Coronary atherosclerosis is one of the leading cause of mortality in developed countries, and is increasingly diagnosed via X-ray computed tomography. Due to the large resulting volume of data, recent research has been directed towards developing automated methods of screening CT scans for coronary atherosclerosis. This task typically consists of lumen extraction, plaque detection, plaque quantification, and material discrimination. In this paper, we describe a novel set of techniques for accomplishing the first three steps, which aim to provide higher precision than previous efforts. We also discuss how such a high-precision detection and quantification system could be used to significantly improve on the state of the art in material discrimination. Our methods extract lumen for 71.2% of centreline points, detect plaque with a detection sensitivity of 67% on CTA reference data, and quantify plaque with a linear weighted kappa coefficient of 0.08.

Background: Glycated hemoglobin is the indicator of long-term diabetes control and a value below 7 percent is recommended by the American Diabetes Association (ADA) to reduce cardiovascular complications. Diabetic patients have a two- to four-fold risk of cardiovascular disease and approximately two-thirds of diabetic patients die as a result of cardiovascular complications. Three large prospective randomized controlled long-term trials within the last decade reported no significant reduction in cardiovascular complications in type 2 diabetic patients by intensive glycemic control. To the author's knowledge, no known retrospective studies have examined the association between mean serial glycated hemoglobin and coronary atherosclerosis (CA) or acute coronary syndromes (ACS). Objective: This study was designed to determine the association between mean serial glycated hemoglobin with incident CA or ACS in type 2 diabetic patients after controlling for age, gender, hypertension, low density lipoprotein cholesterol (LDL-C), microalbuminuria, aspirin use, statin use, insulin use, tobacco use, and body mass index (BMI). Methods: The study was a retrospective cohort database analysis using the Austin Travis County CommUnityCare[trademark] clinics' electronic medical record for the time period between October 1, 2004 and September 30, 2009. The primary outcome of the study was the incidence of CA or ACS and the primary independent variable was glycated hemoglobin (<7% vs. [greater than or equal to]7%). The study subjects included type 2 diabetic patients aged 30 to 80 years with at least one glycated hemoglobin value per year for a minimum of two consecutive years. Study subjects were excluded if CA or ACS occurred within six months of the index date (i.e., first glycated hemoglobin). Logistic regression analysis was used to address the study objective. Results: Overall, 3069 subjects met the study inclusion criteria with a mean follow-up period of approximately two years. Two percent (N=62) of the subjects had incident CA or ACS. After controlling for age, gender, hypertension diagnosis, LDL-C, microalbuminuria, aspirin use, statin use, insulin use, tobacco use and BMI, there was no significant association (OR=1.026, 95% CI=0.589-1.785, p=0.9289) between mean serial glycated hemoglobin and the incident diagnosis of CA or ACS. Increasing age (OR=1.051, 95% CI=1.025-1.077, p<0.0001), male gender (OR=1.855, 95% CI=1.105-3.115, p=0.0195) and normal weight (normal or underweight compared to obese: OR=0.122, 95% CI=0.017-0.895, p=0.0438) were significantly associated with incident CA or ACS. Conclusions: Mean serial glycated hemoglobin (comparing [greater than or equal to]7% to <7%) was not significantly associated with CA or ACS over a mean follow-up period of approximately two years. Until more evidence becomes available, clinicians and diabetic patients should target glycated hemoglobin level below or close to 7 percent as recommended by the ADA soon after diagnosis while concomitantly controlling nonglycemic risk factors of cardiovascular disease (statin use, aspirin use, blood pressure control, smoking cessation and life style modification), to reduce their long-term risk of incident CA or ACS. / text

Objective: To investigate the association between coronary atherosclerosis (CAD) and erectile dysfunction (ED) in men undergoing coronary angiography, according to the complexity of the CAD and the severity of ED and the power of the abridged five item version of the questionnaire International Index of Erectile Function (IIEF) in the diagnosis of CAD. Patients and Methods: A case study - control, conducted between January to November 2010 which evaluated 132 consecutive patients were submitted to coronary angiography divided into two groups according to presence (group 1, composed of 86 patients) or absence (group 2 - composed of 46) of CAD, which was defined by lesions with an area of stenosis greater than or equal to 50% of the diameter of the coronary vessel. Patients underwent IIEF-5 to assess the presence, degree and how long ago were suffering from erectile dysfunction and then was made the measure of the Syntax score for assessing the complexity of coronary lesions. Results: There is an independent association between ED and CAD with an odds ratio of 40.6 (95% CI 14.3 to 115.3 p <0.0001). The cutoff point 21, the IIEF-5 had a sensitivity of 91.2%, specificity of 78.3% and 87% accuracy for diagnosis of CAD. The ED was already present in patients with a period about twice as large (38.8 ± 2.3 months) than in patients without CAD. Patients without erectile dysfunction Syntax average score was 6.3 ± 3.5 while those who had moderate to severe erectile dysfunction was 39.0 ± 11.1. Conclusion: There is an independent association between ED and CAD and ED should be considered an early marker of CAD as well as its complexity and the questionnaire IIEF-5 has exceptional ability to diagnose it. / Objetivo: investigar a associação entre doença aterosclerótica coronariana (DAC) e a presença de disfunção erétil (DE), em homens submetidos à cinecoronariografia, de acordo com a complexidade da DAC e da gravidade da DE e o poder do questionário resumido do Índice Internacional de Função Erétil (IIEF-5) no diagnóstico de DAC. Pacientes e Métodos: estudo de caso controle, realizado no período entre janeiro a novembro de 2010 no qual foram avaliados 132 pacientes, consecutivos, que foram submetidos à cinecoronariografia, divididos em dois grupos, de acordo com a presença (grupo1- composto por 86 pacientes) ou ausência (grupo 2- composto por 46) de DAC, que foi definida por lesões com área de estenose maior ou igual a 50 % do diâmetro do vaso coronariano. Os pacientes foram submetidos ao IIEF-5 para avaliar a presença, o grau e há quanto tempo eram portadores de disfunção erétil e realizada a medida do Syntax Score para avaliação da complexidade das lesões coronarianas. Resultados: Há associação independente entre DE e DAC com odds ratio de 40,6 (IC 95% 14,3 a 115,3 e p<0,0001). No ponto de corte 21 o IIEF-5 apresentou sensibilidade de 91,2%, especificidade de 78,3% e acurácia de 87% para o diagnóstico de DAC. A DE já estava presente nos pacientes com num período cerca de duas vezes maior (38,8 ± 2,3 meses) que nos pacientes sem DAC. Pacientes sem disfunção erétil a média do Syntax Score foi de 6,3 ± 3,5 enquanto os que apresentaram disfunção erétil moderada a grave foi de 39,0±11,1. Conclusão: Há associação independente entre DE e DAC, sendo que a DE deve ser considerada um marcador precoce de DAC bem como da sua complexidade e o questionário IIEF-5 tem capacidade excepcional para o seu diagnóstico.

Background: The human gut microbiota is the complex microbial community that lives in our gut. The gut microbiota has a key role in health and disease and its disruption has been linked to several chronic diseases such as cardiovascular diseases. As antibiotics are well known disruptors of gut microbiota, the aim of this thesis work was to identify associations between previous antibiotic consumption and the abundance of seven gut microbiota species previously linked to subclinical coronary atherosclerosis in the large population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. Materials and Methods: Faecal samples of 9,794 individuals from the SCAPIS Uppsala and Malmö cohorts were analysed by deep shotgun metagenomics sequencing in a cross-sectional study. Previous antibiotic use was retrieved using the Swedish Drug Prescribed Register and divided into three periods: one year, between one and five years, and between five and nine years before faecal sampling. Associations between antibiotic consumption and the gut microbiota species were evaluated using linear regression adjusted for covariates and corrected for multiple testing. Results: Our results showed that antibiotic consumption was associated with an increased abundance of Ligilactobacillus salivarius, Bifidobacterium dentium, Rothia mucilaginosa, Streptococcus parasanguinis and Streptococcus oralis subsp. oralis. Often these positive associations were present for antibiotic consumed between one and five years before sampling.  The strongest associations were for broad-spectrum antibiotics and lincosamides with L. salivarius, B. dentium, R. mucilaginosa and S. parasanguinis; and for nitrofurantoin with S. oralis subsp. oralis.   Conclusions: This study provides insights on how antibiotic consumption is associated with enrichment and higher abundance of species previously linked with subclinical coronary atherosclerosis in the gut. Hence, this study provides insights on unintended effects of using antibiotics for managing infections, which underscores antibiotic use as not only a concern for development of antibiotic resistance but also for disrupting the gut microbiota, which may contribute to disease development. Knowledge about effect of antibiotics in gut microbiota may help to adequate this therapy according to comorbidities of individual profiles and to design better diagnostic tools for the risk population with the goal of preventing cardiovascular events in the general population.

Coronary atherosclerosis is by far the most frequent cause of ischemic heart disease. Intravascular ultrasound (IVUS) along with virtual histology (VH) is a useful tool for quantification of coronary plaque buildup and provides new insights into the diagnosis of coronary disease. Rupture of vulnerable plaque causing acute coronary syndromes, coronary remodeling maintaining lumen size and plaque phenotype revealing pathological severity are among the most important topics related to atherosclerosis. In this thesis, variations of IVUS-VH-derived thin-cap fibroatheroma (TCFA) definitions are proposed to evaluate the plaque rupture, which is further analyzed in a layered manner; statins effects on coronary remodeling are comprehensively assessed with the implementation of automated IVUS segmentation and registration of IVUS pullbacks based on baseline and 1-year followup datasets; plaque phenotypes are determined and analyzed morphologically and compositionally on segmental basis using the same serial datasets. In addition, our research involves another important coronary disease — coronary allograft vasculopathy (CAV) which is a frequent complication of heart transplantation (HTx). Another intra-coronary imaging modality — intravascular optical coherence tomography (IVOCT) for quantifying CAV is involved. We present an optimal and automated 3-D graph search approach for the simultaneous IVOCT multi-layer segmentation by transforming the 3-D segmentation problem into finding a minimum-cost closed set in a weighted graph. Furthermore, a computer-aided just-enough-interaction refinement method is proposed to help achieve fully satisfactory 3-D segmentation of IVOCT images. We believe this is the first work that provides a fast, efficient and accurate solution for IVOCT multi-layer assessment in the context of CAV. The major contributions of this thesis are: (1) Proving that IVUS-VH-derived TCFA prevalence may be overestimated, and elucidating the potential loss of plaque material during rupture, (2) providing a comprehensive understanding of remodeling in the context of both changing the remodeling direction and changing the remodeling extent, and demonstrating the statin therapy effects on remodeling across patients, based on automated segmentation of IVUS images and registration of serial data, (3) showing that the pathological intimal thickening is the most active plaque phenotype in terms of plaque composition changes and plaque vulnerability progression, and (4) developing and validating a method for multi-layer 3-D segmentation of IVOCT images within a novel interactive environment.

The relationship of coronary-prone behavior, hostility, and defense style to atherosclerosis was examined. Subjects were 1,271 patients who underwent coronary angiography at Duke University Medical Center between 1974 and 1980. Type A behavior was assessed using both the Structured Interview and Jenkins Activity Survey. The Cook and Medley Hostility scale and Byrne's Repression-Sensitization scale, both subscales of the Minnesota Multiphasic Personality Inventory, were employed to measure hostility and defense style. The results revealed no significant association between the disease end-points CADSEV, history of myocardial infarction, and history of angina pectoris and either the Structured Interview Type A, hostility, or repression-sensitization, Jenkins Activity Survey defined Type B's, however, were found to more frequently complain of angina. It was suggested future research employ longitudinal or process designs to focus on adaptive functioning from a transactional and developmental perspective which may serve to promote coronary resistance.

Doenças coronárias causam a morte de milhões de pessoas anualmente. Uma dessas disfunções é a aterosclerose coronariana, acúmulo de placas lipídicas, fibrosas, e calcificadas na parede das coronárias. Esse acúmulo pode causar tromboses, infarto do miocárdio, ou morte cardíaca súbita. Porém, essas lesões apresentam graus distintos de periculosidade e elasticidade. As predominantemente lipídicas são de alto risco e elasticidade, enquanto as calcificadas e as fibrosas são mais estáveis e menos elásticas. O Ultrassom Intravascular (IVUS) é uma das modalidades de referência em diagnósticos e acompanhamento de doenças coronárias. Contudo, a imagem de IVUS pura fornece apenas informações subjetivas sobre vasos e placas; assim, é importante a criação de métodos e técnicas que possam tornar objetiva a análise dessa informação. Devido a isso, e levando em conta a riqueza de informações espaciais e temporais presentes nas imagens de IVUS, esse trabalho apresenta métodos de segmentação, e extração de características de lesões, que possibilitam a quantização de informações espaciais, e a discriminação de placas de baixo e elevado-risco. Consequentemente, fornecendo subsídios para diagnósticos, e procedimentos terapêuticos mais adequados. O método de segmentação combina Wavelet, Otsu, e Morfologia Matemática, para delineamento da parede do vaso. A avaliação do método foi feita usando 1300 imagens de IVUS, resultando em 92, 72% e 91, 9% de verdadeiros positivos, e 10, 7% e 9, 1% de falsos positivos, para o lúmen e borda da média adventícia, respectivamente. Adicionalmente, foi criado um método simples, para caracterização de placas a partir de suas propriedades mecânicas. Esse procedimento se baseia em computar um índice, chamado taxa de variação da área da placa, em imagens adquiridas pré e pós deformação do vaso e placas. Phantoms foram usados para avaliação, os resultados conseguidos com o índice proposto e um amplamente usado foram comparados. Uma correlação chegando à 99%, uma forte concordância usando Análise de Bland Altman, e Histogramas muito similares entre os dois índices, mostraram que o método proposto equivale ao já estabelecido. / Coronary diseases are the cause of death of millions of people annually. One of these dysfunctions is the coronary atherosclerosis, which is the accumulation of lipidic, fibrous and calcified plaques in the coronary wall. This accumulation may cause thrombosis, myocardial infarction and sudden cardiac death. Nonetheless, the kind of plaques offers different levels of dangerousness and elasticity. The highly lipidic plaques are very elastic, offers high risk, while the calcified and fibrous are more stable and less elastic. The Intravascular Ultrasound (IVUS) is the reference medical imaging modality for diagnostic and treatment of coronary diseases. However, the conventional IVUS images provides only anatomical vessel and plaque information; therefore, it is very important the creation of methods and techniques that could make objective the analysis of this information. Due to that, and taking into account the spatial and time information of IVUS images, this work presents methods of segmentation, and feature extraction of lesions, which make possible the quantization of spatial information, and the discrimination of high, and low risk plaques. Consequently, subsidies for diagnoses and more appropriate therapeutic procedures are provided. The segmentation method combines Wavelet, Otsu, and Mathematical Morphology, for the vessel wall delineation. The method evaluation was performed using 1300 IVUS images, resulting in 92, 72% and 91, 9% of true positives, and 10, 7% and 9, 1% of false positives, for the lumen and media adventitia border, respectively. Additionally, a simple method, for plaque characterization using the regarding mechanical properties was created. The procedure relies on computing an index, ratio of plaque area variation, in acquired images pre and post deformation procedure of vessel wall and plaques. Phantoms were used for evaluation. The results obtained by the proposed index, and a widely used one was compared. A correlation up to 99%, a strong agreement with Bland Altman, and similar Histograms between the two indexes demonstrated the equivalence between them; however, the proposed index is much simpler.

Introdução: O estudo MASS III não mostrou diferença significativa entre a cirurgia de revascularização miocárdica (CRM) com e sem circulação extracorpórea (CEC) em relação ao desfecho composto primário de morte por todas as causas, infarto agudo do miocárdio, acidente vascular cerebral ou revascularização adicional em pacientes com doença coronariana multiarterial. No entanto, a custo-efetividade dessas estratégias permanece desconhecida. Métodos: Pacientes com doença coronariana multiarterial estável e função ventricular esquerda preservada foram randomizados para CRM com CEC (n=153) ou sem CEC (n=155). Os dois grupos eram bem semelhantes quanto às características basais. A análise dos custos foi realizada a partir da perspectiva do sistema público de saúde brasileiro, e as utilities foram avaliadas pelo questionário SF-6D. Um modelo de Markov, com base nos dados de 5 anos de seguimento, foi utilizado para extrapolar os custos e os anos de vida ajustados pela qualidade (QALY) para doença coronariana crônica. Resultados: A qualidade de vida de ambos os grupos melhorou significativamente após a cirurgia durante o seguimento, em comparação com os dados pré-cirurgia, embora os ganhos de vida adquiridos (LYG) e QALYs tenham sido semelhantes entre os grupos durante o seguimento de 5 anos. Os custos para o período total do estudo não diferiram entre os grupos sem e com CEC (R$ 19.180,65 e R$ 19.909,18, respectivamente, p=0,409). Ao longo de um horizonte de tempo ajustado para a expectativa de vida da população do estudo, a razão de custo-efetividade incremental da CRM com versus sem CEC foi R$ 45.274 por QALY ganho, que foi robusto nas simulações de Monte Carlo e nas análises de sensibilidade. Para um limiar de custo-efetividade de R$ 34.212 por QALY ganho, a CRM sem CEC tem 65% de probabilidade de ser custo-efetiva quando comparada com CRM com CEC. Conclusão: Cirurgia de revascularização miocárdica sem CEC é clinicamente tão segura e efetiva quanto a cirurgia com CEC e parece ser uma estratégia economicamente atraente em comparação com a CRM com CEC em pacientes com doença arterial coronariana estável / Background: The MASS III trial revealed that in patients with multivessel coronary disease, no significant difference was observed between on-pump and off-pump coronary artery bypass surgery (CABG) in the primary composite outcome. However, long-term cost-effectiveness of these strategies is unknown. Methods: Patients with stable multivessel coronary artery disease and preserved left ventricular function were randomized to onpump (n=153) or off-pump CABG (n=155). The 2 groups were well matched for baseline characteristics. Costs analysis was conducted from a Brazilian public healthcare system perspective, and health state utilities were assessed using the SF-6D questionnaire. A Markov\'s model based on the 5- year in-trial data was used to extrapolate costs and quality-adjusted life-years (QALY) for chronic coronary disease. Results: Both groups\' quality of life improved significantly after surgery during follow-up compared with baseline, and life-years gained (LYG) and QALY gains were similar between on-pump and off-pump CABG over the 5-year time frame of the trial. The costs for the overall period of the trial - the mean cost in U.S. dollars per patient - did not differ significantly between the off-pump group and the on-pump group ($5674.75 and $5890.29 respectively, p=0.409). Over a lifetime horizon, the incremental cost-effectiveness ratio of on-pump vs. off-pump CABG was $12,576 per QALY gained, which was robust in Monte Carlo replications and in sensitivity analyses. Using a cost-effectiveness threshold of $10,122 per QALY gained, off-pump has 65% probability of being cost-effective versus on-pump CABG. Conclusions: Off-pump CABG was clinically as safe and effective as on-pump CABG and appears to be an economically attractive strategy compared with on-pump CABG among patients with stable coronary artery disease

Doenças coronárias causam a morte de milhões de pessoas anualmente. Uma dessas disfunções é a aterosclerose coronariana, acúmulo de placas lipídicas, fibrosas, e calcificadas na parede das coronárias. Esse acúmulo pode causar tromboses, infarto do miocárdio, ou morte cardíaca súbita. Porém, essas lesões apresentam graus distintos de periculosidade e elasticidade. As predominantemente lipídicas são de alto risco e elasticidade, enquanto as calcificadas e as fibrosas são mais estáveis e menos elásticas. O Ultrassom Intravascular (IVUS) é uma das modalidades de referência em diagnósticos e acompanhamento de doenças coronárias. Contudo, a imagem de IVUS pura fornece apenas informações subjetivas sobre vasos e placas; assim, é importante a criação de métodos e técnicas que possam tornar objetiva a análise dessa informação. Devido a isso, e levando em conta a riqueza de informações espaciais e temporais presentes nas imagens de IVUS, esse trabalho apresenta métodos de segmentação, e extração de características de lesões, que possibilitam a quantização de informações espaciais, e a discriminação de placas de baixo e elevado-risco. Consequentemente, fornecendo subsídios para diagnósticos, e procedimentos terapêuticos mais adequados. O método de segmentação combina Wavelet, Otsu, e Morfologia Matemática, para delineamento da parede do vaso. A avaliação do método foi feita usando 1300 imagens de IVUS, resultando em 92, 72% e 91, 9% de verdadeiros positivos, e 10, 7% e 9, 1% de falsos positivos, para o lúmen e borda da média adventícia, respectivamente. Adicionalmente, foi criado um método simples, para caracterização de placas a partir de suas propriedades mecânicas. Esse procedimento se baseia em computar um índice, chamado taxa de variação da área da placa, em imagens adquiridas pré e pós deformação do vaso e placas. Phantoms foram usados para avaliação, os resultados conseguidos com o índice proposto e um amplamente usado foram comparados. Uma correlação chegando à 99%, uma forte concordância usando Análise de Bland Altman, e Histogramas muito similares entre os dois índices, mostraram que o método proposto equivale ao já estabelecido. / Coronary diseases are the cause of death of millions of people annually. One of these dysfunctions is the coronary atherosclerosis, which is the accumulation of lipidic, fibrous and calcified plaques in the coronary wall. This accumulation may cause thrombosis, myocardial infarction and sudden cardiac death. Nonetheless, the kind of plaques offers different levels of dangerousness and elasticity. The highly lipidic plaques are very elastic, offers high risk, while the calcified and fibrous are more stable and less elastic. The Intravascular Ultrasound (IVUS) is the reference medical imaging modality for diagnostic and treatment of coronary diseases. However, the conventional IVUS images provides only anatomical vessel and plaque information; therefore, it is very important the creation of methods and techniques that could make objective the analysis of this information. Due to that, and taking into account the spatial and time information of IVUS images, this work presents methods of segmentation, and feature extraction of lesions, which make possible the quantization of spatial information, and the discrimination of high, and low risk plaques. Consequently, subsidies for diagnoses and more appropriate therapeutic procedures are provided. The segmentation method combines Wavelet, Otsu, and Mathematical Morphology, for the vessel wall delineation. The method evaluation was performed using 1300 IVUS images, resulting in 92, 72% and 91, 9% of true positives, and 10, 7% and 9, 1% of false positives, for the lumen and media adventitia border, respectively. Additionally, a simple method, for plaque characterization using the regarding mechanical properties was created. The procedure relies on computing an index, ratio of plaque area variation, in acquired images pre and post deformation procedure of vessel wall and plaques. Phantoms were used for evaluation. The results obtained by the proposed index, and a widely used one was compared. A correlation up to 99%, a strong agreement with Bland Altman, and similar Histograms between the two indexes demonstrated the equivalence between them; however, the proposed index is much simpler.

Apesar de um aumento progressivo do investimento em saúde, a demanda crescente de recursos vem criando um déficit significativo e progressivamente maior, mesmo nos países desenvolvidos. A elevação dos custos em saúde representa, portanto, um desafio para as fontes pagadoras governamentais e privadas. A doença aterosclerótica coronariana (DAC), resultado da obstrução das artérias coronarianas, é uma das principais causas de incapacidade e morte no mundo atual. Uma projeção para 2020 coloca estas patologias como responsáveis por 25 milhões de mortes ao ano. Além do tratamento medicamentoso, uma parte dos pacientes com esta doença vai se beneficiar de algum tipo de intervenção mecânica. A angioplastia coronariana transluminal percutânea (ACTP) é uma tecnologia empregada para restaurar o fluxo nas artérias coronarianas obstruídas, dilatando regiões de estreitamento destes vasos. Esta tecnologia foi utilizada inicialmente como alternativa para os pacientes que deveriam ser submetidos à revascularização miocárdica cirúrgica. Nas últimas três décadas, com o avanço tecnológico, a ACTP se difundiu rapidamente, com uma ampliação da população candidata a esta tecnologia, promovendo mudanças no tratamento da doença aterosclerótica coronariana. O objetivo deste trabalho é, através de uma revisão narrativa, descrever e discutir alguns aspectos associados a difusão da ACTP como terapêutica para o tratamento da DAC. Foi realizada uma busca de evidencias cientificas, de língua inglesa, na Biblioteca Nacional de Medicina dos Estados Unidos (United States National Library of Medicine U.S.NLM and National Center of Biotechnology Information NCBI / MEDLINE), entre 1960 e 2010, com os descritores: Angioplasty, Transluminal, Percutaneous Coronary, stents e diffusion e também nos relatórios de Agências de Avaliação de Tecnologia em Saúde de outros países sobre a introdução e difusão da ACTP. Posteriormente foi realizada uma revisão manual dos resumos de cada artigo, priorizando os artigos obtidos dentro do acervo de Periódicos CAPES. Espera-se que a melhor compreensão da difusão desta tecnologia possa ajudar numa melhor alocação de recursos e na formulação de políticas de saúde. / Despite a gradual increase in health investment, even in developed countries, the growing demand for resources has created a significant and gradually increased deficit. The rise in health costs therefore represents a challenge for government and private payers. Even with the increased longevity of the population, most of this spending appears to be the result of the development and diffusion of new medical technologies applied at all stages of health care (diagnosis, prognosis, therapy and prevention). Atherosclerotic coronary artery disease (CAD), resulting from obstruction of the coronary arteries is a major cause of disability and death in the world today. A projection for 2020 puts these pathologies as responsible for 25 million deaths a year. Besides drug treatment, some patients with this disease will benefit from some type of mechanical intervention. Percutaneous transluminal coronary angioplasty (PTCA) is a technology used to restore flow in clogged coronary arteries, dilating regions of narrowing of these vessels. This technology was initially used as an alternative for patients who should undergo coronary artery bypass graft (CABG) surgery. In the last three decades, with technological advances, PTCA spread rapidly, with an expansion of candidate population for this technology, promoting changes in the treatment of coronary atherosclerosis. The objective of this work is to review and discuss the evidence related to the diffusion of PTCA, trying to identify factors as potential determinants of diffusion and its consequences. We performed a literature search of evidence on the introduction and diffusion of PTCA also considering review articles, editorials and discussion on the subject. A manual review of abstracts of each article was done later, prioritizing items obtained inside of CAPES journals site. It is hoped that better understanding of this technology diffusion may help in better resource allocation and formulation of health policies.