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Percutaneous Coronary Intervention
without On-Site Surgical Backup

Cano, Manuel Nicolás; Fortunato de Cano, Silvia Judith;
Morais Jeffer, Luis; Rodrigues Leon, Pablo Antonio;
Minosso, Tania; Navarro Hirschfeld, Roberto;
Chaccur, Paulo

Neomater Hospital, São Bernardo do Campo, São Paulo, Brasil

RESUMEN

SUMMARY
Introduction: Emergency Primary Percutaneous Coronary Intervention (PCI) is safe and effective at hospitals without cardiac Surgery as has been recently demonstrated by Dr.Aversano´s randomized C-PORT trial, it is logical to postulate that such hospital could also perform non-emergency PCI in stable patients (p).
Objective: All PCI in General Hospital from August 1995 to May 2001 without on-site surgical stand-by.
Methods: 454 Coronary interventions were performed in consecutive 445p. The indications were 47% unstable angina, 31% stable angina, 13,4% myocardial infarction 6,6% positive ischemic tests, there were 285 men; average age 58,7 years, arterial size of 2.7 cm in media. 208 left anterior descending coronary artery, 113 right coronary, 97 circunflex, 19 diagonals, 7marginals, 12grafts, 5 left main and in 9 p 2 arteries were treated. Early en the 95s there was ATC predominance but from 1998 stent implantation prevails to an amount of 381.
The surgeons were communicated before hand ,but there was not an in-house surgical standby, and the emergency surgery was performed, if necessary, 2 to 4h later.
Results: There were 98.2 % immediate success, 8 unsuccessful, 5 p underwent emergency surgery; with one death in 24h. The other 4 patients remain in clinical treatment.
Hospital mortality rate was 1p (0,22) and in late follow up of sixty eight months, 10 p died (2.25) 6 of which cardiac (1.34%). We observed a survival rate of 97.4 in the first 3 years and 95% in 5 years with 91% asinthomatic, 4.7% symptomatic in 3 patients a definitive pacemaker was implanted and 17p underwent CABG.
Conclusion: The authors conclude that with the use of stent it is possible, in selected patients, to submit them to coronary intervention without on-site surgical back up, and achieve a low rate of complications and similar results to those found in hospitals with on-site Surgery.

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INTRODUCTION
   Emergency Primary Percutaneous Coronary Intervention (PCI) is safe and effective at hospitals without cardiac Surgery as has been recently demonstrated by Dr. Aversano´s randomized C-PORT trial, it is logical to postulate that such hospital could also perform non-emergency PCI in stable patients (p)

OBJECTIVES
   All Percutaneus Coronary Interventions in General Hospital from August 1995 to May 2001 without on-site surgical stand-by.

MATHERIAL AND METHOD
   454 Coronary interventions were performed in consecutive 445p. Average age 58,7 years (Figure 1)

   Indications: (Figure 2)

   Treated arteries: (Figure 3)

   The surgeons were communicated before hand, but there was not an in-house surgical standby, and the emergency surgery was performed, if necessary, 2 to 4h later. (Figure 4)

RESULTS
Coronary Procedures (Figure 5)
FOLLOW - UP 436(98%) patients were followed through telephone calls to their home, their relatives or physician during 69 months, we found the following results:
Asintomatic 396p        Sintomatic 21p         Revascularized 19p
Mortality:
(Figure 6)
Non Cardiac death - 5 patients (Figure 7)
Cardiac Deaths - 6 patients (Figure 8)

CONCLUSION
   The authors conclude that with the use of stent it is possible, in selected patients, to submit them to coronary intervention without on-site surgical back up, and achieve a low rate of complications and similar results to those found in hospitals with on-site Surgery.

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Intervención Coronária sin Retaguardia Quirúrgica

RESUMEN
Objetivos: Evaluación de Intervenciones Coronarias (ATC/Stent) en pacientes (p) sin retaguardia quirúrgica, en Hospital General, desde Agosto de 1995 hasta mayo de 2001.
Métodos: Fueron analizados 454 intervenciones coronarias en 445p consecutivos. Las indicaciones fueron 47% angina estable (grado 2 e 3), 31% angina inestable, 13,4% de infarto agudo e 6,6% de pacientes oligosintomáticos, siendo 285 hombres; con edad media de 58,7 años, y tamaño medio de arteria de 2.7cm. Fueron tratadas 208 arterias descendente anterior, 113 coronarias derecha, 97 arterias circunflexa, 19 ramos diagonal, 7 ramos marginal, 12 puentes, 5 troncos de coronaria izquierda y en 9 pacientes se trataron 2 arterias. Inicialmente hubo predominio de ATC y fueron implantados 381 stents.
En el hospital se realiza cirugía cardíaca y los cirujanos eran comunicados del procedimiento con anticipación y, si necesario, la cirugía de emergencia era realizada en 2 a 4 horas desde su indicación.
Resultados: Hubo 98,2% de sucesos inmediatos, 8 insucesos, de los cuales 5 pacientes fueron para cirugía de emergencia; con 1 óbito en 24 horas. Los otros 3 p permanecieron en tratamiento clínico.
La mortalidad registrada fue de 1p (0,22%) hospitalar, y en el seguimiento tardío de sesenta y ocho meses, fueron relatados 10 óbitos (2.25%), siendo 6 cardíacos (1,34%).
Fueron seguidos 98% de los p hasta el presente momento, a través de contacto con el paciente, familiares y el médico asistente. Siendo observada una sobrevida de 97,4% durante 5 años, encontrandose 91% asintomáticos, 4,7% con síntomas discretos, en 3 pacientes fue implantado marcapaso definitivo, y 3,56% de los pacientes fueron sometidos a Cirugía de Revascularización.
Conclusión: Los autores concluyen que con el uso del stent es posible, en p seleccionados, realizar intervenciones coronarias, sin retaguardia quirúrgica y con bajas complicaciones y resultados semejantes a los encontrados en Hospitales con retaguardia quirúrgica.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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