In patients who evolved to cardiogenic shock and hypoxemia after MR, ARM improved oxygenation and was well tolerated hemodynamically.

SummaryBackground: The angiography has been used as a reference standard to define coronary artery disease (CAD), although its limitations are well-known. The significance of the myocardial fractional flow reserve (FFR) in the assessment of CAD is well established.

In-Hospital Outcomes in Patients with Acute Coronary Syndromes Undergoing Coronary Percutaneous Intervention Primarily Assisted in the Emergency Care Units (ECUs)-Results from a Tertiary Cardiology Center Background: Emergency Care Units (ECUs) were created to meet an urgent need of the Brazilian government to improve health care to low-income population. ECUs quickly became reference centers to treat chest pain in this population, due to their ability to provide prompt medical care, availability of last generation drugs and well trained staff. This study is aimed at describing the profile and inhospital follow-up of patients with acute coronary syndromes seen in these units and later referred to a tertiary hospital, where they were treated by percutaneous coronary intervention with stent implantation. Method: Three hundred patients were referred from ECUs to Santa Helena Hospital (Cabo Frio, RJ) from July to December, 2009. One hundred and sixty four patients (202 lesions) were treated by percutaneous intervention with stent and were divided in two groups: group I included 86 patients with acute coronary syndromes with ST segment elevation and group II included 78 patients with acute coronary syndromes without ST segment elevation. Clinical and angiographic characteristics and in-hospital major adverse cardiac events were compared between the two groups. Results: Clinical and angiographic characteristics were similar in both groups except for smoking. Angiographic success was obtained in 99% of the procedures. Mean hospitalization time (ECU + RESUMO

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RESUMOIntrodução: O stent recoberto por titânio-óxido nítrico (Titan) mostrou-se eficaz para redução da hiperplasia neointimal comparado ao stent convencional em animais e seres humanos. Foi elaborado um estudo clínico prospectivo e randomizado do stent Titan versus stent de aço inoxidá-vel, cujo objetivo foi comparar o índice de eventos cardíacos adversos maiores (ECAM) após dois anos. Método: No período de outubro de 2005 a maio de 2006, 200 pacientes (228 lesões) foram submetidos a implante de stent eletivo e randomizados para dois grupos: I) stent metálico (100) e II) stent Titan (100). O acompanhamento dos doentes foi realizado por consulta clínica. ECAM foram definidos como: morte, infarto agudo do miocárdio ou nova revascularização da lesão-alvo. As sobrevidas livres de ECAM e angina após dois anos foram comparadas entre os dois grupos. Resultados: Foi obtido sucesso em todos os procedimentos. As características clínicas e angiográficas foram similares nos dois grupos. O período médio de seguimento foi de 482 ± 264 dias. Aos 30 dias, o índice de ECAM foi de 2% no grupo I e de 1% no grupo II (P = 0,32). Após dois anos, a sobrevida livre de ECAM foi melhor no grupo Titan que no grupo stent metálico (93,6% vs. 82,4%; P = 0,036), assim como a sobrevida livre de angina (84% vs. 71%; P = 0,02). Conclusões: O implante do stent Titan em pacientes com insuficiência coronariana crônica é seguro e efetivo, e cursa com índices de ECAM e angina após dois anos menores que os do stent de aço inoxidável. DESCRITORES:Contenedores. Stents farmacológicos. Reestenose coronária. ABSTRACT Randomized Comparison of Percutaneous Coronary Intervention with Titanium-Nitride-OxideCoated Stents Versus Stainless Steel Stents in Patients with Coronary Artery Disease: RIO TrialBackground: Stent coating with titanium-nitride oxide (Titan) has been shown to reduce neointimal hyperplasia in both animals and humans. A prospective, randomized, clinical study was designed to compare the incidence of major adverse cardiac events (MACE) after two years in patients with the Titan stent versus the stainless steel stent. Methods: Two hundred patients (228 stenosis) submitted to stent implantation between October 2005 and May 2006 were randomized into two groups: I) Bare metal stent (100); II) Titan (100) and followed clinically. MACE was defined as a composite of death, acute myocardial infarction or clinically driven revascularization of target lesion. MACE and angina free survival after 2 years were compared between the two groups. Results: All procedures were successful in both groups. Baseline clinical and angiographic characteristics were similar in both groups. Mean followup period was 482 ± 264 days. After 30 days, MACE was 2% in group I and 1% in group II (P = 0.32). MACE free survival at 2 years was significantly better in the Titan group than in the bare metal stent group (93.6% vs. 82.4%; P = 0.036) as well as angina free survival (84% vs. 71%; P = 0.02). Conclusions: Revascularization with Titan stent in chronic coronary artery disease...