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advances in technology and engineering have increased the availability of new materials with characteristics that enable procedures to be performed rapidly and effectively&#44; including catheters with novel geometry&#44; more maneuverable guidewires&#44; new means of mechanical thrombus aspiration&#44; and stents with better profiles&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years&#44; another important change has taken place&#58; the use of radial access in preference to the previously standard femoral access&#46; Various studies have shown radial access to be superior&#44; mainly due to a significant reduction in bleeding complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Several factors have thus come together to help achieve the main purpose of primary angioplasty&#44; which is recanalization of the culprit artery and the fastest possible return to adequate flow &#40;TIMI 3&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The accumulated experience of operators and teams have also enabled the use of certain techniques to shorten procedure time&#44; such as the first-line use of a guidewire to approach the likely culprit artery &#40;the right coronary artery in inferior MI or the left coronary in anterior MI&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study by MC Arokiaraj published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> describes the experience in their center of a series of 34 cases with a different solution&#58; the use of diagnostic catheters&#44; with a larger internal diameter&#44; for angioplasty&#44; enabling the deployment of balloons and stents&#44; as well as of catheters for intravascular ultrasound and optical coherence tomography&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This solution is recommended for emergency situations&#44; particularly MI and acute coronary syndromes&#44; in which selective catheterization of the culprit artery with appropriate guide catheters is more difficult&#44; thus avoiding prolonged procedure time and the use of greater quantities of contrast agents and hence risk of nephrotoxicity&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As the author points out&#44; this variation from the usual technique has significant practical limitations&#44; notably when more complex maneuvers are foreseen&#44; such as for treating bifurcations or when mechanical thrombus aspiration will be required&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">It is also important to note that&#44; in the patient group described here&#44; radial access&#44; in which the criteria for choice of catheters are different&#44; was not used&#44; and all the catheters were from a single manufacturer&#46; It is unclear whether the considerations presented can be generalized to the different equipment available at other laboratories&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Irrespective of the advantages that this solution may have in specific situations&#44; we would highlight the crucial importance of the level of experience of centers and of operators performing primary angioplasty for MI and other acute coronary syndromes&#46; This experience is directly related to the volume of procedures<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and is without doubt an essential factor in obtaining good clinical outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Editorial comment
Keep it as simple as possible
Deixá-lo tão simples quanto possível
Rui Ferreira
Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary angioplasty as revascularization therapy to treat myocardial infarction &#40;MI&#41; significantly reduces mortality in patients with this condition&#44; for which it is currently the treatment of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> MI is a true cardiovascular emergency&#44; given the linear relationship between time since onset and outcome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The decision to adopt this therapeutic strategy obviously requires the operator to have specific skills&#44; which are strongly influenced by the annual volume of procedures performed at the center and by each operator individually&#46; On the basis of multiple studies&#44; recommended minimum volumes of procedures have been defined&#44; which are now stipulated in the international guidelines&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">From a technical standpoint&#44; advances in technology and engineering have increased the availability of new materials with characteristics that enable procedures to be performed rapidly and effectively&#44; including catheters with novel geometry&#44; more maneuverable guidewires&#44; new means of mechanical thrombus aspiration&#44; and stents with better profiles&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years&#44; another important change has taken place&#58; the use of radial access in preference to the previously standard femoral access&#46; Various studies have shown radial access to be superior&#44; mainly due to a significant reduction in bleeding complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Several factors have thus come together to help achieve the main purpose of primary angioplasty&#44; which is recanalization of the culprit artery and the fastest possible return to adequate flow &#40;TIMI 3&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The accumulated experience of operators and teams have also enabled the use of certain techniques to shorten procedure time&#44; such as the first-line use of a guidewire to approach the likely culprit artery &#40;the right coronary artery in inferior MI or the left coronary in anterior MI&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study by MC Arokiaraj published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> describes the experience in their center of a series of 34 cases with a different solution&#58; the use of diagnostic catheters&#44; with a larger internal diameter&#44; for angioplasty&#44; enabling the deployment of balloons and stents&#44; as well as of catheters for intravascular ultrasound and optical coherence tomography&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This solution is recommended for emergency situations&#44; particularly MI and acute coronary syndromes&#44; in which selective catheterization of the culprit artery with appropriate guide catheters is more difficult&#44; thus avoiding prolonged procedure time and the use of greater quantities of contrast agents and hence risk of nephrotoxicity&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As the author points out&#44; this variation from the usual technique has significant practical limitations&#44; notably when more complex maneuvers are foreseen&#44; such as for treating bifurcations or when mechanical thrombus aspiration will be required&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">It is also important to note that&#44; in the patient group described here&#44; radial access&#44; in which the criteria for choice of catheters are different&#44; was not used&#44; and all the catheters were from a single manufacturer&#46; It is unclear whether the considerations presented can be generalized to the different equipment available at other laboratories&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Irrespective of the advantages that this solution may have in specific situations&#44; we would highlight the crucial importance of the level of experience of centers and of operators performing primary angioplasty for MI and other acute coronary syndromes&#46; This experience is directly related to the volume of procedures<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and is without doubt an essential factor in obtaining good clinical outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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                      "titulo" => "2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST segment elevation&#58; the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology &#40;ESC&#41;"
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ISSN: 21742049
Original language: English
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Revista Portuguesa de Cardiologia (English edition)
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