Objectives. We sought to evaluate the safety and efficacy of Drug eluting stents (DES) in patients with significant CKD in a real world registry Background. Patients with chronic kidney disease (CKD) who undergo percutaneous coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. DES are associated with a lower rate of restenosis compared to bare metal stents (BMS), although in patients with CKD data on DES efficacy and safety is limited. Methods. A total of 504 patients who underwent percutaneous coronary intervention with DES in two centers were included in this study. Outcomes were stratified on the basis of the presence of CKD, defined as a baseline glomerular filtration rate <60ml/min/1.73m². Results. The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7%). Patients with CKD were older, had more hypertension and diabetes. CKD patients presented increased incidence of death (12.3% vs. 2.4%, p<0.001) and myocardial infarction (MI) (7.4% vs. 3.3%, p=0.04) compared to patients without CKD. TLR rates were similar between groups (4.8% vs. 5.6%, p=0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 – 19.5, p<0.001), current smoking (HR 3.66; 1.20 – 11.10, p=0.02) and diabetes (HR 2.66; 1.03 – 6.60, p=0.045). Conclusion. In this real-world registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.

Objectives. We sought to evaluate the safety and efficacy of Drug eluting stents (DES) in patients with significant CKD in a real world registry Background. Patients with chronic kidney disease (CKD) who undergo percutaneous coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. DES are associated with a lower rate of restenosis compared to bare metal stents (BMS), although in patients with CKD data on DES efficacy and safety is limited. Methods. A total of 504 patients who underwent percutaneous coronary intervention with DES in two centers were included in this study. Outcomes were stratified on the basis of the presence of CKD, defined as a baseline glomerular filtration rate <60ml/min/1.73m². Results. The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7%). Patients with CKD were older, had more hypertension and diabetes. CKD patients presented increased incidence of death (12.3% vs. 2.4%, p<0.001) and myocardial infarction (MI) (7.4% vs. 3.3%, p=0.04) compared to patients without CKD. TLR rates were similar between groups (4.8% vs. 5.6%, p=0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 – 19.5, p<0.001), current smoking (HR 3.66; 1.20 – 11.10, p=0.02) and diabetes (HR 2.66; 1.03 – 6.60, p=0.045). Conclusion. In this real-world registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.

Objectives. We sought to evaluate the safety and efficacy of Drug eluting stents (DES) in patients with significant CKD in a real world registry Background. Patients with chronic kidney disease (CKD) who undergo percutaneous coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. DES are associated with a lower rate of restenosis compared to bare metal stents (BMS), although in patients with CKD data on DES efficacy and safety is limited. Methods. A total of 504 patients who underwent percutaneous coronary intervention with DES in two centers were included in this study. Outcomes were stratified on the basis of the presence of CKD, defined as a baseline glomerular filtration rate <60ml/min/1.73m². Results. The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7%). Patients with CKD were older, had more hypertension and diabetes. CKD patients presented increased incidence of death (12.3% vs. 2.4%, p<0.001) and myocardial infarction (MI) (7.4% vs. 3.3%, p=0.04) compared to patients without CKD. TLR rates were similar between groups (4.8% vs. 5.6%, p=0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 – 19.5, p<0.001), current smoking (HR 3.66; 1.20 – 11.10, p=0.02) and diabetes (HR 2.66; 1.03 – 6.60, p=0.045). Conclusion. In this real-world registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.

Atualmente, as doenças cardiovasculares são apontadas como as principais causas de mortes no Brasil e no mundo. Essas doenças são causadas pelo comprometimento das artérias, principalmente as artérias coronárias. Essas artérias possuem a importante função de transportar nutrientes ao próprio coração, possibilitando que o mesmo exerça sua tarefa de suprir todo o resto do corpo com elementos essenciais à sobrevivência do indivíduo. Este trabalho é sobre um estudo do comportamento dessas artérias quando ocorre a difusão de um fluido através de suas paredes. Primeiramente, estudou-se a composição das artérias coronárias, suas funções e patologias, para extrair elementos para compor um modelo fisicamente realístico e analiticamente tratável. Devido à sua composição histológica em três túnicas, a artéria coronária foi modelada como um cilindro elástico composto de cilindros ocos e concêntricos. Investigou-se então a solução do problema da difusão de um fluido em duas e três camadas, sendo esta última configuração geométrica mais próxima da realidade. Por fim, estudou-se a difusão de um fármaco contido em um stent farmacológico, cuja função é desobstruir uma artéria aterosclerosada e evitar sua reestenose. / Currently, cardiovascular diseases are known to be the primary cause of death in Brasil and worldwide. These diseases are caused by the malfunction of the arteries, especially the coronary arteries. These arteries have the important role of transporting nutrients to the heart itself, allowing it to exert its main task of providing the rest of the body with essential elements to the survival of an individual. This work is about a study of the diffusion of a fluid through the walls of a coronary artery. First, the composition of the coronary arteries, their functions, and pathologies were studied to extract elements that could be used to construct a model that is both physically realistic and analytically amenable to analysis. Due to its histologic composition in three layers, a coronary artery was modeled as an elastic cylinder composed of hollow and concentric cylinders. The solution of the diffusion problem of a fluid in two and three layers was studied, being this last geometrical configuration the closest to reality. Finally, the diffusion of a drug contained in a pharmacological stent was investigated. The main task of this type of stent is to clear an atherosclerotic artery and to avoid its restenosis.

Atualmente, as doenças cardiovasculares são apontadas como as principais causas de mortes no Brasil e no mundo. Essas doenças são causadas pelo comprometimento das artérias, principalmente as artérias coronárias. Essas artérias possuem a importante função de transportar nutrientes ao próprio coração, possibilitando que o mesmo exerça sua tarefa de suprir todo o resto do corpo com elementos essenciais à sobrevivência do indivíduo. Este trabalho é sobre um estudo do comportamento dessas artérias quando ocorre a difusão de um fluido através de suas paredes. Primeiramente, estudou-se a composição das artérias coronárias, suas funções e patologias, para extrair elementos para compor um modelo fisicamente realístico e analiticamente tratável. Devido à sua composição histológica em três túnicas, a artéria coronária foi modelada como um cilindro elástico composto de cilindros ocos e concêntricos. Investigou-se então a solução do problema da difusão de um fluido em duas e três camadas, sendo esta última configuração geométrica mais próxima da realidade. Por fim, estudou-se a difusão de um fármaco contido em um stent farmacológico, cuja função é desobstruir uma artéria aterosclerosada e evitar sua reestenose. / Currently, cardiovascular diseases are known to be the primary cause of death in Brasil and worldwide. These diseases are caused by the malfunction of the arteries, especially the coronary arteries. These arteries have the important role of transporting nutrients to the heart itself, allowing it to exert its main task of providing the rest of the body with essential elements to the survival of an individual. This work is about a study of the diffusion of a fluid through the walls of a coronary artery. First, the composition of the coronary arteries, their functions, and pathologies were studied to extract elements that could be used to construct a model that is both physically realistic and analytically amenable to analysis. Due to its histologic composition in three layers, a coronary artery was modeled as an elastic cylinder composed of hollow and concentric cylinders. The solution of the diffusion problem of a fluid in two and three layers was studied, being this last geometrical configuration the closest to reality. Finally, the diffusion of a drug contained in a pharmacological stent was investigated. The main task of this type of stent is to clear an atherosclerotic artery and to avoid its restenosis.

A doença cardiovascular é a principal causa de mortalidade no planeta. Marcantes avanços no seu tratamento foram alcançados nas últimas décadas. O uso de stents farmacológicos (SFs), o mais recente destes avanços, tem sido amplamente testado em diversos cenários clínicos. Quando analisamos a história da cardiologia intervencionista, desde os resultados iniciais de Andreas Gruntzig, até as evidências atuais com plataformas bioabsorvíveis, concluímos que o principal avanço do uso dos stents farmacológicos foi reduzir de forma inequívoca os principais limitantes de suas tecnologias antecedentes (angioplastia por cateter-balão e stents convencionais), a reestenose e trombose intra-stent. Seu progresso não limitou-se às drogas anti-reestenóticas e seus polímeros carreadores. Também houve evolução na confecção de plataformas mais maleáveis e com melhor navegabilidade. Após o impacto inicial da primeira geração de stents farmacológicos, hoje encontramo-nos na transição entre a segunda e a terceira geração destes dispositivos, ainda com resultados iniciais, cuja principal mudança é a confecção de plataformas bioabsorvíveis. Estas evoluções tecnológicas ampliaram o uso dos SFs para cenários clínicos outrora restritos, como pacientes multiarteriais, diabéticos e renais crônicos. Os resultados obtidos demonstram eficácia e segurança neste grupo de pacientes de alto risco. Desta forma, o uso dos stents farmacológicos tornou-se uma realidade no tratamento da doença aterosclerótica cardiovascular. O uso em cenários e pacientes de alta complexidade revolucionou a cardiologia intervencionista, demonstrando a eficácia e segurança destes stents ao longo do tempo. / Cardiovascular disease is the leading cause of mortality on the planet. Remarkable advances in treatment of coronary heart disease have been achieved in recent decades. The use of drug-eluting stents (DES), one of the most important advances, has been widely tested in several clinical scenarios. When we analyze the history of interventional cardiology, from the initial results of Andreas Gruntzig, until the current evidence with bioabsorbable platforms, we concluded that the main advancement of the use of drug-eluting stents was reduce unequivocally the most important limiting factors of their previous technology (angioplasty balloon and conventional stents), restenosis and intra-stent thrombosis. This progress is not limited to antirestenotic drugs or polymeric carriers. There were also developments of platforms more malleable and with better navigability. After the initial impact of the first generation of stents, today we are in transition between the second and third generation of these devices, whose main change is the bioabsorbable platforms. These technological developments have expanded the use of DES for clinical scenarios once restricted, such as patients with multivessel disease, diabetes and chronic renal disease. The obtained results demonstrate safety and efficacy in this group of high-risk patients. Thus, the use of drug-eluting stents has become a reality in the treatment of atherosclerotic cardiovascular disease. The use in scenarios and patients of high complexity revolutionized the interventional cardiology, demonstrating the efficacy and safety of these stents over time.

Resumo não disponível

Resumo não disponível

A doença cardiovascular é a principal causa de mortalidade no planeta. Marcantes avanços no seu tratamento foram alcançados nas últimas décadas. O uso de stents farmacológicos (SFs), o mais recente destes avanços, tem sido amplamente testado em diversos cenários clínicos. Quando analisamos a história da cardiologia intervencionista, desde os resultados iniciais de Andreas Gruntzig, até as evidências atuais com plataformas bioabsorvíveis, concluímos que o principal avanço do uso dos stents farmacológicos foi reduzir de forma inequívoca os principais limitantes de suas tecnologias antecedentes (angioplastia por cateter-balão e stents convencionais), a reestenose e trombose intra-stent. Seu progresso não limitou-se às drogas anti-reestenóticas e seus polímeros carreadores. Também houve evolução na confecção de plataformas mais maleáveis e com melhor navegabilidade. Após o impacto inicial da primeira geração de stents farmacológicos, hoje encontramo-nos na transição entre a segunda e a terceira geração destes dispositivos, ainda com resultados iniciais, cuja principal mudança é a confecção de plataformas bioabsorvíveis. Estas evoluções tecnológicas ampliaram o uso dos SFs para cenários clínicos outrora restritos, como pacientes multiarteriais, diabéticos e renais crônicos. Os resultados obtidos demonstram eficácia e segurança neste grupo de pacientes de alto risco. Desta forma, o uso dos stents farmacológicos tornou-se uma realidade no tratamento da doença aterosclerótica cardiovascular. O uso em cenários e pacientes de alta complexidade revolucionou a cardiologia intervencionista, demonstrando a eficácia e segurança destes stents ao longo do tempo. / Cardiovascular disease is the leading cause of mortality on the planet. Remarkable advances in treatment of coronary heart disease have been achieved in recent decades. The use of drug-eluting stents (DES), one of the most important advances, has been widely tested in several clinical scenarios. When we analyze the history of interventional cardiology, from the initial results of Andreas Gruntzig, until the current evidence with bioabsorbable platforms, we concluded that the main advancement of the use of drug-eluting stents was reduce unequivocally the most important limiting factors of their previous technology (angioplasty balloon and conventional stents), restenosis and intra-stent thrombosis. This progress is not limited to antirestenotic drugs or polymeric carriers. There were also developments of platforms more malleable and with better navigability. After the initial impact of the first generation of stents, today we are in transition between the second and third generation of these devices, whose main change is the bioabsorbable platforms. These technological developments have expanded the use of DES for clinical scenarios once restricted, such as patients with multivessel disease, diabetes and chronic renal disease. The obtained results demonstrate safety and efficacy in this group of high-risk patients. Thus, the use of drug-eluting stents has become a reality in the treatment of atherosclerotic cardiovascular disease. The use in scenarios and patients of high complexity revolutionized the interventional cardiology, demonstrating the efficacy and safety of these stents over time.

Resumo não disponível