Background Percutaneous transluminal coronary angioplasty (PTCA) outcomes were compiled in the 1996 V CONAREC Registry, and in 2005, data collection was repeated using a similar methodology, giving rise to the XIV CONAREC Registry. As no general national PTCA results have been reported since, the Argentine Society of Cardiology, together with CACI, FAC and CONAREC carried out the Coronary Angioplasty Argentine Registry (RAdAC). Objective The aim of this Registry was to evaluate intrahospital outcome and morbi-mortality of patients submitted to PTCA according to different clinical scenarios. Methods One thousand nine hundred and five patients were prospectively and consecutively included in 67 centers of Argentina during a 7-month period. Cardiovascular risk factors and clinical history were analyzed. PTCA procedures were classified as: planned, urgent or emergent and the number of affected and intended-to-treat vessels, as well as the number and type of stents implanted bare metal (BMS) or drug-eluting stents (DES); were estimated. Use of atherectomy, Cutting Balloon?, thrombus aspiration, intravascular ultrasound (IVUS), antiplatelet drugs and intra-aortic balloon pump (IABP) was analyzed. Angiographic success was defined as residual lesion <20% and normal flow (TIMI 3). Results Mean age was 63.8 years. A total of 752 patients (39.5%) presented with acute myocardial infarction (AMI) and 834 patients (43.8%) with unstable angina (UA). Femoral access was used in 92.8% of the cases. Overall, 44.3% of the interventions were planned, 37.8% were urgent and 17.9% emergent. A total of 2753 stents were implanted (1.4 per patient), 33.2% of which were DES. The primary success rate was 97% and overall mortality 1.6%: 3.2% associated to AMI, (4.3% STEMI and 1.7% non-STEMI), 0.8% to UA and 0.3% to chronic stable angina. Death-associated variables were: cardiogenic shock, need of IAPB, Killip-Kimball class 3-4, emergency PTCA, left main PTCA, ventricular function impairment, renal failure or diabetes, number of affected vessels, age and PTCA failure. Conclusions In our setting, most PTCAs are performed in acute coronary syndromes, almost exclusively by femoral access, with primary success comparable to that of international reports, but employing less DES. Use of Rotablator, Cutting Balloon?, thrombus aspiration, IVUS and IABP implementation was lower than expected, while age, cardiogenic shock, emergency and PTCA failure were factors associated with increased morbi-mortality.

Introducción En el Registro CONAREC V, de 1996, se recopilaron los resultados obtenidos con angioplastia transluminal coronaria (ATC) y posteriormente, durante 2005, se recabaron datos con similar metodología generándose el Registro CONAREC XIV. Desde entonces no se cuenta con datos nacionales generales en relación con la revascularización coronaria percutánea, por lo que la Sociedad Argentina de Cardiología, en conjunto con el CACI, la FAC y el CONAREC, implementó el Registro Argentino de Angioplastia Coronaria (RAdAC). Objetivo Evaluar a escala nacional los resultados intrahospitalarios y la morbimortalidad de pacientes sometidos a ATC según los distintos escenarios clínicos. Material y métodos En un período de 7 meses se incluyeron 1.905 pacientes en forma prospectiva y consecutiva en 67 centros de la Argentina. Se analizaron factores de riesgo, antecedentes cardiovasculares y cuadro clínico. La ATC se consideró programada, de urgencia y de emergencia, y se estimó el número de vasos enfermos y la intención de vasos a tratar y la cantidad y tipo de stents convencionales (SC) y liberadores de droga (SLD);. Se analizó el empleo de aterectomía, Cutting Balloon®, tromboaspiración, ultrasonido intravascular (IVUS), antiagregantes y balón de contrapulsación intraaórtico (BCIA). El éxito angiográfico se definió como lesión residual < 20% y flujo normal (TIMI 3). Resultados La edad promedio fue de 63,8 años. Un total de 752 pacientes (39,5%) presentaban infarto agudo de miocardio (IAM) y 834 pacientes (43,8%) angina inestable (AI). Se utilizó acceso femoral en el 92,8% de los casos. El 44,3% de las intervenciones fueron programadas, el 37,8%, de urgencia y el 17,9%, de emergencia. Se implantaron 2.753 stents (1,4 por paciente) con 33,2% de SLD. El éxito primario fue del 97% y la mortalidad global observada, del 1,6%; la asociada con infarto ascendió al 3,2% (con ST 4,3%, sin ST 1,7%), la de AI fue del 0,8% y la de angina crónica estable, del 0,3%. Las variables asociadas con el óbito fueron shock cardiogénico, necesidad de BCIA, Killip y Kimball 3-4, ATC de emergencia, ATC del tronco, mala función ventricular, insuficiencia renal o diabetes, mayor número de vasos enfermos, mayor edad y fracaso de la ATC. Conclusiones En nuestro medio, la mayoría de las ATC se realizan en síndromes coronarios agudos y casi exclusivamente por vía femoral, con éxito primario comparable a datos internacionales pero con menor utilización de SLD. El empleo de Rotablator®, Cutting Balloon®, tromboaspiración, IVUS y BCIA fue más bajo que el esperado, mientras que la edad, el shock cardiogénico, la emergencia y la ATC fallida resultaron factores asociados con mayor morbimortalidad.

The goal of the study is to describe our experience in percutaneous transluminal coronary angioplasty with cutting balloon, evaluating the immediate and mid-term outcomes. The cutting balloon is a device used as a strategy to promote plaque rupture and to allow for its distribution. Methods: This is a descriptive study to evaluate the clinical and angiographic restenosis rate (Binary restenosis). Patients with incomplete clinical data were excluded. From January 2003 to June 2004, 1,300 PTCA with stent were made; we selected a group of 39 patients in whom the cutting balloon was used (3.3%). Average age was 60.4 ± 9.2 years. There were 32 men (80%) and 8 women (20%). Diabetes Mellitus in 10 (25%), dyslipidemia in 18 (45%), systemic hypertension in 22 (55%), smoking in 22 (55%). The indication for coronary angiography was stable angina in 21 (52.5%), unstable angina in 15 (37.5%), acute myocardial infarction without ST segment elevation in 3 (7.5%). Results: We treated 45 lesions: 4 (8.8%) main left, 24 (53.3%) anterior descending, 7 (15.5%) circumflex obtuse, 2 (4.4%) marginal, 8 (17.7%) right coronary. The average lesion severity before treatment was 88.8% ±11. Lesions encountered corresponded to type B1 in 1 (2.2%), B2 in 22 (48.8%), and C in 22 (48.8%). The average lesion length was 19 mm ± 5.8 mm. The average vessel diameter was 3.6 mm ± 0.46 mm. We achieved a clinical follow-up of 100%. We performed angiographic control in 32 patients (71.1%) to evaluate instent restenosis, with an average follow-up of 7.6 ± 3 months. Clinical and angiographic restenosis corresponded to 25 and 31.25% respectively. Complications: Two (6.2%) patients presented complications; one died because of coronary perforation of the right coronary artery with pericardial effusion and tamponade. Conclusions: The cutting balloon is a useful device for the management of complex lesions (B2 and C) but the restenosis rate with this device is similar to the one obtained with PTCA and stenting. So we do not recommend it for rutine use.

Objetivo: Describir nuestra experiencia, resultados clínicos y angiográficos inmediatos en pacientes con ACTP con balón de corte (BC). Éste es un dispositivo que se utiliza como estrategia para incidir la placa facilitando su distribución, se ha sugerido que disminuye la tasa de reestenosis. Material y métodos: Tipo de estudio; retrospectivo, observacional, transversal y descriptivo con seguimiento clínico y angiográfico a 6 meses para valorar la reestenosis clínica y angiográfica (Reestenosis binaria). De enero de 2003 a junio de 2004 se realizaron 1,300 ACTP con colocación de stents, se seleccionó a un grupo de 39 pacientes con BC donde el operador consideró conveniente una dilatación controlada y representan el 3.3% del total del grupo, edad promedio de 60.4 ± 9.2 años, sexo masculino 32 (80%), diabetes mellitus 10 (25%), hipercolesterolemia 18 (45%), hipertensión arterial sistémica 22 (55%), tabaquismo 22 (55%). Motivo de la angiografía coronaria: angor estable 21 (52.5%), angina inestable 15 (37.5%), infarto del miocardio sin elevación del ST 3 (7.5%). Resultados: Se trataron 45 lesiones: Tronco coronario izquierdo 4 (8.8%), descendente anterior 24 (53.3%), circunfleja 7 (15.5%), marginal obtusa 2 (4.4%), coronaria derecha 8 (17.7%). La lesión previa a la dilatación fue: promedio 88.8% ±11. Tipo de lesiones tratadas: B1 1 (2.2%), B2 22 (48.8%) y C 22 (48.8%). Longitud promedio de la lesión de 19 mm ± 5.8 mm. Diámetro de vaso promedio de 3.6 mm ± 0.46 mm. Durante el seguimiento clínico del 100% en 32 (71.1%) se cateterizaron para valorar la reestenosis angiográfica con un seguimiento promedio de 7.6 ± 3 meses, la reestenosis clínica fue del 25% y angiográfica 31.25%. Complicaciones: Se presentaron en 2 (6.2%), una fue defunción por perforación de la arteria CD con hemopericárdio y tamponade. Conclusiones: El BC es un dispositivo útil para el manejo de lesiones complejas tipo "B2 y C", la reestenosis es similar a la encontrada con ACTP convencional por lo que no recomendamos su uso de manera rutinaria

We describe here two patients with angiographic diagnosis of intrastent restenosis and regional myocardial ischemia. One stent restenosis was located in a native coronary artery and the other in a vein graft. Both were treated with cutting balloon angioplasty (CBA), inflated at low pressures. Angiographic success was obtained and both patients were discharged in the day after the procedure. Cutting balloon angioplasty using low inflation pressures achieved important luminal gains, in these two cases of intrastent restenosis. Further studies are necessary before the effectiveness of this procedure can be precisely defined.