Objectives To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. Background CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. Methods An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. Results We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re‐entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In‐hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% Conclusions CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

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.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in women worldwide. Especially for women, traditional risk factors fail to explain most cases, deaths, and disability-adjusted life years (DALYs) from CVD. Risk factors inherent to the female sex and psychosocial aspects play an essential role in the development of CVD in women. Efforts need to be made to narrow the gap in diagnosis and treatment among women, especially younger ones, among whom CVD prevalence is increasing worldwide. 1 Ischemic heart disease (IHD) remains a major threat to public health, and the overall burden is increasing globally. The GBD 2019 Study estimated 126.5 (95% UI, 118.6-134.7) million prevalent cases of IHD in 2019 globally. Agestandardized rates for DALYs, deaths, and prevalent cases declined from 1990 to 2019, probably due to population growth and aging. 2 In addition, IHD was the leading cause of death and DALYs in Brazil in 2019 for both males (12.22% of total death -95% UI, 11.5%-12.77%; annual percent change -0.022) and females (12.03% of total death -95% UI, 10.66%-12.88%; annual percent change 0.07). It is important to note that there has been an increase in the annual percent change in mortality from IHD in women in recent years (Figure 1). 3 The GBD 2017 estimated 1736 (95% UI, 1689-1779) DALYs lost per 100 000 individuals due to IHD, with lower rates for females (1127; 95% UI, 1084-1163) than for males (2153; 95% UI, 2067-2216), in 2017 in Brazil. From 1990 to 2017, there was a decline in DALYs lost for both males (-47%) and females (-52%) in all Brazilian Federative Units (Figure 2). 4In addition, the GBD 2017 estimated 84 events of IHD per 100 000 inhabitants in 2017 in Brazil. The age-standardized incidence was 104 per 100 000 inhabitants for males and 58 per 100 000 for females. 4 The GBD 2017 estimated a prevalence of IHD in 2017 of 2229 (95% UI, 2098-2372) and 1008 (95% UI, 938-1081) per 100 000 inhabitants for males and females, respectively. The IHD prevalence increased in both sexes from 1990 to 2017 (Figure 3). 4 Mortality due to myocardial infarctionMyocardial infarction (MI) is the leading cause of death in Brazil nowadays. The MI mortality rate decreased between 1996 and 2019, in both sexes, especially among females, being more relevant in the state capitals than in the inner areas. 4 According to the Brazilian Unified Health System (SUS) Department of Information Technology (DATASUS), there were 142 982 hospital admissions for MI in 2018, with inhospital mortality of 11%. In 2018, the DATASUS registered 10 811 primary angioplasties for MI, with in-hospital mortality of 6.3% and a mean length of hospital stay of 5.1 days. In 2018, the total amount reimbursed for coronary

Percutaneous coronary intervention in chronic total occlusion is a rapidly evolving area, being considered the last frontier of interventional cardiology. In recent years, the development of new techniques and equipment, as well as the training of specialized personnel, increased their success rates, making it the most predictable procedure available. Although the number of randomized and controlled studies is still limited, results from large multicentered registries allow us to safely offer this intervention to patients, as another treatment option along with the optimized drug treatment and myocardial revascularization surgery. This review summarizes the last and most relevant publications in the subject in order to provide an overall view of the field’s current status.

Fundamento: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. Objetivo: Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. Método: Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOLbrief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. Resultados: Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. Conclusão: O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis. Palavras-chave: Mulheres Médicas; Burnout; Pandemia de COVID-19; Brasil.