Nota: Estas diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

Background: Little is known in our country about regional differences in the treatment of acute coronary disease.

Aims Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). Methods and results The BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified ‘cluster sampling’ methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. A total of 1150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% ± 20.1%. Teaching institutions had a significantly higher PS (71.4% ± 16.9%) compared with non-teaching hospitals (63.4% ± 21%; P < 0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS—per point increase (OR = 0.97, 95% CI 0.95–0.98, P < 0.001), age—per year (OR = 1.06, 95% CI 1.03–1.09, P < 0.001), chronic kidney disease (OR = 3.12, 95% CI 1.08–9.00, P = 0.036), and prior angioplasty (OR = 0.25, 95% CI 0.07–0.84, P = 0.025). Conclusions In BRACE, the adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.

Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.

Objectives: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUS FR ), compared to gold-standard invasive measurements (FFR INVAS ).Background: IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel.Methods: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFR INVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUS FR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFR INVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions.Results: A total of 24 patients with 34 vessels were analyzed. IVUS FR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFR INVAS , with a mean difference of −0.008 AE 0.067 (P = 0.47). IVUS FR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. Conclusion:The computational processing of IVUS FR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS. K E Y W O R D Scomputational fluid dynamics, coronary blood flow/physiology/microvascular function, coronary artery disease, fractional flow reserve, imaging intravascular ultrasound, interventional devices/innovation, quantitative coronary angiography, three-dimensional coronary models