array:25 [
  "pii" => "S217420491400258X"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2014.09.006"
  "estado" => "S300"
  "fechaPublicacion" => "2014-12-01"
  "aid" => "541"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2014;33:761-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3534
    "formatos" => array:3 [
      "EPUB" => 175
      "HTML" => 2662
      "PDF" => 697
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S087025511400256X"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.09.006"
      "estado" => "S300"
      "fechaPublicacion" => "2014-12-01"
      "aid" => "541"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2014;33:761-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3437
        "formatos" => array:3 [
          "EPUB" => 171
          "HTML" => 2616
          "PDF" => 650
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio Editorial</span>"
        "titulo" => "Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "761"
            "paginaFinal" => "764"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Aspiration thrombectomy&#58; Just another piece of the puzzle &#8211; intuitive&#44; but not sufficient"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ricardo Seabra Gomes"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Seabra Gomes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217420491400258X"
          "doi" => "10.1016/j.repce.2014.09.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491400258X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511400256X?idApp=UINPBA00004E"
      "url" => "/08702551/0000003300000012/v1_201412140112/S087025511400256X/v1_201412140112/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204914002554"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.06.004"
    "estado" => "S300"
    "fechaPublicacion" => "2014-12-01"
    "aid" => "522"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:765-72"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3989
      "formatos" => array:3 [
        "EPUB" => 171
        "HTML" => 2992
        "PDF" => 826
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Cardiovascular profile in myotonic dystrophy type 1&#58; Analysis of a case series in a specialized center"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "765"
          "paginaFinal" => "772"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Perfil cardiovascular na distrofia muscular miot&#243;nica tipo 1&#58; estudo de uma s&#233;rie de casos seguida num centro especializado"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lilian Gomes, Telmo Pereira, Lu&#237;s Martins"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Lilian"
              "apellidos" => "Gomes"
            ]
            1 => array:2 [
              "nombre" => "Telmo"
              "apellidos" => "Pereira"
            ]
            2 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Martins"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114002042"
        "doi" => "10.1016/j.repc.2014.06.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002042?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002554?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002554/v1_201501081043/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2174204914002578"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2014-12-01"
    "aid" => "523"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:753-60"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3370
      "formatos" => array:3 [
        "EPUB" => 167
        "HTML" => 2409
        "PDF" => 794
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Thrombus aspiration for reperfusion in myocardial infarction&#58; Predictors and clinical impact of ineffectiveness"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "753"
          "paginaFinal" => "760"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1535
              "Ancho" => 1660
              "Tamanyo" => 88601
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves as a function of thrombus aspiration efficacy&#46; TA&#58; thrombus aspiration&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Andr&#233; Luz, Patr&#237;cia Rodrigues, Maria Jo&#227;o Sousa, In&#234;s Silveira, Diana Anjo, Bruno Brochado, M&#225;rio Santos, Jo&#227;o Silveira, Henrique Cyrne Carvalho, Severo Torres"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Andr&#233;"
              "apellidos" => "Luz"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Rodrigues"
            ]
            2 => array:2 [
              "nombre" => "Maria Jo&#227;o"
              "apellidos" => "Sousa"
            ]
            3 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Silveira"
            ]
            4 => array:2 [
              "nombre" => "Diana"
              "apellidos" => "Anjo"
            ]
            5 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "Brochado"
            ]
            6 => array:2 [
              "nombre" => "M&#225;rio"
              "apellidos" => "Santos"
            ]
            7 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Silveira"
            ]
            8 => array:2 [
              "nombre" => "Henrique Cyrne"
              "apellidos" => "Carvalho"
            ]
            9 => array:2 [
              "nombre" => "Severo"
              "apellidos" => "Torres"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114002054"
        "doi" => "10.1016/j.repc.2014.05.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002054?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002578?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002578/v1_201501081043/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S2174204914002578"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2014.05.007"
      "estado" => "S300"
      "fechaPublicacion" => "2014-12-01"
      "aid" => "523"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2014;33:753-60"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3370
        "formatos" => array:3 [
          "EPUB" => 167
          "HTML" => 2409
          "PDF" => 794
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Thrombus aspiration for reperfusion in myocardial infarction&#58; Predictors and clinical impact of ineffectiveness"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "753"
            "paginaFinal" => "760"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1535
                "Ancho" => 1660
                "Tamanyo" => 88601
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves as a function of thrombus aspiration efficacy&#46; TA&#58; thrombus aspiration&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Andr&#233; Luz, Patr&#237;cia Rodrigues, Maria Jo&#227;o Sousa, In&#234;s Silveira, Diana Anjo, Bruno Brochado, M&#225;rio Santos, Jo&#227;o Silveira, Henrique Cyrne Carvalho, Severo Torres"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "Andr&#233;"
                "apellidos" => "Luz"
              ]
              1 => array:2 [
                "nombre" => "Patr&#237;cia"
                "apellidos" => "Rodrigues"
              ]
              2 => array:2 [
                "nombre" => "Maria Jo&#227;o"
                "apellidos" => "Sousa"
              ]
              3 => array:2 [
                "nombre" => "In&#234;s"
                "apellidos" => "Silveira"
              ]
              4 => array:2 [
                "nombre" => "Diana"
                "apellidos" => "Anjo"
              ]
              5 => array:2 [
                "nombre" => "Bruno"
                "apellidos" => "Brochado"
              ]
              6 => array:2 [
                "nombre" => "M&#225;rio"
                "apellidos" => "Santos"
              ]
              7 => array:2 [
                "nombre" => "Jo&#227;o"
                "apellidos" => "Silveira"
              ]
              8 => array:2 [
                "nombre" => "Henrique Cyrne"
                "apellidos" => "Carvalho"
              ]
              9 => array:2 [
                "nombre" => "Severo"
                "apellidos" => "Torres"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0870255114002054"
          "doi" => "10.1016/j.repc.2014.05.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002054?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002578?idApp=UINPBA00004E"
      "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002578/v1_201501081043/en/main.assets"
    ]
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "Aspiration thrombectomy&#58; Just another piece of the puzzle &#8211; Intuitive&#44; but not sufficient"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "761"
        "paginaFinal" => "764"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Ricardo Seabra Gomes"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Ricardo Seabra"
            "apellidos" => "Gomes"
            "email" => array:2 [
              0 => "seago&#64;esoterica&#46;pt"
              1 => "sgomes&#64;institutocoracao&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Instituto do Cora&#231;&#227;o&#44; Carnaxide&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thrombotic occlusion of a coronary artery was identified over 30 years ago as the pathophysiological mechanism of myocardial infarction &#40;MI&#41;&#46; In 1979&#44; Rentrop et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> first reported successful reperfusion by recanalizing an occluded coronary artery with a guidewire and directly infusing streptokinase&#46; The following year&#44; DeWood et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> demonstrated spontaneous regression of occlusive thrombi in some patients undergoing coronary angiography within 24 hours of symptom onset of MI&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Preventing the formation of thrombi in chronic coronary disease&#44; or dissolving them and proceeding to early recanalization in the acute phase of MI&#44; then became the main therapeutic goal in reducing mortality&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">For years&#44; fibrinolysis&#44; initially intracoronary and later intravenous&#44; dominated treatment of the acute phase of MI&#46; Following progressive advances in percutaneous coronary intervention &#40;PCI&#41;&#44; randomized studies and meta-analyses established primary angioplasty as the treatment of choice to achieve better and faster coronary recanalization and to reduce mortality&#46; At the same time&#44; various antithrombotic agents&#44; particularly anticoagulants and antiplatelets&#44; were developed and tested as an adjunctive therapy in the acute phase of MI&#44; both for fibrinolysis and&#44; more recently&#44; in primary angioplasty&#44; in an effort to improve and maintain coronary reperfusion and to reduce complications&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A recognized limitation of primary angioplasty is microvascular obstruction&#44; known as the no-reflow phenomenon&#44; consisting of reduced myocardial perfusion at the microvascular level despite recanalization of the epicardial coronary artery&#46; This can be due to endothelial damage&#44; vasospasm&#44; inflammation&#44; reperfusion injury to myocytes&#44; or distal embolization of thrombotic material or plaque fragments&#46; Diminished myocardial perfusion is associated with larger infarct size&#44; greater left ventricular remodeling and higher mortality&#46; It thus appears equally important to rapidly obtain normal epicardial flow and adequate myocardial perfusion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is therefore intuitive to think that mechanical thrombus removal before PCI would be one way to reduce distal embolization and microvascular obstruction&#46; However&#44; various early studies using distal protection devices or mechanical thrombus aspiration &#40;TA&#41; did not demonstrate clinical benefit&#46; Manual TA is now the most commonly used technique&#46; It is simple and safe&#44; and is &#8220;reasonable&#8221; and &#8220;should be considered&#8221; during PCI in the American<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and European<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> guidelines for the management of MI&#44; with a class IIa recommendation and level of evidence B&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The best evidence for use of manual TA was provided by the randomized TAPAS trial<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> of 1071 patients&#44; which demonstrated improved perfusion indices &#40;myocardial blush score&#44; degree of resolution of ST-segment elevation&#44; and Q-wave count&#41; and significantly reduced mortality and reinfarction after one year&#46; However&#44; the study has been criticized for lack of statistical power to prove reduced mortality&#44; which was excessively high in the placebo group&#46; A 2013 meta-analysis of randomized trials comparing aspiration and mechanical thrombectomy before primary angioplasty with conventional PCI demonstrated that only manual TA reduced major adverse events&#44; including 6&#8211;12 month mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; other studies have reported negative clinical outcomes&#46; This discrepancy may be explained by the fact that some studies were single- and others multicenter&#44; with differences in patient selection&#44; ischemic times&#44; and occlusion of different arteries&#44; among other factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> In the most recent study&#44; of one-year outcomes in 7244 patients in the registry-based TASTE trial&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> no reduction was seen in all-cause mortality or in the composite endpoint of all-cause death&#44; rehospitalization for MI or stent thrombosis&#44; with TA compared to primary PCI alone&#46; Results are awaited of the randomized TOTAL trial<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> of 10<span class="elsevierStyleHsp" style=""></span>700 patients in order to determine definitively the effect of manual TA&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For the moment&#44; while use of TA has proved beneficial in improving myocardial perfusion and reducing distal embolization&#44; there are still conflicting results in terms of clinical outcomes&#44; including mortality&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The article by Luz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> assesses the impact of ineffective TA in a series of 417 consecutive patients at a single center where the technique was routinely used&#46; The authors defined TA failure as persistence of TIMI flow 0 or 1&#44; which was observed in 12&#46;5&#37; of the study population&#46; Independent predictors of TA failure were total ischemic time and the SYNTAX score of complexity of coronary artery disease&#46; The study also demonstrated that ineffective TA had no impact on medium-term mortality&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Few studies have addressed the problem of failed TA&#46; In a study by Vink et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> of 1399 patients&#44; the aspiration catheter could not reach or cross the lesion in 10&#46;3&#37; of cases&#44; independent predictors of failure being vessel tortuosity&#44; calcified lesions and bifurcation&#46; No thrombotic material could be retrieved in a further 27&#46;3&#37;&#44; predictors for which were age and the circumflex being the infarct-related artery&#46; In the TASTE registry&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> thrombectomy was not possible in 16&#37; and was ineffective in 11&#37;&#59; and in the INFUSE-AMI trial&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> exclusively of patients with occlusion of the anterior descending artery&#44; the failure rate was 1&#46;7&#37;&#46; It is thus clear that aspiration thrombectomy may be impossible or ineffective in certain cases&#44; important factors being the composition and size of the thrombus and coronary anatomy&#44; and possibly operator experience&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">It is not surprising that the anatomical features of lesions should affect the success of thrombectomy&#44; especially since the technique is used in any artery with an occlusive thrombus&#59; nor it is surprising that ischemic time should be a predictor of failure&#44; since the degree of thrombus organization is likely to affect the procedure&#39;s efficacy&#44; or that failure has no impact on mortality in the light of previous studies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the study by Luz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> mean ischemic time was over five hours in patients in whom TA was ineffective &#40;332&#46;5 min&#44; interquartile range&#58; 393 min&#41; and significantly shorter in successful TA &#40;210 min&#44; p&#61;0&#46;002&#41;&#46; By way of comparison&#44; in the study by Vink et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> mean ischemic time was three hours for both effective and ineffective TA&#46; With regard to clinical outcomes&#44; Luz et al&#46; reported no reflow in 35&#46;3&#37; of cases of ineffective TA &#40;as opposed to 1&#46;4&#37; in effective TA&#44; p&#60;0&#46;001&#41;&#44; which may be related to Killip class III&#47;IV &#40;p&#61;0&#46;031&#41; and use of intra-aortic balloon pump &#40;p&#61;0&#46;002&#41;&#46; There was also a tendency for higher in-hospital mortality &#40;p&#61;0&#46;073&#41;&#44; which might have been statistically significant had the study population been larger&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The greatest challenge now in the treatment of ST-elevation MI &#40;STEMI&#41; is not only to restore normal coronary flow but also to improve microvascular perfusion&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Recent years have seen considerable research into antithrombotic agents as adjunctive therapy in primary angioplasty&#46; The acute phase of STEMI is a highly prothrombotic state and early&#44; effective antiplatelet therapy is considered essential in achieving optimal myocardial reperfusion&#46; P2Y12 receptor inhibitors &#40;clopidogrel&#44; prasugrel and ticagrelor&#41; should be initiated as soon as possible before primary angioplasty&#44; although their use in the pre-hospital phase is the subject of debate&#46; A possible limitation is increased bleeding risk if taken together with glycoprotein &#40;Gp&#41; IIb&#47;IIIa inhibitors and for this reason the latter are now being used less&#46; The ideal antithrombotic therapy is far from consensual&#46;</p><p id="par1055" class="elsevierStylePara elsevierViewall">Intracoronary administration of Gp IIb&#47;IIIa inhibitors was first described in 1999 as a way to dissolve thrombi and thus reduce adverse events in MI&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Local administration is more beneficial than intravenous infusion due to the higher drug concentration&#44; and the benefits are even greater if the drug is delivered locally into the target artery by means of a dedicated perfusion catheter&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par2055" class="elsevierStylePara elsevierViewall">The recent INFUSE-AMI randomized trial<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> compared manual aspiration thrombectomy and bolus intracoronary abciximab with conventional primary PCI in 452 patients with anterior MI&#46; Only intracoronary abciximab was shown to reduce infarct size&#46; Patients who underwent thrombectomy&#44; with or without abciximab&#44; showed a higher rate of TIMI flow 3 and those undergoing thrombectomy with abciximab had the greatest reduction in infarct size&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Comparing patients in terms of delay to reperfusion &#40;&#60;3 vs&#46; &#62;3 h&#41;&#44; shorter ischemic time was an important predictor of reduced infarct size and mortality at one year&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Another recent study&#44; albeit small&#44; confirmed improved myocardial perfusion with the combined use of intracoronary abciximab and TA&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Similarly&#44; intracoronary fibrinolysis with low-dose urokinase&#44; tenecteplase or alteplase has also been described in cases of large thrombus burden and failed manual aspiration&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">It is surprising that in the study by Luz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> while aspirin 300 mg and clopidogrel 600 mg were given to all patients before PCI&#44; use of Gp IIb&#47;IIIa inhibitors was low overall and similar in those with ineffective &#40;38&#37;&#41; and effective TA &#40;33&#46;5&#37;&#41;&#46; In the Portuguese National Registry of Interventional Cardiology&#44; of 3311 patients who underwent thrombectomy between January 2006 and December 2012 &#40;performed in 46&#46;1&#37; of PCI procedures in 2012&#41;&#44; use of Gp IIb&#47;IIIa inhibitors was also low &#40;36&#46;9&#37;&#41; but significantly higher than in those undergoing primary angioplasty alone &#40;18&#46;9&#37;&#44; p&#61;0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Bearing in mind that reperfusion remains suboptimal in 20&#8211;30&#37; of patients&#44; despite considerable advances in the techniques and equipment used in primary angioplasty&#44; including manual TA&#44; adjunctive drug therapy will continue to play a role&#46; For the interventional cardiologist&#44; the combination of TA and intracoronary or local delivery of Gp IIb&#47;IIIa inhibitors is in theory an attractive option for maximizing microvascular perfusion&#46; The challenge will be the judicious concomitant use of anticoagulants and potent antiplatelets that provides a positive risk-benefit ratio for the individual patient&#46; In the meantime&#44; the most important aspect of STEMI treatment remains reperfusion as early as possible&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gomes RS&#46; Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;761&#8211;764&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reopening of infarct-occluded vessel by transluminal recanalisation and intracoronary streptokinase application"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Rentrop"
                            1 => "H&#46; Blanke"
                            2 => "K&#46;R&#46; Karsch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dtsch Med Wochschr"
                        "fecha" => "1979"
                        "volumen" => "104"
                        "paginaInicial" => "1438"
                        "paginaFinal" => "1440"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; DeWood"
                            1 => "J&#46; Spores"
                            2 => "R&#46; Notske"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198010163031601"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1980"
                        "volumen" => "303"
                        "paginaInicial" => "897"
                        "paginaFinal" => "902"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7412821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of ST-elevation myocardial infarction&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;T&#46; O¿Gara"
                            1 => "F&#46;G&#46; Kushner"
                            2 => "D&#46;D&#46; Ascheim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e3182742cf6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "e362"
                        "paginaFinal" => "e425"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23247304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation&#46; The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Steg"
                            1 => "S&#46;K&#46; James"
                            2 => "D&#46; Atar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs215"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2569"
                        "paginaFinal" => "2619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study &#40;TAPAS&#41;&#58; a 1-year follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;J&#46; Vlaar"
                            1 => "T&#46; Svilaas"
                            2 => "I&#46;C&#46; van der Horst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60833-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "371"
                        "paginaInicial" => "1915"
                        "paginaFinal" => "1920"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18539223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty&#46; An updated meta-analysis of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Kumbhani"
                            1 => "A&#46;A&#46; Bavry"
                            2 => "M&#46;Y&#46; Desai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.04.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "1409"
                        "paginaFinal" => "1418"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23665372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention&#58; findings from the HORIZONS-AMI trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;W&#46; Nilsen"
                            1 => "R&#46; Mehran"
                            2 => "R&#46;S&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.24705"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2013"
                        "volumen" => "82"
                        "paginaInicial" => "594"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23074151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus aspiration during ST-elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46; Fr&#246;bert"
                            1 => "B&#46; Lagerqvist"
                            2 => "G&#46;K&#46; Olivecrona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1308789"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "1587"
                        "paginaFinal" => "1597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23991656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimization in stent implantation by manual thrombus aspiration in ST-segment-elevation myocardial infarction&#58; findings from the EXAMINATION trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Fern&#225;ndez-Rodr&#237;guez"
                            1 => "A&#46; Regueiro"
                            2 => "S&#46; Brugaletta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCINTERVENTIONS.113.000964"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Interv"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "294"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24867891"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes 1 year after thrombus aspiration for myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Lagerqvist"
                            1 => "O&#46; Fr&#246;bert"
                            2 => "G&#46;K&#46; Olivecrona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1405707"
                      "Revista" => array:2 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and rationale of the TOTAL trial&#58; a randomized trial of routine aspiration ThrOmnecTomy with percutaneous coronary intervention &#40;PCI&#41; versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Jolly"
                            1 => "J&#46; Cairns"
                            2 => "S&#46; Yusuf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2013.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2014"
                        "volumen" => "167"
                        "paginaInicial" => "315"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24576514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Luz"
                            1 => "P&#46; Rodrigues"
                            2 => "M&#46;J&#46; Sousa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2014.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2014"
                        "volumen" => "33"
                        "paginaInicial" => "761"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25481781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and angiographic predictors and prognostic value of failed thrombus aspiration in primary percutaneous coronary intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Vink"
                            1 => "M&#46;C&#46; Kramer"
                            2 => "X&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "634"
                        "paginaFinal" => "642"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction&#46; The INFUSE-AMI Randomized Trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;W&#46; Stone"
                            1 => "A&#46; Maehara"
                            2 => "B&#46; Witzenbichler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.421"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "1817"
                        "paginaFinal" => "1826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22447888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful dissolution of occlusive coronary thrombus with local administration of abciximab during PTCA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;L&#46; Bartorelli"
                            1 => "D&#46; Trabattoni"
                            2 => "S&#46; Galli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "1999"
                        "volumen" => "48"
                        "paginaInicial" => "211"
                        "paginaFinal" => "213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10506783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local delivery versus intracoronary infusion of abciximab in patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Prati"
                            1 => "D&#46; Capodanno"
                            2 => "T&#46; Pawlowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2010"
                        "volumen" => "3"
                        "paginaInicial" => "928"
                        "paginaFinal" => "934"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction&#58; insights from the INFUSE-AMI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Brener"
                            1 => "J&#46;-H&#46; Dambrink"
                            2 => "A&#46; Maehara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4244/EIJV9I10A201"
                      "Revista" => array:6 [
                        "tituloSerie" => "EuroIntervention"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24561570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of delay to reperfusion on reperfusion success&#44; infarct size&#44; and clinical outcomes in patients with ST-segment elevation myocardial infarction&#46; The INFUSE-AMI Trial &#40;INFUSE-Anterior Myocardial Infarction&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Guerchicoff"
                            1 => "S&#46;J&#46; Brener"
                            2 => "A&#46; Maehara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "733"
                        "paginaFinal" => "740"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of combination treatment with intracoronary abciximab and aspiration thrombectomy on myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary coronary stenting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;G&#46; Ahn"
                            1 => "S&#46;H&#46; Lee"
                            2 => "J&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3349/ymj.2014.55.3.606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Yonsei Med J"
                        "fecha" => "2014"
                        "volumen" => "55"
                        "paginaInicial" => "606"
                        "paginaFinal" => "616"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24719126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of local delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention &#40;the Delivery of thrombolytics before thrombectomy In patients with ST-Segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary InterventiON &#91;DISSOLUTION&#93; randomized trial&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Greco"
                            1 => "F&#46; Pelliccia"
                            2 => "G&#46; Tanzilli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2013.04.036"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2013"
                        "volumen" => "112"
                        "paginaInicial" => "630"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23711809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Boscarelli"
                            1 => "B&#46; Vaquerizo"
                            2 => "F&#46; Miranda-Guardiola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus aspiration in patients with ST-elevation myocardial infarction&#58; results of a national registry of interventional cardiology"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of Investigators of National Registry of Interventional Cardiology"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Pereira"
                            1 => "D&#46; Caldeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Oral communication at the XXX European Congress of Cardiology"
                        "conferencia" => "Barcelona"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003300000012/v1_201501081043/S217420491400258X/v1_201501081043/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000012/v1_201501081043/S217420491400258X/v1_201501081043/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491400258X?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial comment
Aspiration thrombectomy: Just another piece of the puzzle – Intuitive, but not sufficient
Trombectomia aspirativa: apenas mais uma peça do puzzle. Intuitiva, mas não suficiente
Ricardo Seabra Gomes
Instituto do Coração, Carnaxide, Portugal
Read
5936
Times
was read the article
1800
Total PDF
4136
Total HTML
Share statistics
 array:25 [
  "pii" => "S217420491400258X"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2014.09.006"
  "estado" => "S300"
  "fechaPublicacion" => "2014-12-01"
  "aid" => "541"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2014;33:761-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3534
    "formatos" => array:3 [
      "EPUB" => 175
      "HTML" => 2662
      "PDF" => 697
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S087025511400256X"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.09.006"
      "estado" => "S300"
      "fechaPublicacion" => "2014-12-01"
      "aid" => "541"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2014;33:761-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3437
        "formatos" => array:3 [
          "EPUB" => 171
          "HTML" => 2616
          "PDF" => 650
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio Editorial</span>"
        "titulo" => "Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "761"
            "paginaFinal" => "764"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Aspiration thrombectomy&#58; Just another piece of the puzzle &#8211; intuitive&#44; but not sufficient"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ricardo Seabra Gomes"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Seabra Gomes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217420491400258X"
          "doi" => "10.1016/j.repce.2014.09.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491400258X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511400256X?idApp=UINPBA00004E"
      "url" => "/08702551/0000003300000012/v1_201412140112/S087025511400256X/v1_201412140112/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204914002554"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.06.004"
    "estado" => "S300"
    "fechaPublicacion" => "2014-12-01"
    "aid" => "522"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:765-72"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3989
      "formatos" => array:3 [
        "EPUB" => 171
        "HTML" => 2992
        "PDF" => 826
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Cardiovascular profile in myotonic dystrophy type 1&#58; Analysis of a case series in a specialized center"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "765"
          "paginaFinal" => "772"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Perfil cardiovascular na distrofia muscular miot&#243;nica tipo 1&#58; estudo de uma s&#233;rie de casos seguida num centro especializado"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lilian Gomes, Telmo Pereira, Lu&#237;s Martins"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Lilian"
              "apellidos" => "Gomes"
            ]
            1 => array:2 [
              "nombre" => "Telmo"
              "apellidos" => "Pereira"
            ]
            2 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Martins"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114002042"
        "doi" => "10.1016/j.repc.2014.06.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002042?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002554?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002554/v1_201501081043/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2174204914002578"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2014-12-01"
    "aid" => "523"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:753-60"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3370
      "formatos" => array:3 [
        "EPUB" => 167
        "HTML" => 2409
        "PDF" => 794
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Thrombus aspiration for reperfusion in myocardial infarction&#58; Predictors and clinical impact of ineffectiveness"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "753"
          "paginaFinal" => "760"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1535
              "Ancho" => 1660
              "Tamanyo" => 88601
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves as a function of thrombus aspiration efficacy&#46; TA&#58; thrombus aspiration&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Andr&#233; Luz, Patr&#237;cia Rodrigues, Maria Jo&#227;o Sousa, In&#234;s Silveira, Diana Anjo, Bruno Brochado, M&#225;rio Santos, Jo&#227;o Silveira, Henrique Cyrne Carvalho, Severo Torres"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Andr&#233;"
              "apellidos" => "Luz"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Rodrigues"
            ]
            2 => array:2 [
              "nombre" => "Maria Jo&#227;o"
              "apellidos" => "Sousa"
            ]
            3 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Silveira"
            ]
            4 => array:2 [
              "nombre" => "Diana"
              "apellidos" => "Anjo"
            ]
            5 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "Brochado"
            ]
            6 => array:2 [
              "nombre" => "M&#225;rio"
              "apellidos" => "Santos"
            ]
            7 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Silveira"
            ]
            8 => array:2 [
              "nombre" => "Henrique Cyrne"
              "apellidos" => "Carvalho"
            ]
            9 => array:2 [
              "nombre" => "Severo"
              "apellidos" => "Torres"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114002054"
        "doi" => "10.1016/j.repc.2014.05.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002054?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002578?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002578/v1_201501081043/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S2174204914002578"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2014.05.007"
      "estado" => "S300"
      "fechaPublicacion" => "2014-12-01"
      "aid" => "523"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2014;33:753-60"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3370
        "formatos" => array:3 [
          "EPUB" => 167
          "HTML" => 2409
          "PDF" => 794
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Thrombus aspiration for reperfusion in myocardial infarction&#58; Predictors and clinical impact of ineffectiveness"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "753"
            "paginaFinal" => "760"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1535
                "Ancho" => 1660
                "Tamanyo" => 88601
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves as a function of thrombus aspiration efficacy&#46; TA&#58; thrombus aspiration&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Andr&#233; Luz, Patr&#237;cia Rodrigues, Maria Jo&#227;o Sousa, In&#234;s Silveira, Diana Anjo, Bruno Brochado, M&#225;rio Santos, Jo&#227;o Silveira, Henrique Cyrne Carvalho, Severo Torres"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "Andr&#233;"
                "apellidos" => "Luz"
              ]
              1 => array:2 [
                "nombre" => "Patr&#237;cia"
                "apellidos" => "Rodrigues"
              ]
              2 => array:2 [
                "nombre" => "Maria Jo&#227;o"
                "apellidos" => "Sousa"
              ]
              3 => array:2 [
                "nombre" => "In&#234;s"
                "apellidos" => "Silveira"
              ]
              4 => array:2 [
                "nombre" => "Diana"
                "apellidos" => "Anjo"
              ]
              5 => array:2 [
                "nombre" => "Bruno"
                "apellidos" => "Brochado"
              ]
              6 => array:2 [
                "nombre" => "M&#225;rio"
                "apellidos" => "Santos"
              ]
              7 => array:2 [
                "nombre" => "Jo&#227;o"
                "apellidos" => "Silveira"
              ]
              8 => array:2 [
                "nombre" => "Henrique Cyrne"
                "apellidos" => "Carvalho"
              ]
              9 => array:2 [
                "nombre" => "Severo"
                "apellidos" => "Torres"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0870255114002054"
          "doi" => "10.1016/j.repc.2014.05.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002054?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002578?idApp=UINPBA00004E"
      "url" => "/21742049/0000003300000012/v1_201501081043/S2174204914002578/v1_201501081043/en/main.assets"
    ]
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "Aspiration thrombectomy&#58; Just another piece of the puzzle &#8211; Intuitive&#44; but not sufficient"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "761"
        "paginaFinal" => "764"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Ricardo Seabra Gomes"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Ricardo Seabra"
            "apellidos" => "Gomes"
            "email" => array:2 [
              0 => "seago&#64;esoterica&#46;pt"
              1 => "sgomes&#64;institutocoracao&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Instituto do Cora&#231;&#227;o&#44; Carnaxide&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thrombotic occlusion of a coronary artery was identified over 30 years ago as the pathophysiological mechanism of myocardial infarction &#40;MI&#41;&#46; In 1979&#44; Rentrop et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> first reported successful reperfusion by recanalizing an occluded coronary artery with a guidewire and directly infusing streptokinase&#46; The following year&#44; DeWood et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> demonstrated spontaneous regression of occlusive thrombi in some patients undergoing coronary angiography within 24 hours of symptom onset of MI&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Preventing the formation of thrombi in chronic coronary disease&#44; or dissolving them and proceeding to early recanalization in the acute phase of MI&#44; then became the main therapeutic goal in reducing mortality&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">For years&#44; fibrinolysis&#44; initially intracoronary and later intravenous&#44; dominated treatment of the acute phase of MI&#46; Following progressive advances in percutaneous coronary intervention &#40;PCI&#41;&#44; randomized studies and meta-analyses established primary angioplasty as the treatment of choice to achieve better and faster coronary recanalization and to reduce mortality&#46; At the same time&#44; various antithrombotic agents&#44; particularly anticoagulants and antiplatelets&#44; were developed and tested as an adjunctive therapy in the acute phase of MI&#44; both for fibrinolysis and&#44; more recently&#44; in primary angioplasty&#44; in an effort to improve and maintain coronary reperfusion and to reduce complications&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A recognized limitation of primary angioplasty is microvascular obstruction&#44; known as the no-reflow phenomenon&#44; consisting of reduced myocardial perfusion at the microvascular level despite recanalization of the epicardial coronary artery&#46; This can be due to endothelial damage&#44; vasospasm&#44; inflammation&#44; reperfusion injury to myocytes&#44; or distal embolization of thrombotic material or plaque fragments&#46; Diminished myocardial perfusion is associated with larger infarct size&#44; greater left ventricular remodeling and higher mortality&#46; It thus appears equally important to rapidly obtain normal epicardial flow and adequate myocardial perfusion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is therefore intuitive to think that mechanical thrombus removal before PCI would be one way to reduce distal embolization and microvascular obstruction&#46; However&#44; various early studies using distal protection devices or mechanical thrombus aspiration &#40;TA&#41; did not demonstrate clinical benefit&#46; Manual TA is now the most commonly used technique&#46; It is simple and safe&#44; and is &#8220;reasonable&#8221; and &#8220;should be considered&#8221; during PCI in the American<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and European<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> guidelines for the management of MI&#44; with a class IIa recommendation and level of evidence B&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The best evidence for use of manual TA was provided by the randomized TAPAS trial<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> of 1071 patients&#44; which demonstrated improved perfusion indices &#40;myocardial blush score&#44; degree of resolution of ST-segment elevation&#44; and Q-wave count&#41; and significantly reduced mortality and reinfarction after one year&#46; However&#44; the study has been criticized for lack of statistical power to prove reduced mortality&#44; which was excessively high in the placebo group&#46; A 2013 meta-analysis of randomized trials comparing aspiration and mechanical thrombectomy before primary angioplasty with conventional PCI demonstrated that only manual TA reduced major adverse events&#44; including 6&#8211;12 month mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; other studies have reported negative clinical outcomes&#46; This discrepancy may be explained by the fact that some studies were single- and others multicenter&#44; with differences in patient selection&#44; ischemic times&#44; and occlusion of different arteries&#44; among other factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> In the most recent study&#44; of one-year outcomes in 7244 patients in the registry-based TASTE trial&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> no reduction was seen in all-cause mortality or in the composite endpoint of all-cause death&#44; rehospitalization for MI or stent thrombosis&#44; with TA compared to primary PCI alone&#46; Results are awaited of the randomized TOTAL trial<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> of 10<span class="elsevierStyleHsp" style=""></span>700 patients in order to determine definitively the effect of manual TA&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For the moment&#44; while use of TA has proved beneficial in improving myocardial perfusion and reducing distal embolization&#44; there are still conflicting results in terms of clinical outcomes&#44; including mortality&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The article by Luz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> assesses the impact of ineffective TA in a series of 417 consecutive patients at a single center where the technique was routinely used&#46; The authors defined TA failure as persistence of TIMI flow 0 or 1&#44; which was observed in 12&#46;5&#37; of the study population&#46; Independent predictors of TA failure were total ischemic time and the SYNTAX score of complexity of coronary artery disease&#46; The study also demonstrated that ineffective TA had no impact on medium-term mortality&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Few studies have addressed the problem of failed TA&#46; In a study by Vink et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> of 1399 patients&#44; the aspiration catheter could not reach or cross the lesion in 10&#46;3&#37; of cases&#44; independent predictors of failure being vessel tortuosity&#44; calcified lesions and bifurcation&#46; No thrombotic material could be retrieved in a further 27&#46;3&#37;&#44; predictors for which were age and the circumflex being the infarct-related artery&#46; In the TASTE registry&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> thrombectomy was not possible in 16&#37; and was ineffective in 11&#37;&#59; and in the INFUSE-AMI trial&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> exclusively of patients with occlusion of the anterior descending artery&#44; the failure rate was 1&#46;7&#37;&#46; It is thus clear that aspiration thrombectomy may be impossible or ineffective in certain cases&#44; important factors being the composition and size of the thrombus and coronary anatomy&#44; and possibly operator experience&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">It is not surprising that the anatomical features of lesions should affect the success of thrombectomy&#44; especially since the technique is used in any artery with an occlusive thrombus&#59; nor it is surprising that ischemic time should be a predictor of failure&#44; since the degree of thrombus organization is likely to affect the procedure&#39;s efficacy&#44; or that failure has no impact on mortality in the light of previous studies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the study by Luz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> mean ischemic time was over five hours in patients in whom TA was ineffective &#40;332&#46;5 min&#44; interquartile range&#58; 393 min&#41; and significantly shorter in successful TA &#40;210 min&#44; p&#61;0&#46;002&#41;&#46; By way of comparison&#44; in the study by Vink et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> mean ischemic time was three hours for both effective and ineffective TA&#46; With regard to clinical outcomes&#44; Luz et al&#46; reported no reflow in 35&#46;3&#37; of cases of ineffective TA &#40;as opposed to 1&#46;4&#37; in effective TA&#44; p&#60;0&#46;001&#41;&#44; which may be related to Killip class III&#47;IV &#40;p&#61;0&#46;031&#41; and use of intra-aortic balloon pump &#40;p&#61;0&#46;002&#41;&#46; There was also a tendency for higher in-hospital mortality &#40;p&#61;0&#46;073&#41;&#44; which might have been statistically significant had the study population been larger&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The greatest challenge now in the treatment of ST-elevation MI &#40;STEMI&#41; is not only to restore normal coronary flow but also to improve microvascular perfusion&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Recent years have seen considerable research into antithrombotic agents as adjunctive therapy in primary angioplasty&#46; The acute phase of STEMI is a highly prothrombotic state and early&#44; effective antiplatelet therapy is considered essential in achieving optimal myocardial reperfusion&#46; P2Y12 receptor inhibitors &#40;clopidogrel&#44; prasugrel and ticagrelor&#41; should be initiated as soon as possible before primary angioplasty&#44; although their use in the pre-hospital phase is the subject of debate&#46; A possible limitation is increased bleeding risk if taken together with glycoprotein &#40;Gp&#41; IIb&#47;IIIa inhibitors and for this reason the latter are now being used less&#46; The ideal antithrombotic therapy is far from consensual&#46;</p><p id="par1055" class="elsevierStylePara elsevierViewall">Intracoronary administration of Gp IIb&#47;IIIa inhibitors was first described in 1999 as a way to dissolve thrombi and thus reduce adverse events in MI&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Local administration is more beneficial than intravenous infusion due to the higher drug concentration&#44; and the benefits are even greater if the drug is delivered locally into the target artery by means of a dedicated perfusion catheter&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par2055" class="elsevierStylePara elsevierViewall">The recent INFUSE-AMI randomized trial<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> compared manual aspiration thrombectomy and bolus intracoronary abciximab with conventional primary PCI in 452 patients with anterior MI&#46; Only intracoronary abciximab was shown to reduce infarct size&#46; Patients who underwent thrombectomy&#44; with or without abciximab&#44; showed a higher rate of TIMI flow 3 and those undergoing thrombectomy with abciximab had the greatest reduction in infarct size&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Comparing patients in terms of delay to reperfusion &#40;&#60;3 vs&#46; &#62;3 h&#41;&#44; shorter ischemic time was an important predictor of reduced infarct size and mortality at one year&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Another recent study&#44; albeit small&#44; confirmed improved myocardial perfusion with the combined use of intracoronary abciximab and TA&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Similarly&#44; intracoronary fibrinolysis with low-dose urokinase&#44; tenecteplase or alteplase has also been described in cases of large thrombus burden and failed manual aspiration&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">It is surprising that in the study by Luz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">12</span></a> while aspirin 300 mg and clopidogrel 600 mg were given to all patients before PCI&#44; use of Gp IIb&#47;IIIa inhibitors was low overall and similar in those with ineffective &#40;38&#37;&#41; and effective TA &#40;33&#46;5&#37;&#41;&#46; In the Portuguese National Registry of Interventional Cardiology&#44; of 3311 patients who underwent thrombectomy between January 2006 and December 2012 &#40;performed in 46&#46;1&#37; of PCI procedures in 2012&#41;&#44; use of Gp IIb&#47;IIIa inhibitors was also low &#40;36&#46;9&#37;&#41; but significantly higher than in those undergoing primary angioplasty alone &#40;18&#46;9&#37;&#44; p&#61;0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Bearing in mind that reperfusion remains suboptimal in 20&#8211;30&#37; of patients&#44; despite considerable advances in the techniques and equipment used in primary angioplasty&#44; including manual TA&#44; adjunctive drug therapy will continue to play a role&#46; For the interventional cardiologist&#44; the combination of TA and intracoronary or local delivery of Gp IIb&#47;IIIa inhibitors is in theory an attractive option for maximizing microvascular perfusion&#46; The challenge will be the judicious concomitant use of anticoagulants and potent antiplatelets that provides a positive risk-benefit ratio for the individual patient&#46; In the meantime&#44; the most important aspect of STEMI treatment remains reperfusion as early as possible&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gomes RS&#46; Trombectomia aspirativa&#58; apenas mais uma pe&#231;a do <span class="elsevierStyleItalic">puzzle</span>&#46; Intuitiva&#44; mas n&#227;o suficiente&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;761&#8211;764&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reopening of infarct-occluded vessel by transluminal recanalisation and intracoronary streptokinase application"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Rentrop"
                            1 => "H&#46; Blanke"
                            2 => "K&#46;R&#46; Karsch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dtsch Med Wochschr"
                        "fecha" => "1979"
                        "volumen" => "104"
                        "paginaInicial" => "1438"
                        "paginaFinal" => "1440"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; DeWood"
                            1 => "J&#46; Spores"
                            2 => "R&#46; Notske"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198010163031601"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1980"
                        "volumen" => "303"
                        "paginaInicial" => "897"
                        "paginaFinal" => "902"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7412821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of ST-elevation myocardial infarction&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;T&#46; O¿Gara"
                            1 => "F&#46;G&#46; Kushner"
                            2 => "D&#46;D&#46; Ascheim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e3182742cf6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "e362"
                        "paginaFinal" => "e425"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23247304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation&#46; The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Steg"
                            1 => "S&#46;K&#46; James"
                            2 => "D&#46; Atar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs215"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2569"
                        "paginaFinal" => "2619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study &#40;TAPAS&#41;&#58; a 1-year follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;J&#46; Vlaar"
                            1 => "T&#46; Svilaas"
                            2 => "I&#46;C&#46; van der Horst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60833-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "371"
                        "paginaInicial" => "1915"
                        "paginaFinal" => "1920"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18539223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty&#46; An updated meta-analysis of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Kumbhani"
                            1 => "A&#46;A&#46; Bavry"
                            2 => "M&#46;Y&#46; Desai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.04.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "1409"
                        "paginaFinal" => "1418"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23665372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention&#58; findings from the HORIZONS-AMI trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;W&#46; Nilsen"
                            1 => "R&#46; Mehran"
                            2 => "R&#46;S&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.24705"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2013"
                        "volumen" => "82"
                        "paginaInicial" => "594"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23074151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus aspiration during ST-elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46; Fr&#246;bert"
                            1 => "B&#46; Lagerqvist"
                            2 => "G&#46;K&#46; Olivecrona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1308789"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "1587"
                        "paginaFinal" => "1597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23991656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimization in stent implantation by manual thrombus aspiration in ST-segment-elevation myocardial infarction&#58; findings from the EXAMINATION trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Fern&#225;ndez-Rodr&#237;guez"
                            1 => "A&#46; Regueiro"
                            2 => "S&#46; Brugaletta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCINTERVENTIONS.113.000964"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Interv"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "294"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24867891"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes 1 year after thrombus aspiration for myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Lagerqvist"
                            1 => "O&#46; Fr&#246;bert"
                            2 => "G&#46;K&#46; Olivecrona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1405707"
                      "Revista" => array:2 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and rationale of the TOTAL trial&#58; a randomized trial of routine aspiration ThrOmnecTomy with percutaneous coronary intervention &#40;PCI&#41; versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Jolly"
                            1 => "J&#46; Cairns"
                            2 => "S&#46; Yusuf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2013.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2014"
                        "volumen" => "167"
                        "paginaInicial" => "315"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24576514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A trombectomia aspirativa na reperfus&#227;o do enfarte agudo de mioc&#225;rdio&#58; preditores e impacto cl&#237;nico da sua inefic&#225;cia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Luz"
                            1 => "P&#46; Rodrigues"
                            2 => "M&#46;J&#46; Sousa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2014.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2014"
                        "volumen" => "33"
                        "paginaInicial" => "761"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25481781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and angiographic predictors and prognostic value of failed thrombus aspiration in primary percutaneous coronary intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Vink"
                            1 => "M&#46;C&#46; Kramer"
                            2 => "X&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "634"
                        "paginaFinal" => "642"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction&#46; The INFUSE-AMI Randomized Trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;W&#46; Stone"
                            1 => "A&#46; Maehara"
                            2 => "B&#46; Witzenbichler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.421"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "1817"
                        "paginaFinal" => "1826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22447888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful dissolution of occlusive coronary thrombus with local administration of abciximab during PTCA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;L&#46; Bartorelli"
                            1 => "D&#46; Trabattoni"
                            2 => "S&#46; Galli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "1999"
                        "volumen" => "48"
                        "paginaInicial" => "211"
                        "paginaFinal" => "213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10506783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local delivery versus intracoronary infusion of abciximab in patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Prati"
                            1 => "D&#46; Capodanno"
                            2 => "T&#46; Pawlowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2010"
                        "volumen" => "3"
                        "paginaInicial" => "928"
                        "paginaFinal" => "934"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction&#58; insights from the INFUSE-AMI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Brener"
                            1 => "J&#46;-H&#46; Dambrink"
                            2 => "A&#46; Maehara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4244/EIJV9I10A201"
                      "Revista" => array:6 [
                        "tituloSerie" => "EuroIntervention"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24561570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of delay to reperfusion on reperfusion success&#44; infarct size&#44; and clinical outcomes in patients with ST-segment elevation myocardial infarction&#46; The INFUSE-AMI Trial &#40;INFUSE-Anterior Myocardial Infarction&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Guerchicoff"
                            1 => "S&#46;J&#46; Brener"
                            2 => "A&#46; Maehara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "733"
                        "paginaFinal" => "740"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of combination treatment with intracoronary abciximab and aspiration thrombectomy on myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary coronary stenting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;G&#46; Ahn"
                            1 => "S&#46;H&#46; Lee"
                            2 => "J&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3349/ymj.2014.55.3.606"
                      "Revista" => array:6 [
                        "tituloSerie" => "Yonsei Med J"
                        "fecha" => "2014"
                        "volumen" => "55"
                        "paginaInicial" => "606"
                        "paginaFinal" => "616"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24719126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of local delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention &#40;the Delivery of thrombolytics before thrombectomy In patients with ST-Segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary InterventiON &#91;DISSOLUTION&#93; randomized trial&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Greco"
                            1 => "F&#46; Pelliccia"
                            2 => "G&#46; Tanzilli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2013.04.036"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2013"
                        "volumen" => "112"
                        "paginaInicial" => "630"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23711809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Boscarelli"
                            1 => "B&#46; Vaquerizo"
                            2 => "F&#46; Miranda-Guardiola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus aspiration in patients with ST-elevation myocardial infarction&#58; results of a national registry of interventional cardiology"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of Investigators of National Registry of Interventional Cardiology"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Pereira"
                            1 => "D&#46; Caldeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Oral communication at the XXX European Congress of Cardiology"
                        "conferencia" => "Barcelona"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003300000012/v1_201501081043/S217420491400258X/v1_201501081043/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000012/v1_201501081043/S217420491400258X/v1_201501081043/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491400258X?idApp=UINPBA00004E"
]
Article information
ISSN: 21742049
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 4 7 11
2024 October 29 22 51
2024 September 28 21 49
2024 August 40 31 71
2024 July 32 29 61
2024 June 24 18 42
2024 May 24 20 44
2024 April 26 24 50
2024 March 31 16 47
2024 February 31 19 50
2024 January 22 27 49
2023 December 19 27 46
2023 November 33 21 54
2023 October 22 15 37
2023 September 22 23 45
2023 August 20 16 36
2023 July 19 8 27
2023 June 28 11 39
2023 May 43 26 69
2023 April 15 3 18
2023 March 38 29 67
2023 February 32 18 50
2023 January 17 15 32
2022 December 35 23 58
2022 November 37 19 56
2022 October 22 21 43
2022 September 20 19 39
2022 August 12 37 49
2022 July 33 29 62
2022 June 19 20 39
2022 May 16 30 46
2022 April 23 27 50
2022 March 20 18 38
2022 February 20 24 44
2022 January 24 18 42
2021 December 15 25 40
2021 November 28 32 60
2021 October 25 31 56
2021 September 22 30 52
2021 August 21 25 46
2021 July 16 17 33
2021 June 16 28 44
2021 May 21 24 45
2021 April 35 32 67
2021 March 53 19 72
2021 February 32 13 45
2021 January 24 14 38
2020 December 17 6 23
2020 November 30 10 40
2020 October 22 9 31
2020 September 27 15 42
2020 August 18 4 22
2020 July 37 12 49
2020 June 33 6 39
2020 May 26 5 31
2020 April 33 3 36
2020 March 39 9 48
2020 February 43 16 59
2020 January 24 7 31
2019 December 33 3 36
2019 November 38 7 45
2019 October 44 5 49
2019 September 15 10 25
2019 August 21 3 24
2019 July 32 11 43
2019 June 40 9 49
2019 May 28 2 30
2019 April 37 9 46
2019 March 108 13 121
2019 February 78 14 92
2019 January 56 7 63
2018 December 51 9 60
2018 November 143 10 153
2018 October 273 11 284
2018 September 51 12 63
2018 August 38 4 42
2018 July 23 3 26
2018 June 32 8 40
2018 May 41 6 47
2018 April 48 4 52
2018 March 43 3 46
2018 February 31 2 33
2018 January 21 3 24
2017 December 50 32 82
2017 November 38 0 38
2017 October 40 19 59
2017 September 41 12 53
2017 August 42 15 57
2017 July 25 10 35
2017 June 45 35 80
2017 May 32 14 46
2017 April 30 8 38
2017 March 23 29 52
2017 February 26 6 32
2017 January 25 4 29
2016 December 31 14 45
2016 November 18 6 24
2016 October 19 7 26
2016 September 16 9 25
2016 August 3 3 6
2016 July 9 4 13
2016 June 17 3 20
2016 May 16 4 20
2016 April 23 2 25
2016 March 47 17 64
2016 February 63 45 108
2016 January 39 20 59
2015 December 34 13 47
2015 November 40 14 54
2015 October 43 20 63
2015 September 36 17 53
2015 August 40 14 54
2015 July 50 8 58
2015 June 31 5 36
2015 May 37 7 44
2015 April 50 19 69
2015 March 44 6 50
2015 February 50 24 74
2015 January 101 44 145
Show all

Follow this link to access the full text of the article

Idiomas
Revista Portuguesa de Cardiologia (English edition)
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.