Incidência, preditores e impacto clínico dos sangramentos maiores associados à intervenção coronária percutânea

Dall'Orto, Clarissa Campo; Willi, Luiz Felipe; Nogueira, Maria Sílvia Faraco; Lapa, Guilherme Alves; Neto, João Batista; Mauro, Maria Fernanda Zuliani; Cristóvão, Salvador André Bavaresco; Salman, Adnan Ali; Mangione, José Armando

doi:10.1590/s2179-83972008000400013

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…[1][2][3][4] This access is particularly important in scenarios associated with high risk of bleeding, such as acute coronary syndromes, in which the use of antiplatelet and antithrombotic therapies is more aggressive, in female patients, and in the elderly. 5,6 However, radial access in the elderly may be a more difficult approach due to tortuosity and arterial stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Intervenção coronária percutânea por acesso transradial em pacientes idosos vs. não-idosos

Dall'Orto¹,

Lopes²,

Alcântara³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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background: Radial access is the object of increasing interest for interventional cardiologists, providing several advantages, including a reduction of bleeding and major adverse cardiovascular event (MACE) rates. However, even though elderly patients have a greater risk of access site bleedings, the use of the radial approach is controversial, due to the greater anatomical complexity of these patients. Methods: Retrospective study including patients undergoing percutaneous coronary intervention (PCIs) using the radial access divided into an elderly (> 65 years) and a non-elderly (< 65 years) group. Clinical, angiographic and procedural characteristics as well as early and late follow-up outcomes were analyzed. results: The elderly group included 131 patients (145 PCIs) and the non-elderly group, 149 patients (176 PCIs). The elderly group presented lower body mass index and fewer smokers and higher rates of chronic renal failure, peripheral arterial disease, stable coronary artery disease, multivessel disease and calcified lesions. There was no difference in the rate of access-site crossover (4.8% vs. 3.4%), fluoroscopy time (15.3 ± 10.3 minutes vs. 16.1 ± 10.3 minutes), procedure time (40.6 ± 26.4 minutes vs 46.4 ± 53.6 minutes), angiographic (96.3% vs 97.5%) and clinical (94.5% vs 95.4%) success, MACE (3.4% vs 3.4%) and bleedings (0.21% vs 0.6%) during hospitalization. In the late follow-up there was no difference in the MACE rates (9.6% vs 11%). Conclusions: Despite the greater clinical and angiographic complexity, PCI using the radial access is safe and effective, with a high procedural success rate and low in-hospital and late follow-up complication rates.

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Section: Discussionmentioning

confidence: 99%

“…Teixeira de Freitas, BA, Brazil. 6 Cardiologist physician of the Hospital Regional de Teixeira de Freitas. Teixeira de Freitas, BA, Brazil.…”

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confidence: 99%

Intervenção coronária percutânea por acesso transradial em pacientes idosos vs. não-idosos

Dall'Orto¹,

Lopes²,

Alcântara³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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“…15 Alguns estudos sugerem uma relação entre a ocorrência de sangramentos e um aumento na mortalidade em pacientes com IAM. 16,17 No contexto da ICP primária, no qual existe um risco particularmente elevado devido à necessidade de anticoagulação e antiagregação plaquetária agressiva, a incidência de complicações vasculares, nesse subgrupo de pacientes com disfunção renal, permanece incerta. 18 No presente estudo, não observamos aumento significativo de complicações re lacionado ao acesso arterial (pseudoaneurismas, fístulas ou sangramento significativo no local do acesso) em pacientes que apresentaram piora da função renal após a intervenção coronária: 8,0% nos pacientes com IRA e 4,7% naqueles sem disfunção renal.…”

Section: Discussionunclassified

Impacto da insuficiência renal aguda na evolução hospitalar após tratamento percutâneo do infarto agudo do miocárdio

Santos¹,

Conejo²,

Filho³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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“…The low risk of puncture site complications leads to a reduced rate of major bleeding, which, in turn, is associated with a decreased risk of death and ischaemic events. [1][2][3][4][5] This access is particularly important in the setting of acute myocardial infarction with ST-segment elevation (STEMI), in which the use of antiplatelet and antithrombotic therapies is more aggressive, increasing the risk of bleeding. However, the role of percutaneous coronary intervention (PCI) through radial access in STEMI remains controversial, for reasons related to the complexity of the procedure and its possible delay in obtaining early reperfusion, the main goal of primary PCI.…”

Section: Descritoresmentioning

confidence: 99%

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

Dall'Orto¹,

Lopes²,

Oliveira³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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background: Radial access is the object of increasing interest for interventional cardiologists, providing several advantages, including the reduced rates of major bleeding, which is related to increased risk of death and ischemic events. However, its role as an access technique in primary percutaneous coronary intervention (PCI) remains controversial due to the greater complexity of the procedure and possible delay in obtaining myocardial reperfusion, compared to femoral access. Methods: Retrospective study including consecutive patients with a diagnosis of ST-elevation acute myocardial infarction (STEMI) undergoing primary PCI by radial access. Clinical, angiographic and procedure characteristics were analyzed, as well as early and late follow-up outcomes. results: From October 2010 to February 2012, 61 patients underwent primary PCI by radial access. Mean age was 59 ± 11.1 years, 24.6% were female and 21.3% were diabetic. Door-to-balloon time was 126.1 ± 44.7 minutes, fluoroscopy time was 16.1 ± 9.5 minutes, angiographic success was achieved in 98.5%, with myocardial blush grades 2 and 3 in 77.4% and ST-segment elevation resolution > 50% at 90 minutes in 70.5% of the patients. Hospital mortality was 6.6% and the rate of major bleeding was 1.6%. In the late follow-up, clinical restenosis was observed in 7.2% and additional deaths in 3.5% of the patients. Conclusions: The use of radial access for primary PCI is safe and effective when performed at experienced centers and did not pres-

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Incidência, preditores e impacto clínico dos sangramentos maiores associados à intervenção coronária percutânea

Cited by 10 publications

References 11 publications

Intervenção coronária percutânea por acesso transradial em pacientes idosos vs. não-idosos

Intervenção coronária percutânea por acesso transradial em pacientes idosos vs. não-idosos

Impacto da insuficiência renal aguda na evolução hospitalar após tratamento percutâneo do infarto agudo do miocárdio

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

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