-
Fernando J R Sales,
Breno A Falcão,
João L A Falcão,
Expedito E Ribeiro,
Marco A Perin, Pedro E Horta,
André G Spadaro,
John A Ambrose,
Eulógio E Martinez,
Sergio S Furuie,
Pedro A Lemos
[show abstract]
[hide abstract]
ABSTRACT: We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated.
We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the "added calcium". The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of "calcium" increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p<0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p<0.01). The "added" calcium strongly predicted a proportional increase in necrosis-coded tissue in the areas surrounding the calcium-like spots (model R2=0.70; p<0.001).
Artificial addition of calcium-like elements to the atherosclerotic plaque led to an increase in necrotic tissue in virtual histology that is probably artefactual. The overestimation of necrotic tissue by calcium strictly followed a linear pattern, indicating that it may be amenable to mathematical correction.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2010; 6(3):394-9. · 3.29 Impact Factor
-
Pedro A Lemos,
Carlos A H Campos,
João L A A Falcão,
Expedito E Ribeiro,
Marco A Perin,
Luiz J Kajita,
Antonio Esteves Filho,
Marcus N da Gama, Pedro E Horta,
Gilberto G Marchiori,
Andre G Spadaro,
Eulógio E Martinez
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the risk and predictors of death in a large population of patients with stable coronary disease treated with percutaneous intervention.
The study population comprised 1,276 patients with chronic angina or silent ischaemia who underwent elective coronary angioplasty. Baseline and in-hospital mortality data were prospectively collected for all patients during the index hospitalisation. Post-discharge outcome was assessed at out-patient clinic, by review of the patients' records, or direct phone contact. Deaths were classified as cardiac and non-cardiac. Age, peripheral arterial disease, congestive heart failure with NYHA class >or= III, triple-vessel disease, and procedural success (i.e. angiographic success for all lesions in the absence of peri-procedural infarction) remained as multivariate independent predictors of death. For the entire population 4-year cumulative all-cause and cardiac mortality were respectively 5.4% and 4.1%. Four-year mortality for patients without any multivariate predictor was 2.4%, while for patients with two or more predictors the death rate was 16.3% after four years.
Patients with stable coronary disease undergoing percutaneous treatment have an overall low mortality rate after four years. Nevertheless, stable patients comprise a heterogeneous population in terms of risk profile, ranging from patients at very low risk of late death to individuals with a poor long-term prognosis.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 07/2009; 5(2):239-43. · 3.29 Impact Factor
-
Pedro A Lemos,
Expedito E Ribeiro,
Marco A Perin,
Luiz J Kajita,
Marco A de Magalhães,
João L A A Falcão,
Antonio Esteves Filho,
Marcus N da Gama, Pedro E Horta,
Gilberto G Marchiori,
Andre G Spadaro,
Eulógio E Martinez
[show abstract]
[hide abstract]
ABSTRACT: Factors influencing the size of target vessels of patients referred for coronary intervention are poorly defined. We aimed to investigate in a large series of patients undergoing percutaneous intervention the relation of constitutional, anatomical, and clinical features with the reference diameter of coronary vessels treated with stenting.
A total of 4,850 de novo coronary lesions, non-ostial and non-bifurcational, located in native vessels were analyzed. The following pre-specified characteristics were analyzed to reflect the relation between constitutional, anatomical, and clinical features on reference vessel diameter: age, gender, height, weight, proximal location, vessel, diabetes, hypertension, multivessel disease, and clinical presentation.
The average reference diameter was 2.66+/-0.50 mm. All pre-specified markers had a significant relation with the vessel reference diameter at univariate analysis, except by hypertension which showed a strong tendency. However, at multivariate analysis, only diabetes, proximal location, multivessel disease, clinical presentation, vessel, weight, and height were identified as independent predictors of reference vessel diameter.
Reference diameter of coronary vessels at the site of lesions treated by stenting is significantly influenced by a variety of characteristics. We hypothesize that the treated segment size of patients undergoing stenting ultimately reflects the conjoint effect of several different factors, including constitutional, anatomical, and clinical features.
The International Journal of Cardiovascular Imaging 03/2007; 23(1):1-7. · 2.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aims: We hypothesised that ischaemic preconditioning (IP) results from complex cellular mechanisms without significant collateral recruitment or clinical pre-intervention interference.Methods and results: A total of 58 patients underwent three 2-min balloon inflations separated by 5-min reperfusions. Anginal symptoms were graded according to this scale: 0 = absent, 1 = mild, 2 = moderate and 3 = severe. ST-segment shift and QT dispersion (QTd) were measured from 12 lead ECGs. Ejection fraction (EF) was assessed by 2D echo and collateral flow recruitment by collateral flow index (CFI). Anginal scores were 2.4+/-0.6, 1.7+/-0.5 and 1.2+/-0.6 (p<0.05); ST-segment shifts were 6.0+/-2.1, 3.8+/-1.8, and 1.9+/-1.2 mm (p<0.05); QTd increased from a baseline value of 39+/-24 to 96+/-27 (p<0.05) and decreased to 66+/-23 and 45+/-16 ms, at the end of the first, second and third inflation, respectively. EF decreased from a baseline value of 63+/-3% to 33+/-2%, 34+/-3%, and 36+/-5% in the three inflations. The CFI was approximately 0.15 in all ischaemic periods.Conclusion: These results suggest that IP does occur during repeated brief coronary artery occlusion in patients with a low likelihood of both collateral recruitment and clinical pre-intervention interference.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 11/2006; 2(3):345-50. · 3.29 Impact Factor
-
Silvio Zalc,
John A Ambrose,
Pedro A Lemos,
Expedito E Ribeiro,
José Soares,
Maria C P Giorgi,
Antonio Esteves-Filho, Pedro E Horta,
José C Meneghetti,
José A F Ramires,
Eulógio E Martinez
[show abstract]
[hide abstract]
ABSTRACT: The value of myocardial perfusion scintigraphy (MPS) in predicting the occurrence of restenosis or new coronary lesions after stent implantation is debatable. A total of 47 patients treated with successful bare stent implantation underwent stress gated SPECT MPS at three time-points: pre-procedure, early pos-procedure, and 6-month follow-up. Follow-up angiographic re-study was obtained at 6 months. Overall, 51.1% of patients had angiographic in-stent restenosis or a new lesion at follow-up. Pre-procedure MPS and early MPS scans did not differ between patients with or without restenosis/new lesions. At follow-up transient perfusion defects were observed in 26.1% of patients without restenosis/new lesions and in 75.0% of patients presenting with restenosis/new lesions (p<0.01) (sensitivity: 75.0%; especificity: 73.9%). When comparing early post procedure MPS to follow-up MPS, patients without restenosis/new lesions had no changes or a decrease in the number of segments with transient defects (median difference 0 [interquartile range -2 - 0]), while patients with restenosis/new lesions had an increase in transient defects (+2 [interquartile range 2 - 3.75]; p<0.01). Two multivariate factors independently predicted new lesion/restenosis: reference diameter < 2.9 mm (OR 6.50; p=0.05) and the difference in the number of segments with transient defects between early post procedure and follow-up MPS (OR 1.87; p<0.01). In conclusion, pre-procedure and early MPS did not predict complications after coronary stenting, while follow-up MPS was suboptimal in differentiating patients with or without new lesions/restenosis. However, the change in myocardial perfusion from early post-procedure to the follow-up scan was an important -prognostic factor to predict the incidence of new lesion/restenosis.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2006; 2(2):224-30. · 3.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A group of 50 patients with 51 de novo lesions treated with thicker strut stents (strut thickness >100 microm) was angiographically evaluated at baseline, after stenting, and at 6 and 12 months. Minimal luminal diameter (MLD) significantly increased from 6 to 12 months (6 months: 1.72 +/- 0.50 mm vs 12 months: 1.81 +/- 0.47 mm; p <0.01). The binary restenosis (diameter stenosis >50%) rate was 17% at 6 months and 11% at 12 months (p = NS). At multivariate analysis, lumen loss at 6 months (p = 0.018) and deployment pressure (p = 0.041) independently predicted the changes in MLD between 6 and 12 months.
The American Journal of Cardiology 02/2004; 93(2):210-3. · 3.37 Impact Factor
-
Pedro A Lemos,
Eulogio E Martinez,
Edgard Quintella,
Lari C Harrell,
Jose A F Ramires,
Expedito E Ribeiro,
Marcus N da Gama, Pedro E Horta,
Luiz J Kajita,
Antonio Esteves,
Marco A Perin,
Paulo R Soares,
Silvio Zalc,
Igor F Palacios
[show abstract]
[hide abstract]
ABSTRACT: A consecutive series of interventions in vessels with reference diameter < or = 2.75 mm was retrospectively analyzed according to preprocedure strategy: balloon angioplasty with provisional stenting (PTCA group, 73 patients) and primary stenting (PS group, 122 patients). In the PS group, there were more patients with single-vessel disease (54.1% vs. 37.0%; P = 0.021), less patients with three-vessel disease (9.0% vs. 24.7%; P = 0.003), more LAD interventions (54.9% vs. 31.5; P = 0.002), and less left circumflex interventions (22.1% vs. 45.2%; P < 0.001). Reference diameter was larger in the PS group (2.28 +/- 0.35 mm vs. 2.11 +/- 0.36 mm; P = 0.001). Provisional stenting was performed in 39.7% of PTCA group. At long-term outcome, the incidence of composite major events was similar between the PTCA and the PS groups (20.5% vs. 17.2%, respectively; P = NS). Treatment of small vessels with balloon dilatation and provisional stenting or with primary stenting yielded similar late outcomes. Operators' choice of treatment strategy was based on particular angiographic characteristics.
Catheterization and Cardiovascular Interventions 04/2002; 55(3):309-14. · 2.29 Impact Factor
-
Carlos Augusto,
Homem De,
Magalhães Campos,
Expedito E Ribeiro,
Pedro A Lemos,
João L Falcão,
Andre G Spadaro,
Luiz J Kajita,
Antonio Esteves Filho,
Marco A Perin, Pedro E Horta,
Marcus N Gama,
Gilberto Marchiori,
Eulógio Martinez,
Artigo Original
-
Pedro A Lemos,
Expedito E Ribeiro,
Luiz J Kajita,
Antonio Esteves Filho,
Carlos A H Campos,
Breno A A Falcão,
Marco A Perin,
Marcus N Da Gama, Pedro E Horta,
Gilberto G Marchiori,
Andre G Spadaro,
Paulo R Soares,
Sílvio Zalc,
Eulógio E Martinez,
Artigo Original
