Papers by Adriano Caixeta
Canadian Journal of Cardiology, 2015
Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes aft... more Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm(3) were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009). The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.
Circulation. Cardiovascular interventions, 2015
Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cob... more Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-ad...
We assessed the impact of early infarct-related artery (IRA) recanalisation on the outcomes of pa... more We assessed the impact of early infarct-related artery (IRA) recanalisation on the outcomes of patients in the recently conducted, large-scale, multicentre HORIZONS-AMI trial.
Circulation. Cardiovascular interventions, 2011
In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX)... more In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, the SYNTAX score was useful in risk stratifying patients with complex coronary artery disease. The reproducibility of this score may affect its clinical utility. We therefore assessed SYNTAX score interobserver and intraobserver variability among a group of interventional cardiologists (ICs) and an experienced group of angiographic core laboratory (ACL) technicians. After basic training from the SYNTAX score website, 3 ICs and 4 ACL technicians, each working independently, assessed the SYNTAX score of 30 multivessel disease angiograms. The ICs then underwent an intensive training session with ACL technicians, after which the SYNTAX score from 50 additional angiograms were assessed independently by both groups. Interobserver Fleiss Îş statistic values were determined. A third assessment was performed using quantitative coronary angiography (QCA). The ACL technician interobserver st...
Clinics (SĂŁo Paulo, Brazil), 2013
To identify predictors of in-hospital mortality in patients with acute myocardial infarction unde... more To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment. This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764 RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09;...
Catheterization and Cardiovascular Diagnosis, 1995
A newborn with transposition of the great arteries presented with rupture of the ductus arteriosu... more A newborn with transposition of the great arteries presented with rupture of the ductus arteriosus after balloon catheter atrioseptostomy. The necropsy study demonstrated persistent ductus patency, and a 0.5-cm-long horizontal fissure could be observed. On microscopy, there was laceration of the intimal layer, with wall dissection and focal hemorrhage extending to the adventitia. Ductus rupture was attributed to the wall weakess, as a consequence of prostaglandin E l administration.
Current Cardiology Reports, 2009
Contrast-induced nephropathy (CIN) is a common complication after diagnostic and therapeutic card... more Contrast-induced nephropathy (CIN) is a common complication after diagnostic and therapeutic cardiovascular procedures that is associated with significant mortality and morbidity. CIN is highly prevalent in patients with well-known risk factors, including older age, chronic renal insufficiency, congestive heart failure, and diabetes. Thus far, no strategies have been shown to be effective in preventing CIN beyond thorough patient selection, minimizing the amount of contrast agent, and meticulous hydration of the patient. The role of various drugs in preventing CIN is still controversial and warrants future studies. Despite the remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, nonionic low-osmolar contrast media may be preferred in patients at high risk for CIN.
Journal of Thrombosis and Thrombolysis, 2011
We sought to evaluate the association between C-reactive protein (CRP) sampled on admission and s... more We sought to evaluate the association between C-reactive protein (CRP) sampled on admission and shortand long-term mortality in patients with acute coronary syndromes (ACS) undergoing early invasive treatment. Baseline levels of CRP were determined in 2,974 patients with moderate and high-risk ACS undergoing an early invasive treatment strategy in the large-scale randomized ACUITY trial.
Journal of the American College of Cardiology, 2009
Journal of the American College of Cardiology, 2010
The introduction of the drug-eluting stent (DES) proved to be an important step forward in reduci... more The introduction of the drug-eluting stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention. However, the rapid implementation of DES in standard practice and expansion of the indications for percutaneous coronary intervention to high-risk patients and complex lesions also introduced a new problem: DES in-stent restenosis (ISR), which occurs in 3% to 20% of patients, depending on patient and lesion characteristics and DES type. The clinical presentation of DES ISR is usually recurrent angina, but some patients present with acute coronary syndrome. Mechanisms of DES ISR can be biological, mechanical, and technical, and its pattern is predominantly focal. Intravascular imaging can assist in defining the mechanism and selecting treatment modalities. Based upon the current available evidence, an algorithm for the treatment approaches to DES restenosis is proposed. (J Am Coll Cardiol 2010;56:1897-907)
Journal of the American College of Cardiology, 2009
Our aim was to determine whether a 600-mg loading dose of clopidogrel compared with 300 mg result... more Our aim was to determine whether a 600-mg loading dose of clopidogrel compared with 300 mg results in improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Journal of the American College of Cardiology, 2010
Category: Myocardial Ischemia/Infarction--Basic Presentation Number: 1215-309
Journal of the American College of Cardiology, 2010
Background: During the pre-reperfusion era, plasma glucose on admission for ST-elevation myocardi... more Background: During the pre-reperfusion era, plasma glucose on admission for ST-elevation myocardial infarction (STEMI) was considered a marker of the severity of myocardial damage, however data is lacking on the relationship between plasma glucose on admission and outcomes of patients with STEMI treated with primary percutaneous coronary intervention (PCI). We evaluated the impact of admission blood glucose in patients without a history of diabetes on clinical outcomes in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.
Journal of the American College of Cardiology, 2010
... Mehran, and Gregg W. Stone Witzenbichler, Giulio Guagliumi, Jan Z. Peruga, Bruce R. Brodie, D... more ... Mehran, and Gregg W. Stone Witzenbichler, Giulio Guagliumi, Jan Z. Peruga, Bruce R. Brodie, Dariusz Dudek, Adriano Caixeta, Helen Parise, Martin Fahy, Ecaterina Criatea, BernhardAlf-Ing Larsen, Dennis WT Nilsen, Eugenia Nikolsky, Alexandra J. Lansky, ANALYSIS FROM ...
Journal of the American College of Cardiology, 2010
Category: PCI -Acute MI
Journal of the American College of Cardiology, 2010
Category: PCI -Acute MI Background: We deined the rates of and reasons for premature cessation of... more Category: PCI -Acute MI Background: We deined the rates of and reasons for premature cessation of aspirin and/or thienopyridine therapy in pts with ST-elevation myocardial infarction (STEMI) in whom stents were implanted in the HORIZONS-AMI trial.
Journal of the American College of Cardiology, 2010
Background: Presence of thrombus is known to worsen microvascular perfusion in patients with STEM... more Background: Presence of thrombus is known to worsen microvascular perfusion in patients with STEMI undergoing primary PCI. However, impact of thrombus burden as assessed by thrombus area on prognosis of patients with STEMI is less certain.
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Papers by Adriano Caixeta