de punção limitaram-se a três casos de hematoma tipo II e a dois casos de hematoma tipo III, sem repercussão clínica e com resolução espontânea. CONCLUSÃO: O acesso radial representa uma via eficaz e segura para a realização de intervenção coronária percutânea primária por operadores habituados ao emprego da técnica, com ocorrência virtualmente nula de complicações vasculares graves relacionadas ao sítio de punção.]]>

Background: The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective: To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with singlevessel coronary artery disease. Methods: Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included instent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values <0.05 were considered significant. Results: In the DES group, of 74 patients (96.1%) who completed the follow-up, 1 developed ISR (1.4%), 1 had TLR (1.4%), and 1 died (1.4%), with no cases of thrombosis. In the BMS group, of 141 patients (91.5%), ISR occurred in 14 (10.1%), TLR in 10 (7.3%), death in 3 (2.1%), and thrombosis in 1 (0.74%). In the economic analysis, the cost of the procedure was R$ 5,722.

RESUMOIntrodução: A realização de procedimentos coronários invasivos pelo acesso radial tem sido crescente, graças à exibição de dados consistentes que corroboram sua segurança e eficácia. Embora seja uma complicação infrequente e, na maioria das vezes, assintomática, a oclusão da arté-ria radial, quando ocorre, impede a reutilização dessa via em procedimentos futuros. Métodos: Estudo prospectivo que avaliou pacientes submetidos a intervenção coronária percutânea (ICP) pelo acesso radial, utilizando o dispositivo de compressão radial TR Band TM como técnica para obtenção de hemostasia com manutenção de fluxo anterógrado, de acordo com novo protocolo proposto para o manuseio do dispositivo. Resultados: No período entre fevereiro e março de 2011, foram incluídos 30 pacientes submetidos a ICP com a utilização do dispositivo TR Band TM para obtenção de hemostasia após o procedimento. Entre os pacientes avaliados, 27 (90%) relataram conforto e ausência de dor na região do punho; a saturação arterial de oxigênio manteve-se > 90% em 29 (96,6%) pacientes; não se constatou episódio de oclusão arterial, mantendo-se o pulso presente após o término da compressão e na alta hospitalar em todos os casos; e a hemostasia foi obtida no intervalo e com a retirada do volume de ar predeterminado em 26 (86,7%) pacientes. Conclusões: Neste estudo, o dispositivo de compressão radial TR Band TM demonstrou ser técnica segura e eficaz de hemostasia, com manutenção de fluxo anterógrado após a ICP. A utilização do protocolo proposto neste estudo para o manejo do dispositivo mostrou ser factível e de fácil aplicação, sem a demanda por avaliações frequentes, que podem desestimular seu uso mais amplo.

Primary percutaneous coronary intervention is the preferred reperfusion therapy for ST-segment elevation acute myocardial infarction patients within 12 hours of symptom-onset. Routine stent implantation during the procedure significantly reduces the rate of target vessel revascularization, although restenosis still represents a current limitation of the technique. Drug-eluting stents were developed to treat and prevent coronary restenosis. Randomized trials, meta-analysis, and registries proved their efficacy and safety in different clinical situations, including acute myocardial infarction. However, the increased risk of late stent thrombosis associated with drug-eluting stents during primary percutaneous coronary interventions encourages a careful analysis to identify which patients most benefit from them, as well as those where a prolonged dual antiplatelet therapy does not represent a limiting factor.

Background: When it is not suitable to use the radial access in invasive coronary procedures, the ulnar technique is a feasible and safe alternative. The objective of the present study was to characterize the relevance of the ulnar technique in the daily practice of a center that adopts the radial strategy as the first option. Methods: The sample was extracted from a single-center prospective registry, from May 2008 to October 2018, including all patients undergoing invasive coronary procedures in a large tertiary care hospital. The efficacy of the technique was determined by the need for crossover to another access route to finish the procedure. Vascular complications, such as hematoma, pseudoaneurysm, arterial occlusion, ischemic injury of the hand, compartment syndrome, arteriovenous fistula, infection, and the need for repairing vascular surgery, were evaluated at the time of hospital discharge, defining the safety outcomes. Results: In the analyzed period, 608 patients underwent ulnar access procedures. The mean age was 62.4 years, with a predominance of female patients (52.6%) and a high prevalence of cardiovascular risk factors. The procedures were mostly diagnostic (71.4%) and were performed by right ulnar access (86.7%). The efficacy of the technique was high (98.2%), and complications associated with the access route were infrequent, with a rate of 1.6% for asymptomatic ulnar artery occlusion, and of 3.1% for hematoma. Conclusion: The ulnar technique as an alternative access route is not very often used, but it is useful when the radial access is inadequate or in cases of failed radial artery cannulation.