Complicações vasculares do transplante hepático podem causar alterações de perfusão e drenagem do enxerto com prejuízo à sua função, comprometendo a qualidade de vida e a sobrevida do receptor. A angioplastia transluminal percutânea é uma opção de tratamento para estas complicações. No entanto, pela falta de trabalhos dedicados para população pediátrica, não há consenso sobre sua segurança em longo prazo e qual técnica seria a mais adequada. Este estudo teve como objetivo avaliar a resposta terapêutica do tratamento endovascular percutâneo da estenose de veia porta em crianças submetidas ao transplante de fígado. Entre agosto de 2000 e agosto de 2009, foram realizados 254 transplantes hepáticos no Instituto da Criança Professor Pedro de Alcântara do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Quinze delas (5,9%; 15/254) desenvolveram estenose de veia porta com indicação de tratamento. O diagnóstico da lesão foi confirmado pela ultrassonografia em todos os casos. O tratamento da estenose consistiu inicialmente na angioplastia com balão por acesso transparietohepático ao sistema porta, sendo o implante de stent indicado nos casos de estenose residual maior que 30%, ou na recidiva da estenose. A idade média do grupo tratado foi de 4,5 anos ± 2,9 anos (mediana de 3,6 anos) e o peso médio, de 15,3 kg ± 5,7 kg (mediana de 14,6 kg). Dez pacientes (66,7%; 10/15) foram tratados com sucesso por uma única sessão de angioplastia com balão. Outra criança (1/15; 6,7%) foi tratada com sucesso por implante de stent indicado pela estenose residual > 30% após a tentativa de tratamento com balão numa mesma sessão. Outras quatro, inicialmente tratadas por angioplastia com balão (26,7%; 4/15), evoluíram com recidiva da estenose após 19 dias, 2 meses, 8 meses e 2 anos do tratamento e foram submetidas a nova angioplastia, desta vez com implante de stent. O tempo médio de seguimento foi de 7,4 anos ± 2,6 anos (mediana de 7,9 anos) com taxa de perviedade primária foi de 73,3% (11/15) e taxa de perviedade primária assistida, obtida pela reintervenção precoce da re-estenose da veia porta antes de sua obstrução, de 100%. A angioplastia com balão da estenose de veia porta após transplante hepático em crianças demonstrou ser um método seguro e efetivo neste grupo de pacientes no seguimento avaliado. Os casos tratados com stent apresentaram índices semelhantes de segurança e sucesso terapêutico / Vascular complications of liver transplantation can compromise grafts perfusion and drainage affecting its function and recipients quality of life. Percutaneous transluminal angioplasty is an option for these complications. However, especially in children, there is no consensus about its long-term safety and which technique would be most appropriate. This study has the objective to evaluate the therapeutic response of percutaneous endovascular treatment of portal vein stenosis in children submitted to liver transplantation. Between August 2000 and August 2009, 254 liver transplants were performed at the Instituto da Criança - Professor Pedro de Alcântara do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo. Fifteen of them (5.9%, 15/254) developed portal vein stenosis confirmed by ultrasound in all cases. The treatment of the portal vein stenosis consisted initially in balloon angioplasty. The stent was indicated in residual (greater than 30%) or recurrent stenosis. The mean age of the treated group was 4.5 years ± 2.9 years (median 3.6 years) and the mean weight was 15.3 kg ± 5.7 kg (median 14.6 kg). Ten patients (66.7%, 10/15) were successfully treated by a single session of balloon angioplasty. Another child (1/15, 6.7%) was successfully treated by stent due to residual stenosis after balloon angioplasty. Four other children (26.7%, 4/15) developed recurrent stenosis after 19 days, 2 months, 8 months and 2 years of initial treatment with balloon and underwent to a new angioplasty this time, with stent. The primary patency rate was 73.3% (11/15) and the assisted primary patency rate, determined by early intervention before portal vein occlusion, was 100%. Follow-up time was 7.4 years ± 2.6 years (median 7.9 years). Balloon angioplasty of portal vein stenosis after liver transplantation in children demonstrated to be a safe and effective method in this group of patients during the follow-up period of this research. Cases treated with stent had similar rates of safety and therapeutic successes

published_or_final_version / Medicine / Master / Master of Philosophy

Aterosklerozė, kaip arterijas pažeidžianti liga, žinoma jau daugelį metų. Periferinių arterijų okliuzinės ligos (PAOL) simptomus jaučia apie 27 milijonai žmonių Šiaurės Amerikoje ir Europoje. Nežiūrint gerėjančios PAOL diagnostikos, chirurginio, endovaskulinio ir medikamentinio gydymo, jos paplitimas toliau didėja. Ši liga ypač neigiamai veikia gyvenimo kokybę ir išgyvenamumą. Populiacijai senstant, 2040 metais žmonių, sergančių PAOL, skaičius padidės iki 22 proc.. Taigi, akivaizdžiai galime pastebėti, kad žmonėms senstant, daugėja PAOL sergančiųjų ir ši liga progresuoja, blogina žmonių gyvenimo kokybę bei didina mirštamumą ar sunkina gretutinių susirgimų eigą. Ilgėjant žmonių amžiui, jie turi daug gretutinių susirgimų. Todėl PAOL operacinis gydymas gali būti gyvybei pavojingas, nes sukelia gretutinių ligų pasunkėjimą. Šiuo metu šią problemą bandoma spręsti pritaikant endovaskulinius arterijų užakimo koregavimo metodus, kurie yra mažai invazyvūs, atliekami vietinėje nejautroje ir sąlyginai pigūs. Darbo tikslas: palyginti subintiminės angioplastikos (SA), arterijų šuntavimo operacijų ir perkutaninės transliuminalinės angioplastikos (PTA) gydymo rezultatus, esant paviršinės šlaunies arterijos lėtiniam užakimui bei įvertinti subintiminės angioplastikos rizikos veiksnius. Darbo uždaviniai: 1. Įvertinti subintiminės ir perkutaninės transliuminalinės angioplastikų bei arterijų šuntavimo operacijos ypatumus, gydant lėtinį paviršinės šlaunies arterijos užakimą. 2. Įvertinti... [toliau žr. visą tekstą] / The Aim The aim of this study is to compare the results of subintimal angioplasty (SA), the bypass surgery and percutaneus transluminal angioplasty (PTA) in treatment of the chronic occlusion of superficial femoral artery (SFA) and determine risk factors of subintimal angioplasty. The objectives: 1. To evaluate peculiarity of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 2. To evaluate the primary results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 3. To evaluate the early results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 4. To determine risk factors predicting the primary and the early results of chronic superficial femoral artery occlusion treatment by means of subintimal and percutaneus transluminal angioplasty and the arterial bypass surgery. 2.1. Patients The prospective clinical study is being performed at the Department of Vascular Surgery of the Clinic of Cardiac, Thoracic and Vascular Surgery of Kaunas University of Medicine. The study was started in November 2002 and ended on December 2006. We had 255 patients admitted to the clinic during this period of time due to the occlusion of SFA, which matched the criteria of the study. The patients were... [to full text]

Objective - to assess possibilities and specific characteristics of pediatric cardiology in treatment of congenital heart diseases (CHD), to evaluate efficacy of curative per-catheter procedures by means of analysis of immediate and long-term results. Retrospective study. The data of 422 patients who underwent 467 CHD palliative-curative procedures during the period since 1971 till 2007 were analyzed. It was postulated that balloon atrial septostomy resulted in statistically significant increase of atrial septal defect, increase of arterial blood oxygen saturation and decrease of interatrial preasure gradient (PG). Balloon pulmonary valvulotomy (BPV) is one of the most common curative procedures; this procedure has an effect of marked decrease of pressure gradient between the right ventricle and right atrium; development of pulmonary artery valve insufficiency is the most common complication of this procedure. The long - term results of BPV are less positive when higher PG prior the procedure is present and residual PG after the procedure is 36mmHg and higher. It was postulated, that closure of small (less than 3 mm) persistent ductus arteriosus using Cook coils may compete with surgical treatment successfully. It was stated, that the efficacy of balloon angioplasties of aorta, caval veins and pulmonary artery branches is transient; treatment using stents is more effective. It was postulated, that closure of congenital and postsurgical anomalies connections using coils is... [to full text] / Disertacijos objektas yra nustatyti intervencinės pediatrinės kardiologijos galimybes ir ypatumus, gydant įgimtas širdies ydas (ĮŠY), įvertinti gydomųjų perkateterinių procedūrų efektingumą, remiantis ankstyvųjų ir vėlyvųjų rezultatų analize. Tai retrospektyvus tyrimas. Analizuoti 422 ligonių duomenys, kuriems 1971 - 2007 m. buvo atliekamos 467 įgimtų širdies ydų paliatyvinės - gydomosios procedūros. Nustatyta, kad po balioninės tarpprieširdinės pertvaros septostomijos, statistiškai reikšmingai padidėja prieširdžių pertvaros defektas, didėja arterinio kraujo įsotinimas deguonimi ir mažėja spaudimų skirtumas (SS) tarp prieširdžių. Balioninė plaučių arterijos valvuloplastika (BPV) yra viena iš dažniausiai taikomų gydomųjų procedūrų, jos efektas – ryškus SS tarp dešiniojo skilvelio ir plaučių arterijos (PA) sumažėjimas, o pagrindinė komplikacija – PA vožtuvo nesandarumo vystymasis. BPV vėlyvieji rezultatai blogesni, kai yra didelis SS prieš procedūrą, o po procedūros liekamasis SS ≥ 36mmHg. Nustatyta, kad mažų iki 3mm AAL kimšimas Cook spiralėmis gali sėkmingai konkuruoti su operaciniu gydymu. Rasta, kad aortos, tuščiųjų venų ir plaučių arterijos šakų balioninės plastikos efektas trumpalaikis, o gydymas stentais daug sėkmingesnis. Nustatyta, kad anomalinių įgimtų ir pooperacinių kraujagyslinių jungčių užkimšimas spiralėmis yra saugus ir efektyvus gydymo metodas.

Interventional technologies such as elective percutaneous coronary interventions (PCI)are increasingly used to manage the symptoms of coronary artery disease (CAD); however, this treatment approach is associated with poor risk factor management. The purpose of this study was to understand the factors that influence the health behaviors of elective PCI patients. A qualitative approach, using Interpretive Description, was used to explore the ten participants’ healthcare experiences, their perceptions of CAD, and the rationale for their health choices. This generated a profile of these individuals and their post-PCI health behaviours. Health behaviours were influenced by multiple factors and are reflected in the themes: what a relief – I’m better; uncertainty about their future health; the importance of relations; and barriers to lifestyle change. These findings not only extend our understanding of the elective PCI patients’ health behaviour choices but also provides insight into key areas to target for improving health service delivery.

Interventional technologies such as elective percutaneous coronary interventions (PCI)are increasingly used to manage the symptoms of coronary artery disease (CAD); however, this treatment approach is associated with poor risk factor management. The purpose of this study was to understand the factors that influence the health behaviors of elective PCI patients. A qualitative approach, using Interpretive Description, was used to explore the ten participants’ healthcare experiences, their perceptions of CAD, and the rationale for their health choices. This generated a profile of these individuals and their post-PCI health behaviours. Health behaviours were influenced by multiple factors and are reflected in the themes: what a relief – I’m better; uncertainty about their future health; the importance of relations; and barriers to lifestyle change. These findings not only extend our understanding of the elective PCI patients’ health behaviour choices but also provides insight into key areas to target for improving health service delivery.

Darbo tikslas: nustatyti veiksnius, susijusius su arterioveninių jung¬čių (AVJ) dializuojamiems pacientams funkcionavimo trukme bei įvertinti jungčių funkcijos monitoravimo naudą jų funkcionavimo trukmei prail-ginti. Darbo uždaviniai: 1. Įvertinti AVJ funkcijos monitoravimo naudą jos funkcionavimo trukmei prailginti. 2. Nustatyti pirmosios hemodializės procedūros atlikimo būdo ryšį su paciento stacionarizavimo trukme. 3. Nustatyti veiksnius, susijusius su AVJ funkcionavimo trukme. 4. Nustatyti centrinės venos kateterio buvimo ir lokalizacijos reikšmę AVJ funkcionavimo trukmei. 5. Įvertinti AVJ „brandinimo“ trukmės ryšį su AVJ funkcionavimo trukme. 6. Įvertinti priešoperacinio kraujagyslių ultragarsinio ištyrimo reikšmę pirminių jungties disfunkcijų išsivystymui bei AVJ funkcionavimo trukmei. DARBO METODIKA Tyrimas atliktas Lietuvos sveikatos mokslų universiteto Nefrologijos klinikoje, gavus Kauno regioninio tyrimų etikos komiteto leidimą Nr. BE 2-20. Dalis duomenų buvo renkama retrospektyviai, naudojant medicinos dokumentaciją, kita dalis informacijos apie pacientų laboratorinių tyrimų duomenis bei HD procedūros parametrus buvo renkama viso tyrimo ei¬goje. Visos AVJ pagal buvo suskirstytos į tris grupes: 1. Istorinė grupė – monitoravimas taikytas nebuvo (187 pacientai, 260 AVJ); 2. Monitoruota grupė – AVJ buvo monitoruojamos nuo pirmosios per ją atliktos HD (29 pacientai, 31 AVJ); 3. Dalinai monitoruota grupė – AVJ naudojamos HD iki 2008 m. gruo-džio 31 d., o vėliau... [toliau žr. visą tekstą] / Patients to be treated with chronic hemodialysis (HD) must have blood vessel connection. There are three types of blood vessel connections: native arteriovenous fistula (AVF), synthetic prosthesis and permanent central venous catheter. Each connection has its strengths and weaknesses. Primary AVF dysfunction occurs in 7.5% of the whole population of patients receiving HD, and in up to 80% of high risk patients (those with diabetes, elderly patients, and women) [Mann et al 2005]. Compared to other blood vessel connections (permanent central venous catheter or synthetic prosthesis) function of properly formed AVF is the longest, and incurs the lowest incidence of infectious and thrombotic complications. All international guidelines on HD procedures recommend native AVF as the method of choice. Formation of blood vessel junctions and treatment of their complications account for up to 20% of all hospitalizations of patients with end stage renal failure in USA [Allon et al 2002], up to 30% in Canada [Mann et al 2005], and up to 25% in Europe [Pissoni et al 2002]. It should be stated that formation of AVF and treatment of their complications are very expensive, and therefore determining the causes of the development of AVF complications and their timely diagnosis and correction are extremely important. Various methods of monitoring of AVF function are used in many European and USA HD centers; however, the most important criterion of early diagnosis of AVF complications has not... [to full text]

Os avanços na área da saúde têm resultado na redução da morbidade e permitido maior sobrevida aos pacientes coronariopatas. Entr etanto, a Síndrome Coronariana Aguda (SCA) ainda representa uma das questões de saúde públ ica mais relevante da atualidade. O objetivo geral do estudo foi avaliar a evolução clínica dos pacientes dur ante a primeira internação decorrente da SCA e nos primeiros dois anos a pós a hospitalização. As principais variáveis de interesse investigadas foram: mortalidade, rein ternações e tratamentos de revascularização do miocárdio (Intervenção Coronária Percutânea - ICP e Cirurgia de Revascularização do Miocárdio - CRVM). O delineamento utilizado foi observacional, tipo coorte. A amostra foi composta por pacientes que foram internados em decorrência do prim eiro episódio de uma SCA, entre maio de 2006 e julho de 2009, em um hospital geral público de ensino. Os dados foram coletados em 2011 mediante consultas ao s prontuários dos participantes e ao sistema eletrônico de agendamento do hospital, utilizando-se de um instrumento elaborado pela pesquisadora. Os dados foram analisados utiliz ando testes de associação Qui-quadrado, Exato de Fisher e t de Student para amostras independentes. O nível de significância adotado foi de 0,05. A taxa de mortalidade foi calculada divi dindo o número de óbitos ocorridos em até dois anos de seguimento pela somatória do tempo total de observação do estudo. Participaram da investigação 234 pacientes, sendo 140 (59,8%) diagnosticados com Infarto Agudo do Miocárdio (IAM) e 94 (40,2%) com Angina Instável (AI). A idade média foi de 58 anos (D.P.=12,2 anos), com predomínio de indiví duos do sexo masculino (69,2%). Durante a internação inicial não houve associação entre a presença de complicações e a manifestação clínica da SCA; os pacientes com AI tiveram média de tempo de permanência hospitalar maior que IAM (12,5 e 10 dias, respectivamente), mas essa diferença não foi estatisticamente significante. As ICPs foram mais realizadas nos pacien tes com IAM, enquanto as CRVMs foram mais realizadas nos pacientes com AI , sendo a associação entre essas variáveis estatisticamente significantes. Ao longo do se guimento de até dois anos após a alta da internação inicial, 71,4% dos pacientes foram subm etidos a, pelo menos, um procedimento de revascularização do miocárdio; 27,4% necessita ram de outras hospitalizações, e desses, 71% tiveram uma nova internação e 6,5% reinternaram cinco vezes. Na primeira reinternação, a causa mais prevalente foi a ICP programada e na s internações posteriores foi a angina. A taxa de mortalidade hospitalar foi de 3%, tendo ocorrido 13 óbitos durante todo o seguimento do estudo, sem diferença estatística entre as manifestações da SCA. A taxa de mortalidade geral do estudo foi de 35,75/1000 pessoas por ano. Os resultados do estudo ampliaram nossos conhecimentos sobre como é o perfil deste grupo de pacientes atendidos em decorrência do primeiro episódio de SCA em um hospital geral, de nível terciário, e como se dá a evolução clínica durante a internação e a longo prazo. / The advances in health have led to reduced mo rbidity and improved survival of patients living with coronary diseases. However, Acute Cor onary Syndrome (ACS) represents one of the most relevant public health issues nowadays. The aim of this study was to assess the clinical evolution of patients who suffered from ACS, fr om their first admission to the hospital until two years after that episode. The main interest variables investigated were: mortality, hospital readmissions and myocardial reva scularization therapies (percuta neous coronary intervention - PCI and Coronary Artery Bypass Grafting surg ery - CABG). This research was designed as an observational cohort study. The study sample was patients admitted into a general school hospital due to the first episode of ACS, from May 2006 through July 2009. Data were collected in 2011 from patients\' medical records and the hospital\'s appointment schedule database, using a form designed by the researcher. Data were analyzed by chi-square, Fisher\'s exact test and t-Student association tests for independent samples. The significance level was 0.05. Mortality rate was calculated by dividing the number of deaths occurred up to two years after the first ACS episode by the total period of observation taken within the study. As such, 234 patients took part in the study, 140 (59.8%) were diagnosed with Acute Myocardial Infarction (AMI) and 94 with Unstable Angi na (UA). The mean age was 58 years old (s.d.=12.2), most were male (69.2%). During hosp ital stay there was no association between medical complications and clinical manifest ation of ACS. Patients with UA had mean hospital stay higher than AMI patients (12.5 and 10 days, respectively), alt hough this was not statistically relevant. PCI were more prevalen t in AMI patients, whereas CABG were to UA patients, displaying statistically relevant association between these variables. During the two-year follow up period after hospital discharge, 71.4% of patients were submitted to, at least, a myocardial revascularization pr ocedure. 27.4% of patients were hospitalized again, 71% of this group had to be readmitted and 6.5% had been readmitted five times. At their first readmission, the most prevalent cause was a sc heduled PCI and the following hospitalizations were due to angina. The hospital mortality rate was 3%, as 13 deaths occurred during the period of study, with no statistically significance between the ACS manifestations. The general mortality rate of this study was 35.75/1000 people per year. The results of this study improved our knowledge over the profile of this population admitted into a general tertiary hospital due to their first ACS episode. It also shone some light over the clinical evolution of this disease during hospitalizat ion and at long term period.

Made available in DSpace on 2014-07-29T15:29:19Z (GMT). No. of bitstreams: 1 dissertacao nancy vieira.pdf: 795865 bytes, checksum: dfeac68319198e6608dcf82885225d60 (MD5) Previous issue date: 2009-11-23 / Bakground: The presence of an increase in troponin I (cTnI) is common in patients who have undergone a percutaneous coronary intervention (PCI), but it is questionable if the myocardial lesion occurring in the intervention allows one to identify patients with a greater risk of presenting adverse cardiac events (ACE) .Objective : The overall objective of the study was to evaluate the immediate evolution of cardiac troponin I (cTnI) in patients undergoing elective coronary angioplasty with stenting, and also compare patients with serum changes after the procedure of coronary angioplasty stenting, with the clinical variables and the occurrence of adverse cardiac events (ACE) following 12 months.. Methods: This is a study of a prospective cut, which evaluates 49 consecutive patients who underwent coronary angioplasty with stent implantation. A cTnI serum dosage was done both before and after the procedure. Patients with a cut off >1.0 ng/mL before implantation were excluded. All the others received follow up for one year, to record the presence of ACE (death, acute myocardial infarction, another angioplasty). Results: cTnI serum elevations occurred in 21(45.7%) of the patients after the PCI. At the end of the follow up period, 11(23.9%) of the patients presented adverse cardiac events. There was no association between the cTnI serum elevation and the presence of ACE in the follow up. Conclusions: The elevation of cTnI found after a coronary angioplasty with stent implantation was frequent in our sample, but these elevations in serum did not show any association with clinical variables and the occurrence of adverse cardiac events following 12 months / A presença da elevação da troponina I(cTnI) é comum em pacientes submetidos a uma intervenção coronariana percutânea (ICP), porém é questionado se a lesão miocárdica ocorrida na intervenção permite identificar pacientes com maior risco de apresentar eventos cardíacos adversos. Objetivo: O objetivo geral do estudo foi avaliar o comportamento evolutivo imediato dos níveis séricos de troponina I (cTnI), em pacientes submetidos eletivamente à angioplastia coronária com implante de stent , e também, comparar pacientes com alterações séricas pós-procedimento de angioplastia coronária com implante de stent, com as variáveis clínicas e a ocorrência de eventos cardíacos adversos (ECA) no seguimento de 12 meses. Metodologia: Este é um estudo de coorte prospectivo, que avaliou 49 pacientes consecutivos, submetidos à angioplastia coronariana com implante de stent. Fez-se dosagens séricas de cTnI antes e após o procedimento. Pacientes com cut off > 1,0 ng/mL antes do implante foram excluídos, e os demais foram acompanhados em um ano de seguimento, para registro da presença de ECA (óbito, infarto do miocárdio e nova angioplastia). Resultados: Ocorreram elevações séricas de cTnI em 21(45,7%) dos pacientes após a ICP. Ao término do seguimento 11(23,9%) dos pacientes apresentaram eventos cardíacos adversos. A correlação entre a elevação sérica da cTnI e a presença de ECA no seguimento não mostrou associação. Conclusão: A elevação da cTnI encontrada após uma angioplastia coronariana com o implante de stent foi freqüente em nossa amostra, porém estas elevações séricas não apresentaram nenhuma associação com as variáveis clínicas e a ocorrência de eventos cardíacos adversos no seguimento de 12 meses

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-05-12T19:51:27Z No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-13T11:51:25Z (GMT) No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Made available in DSpace on 2016-05-13T11:51:25Z (GMT). No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) Previous issue date: 2015-10-26 / Background: the specialized early treatment of acute myocardial infarction provides the best prognosis and enzyme values, during in-hospital phase, can correlate with cardiovascular events along the follow-up. The creatino-phosphokinase-MB is still widely used for diagnosis of acute myocardial infarction with ST-elevation. The percutaneous coronary intervention is the main therapeutic method, where the manual aspirative thrombectomy is a possibility of adjuvant treatment. Objectives: to evaluate the systematic chain of care in the myocardial infarction and the levels of CK-MB in cases treated with angioplasty and coronary thrombus aspiration, and assess 6 months follow-up survival. Assess also the association of CK-MB with the Blush grade, ST resolution and the concomitant correlation with delta-T and death. Methods: 835 patients with ST elevation myocardial infarction were analised, from March 2012 to June 2014 in two reference centers in Goiânia-GO. Only those who arrived within 12h underwent invasive treatment, where serial CK-MB and electrocardiogram were obtained and analyzed during the hospitalization. During the six months follow-up there were observed the events death and reinfarction in this group. For associative and correlation analysis there were used Mann-Whitney, Kruskall-Wallis and Spearman tests. For analysis of categorical variables, the Chi-square test or Fisher, and considered significant p<0.05. Results: out of 835 patients, only 51 (6%) presented within the delta T less than 12h, who were invasively treated immediately on admission. 507 (61%) were presented with more than 12h. The curve of the CK-MB showed peak around 12h. Of those treated with invasive aproach on admission, 6 deaths were observed (11.7%) and 1 re-infarction (2%), all of which occurred in the first month of follow-up. Lower Blush grade and resolution of less than 50% in ST-elevation were associated to significantly higher values of CK-MB. Higher values of CK-MB were significantly correlated with higher delta T and higher mortality. Conclusion: contrary to what recommend the guidelines, only few cases who reached the specialised centres had delta T less than 12h, impacting negatively on prognosis. The curve of CK-MB in patients with myocardial infarction invasivelly treated on admission had early peak. The highest levels were observed in the cases with low Blush grade, less than 50% resolution in ST-elevation and larger delta-T, which were related to the worst prognosis. / o tratamento especializado e precoce no infarto agudo do miocárdio proporciona o melhor prognóstico e os valores enzimáticos, na fase intra-hospitalar, podem se correlacionar com eventos cardiovasculares durante o seguimento clínico. A creatino-fosfoquinase-MB ainda é muito utilizada para diagnóstico do infarto agudo do miocárdio com supra-de-ST. A intervenção coronária percutânea é o principal método terapêutico, onde a trombéctomia por aspiração manual é uma possibilidade de tratamento adjuvante. Objetivos: avaliar a sistemática na cadeia de atendimento do infarto do miocárdio, os níveis da CK-MB dos casos tratados com angioplastia e aspiração de trombo coronário e a sobrevida no seguimento de 6 meses. Avaliar também a associação da CK-MB com o Blush, resolução de ST e a correlação concomitante com o delta-T e morte. Métodos: foram analisados 835 pacientes com infarto do miocárdio com supra de ST atendidos de março de 2012 a junho de 2014 em dois centros de referência em Goiânia-GO. Apenas os que chegaram com delta de até 12h foram submetidos ao tratamento invasivo, onde CK-MB e ECG seriados foram obtidos e analisados durante a internação. No seguimento de seis meses foram observados os desfechos morte e reinfarto neste grupo. Para análises associativas e de correlação foram utilizados teste de Mann-Whitney, Kruskall-Wallis e Spearman. Para análise das variáveis categóricas, realizou-se o teste do qui-quadrado ou de Fisher, e considerados significativos p<0,05. Resultados: dos 835 pacientes, somente 51 (6%) apresentaram delta T menor que 12h e foram tratados invasivamente logo na admissão, sendo que 507 (61%) tinham delta T maior que 24h. A Curva da CK-MB mostrou pico próximo de 12h. Daqueles tratados invasivamente na admissão, foram observados 6 óbitos (11,7%) e 1 reinfarto (2%), sendo que todos ocorreram no primeiro mês de seguimento. Blush baixo e resolução de ST menor que 50% no ECG associaram-se significativamente aos valores mais elevados de CK-MB. Valores elevados de CK-MB estiveram significativamente correlacionados com maior delta T e maior mortalidade. Conclusão: contrariamente ao que recomenda as diretrizes, poucos foram os pacientes que chegaram aos centros especializados com delta T menor que 12h, impactando negativamente no prognóstico. A curva de CK-MB em pacientes com infarto tratados invasivamente na admissão teve pico precoce. Os níveis mais elevados foram constatados nos casos com baixo Blush, resolução de ST menor que 50% no ECG e maior delta-T, estando relacionados aos piores prognósticos.