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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.

Objective: To assess the percentage of patients with normal coronary angiography in a hospital and to determine the predictor variables of this finding. Methods: All elective coronary angiographies performed from April to October 2018 were analyzed, excluding patients with valve diseases and who had a previous catheterization. A total of 503 patients were recruited, divided into 2 groups: Group A for normal coronary arteries, and group B for coronary artery disease. Coronary vessels with diameter ≥2.0mm and with no stenosis ≥40% determined by quantitative coronary angiography were considered normal. After the univariate analysis of the differences between groups, a multivariate analysis was performed by logistic regression, to determine the independent predictors of a normal exam. Results: The clinical characteristics were as follows: mean age of 62 years; 55% male; hypertension present in 86%; diabetes mellitus in 35%; smoking habit reported by 20.5%; dyslipidemia present in 20.5%; and family history of coronary artery disease in 59%. The prevalence of normal coronary angiography was 45%. In the univariate analysis, there were differences between the two groups in regard to sex, age, symptoms, diabetes mellitus and smoking habit. In the multivariate analysis, female sex (OR=3.22; 95%CI 2.20-4.80; p<0.0001), younger age (OR=0.96; 95%CI 0.94-0.98; p<0.0001), absence of diabetes mellitus (OR=0.46; 95%CI 0.30-0.70; p<0.0001), and no smoking habit (OR=0.33; 95%CI 0.19-0.55; p<0.0001) were predictors of normal coronary angiography. Conclusion: The prevalence of normal coronary arteries in this study was high. Female sex, younger age, absence of diabetes mellitus, and no smoking habit were independent predictors of this finding. RESUMO -Objetivo:Averiguar o percentual de pacientes com coronariografia normal em um hospital e determinar as variáveis preditoras desse achado. Métodos: Foram analisadas todas as co ro nariografias eletivas realizadas de abril a outubro de 2018, excluindo pacientes com doenças valvares e que já tinham cateterismo prévio. Foram recrutados 503 pacientes, divididos em 2 grupos: A para coronárias normais e B para doença arterial coronariana. Foram consideradas coronárias normais vasos ≥2,0mm e sem lesões ≥40% pela angiografia coronariana quantitativa. Após análise univariada das diferenças entre os grupos, foi realizada análise multivariada por regressão logística, para determinar os preditores independentes de um exame normal. Resultados: As características clínicas foram as seguintes: média de idade de 62 anos; 55% do sexo masculino; hipertensão arterial sistêmica presente em 86%; diabetes melito em 35%; tabagismo relatado por 20,5%; dislipidemia encontrada em 20,5%; e achado de história familiar de doença arterial coronariana em 59%. A prevalência de coronariografia normal foi de 45%. Na análise univariada, houve diferença entre os dois grupos em relação a sexo, idade, sintomas, diabetes e tabagismo. Na análise multivariada, sexo feminino (RC=3,22; IC95% 2,20-4,80; p<0,0001), idade mais jovem ...

Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established.Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence.Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p &lt; 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p &lt; 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p &lt; 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43).Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.