CAR - Artigos publicados em revistas indexadas
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Browsing CAR - Artigos publicados em revistas indexadas by Subject "Angiografia coronária"
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- Cateterização simultânea das artérias coronárias no tratamento das oclusões crónicas totaisPublication . Abreu, PF; Loureiro, J; Thomas, B; Ferreira, RAs oclusões crónicas totais apresentam-se como um grande desafio para os cardiologistas de intervenção, sendo o seu tratamento geralmente acompanhado de um aumento das complicações. É apresentado um argumento para a utilização da cateterização simultânea das artérias coronárias para a melhoria das características da lesão e optimização dos resultados. Oito doentes com oclusões crónicas totais foram revascularizados percutaneamente utilizando esta técnica com sucesso imediato e ausência de complicações em todos eles.
- Enfarte do Miocárdio Combinado: a Propósito de Dois CasosPublication . Magno, P; Abreu, PF; Baptista, SB; Gil, VMO enfarte agudo do miocárdio define-se como combinado quando o electrocardiograma (ECG) revela a existência de corrente de lesão nas derivações inferiores e anteriores. Do ponto de vista fisiopatológico pressupõe o envolvimento de isquémia aguda transmural de territórios vasculares contra-laterais em simultâneo. Constitui um evento raro, e por isso os autores descrevem dois casos clínicos de doentes internados por enfarte combinado. Subsequentemente discute-se a relação dos dados electrocardiográficos com os dados angiográficos e o seu valor na avaliação prognóstica desta entidade clínica
- Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT Multicenter RegistryPublication . Baptista, SB; Raposo, L; Santos, L; Ramos, R; Calé, R; Jorge, E; Machado, C; Costa, M; Oliveira, E; Costa, J; Pipa, J; Fonseca, N; Guardado, J; Silva, B; Sousa, MJ; Silva, JC; Rodrigues, A; Seca, L; Fernandes, RPenetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.
- 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.