Qual o erro da angiografia na definição de isquemia miocárdica durante intervenções coronarianas percutâneas?

Sant’Anna, Fernando Mendes; Silva, Expedito Ribeiro da; Batista, Leonardo Alves; Brito, Marcelo Bastos; Ventura, Fábio Machado; Ferraz, Haroldo Adans; Buczynski, Leonardo da Costa; Barrozo, Carlos Alberto Mussel; Pijls, Nico H.J.

doi:10.1590/s0066-782x2008001500007

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…No entanto, as Diretrizes da Sociedade Brasileira de Cardiologia para Intervenção Coronária 6 consideram a angioplastia de lesões > 50% e < 100% após fibrinólise como recomendação classe IIA, nível de evidência A. Sabe-se ainda da grande dificuldade de estratificação não-invasiva e invasiva ambulatorial em pacientes do SUS, que, por vezes, pode demorar meses. 18 Além disso, em estudo publicado por Sant'Anna et al, 19 em 2008, os autores, utilizando o fluxo fracionado de reserva do miocárdio para definir a acurácia da angiografia em predizer se uma lesão seria ou não isquêmica, demonstraram que lesões maiores que 70% pela angiografia coronária quantitativa eram responsáveis por isquemia em 96% dos casos, enquanto nas lesões moderadas (entre 40% e 70%) apenas 57% foram responsáveis por isquemia miocárdica.…”

Section: Discussionunclassified

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea na vigência de síndromes coronárias agudas atendidos em Unidades de Pronto Atendimento (UPAs): resultados de um Centro de Cardiologia Terciário

Sant’Anna¹,

Álvarez²,

Bruno³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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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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Section: Discussionunclassified

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea na vigência de síndromes coronárias agudas atendidos em Unidades de Pronto Atendimento (UPAs): resultados de um Centro de Cardiologia Terciário

Sant’Anna¹,

Álvarez²,

Bruno³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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“…The non-inferiority of iFR to FFR in predicting cardiovascular outcomes and a reasonable alternative for physiologic assessment has also been demonstrated. In patients with multi-vessel disease, non-invasive testing often underestimates the burden of coronary stenosis [ 11 , 12 ]. Even though non-invasive tests, such as stress echocardiography and myocardial perfusion scintigraphy, provide information regarding ischemic burden, these tests have poor discrimination in identifying which lesions cause ischemia, especially in patients with multi-vessel disease [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with multi-vessel disease, non-invasive testing often underestimates the burden of coronary stenosis [ 11 , 12 ]. Even though non-invasive tests, such as stress echocardiography and myocardial perfusion scintigraphy, provide information regarding ischemic burden, these tests have poor discrimination in identifying which lesions cause ischemia, especially in patients with multi-vessel disease [ 11 , 12 ]. Hence, there is a strong need for accurate functional testing to identify if a specific coronary lesion produces ischemia or not.…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of physiologic lesion testing in influencing treatment strategy for multi-vessel coronary artery disease

Rawal,

Nguyen,

Igbinomwanhia

et al. 2024

American Heart Journal Plus: Cardiology Research and Practice

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“…Although most percutaneous coronary interventions (PCIs) are still performed without NITs, 70% of patients referred for PCI have multivessel diseases, and 80% have moderate lesions. 5 However, it is estimated that 40-50% of these lesions are ischemic.…”

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confidence: 99%

Clinical Outcomes and Cost-Effectiveness Analysis of FFR Compared with Angiography in Multivessel Disease Patient

Quintella¹,

Ferreira²,

Azevedo³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundIn multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS).ObjectivesTo evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS.MethodsMultivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE.ResultsWe studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%.ConclusionFFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.

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Qual o erro da angiografia na definição de isquemia miocárdica durante intervenções coronarianas percutâneas?

Abstract: 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.

Cited by 5 publications

References 22 publications

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea na vigência de síndromes coronárias agudas atendidos em Unidades de Pronto Atendimento (UPAs): resultados de um Centro de Cardiologia Terciário

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea na vigência de síndromes coronárias agudas atendidos em Unidades de Pronto Atendimento (UPAs): resultados de um Centro de Cardiologia Terciário

Clinical effects of physiologic lesion testing in influencing treatment strategy for multi-vessel coronary artery disease

Clinical Outcomes and Cost-Effectiveness Analysis of FFR Compared with Angiography in Multivessel Disease Patient

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