Browsing by Author "Baptista, J"
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- Angioplastia primária em Portugal entre 2002-2013. Atividade segundo o Registo Nacional de Cardiologia de IntervençãoPublication . Pereira, H; Teles, R; Costa, M; Silva, P; Ribeiro, V; Brandão, V; Martins, D; Matias, F; Pereira-Machado, F; Baptista, J; Abreu, PF; Santos, R; Drummond, A; Carvalho, H; Calisto, J; Silva, JC; Pipa, JL; Marques, J; Sousa, P; Fernandes, R; Ferreira, R; Ramos, S; Oliveira, E; Almeida, M; Registo Nacional de Cardiologia de IntervençãoIntrodução e objectivos: Foi nosso objectivo reportar a evolução da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST), entre 2002-2013. Métodos: Os dados prospectivos multicêntricos do Registo Nacional de Cardiologia de Intervenção (RNCI) e os dados oficiais da Direção Geral de Saúde (DGS) foram conjugados para estudar os procedimentos no EAMCST entre 2002 e 2013. Resultados: Em 2013 realizaram-se 3524 angioplastias primárias (ICP-P), representando um crescimento de 315% relativamente ao ano 2002. Em 2002 a ICP-P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012-2013. Entre 2002-2013 o número de procedimentos por milhão de habitantes aumentou de 106 de 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilização de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou-se uma utilização crescente de trombectomia de aspiração, atingindo 46,7% em 2013. Os inibidores das glicoproteínas IIb/IIIa registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram-se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando-se a utilização de stents eluidores de fármacos e o acesso radial.
- Evolução da intervenção coronária percutânea entre 2004‐2013. Atividade em Portugal segundo o Registo Nacional de Cardiologia de IntervençãoPublication . Pereira, H; Teles, R; Costa, M; Silva, P; Ferreira, R; Ribeiro, V; Santos, R; Abreu, PF; Carvalho, H; Marques, J; Fernandes, R; Brandão, V; Martins, D; Drummond, A; Pipa, J; Seca, L; Calisto, J; Baptista, J; Matias, F; Ramos, J; Pereira-Machado, F; Silva, J; Almeida, M; Registo Nacional de Cardiologia de IntervençãoINTRODUCTION AND OBJECTIVES: The aim of the present paper is to report trends in Portuguese interventional cardiology from 2004 to 2013 and to compare them with other European countries. METHODS: Based on the Portuguese National Registry of Interventional Cardiology and on official data from the Directorate-General of Health, we give an overview of developments in coronary interventions from 2004 to 2013. RESULTS: In 2013, 36 810 diagnostic catheterization procedures were performed, representing an increase of 34% compared to 2007 and a rate of 3529 coronary angiograms per million population. Coronary interventions increased by 65% in the decade from 2004 to 2013, with a total of 13 897 procedures and a rate of 1333 coronary interventions per million population in 2013. Primary percutaneous coronary intervention (PCI) increased by 265% from 2004 to 2013 (1328 vs. 3524), an adjusted rate of 338 primary PCIs per million, representing 25% of total angioplasties. Stents were the most frequently used devices, drug-eluting stents being used in 73% in 2013. Radial access increased from 4.1% in 2004 to 57.9% in 2013. CONCLUSION: Interventional cardiology in Portugal has been expanding since 2004. We would emphasize the fact that in 2013 all Portuguese interventional cardiology centers were participating in the National Registry of Interventional Cardiology, as well as the growth in primary PCI and increased use of radial access.
- Laterality of Pneumonia in Acute StrokePublication . Alves, P; Silva, C; Baptista, J; Lima, B; Jacinto, M; Trigueiros, F; Martins, A; Melo, T; Fonseca, ACBACKGROUND/AIMS: Previous studies demonstrated an alteration of diaphragmatic excursion on the paretic side after stroke; however, it is unclear if this change has clinical repercussions. We aimed to determine if there was an association between the paretic side and the laterality of pneumonia after stroke. METHODS: A retrospective analysis of a consecutive cohort of patients admitted to a stroke unit from 2008 to May 2016 was performed. Patients with the diagnosis of acute stroke and pneumonia were included. The laterality of pneumonia was determined through the blinded observation of chest X-rays. Fisher's exact test was applied to study the association between the side of paresis and pneumonia. RESULTS: One hundred and five patients were included. Sixty one percent (n = 64) had an ischemic stroke, 39% (n = 41) had brain hemorrhage, and 49.5% (n = 52) had right side paresis. We did not find in general an association between the side of paresis and the side of pneumonia (p = 1.00); however, we found a statistically significant association in patients with severe lower limb paresis (Medical Research Council, MRC ≤2; p = 0.035). CONCLUSION: We found an association between severe paresis of the lower limb (MRC ≤2) and ipsilateral pneumonia. We hypothesize that the proximity between the diaphragmatic and inferior limb corticospinal pathways could be the reason for this association.
- Posição sobre suportes vasculares restaurativos transitórios coronários em PortugalPublication . Teles, R; Pereira, H; Carvalho, H; Patricío, L; Santos, R; Baptista, J; Pipa, J; Abreu, PF, et al.BACKGROUND: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal. METHODS AND RESULTS: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience. The evidence suggests that currently available BVS can produce physiological and clinical improvements in selected patients. There are encouraging data on their durability and long-term safety. Initial indications were grouped into three categories: (a) consensual and appropriate - young patients, diabetic patients, left anterior descending artery, long lesions, diffuse disease, and hybrid strategy; (b) less consensual but possible - small collateral branches, stabilized acute coronary syndromes; and (c) inappropriate - left main disease, tortuosity, severe calcification. CONCLUSION: BVS are a viable treatment option based on the encouraging evidence of their applicability and physiological and clinical results. They should be used in appropriate indications and will require technical adaptations. Outcome monitoring and evaluation is essential to avoid inappropriate use. It is recommended that medical societies produce clinical guidelines based on high-quality registries as soon as possible.
- Posição sobre suportes vasculares restaurativos transitórios coronários em PortugalPublication . Teles, R; Pereira, H; Carvalho, H; Patrício, L; Santos, R; Baptista, J; Pipa, J; Abreu, PF; Faria, H; Ramos, S; Ribeiro, V; Martins, D; Almeida, MIntrodução: Os suportes vasculares restaurativos transitórios (sVRT) foram recentemente aprovados para intervenção coronária percutânea (ICP) na Europa e possuem propriedades muito inovadoras. O objetivo desta declaração de posição é rever criticamente a informação e os estudos com os sVRT disponíveis e contribuir para uma reflexão científica que promova o seu uso racional com orientações estruturadas para a sua aplicação inicial em Portugal. Métodos e resultados: Foi constituído um grupo de trabalho para alcançar um consenso com base na evidência científica conhecida, na discussão de casos clínicos modelo e na experiência individual. A evidência reunida sugere que os sVRT disponíveis podem produzir uma melhoria fisiológica e clínica em doentes selecionados. Os dados relativos à sua durabilidade e segurança a longo prazo são animadores. As indicações iniciais foram agrupadas em três categorias: a) consensuais e apropriadas --- jovens, diabéticos, descendente anterior, lesões longas, doença difusa; b) menos consensuais mas possíveis --- lesões com pequeno colateral, síndromas coronárias agudas estabilizadas; c) inapropriadas --- tronco comum, tortuosidade, calcificação grave. Conclusão: Os suportes vasculares restaurativos transitórios constituem uma terapêutica válida pela evidência científica encorajadora da sua aplicabilidade, da melhoria fisiológica e clínica. Devemos privilegiar as indicações aconselhadas e adequar as técnicas de angioplastia coronária, bem como monitorizar e avaliar os resultados para evitar uma adoção inapropriada. É recomendável o desenvolvimento expedito de normas de orientação clínica pelas sociedades científicas apoiada em registos de elevada qualidade.
- Trends in primary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional CardiologyPublication . Pereira, H; Teles, R; Costa, M; Silva, P; Ribeiro, V; Brandão, V; Martins, D; Matias, F; Pereira-Machado, F; Baptista, J; Abreu, PF; Santos, R; Drummond, A; Carvalho, H; Calisto, J; Silva, J; Pipa, J; Marques, J; Sousa, P; Fernandes, R; Ferreira, R; Ramos, S; Oliveira, E; Almeida, MIntroduction and Objectives: The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. Methods: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. Results: In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per mil- lion population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. Conclusion: During the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach.