Pacientes com angina instável tratados por meio de intervenções coronarianas percutâneas no novo milênio: o que os caracteriza?

Abstract

Objective: To identify clinical and angiographic profiles of patients with unstable angina seen at a tertiary hospital and treated with percutaneous coronary intervention (PCI). Methods:Study of a consecutive series of 1413 patients, selected from a computerized database, who underwent percutaneous revascularization in the three-year period of [2002][2003][2004]. There were no inclusion/exclusion criteria.Results: Systemic arterial hypertension (74%) and hypercholesterolemia (65%) were the classical risk factors for coronary disease most frequently observed. Coronary artery bypass grafting and history of myocardial infarction were found in 24% and 28% of the cases, respectively. The subgroups most commonly treated were the IIB (48%) and IIIB (28%). Clopidogrel was prescribed for 51% of the patients and glycoprotein IIb/IIIa inhibitors, for 7%. Multivessel disease evidenced by coronary angiography was detected in 42% of the cases. Type B2 or C lesions were treated in 64%, 94% of which in native vessels. Restenotic lesions were dilated in 5% of the patients. All interventions were performed using coronary stents, the majority of which (67%) were standard bare-metal stents.Conclusions: 1) Subgroups IIB and IIIB were the most frequently treated (76%); 2) Clopidogrel was the most prescribed antithrombotic agent (51%); 3) Multivessel coronary artery disease was found in 42% of the cases, most of which were complex target lesions located in native vessels; 4) Coronary stent implantation was the chief dilation technique used.Key words: Unstable angina, coronary angioplasty. Unstable angina (UA) is one of the most important medical emergencies because of its high frequency and expressive morbidity and mortality 1,2 . For example, in the United States, approximately 1.3 million patients (p) are hospitalized for this condition each year 3 , a figure that underscores the need for providing the best available treatment for this population.In the second half of the last decade, three randomized clinical trials have proved the superiority of invasive strategy involving coronary angiography and early myocardial revascularization, whenever possible, over the conservative approach [4][5][6] . In this context, percutaneous coronary intervention (PCI) is the revascularization method most widely used. This has been made possible by the development of adjunctive antithrombotic drug therapy (fractionated heparin, glycoprotein IIb/IIIa inhibitors and clopidogrel) and the advent of coronary stents, after which procedural outcomes have become safer and more predictable [4][5][6] . More recently, the introduction of drug-eluting stents has resulted in a significant drop in late clinical events, by considerably reducing angiographic and clinical restenosis rates 7,8 . This investigation sought to identify the main angiographic/ clinical features related to the percutaneous procedure in a consecutive series of patients (p) who underwent PCI in the presence of unstable angina in a very busy tertiary hospital. MethodsA retrospective analysis ...

Gravidade da lesão angiográfica coronariana e polimorfismo da APOE nas síndromes coronarianas agudas

“…In a Brazilian study carried out in São Paulo 20 , which evaluated 1,413 patients with unstable angina submitted to coronary angioplasty, the predominance of the male sex was also observed (62%), with a mean age of 61 years; however, the frequency of multivascular lesions was lower (42%). Other authors in a study carried out in patients with Ami in the city of Niteroi 21 found almost the same percentage of male sex patients (66.8%), also with a lower percentage of multivascular disease (54.9% in men and 63.3% in women).…”

G-Proteins Agonists and NO/cGMP Blockers: Unexplored Frontiers in the Pharmaceutical Industry

“…Why these therapeutic alternatives do not always work?’ We believe that there are at least, five aspects pertaining to this inquiry: 1) The lack of consideration of existing ‘guidelines’ or ‘evidence based medicine’ regarding the accepted treatment options available; 2) lack of knowledge of different vasodilatation mechanisms; 3) the possibility of a crosstalk between different vasodilatation mechanisms; 4) the soluble guanylyl cyclase (sGC) enzymatic activity and; 5) the common use of MB as a ‘rescue’ or ‘ultimate’ therapeutic attempt. 6 …”