Mudanças no perfil populacional e resultados da intervenção coronária percutânea do Registro Angiocardio

INTRODUCAO: A evolucao tecnologica tem permitido ampliar a indicacao da intervencao coronaria percutânea (ICP) para cenarios clinicos e angiograficos mais desafiadores. Nosso objetivo foi avaliar os resultados da ICP em dois diferentes periodos, nos ultimos 6 anos. METODOS: Registro multicentrico no qual 6.288 pacientes consecutivos tratados por ICP foram divididos por periodos de tratamento: 2006 a 2008 (P1; n = 1.779) e 2009 a 2012 (P2; n = 4.509). Buscamos comparar as taxas de eventos cardiacos e cerebrovasculares adversos maiores (ECCAM) hospitalares e identificar seus preditores. RESULTADOS: Pacientes do Grupo P2 mostraram ser mais jovens, com maior prevalencia de tabagismo e diabetes. Esses pacientes mostraram maior acometimento de multiplos vasos, maior numero de lesoes tromboticas e lesoes em bifurcacoes. A relacao de vasos tratados/paciente foi maior no Grupo P2, assim como a relacao stent/paciente e a utilizacao de stents farmacologicos. ECCAM foi mais frequente no Grupo P2 (2,5% vs. 3,5%; P = 0,04), as custas do infarto periprocedimento (1,7% vs. 2,6%; P = 0,05), nao havendo diferencas quanto a obito (1,0% vs. 1,0%; P = 0,87), acidente vascular cerebral (0,2% vs. 0,1%; P = 0,47) ou cirurgia de revascularizacao de emergencia (0,1% vs. 0; P = 0,68). Idade (odds ratio - OR - de 1,02; intervalo de confianca de 95% - IC 95% - de 1,00-1,05; P = 0,04) e Killip III/IV (OR = 6,03, IC 95%; 3,39-10,90; P BACKGROUND: Technological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years. METHODS: This was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n = 1,779) and 2009 to 2012 (P2; n = 4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors. RESULTS: P2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P = 0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P = 0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P = 0.87), stroke (0.2% vs. 0.1%; P = 0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P = 0.68). Age (odds ratio - OR - 1.02; 95% confidence interval - CI 95% - 1.00-1.05; P = 0.04) and Killip III/IV (OR = 6.0, 95% CI; 3.3-10.9; P