Perfil demográfico e resultados imediatos dos pacientes submetidos a angioplastia primária no Registro SOLACI

Abstract

Introduction:The superiority of primary angioplasty compared to fibrinolytic agents has been broadly demonstrated in different studies, but due to logistic issues we have observed a delay in the implementation of the recommendations in real world scenarios. We compared primary angioplasty results at three different timepoints in the SOLACI Registry. Methods: The SOLACI Registry included data of 43,725 primary angioplasties carried out from 1995-97 (n = 6,793), 2000-03 (n = 23,007) and 2007-08 (n = 13,925). Results: An increasing complexity of treated patients was observed, with an increment in the percentage of women, diabetics, patients with prior myocardial infarction and patients with moderate to severe ventricular dysfunction. Procedural success remained high (> 91%) at all timepoints, regardless of the device used. In addition, we observed a significant decrease of door-to-balloon time, increased use of stents and a 45% decrease in the use of glycoprotein IIb/IIIa inhibitors. Regarding in-hospital outcomes, a decreased mortality (9.1% vs. 5.3% vs. 4.5%), reinfarction (4.1% vs. 2.6% vs. 2.7%) and target vessel revascularization procedures (3.5% vs. 0.7% vs. 0.7%) was observed. Conclusion: Despite the more complex risk profile, the incorporation of technological advances and

Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

“…The verification of MCAD in individuals admitted with STEMI implies an increased morbidity and mortality compared to those individuals with a single coronary lesion [ 23 ] . In our sample, such diffuse atherosclerotic involvement was observed in 45.3% of patients who underwent angiography coronary, corroborating national [ 14 , 15 ] and international data [ 6 , 7 ] in the literature. In this scenario, in which the current guidelines [ 1 - 3 ] do not recommend primary PCI in arteries not related to the index ischemic event in the absence of hemodynamic instability - as opposed to results recently published [ 24 , 25 ] that were performed during a period of great technological advancement in the endovascular area combined with the current therapy with new antiplatelet agents and glycoprotein IIb/IIIa inhibitors - this study is distinguished by its unprecedented comparison of long-term cardiovascular endpoints in "real world" Brazilian individuals who underwent staged angioplasty or a unique clinical treatment.…”

“…However, these guidelines do not include clear recommendations for managing residual MCAD after angiographic success in primary PCI. In addition, information from national records [ 14 , 15 ] involving patients with MCAD admitted with STEMI and who underwent primary PCI do not specify strategies to monitor significant residual lesions that are not treated in the initial procedure.…”

Intervenção coronariana percutânea no Brasil: resultados do Sistema Único de Saúde

“…Mortality is low when the indication is for angina, whereas in cases categorized as infarction (primary angioplasty) is about six times larger. The SOLACI Registry, a spontaneous and non-mandatory registry of the Latin American Society of Interventional Cardiology, reported in 2007 to 2008, 13,925 interventions of primary angioplasty with a hospital mortality of 4.5% 29 . Data from the New York State PCI Registry, a mandatory controlled registry of this American state, show an interaction between hospital volume and physician experience.…”

Resultados hospitalares da intervenção coronária percutânea primária em mulheres

“…28 Esses resultados podem ser parcialmente explicados pelo fato de as mulheres terem menor chance de receber terapia medicamentosa precoce (aspirina e betabloqueadores), terapia de reperfusão na fase aguda ou procedimentos invasivos. 29,30 A taxa de utilização de stents foi elevada em ambos os grupos deste estudo, sendo condizente com a evolução tecnológica do procedimento. No entanto, o emprego de stents farmacológicos foi baixo e justificado por razões econômicas (limitação a seu uso por fontes financiadoras da saúde pública e suplementar) e não clínicas.…”

“…Já a utilização de inibidores da glicoproteína IIb/IIIa (32% entre as mulheres e 31% entre os homens) está de acordo com as estatísticas do registro da Sociedade Latino-Americana de Cardiologia Intervencionista (SOLACI) no período de 2000 a 2008 (22,7% e 40%). 30 As mulheres estão também mais sujeitas a complicações vasculares durante a realização de ICP, principalmente quando, objetivando terapia de reperfusão rápida e eficaz, como ocorre no IAM, são utilizadas medicações anticoagulantes e antiagregantes em doses nem sempre adequadas à menor área de superfície corporal geralmente apresentada pelas mulheres. 23,24 Observou-se, no entanto, incidência semelhante de complicações vasculares entre homens e mulheres neste estudo.…”