The Stent for Life initiative: Factors predicting system delay in patients with ST-segment elevation myocardial infarction.

Introduction And Aims: System delay (time between first medical contact and reperfusion therapy) is an indicator of quality of primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients. This study aimed to assess changes in system delay between 2011 and 2015, and to identify its predictors.

Methods: The study included 838 patients admitted to 18 Portuguese interventional cardiology centers suspected of having STEMI with less than 12 hours' duration who were referred for primary percutaneous coronary intervention.

Propensity score matched all comers population treated with ultra-thin strut bare metal and sirolimus-probucol coated drug-eluting stents of identical stent architecture.

Objective: The objective of this study was to compare the safety and efficacy of a polymer-free sirolimus coated, ultrathin strut drug eluting stent (PF-SES) to its uncoated bare-metal stent (BMS) platform of identical stent architecture.

Background: Recently published randomized trials comparing BMS to DES with a focus on shortened dual-antiplatelet therapy reported incidences of stent thrombosis (ST) and bleeding complications (LEADERS FREE) in favor of drug eluting stents (DES).

Methods: Data of previously published large-sale, international, single-armed, multicenter, observational studies of ultra-thin PF-SES, and BMS were propensity score (PS) matched for selected lesion morphological and cardiovascular risk factors to compare target lesion revascularization (TLR), myocardial infarction, cardiac death, major adverse cardiac events (MACE), bleeding complications and ST rates.

Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden.

Objective: To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden.

Methods: We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms.

Cardiovascular risk profile of young adults: changes over time.

Background And Objective: The high prevalence and natural history of atherosclerosis make young people important targets for cardiovascular prevention. This study aimed to analyze changes over time in the cardiovascular risk profile of a population of healthy young adults.

Methods: We studied 923 Portuguese Air Force applicants between 1991 and 2007, divided into two-year periods.

Percutaneous coronary intervention of unprotected left main disease: five-year outcome of a single-center registry.

Introduction And Aims: Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main coronary artery (ULMCA) lesions. We aimed to evaluate the long-term outcome of patients undergoing ULMCA PCI.

Methods And Results: We retrospectively analyzed 95 consecutive patients (median EuroSCORE I 2.

Prevalence and predictors of coronary artery disease in patients with a calcium score of zero.

The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero.

Percutaneous coronary intervention using a full metal jacket with drug-eluting stents: major adverse cardiac events at one year.

Background: The clinical benefit of percutaneous coronary intervention (PCI) for long coronary lesions is unclear; furthermore, concerns have been raised about its safety.

Objectives: To evaluate the predictors of major adverse cardiac events (MACE) associated with PCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents (DES) measuring >60 mm in length, for very long lesions.

Methods: We enrolled 136 consecutive patients with long coronary lesions requiring FMJ in our single-center registry.

[Non-obstructive coronary artery disease documented by cardiac computed tomography: Discrepancy between atherosclerotic burden and cardiovascular risk].

Cardiac computed tomography (CT) documents the presence of coronary artery disease, regardless of the degree of stenosis. The prognostic value of non-obstructive coronary artery disease documented by cardiac CT has recently been validated. However, there are still no clear guidelines on the management of such patients, particularly concerning initiation of more aggressive pharmacological measures for primary prevention.

Body mass index as a predictor of the presence but not the severity of coronary artery disease evaluated by cardiac computed tomography.

Background: The relation between body mass index (BMI) and coronary artery disease (CAD) extension remains controversial. The aim of this study was to evaluate the correlation between BMI and CAD extension documented by coronary computed tomography angiography (CCTA).

Methods And Results: Prospective registry including 1706 consecutive stable patients that performed CCTA (dual source scanner) for the evaluation of CAD.

One-year clinical outcomes of percutaneous treatment with drug-eluting balloons: results from a multicenter registry.

Introduction And Objectives: Percutaneous coronary intervention (PCI) with paclitaxel drug-eluting balloons (DEBs) is used mainly for treatment of in-stent restenosis (ISR) and small vessel disease. Our objective was to evaluate the clinical efficacy of this strategy in a multicenter registry.

Methods: Between 2009 and 2010 a prospective registry from two centers enrolled 156 consecutive patients undergoing PCI with at least one DEB.

Marfan syndrome with ascending aortic aneurysm: value of cardiac computed tomography.

We report the case of a 40-year-old man with known Marfan syndrome who presented with severe aortic valve regurgitation secondary to significant aortic root dilatation. To rule out coronary artery disease and to evaluate the rest of the thoracic aorta before surgery, cardiac computed tomography (CT) was performed. A brief review of the literature shows how cardiac CT can, in selected cases, rule out coronary artery disease before non-coronary cardiothoracic surgery.

Nonobstructive coronary disease leading to STEMI: assessment of residual stenosis after thrombus aspiration.

Aims: Nonobstructive coronary atherosclerotic lesions can lead to ST-elevation myocardial infarction (STEMI). Thrombus aspiration during a primary percutaneous coronary intervention provides a setting to evaluate the degree of stenosis of culprit lesions leading to STEMI. The aim of this study was to assess the degree of culprit lesion residual stenosis after thrombus aspiration and to compare the demographic, clinical, and angiographic characteristics between patients with obstructive versus nonobstructive residual stenosis.

Diabetes as an independent predictor of high atherosclerotic burden assessed by coronary computed tomography angiography: the coronary artery disease equivalent revisited.

(1) To study the prevalence and severity of coronary artery disease (CAD) in diabetic patients. (2) To provide a detailed characterization of the coronary atherosclerotic burden, including the localization, degree of stenosis and plaque composition by coronary computed tomography angiography (CCTA). Single center prospective registry including a total of 581 consecutive stable patients (April 2011-March 2012) undergoing CCTA (Dual-source CT) for the evaluation of suspected CAD without previous myocardial infarction or revascularization procedures.

[Anomalous origin of left coronary artery: a malignant interarterial variant with a benign clinical course].

Anomalous origin of coronary arteries represents a clinical challenge not only because of the anatomical variability, but also the possible functional consequences, pathophysiological mechanisms involved and the absence of large series in the literature that would provide evidence for clinical and therapeutic orientation. The authors describe the case of a 55-year-old male patient with a long history of atypical chest pain who was considered to have a low to intermediate likelihood of coronary artery disease. Therefore, and also bearing in mind his physical limitations (congenital left leg atrophy), he was referred for cardiac CT to rule out coronary artery disease.

Percutaneous revascularization strategies in saphenous vein graft lesions: long-term results.

Aims: Although half of saphenous vein grafts (SVGs) present obstructive atherosclerotic disease 10 years after implantation, controversy remains concerning the ideal treatment. Our aim was to compare percutaneous revascularization (PCI) options in SVG lesions, according to intervention strategy and type of stent.

Methods: A retrospective single-center analysis selected 618 consecutive patients with previous bypass surgery who underwent PCI between 2003 and 2008.

Radiation in cardiac CT: predictors of higher dose and its reduction over time.

Introduction: Cardiac CT provides noninvasive information on cardiac anatomy, particularly in coronary artery disease. However, exposure to radiation has been identified as a limitation of this exam. The aim of this study was to evaluate variations in radiation dose over time and to identify variables associated with use of higher radiation doses.

Subcutaneous ICD implantation.

An 18-year-old patient, with hypertrophic cardiomyopathy and an implantable cardioverter defibrillator for 6 years, was admitted with inappropriate shocks as a consequence of a lead fracture (Sprint Quattro, Medtronic). The device was explanted and replaced with a new subcutaneous defibrillator (Cameron SQ-RX), without complications. This was the first time that a subcutaneous cardioverter defibrillator had been used in the Iberian Peninsula.

No fate but what we make: a case of full recovery after out-of-hospital cardiac arrest.

An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on reevaluation, the victim had pulse and spontaneous breathing.

Hypertrophic cardiomyopathy--two atypical forms diagnosed by cardiac CT.

Hypertrophic cardiomyopathy is a relatively common genetic disease (prevalence of 0.2%), with a clinical spectrum that ranges from absence of symptoms to presentation as sudden cardiac death. Atypical forms are a diagnostic challenge and recent cardiac imaging techniques, such as cardiac CT and magnetic resonance imaging, can make an important contribution.

[Fear of child/family in pediatric intensive care units: what is the nurse's role?].

The fear is considered a negative emotion, lived with apprehension, uncertainty and a sense of threat or danger to the personal integrity (Torres & Guerra, 2003). It is often associated with hospitalization of the chid/family, and may be the cause to start an emotional crisis due to the separation from environment and the usual routines, the loss of independence and autonomy, and also due to be with strange people (Bicho, 2006; Festas 1994; Freitas &Freitas, 2005; Hockenberry, 2006). Hospitalization in a Pediatric Intensive Care Unit (PICU) may worsen an already existing crisis not only for the given reasons but also because the child may be in life danger.