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Est&#227;o inclu&#237;dos no registo 220 doentes&#44; mas apenas foram avaliados neste estudo os doentes que foram submetidos a ICP com DEB h&#225; mais de 12 meses&#44; de forma a possibilitar um seguimento cl&#237;nico de pelo menos um ano&#46; Foram eleg&#237;veis doentes com mais de 18 anos e com evid&#234;ncia cl&#237;nica de isquemia mioc&#225;rdica&#46; N&#227;o houve crit&#233;rios de exclus&#227;o relativamente &#224; forma de apresenta&#231;&#227;o da doen&#231;a coron&#225;ria ou &#224; complexidade das les&#245;es&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados foram colhidos prospetivamente e registados numa base de dados inform&#225;tica presente igualmente nas duas unidades de cardiologia de interven&#231;&#227;o &#40;Cardiobase<span class="elsevierStyleSup">&#174;</span>&#44; Infortucano&#8482;&#41;&#46; Todos os doentes deram o seu consentimento informado&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimento de interven&#231;&#227;o coron&#225;ria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Os aspetos t&#233;cnicos relacionados com o procedimento de ICP foram efetuados de acordo com as normas de boa pr&#225;tica habitualmente aceites&#46; A sele&#231;&#227;o da t&#233;cnica e estrat&#233;gia de revasculariza&#231;&#227;o foi por decis&#227;o dos operadores&#44; assim como a escolha do acesso vascular&#44; o uso de inibidores da glicoprote&#237;na <span class="elsevierStyleSmallCaps">ii</span>b&#47;<span class="elsevierStyleSmallCaps">iii</span>a&#44; a necessidade de p&#243;s-dilata&#231;&#227;o ou de coloca&#231;&#227;o de <span class="elsevierStyleItalic">stent</span> em <span class="elsevierStyleItalic">bail out</span>&#46; Foi recomendada a administra&#231;&#227;o de heparina n&#227;o fracionada em forma de b&#243;lus endovenoso numa dose de 70-100&#160;U&#47;kg&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os bal&#245;es eluidores de f&#225;rmaco utilizados encontravam-se revestidos por paclitaxel numa dose de 3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mm<span class="elsevierStyleSup">2</span> &#40;Sequent Please<span class="elsevierStyleSup">&#174;</span>&#44; B-Braun&#8482;&#41; e apresentaram di&#226;metros que variaram entre 2&#44;5-4&#44;0<span class="elsevierStyleHsp" style=""></span>mm e comprimentos entre 10 e 30<span class="elsevierStyleHsp" style=""></span>mm&#46; Recomendou-se um <span class="elsevierStyleItalic">ratio</span> art&#233;ria-bal&#227;o de 1&#58;1 e um tempo de insufla&#231;&#227;o de 60&#160;s&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos os doentes foram medicados na altura da interven&#231;&#227;o com clopidogrel &#40;75<span class="elsevierStyleHsp" style=""></span>mg no caso de tratamento cr&#243;nico com clopidogrel&#160;&#62;&#160;10&#160;d&#44; e 600<span class="elsevierStyleHsp" style=""></span>mg&#44; se n&#227;o&#41;&#46; Depois da ICP&#44; todos os doentes foram medicados com aspirina &#40;&#8804;&#160;150<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; e clopidogrel &#40;75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; por um per&#237;odo m&#237;nimo de 3 meses&#44; seguido de tratamento com monoagrega&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimento cl&#237;nico e <span class="elsevierStyleItalic">endpoint</span> do estudo</span><p id="par0050" class="elsevierStylePara elsevierViewall">O seguimento cl&#237;nico foi efetuado por contacto telef&#243;nico e por consulta dos registos cl&#237;nicos dos doentes&#46; Todos os doentes foram seguidos aos 30&#160;d e por um per&#237;odo m&#237;nimo de um ano ou at&#233; ocorr&#234;ncia de morte&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">endpoint</span> do estudo foi uma combina&#231;&#227;o de morte por todas as causas&#44; EAM n&#227;o fatal e revasculariza&#231;&#227;o da les&#227;o alvo &#40;TLR&#41;&#46; O <span class="elsevierStyleItalic">endpoint</span> foi analisado a um ano de seguimento&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As mortes foram classificadas como card&#237;aca ou n&#227;o card&#237;aca&#44; com todas as mortes consideradas de etiologia card&#237;aca&#44; a menos que uma causa n&#227;o card&#237;aca inequ&#237;voca fosse estabelecida&#46; O EAM foi definido de acordo com a nova defini&#231;&#227;o universal<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; A revasculariza&#231;&#227;o da les&#227;o alvo incluiu reinterven&#231;&#227;o percut&#226;nea ou cir&#250;rgica no segmento previamente tratado envolvendo 5<span class="elsevierStyleHsp" style=""></span>mm dos seus bordos proximal ou distal&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A trombose de <span class="elsevierStyleItalic">stent</span> definitiva ou prov&#225;vel foi definida segundo a defini&#231;&#227;o da <span class="elsevierStyleItalic">Academic Research and Consortium</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Definiu-se como sucesso do dispositivo a capacidade do DEB ultrapassar a les&#227;o e ser expandido com sucesso&#46; O sucesso angiogr&#225;fico foi definido como fluxo TIMI 3 final&#44; com estenose residual inferior ou igual a 30&#37;&#46; O sucesso do procedimento foi definido como o sucesso do dispositivo sem a ocorr&#234;ncia de MACE durante o internamento <span class="elsevierStyleItalic">index</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis cont&#237;nuas foram testadas para a distribui&#231;&#227;o normal atrav&#233;s do teste de <span class="elsevierStyleItalic">Kolmogorov-Smirnov</span> e para a igualdade de vari&#226;ncias pelo teste de <span class="elsevierStyleItalic">Levene</span>&#46; As vari&#225;veis cont&#237;nuas foram apresentadas por m&#233;dia&#160;&#177;&#160;desvio padr&#227;o e comparadas atrav&#233;s do teste <span class="elsevierStyleItalic">T de Student&#46;</span> As vari&#225;veis cont&#237;nuas que n&#227;o seguiram o padr&#227;o da normalidade ou semelhan&#231;a de vari&#226;ncias foram apresentadas por medianas com os respetivos intervalos interquartis e comparadas atrav&#233;s do teste de <span class="elsevierStyleItalic">Mann-Whitney&#46;</span> As vari&#225;veis categ&#243;ricas foram apresentadas sob a forma de percentagem e comparadas utilizando o teste de Qui-quadrado ou de Fisher&#44; conforme apropriado&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Procedeu-se ao c&#225;lculo dos <span class="elsevierStyleItalic">hazard ratios</span> &#40;HR&#41; e respetivo intervalo de confian&#231;a a 95&#37; &#40;IC&#41; para a ocorr&#234;ncia de MACE a um ano de seguimento&#46; Efetuou-se uma an&#225;lise de regress&#227;o de <span class="elsevierStyleItalic">Cox</span> para avaliar o impacto das caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas e de procedimento no <span class="elsevierStyleItalic">endpoint</span> do estudo a um ano&#46; No modelo de an&#225;lise multivari&#225;vel&#44; as vari&#225;veis foram selecionadas de acordo com o seu peso na an&#225;lise univariada &#40;valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 e menor intervalo de confian&#231;a de 95&#37;&#41;&#46; O modelo final foi constru&#237;do por <span class="elsevierStyleItalic">forward stepwise</span> com p de entrada e sa&#237;da de 0&#44;05 e 0&#44;1&#44; respetivamente&#46; A incid&#234;ncia cumulativa de eventos adversos foi calculado de acordo com o m&#233;todo de Kaplan-Meier e as diferen&#231;as foram avaliadas pelo teste de <span class="elsevierStyleItalic">log-rank</span>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Foi considerado estatisticamente significativo quando p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; A an&#225;lise estat&#237;stica foi efetuada em <span class="elsevierStyleItalic">software Statistical Pack for Social Sciences</span> &#40;SPSS&#41;&#44; vers&#227;o 17&#46;0 &#40;Institute&#44; Estados Unidos&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas basais</span><p id="par0090" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 156 doentes consecutivos &#40;idade m&#233;dia 66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 anos&#44; 73&#37; sexo masculino&#41; submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea com bal&#245;es revestidos por paclitaxel&#46; As caracter&#237;sticas basais e a apresenta&#231;&#227;o cl&#237;nica da ICP <span class="elsevierStyleItalic">index</span> encontram-se descritas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Trata-se de uma <span class="elsevierStyleItalic">cohort</span> de doentes de elevado risco com 44&#37; de diab&#233;ticos e 83&#37; hipertensos&#46; A maioria dos doentes apresentou doen&#231;a coron&#225;ria conhecida e intervencionada previamente &#40;76&#37; submetidos a ICP anteriormente e 21&#37; a CABG&#41;&#46; Cerca de tr&#234;s quartos da popula&#231;&#227;o apresentou doen&#231;a coron&#225;ria de 2 ou mais vasos e frequentemente a ICP foi no contexto de EAM &#40;30&#37;&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas do procedimento</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nos 156 doentes inclu&#237;dos&#44; foram tratadas 184 les&#245;es com 206 DEB &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; A art&#233;ria descendente anterior foi a mais frequentemente envolvida &#40;43&#37;&#41;&#46; As indica&#231;&#245;es para o uso de DEB foram&#44; de forma equilibrada&#44; a reestenose intra-<span class="elsevierStyleItalic">stent</span> pr&#233;via em 52&#37; &#40;dos quais 30&#37; foram <span class="elsevierStyleItalic">stents</span> met&#225;licos e 70&#37; <span class="elsevierStyleItalic">stents</span> revestidos por f&#225;rmaco&#41; e a doen&#231;a coron&#225;ria de novo em 48&#37;&#44; maioritariamente por doen&#231;a dos pequenos vasos&#46; O padr&#227;o da reestenose intra-<span class="elsevierStyleItalic">stent</span> foi em 48&#37; dos casos difuso&#46; Antes da utiliza&#231;&#227;o do DEB&#44; a maioria dos doentes foi submetida a pr&#233;-dilata&#231;&#227;o &#40;80&#37;&#41;&#46; As medianas do di&#226;metro e do comprimento do DEB foram de 2&#44;5<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo interquartil &#91;IQR&#93; 2&#44;5-3&#44;0&#41; e de 20<span class="elsevierStyleHsp" style=""></span>mm &#40;IQR 15-26&#41;&#44; respetivamente&#46; Cinco les&#245;es foram submetidas a coloca&#231;&#227;o de <span class="elsevierStyleItalic">stent</span> por <span class="elsevierStyleItalic">bail-out</span> &#40;4 por dissec&#231;&#227;o e um por <span class="elsevierStyleItalic">recoil</span> significativo&#41;&#46; O sucesso do dispositivo foi de 98&#37;&#58; em 3 doentes n&#227;o foi poss&#237;vel atravessar a les&#227;o com o DEB&#44; um no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> numa p&#243;stero-lateral &#40;DEB 2&#44;75&#47;15<span class="elsevierStyleHsp" style=""></span>mm&#41; e 2 em doen&#231;a coron&#225;ria de pequenos vasos na circunflexa distal e descendente anterior m&#233;dia &#40;DEB 2&#44;5&#47;15 e 2&#44;5&#47;17<span class="elsevierStyleHsp" style=""></span>mm&#44; respetivamente&#41;&#46; O sucesso angiogr&#225;fico por les&#227;o foi de 98&#37; &#40;2 les&#245;es com fluxo TIMI 2 final e 2 les&#245;es com estenose residual superior a 30&#37;&#41;&#46; O sucesso do procedimento foi de 96&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Preditores do <span class="elsevierStyleItalic">endpoint</span> do estudo</span><p id="par0105" class="elsevierStylePara elsevierViewall">Aos 30&#160;d de seguimento&#44; houve 6 eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;MACE&#41;&#44; 2 mortes de causa cardiovascular&#44; 4 EAM e 2 TLR&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A um ano de seguimento nove doentes &#40;5&#44;8&#37;&#41; faleceram&#44; sete de causa card&#237;aca&#44; nove tiveram um EAM &#40;5&#44;8&#37;&#41; e oito &#40;5&#44;1&#37;&#41; tiveram TLR&#44; com uma incid&#234;ncia combinada de eventos de 14&#44;1&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; N&#227;o houve nenhum caso de trombose de <span class="elsevierStyleItalic">stent</span> definitiva ou prov&#225;vel documentada&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;as na taxa de MACE ou TLR entre os grupos tratados com DEB por reestenose intra-<span class="elsevierStyleItalic">stent</span> ou doen&#231;a coron&#225;ria de novo &#40;13&#44;6&#37; <span class="elsevierStyleItalic">versus</span> 14&#44;7&#37; de MACE&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;846 e 6&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 4&#44;0&#37; de TLR&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;721&#41;&#46; O tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos &#40;DES&#41; com DEB apresentou as mesmas taxas de MACE &#40;14&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 12&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;000&#41; e TLR a um ano &#40;5&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 8&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;633&#41; comparadas com a ICP da reestenose de <span class="elsevierStyleItalic">stents</span> met&#225;licos &#40;BMS&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por an&#225;lise univariada &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">Tabelas 4 e 5</a>&#41;&#44; foram preditores de MACE a um ano a presen&#231;a de EAM e CABG pr&#233;vias&#44; s&#237;ndrome coron&#225;ria aguda na apresenta&#231;&#227;o e ICP da descendente anterior no caso &#237;ndex&#46; A doen&#231;a multivaso esteve tendencialmente associada a mais eventos cardiovasculares adversos a um ano &#40;HR 4&#44;04&#59; 95&#37;IC 0&#44;94-17&#44;28&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;060&#41;&#46; Hist&#243;ria pr&#233;via de CABG foi o &#250;nico preditor de TLR a um ano &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a>&#41;&#46; N&#227;o foram preditores de MACE ou de TLR a 1 ano&#44; a diabetes&#44; a disfun&#231;&#227;o ventricular esquerda&#44; assim como a reestenose intra-<span class="elsevierStyleItalic">stent</span>&#44; o comprimento e o di&#226;metro do DEB&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Ap&#243;s ajuste &#224;s vari&#225;veis demogr&#225;ficas e caracter&#237;sticas cl&#237;nicas basais&#44; a an&#225;lise multivariada identificou a hist&#243;ria pr&#233;via de EAM &#40;HR 3&#44;46&#59; 95&#37; IC&#44; 1&#44;35-8&#44;84&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41; e a ICP da descendente anterior &#40;DA&#41; &#40;HR 2&#44;81&#59; 95&#37; IC&#44; 1&#44;21-6&#44;51&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41; como preditores independentes de MACE a 1 ano &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46; Foram preditores independentes de TLR a um ano a hist&#243;ria pr&#233;via de CABG &#40;HR 5&#44;48&#59; 95&#37; IC&#44; 1&#44;34-22&#44;35&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41; e ICP da DA &#40;HR 4&#44;76&#59; 95&#37; IC&#44; 1&#44;11-20&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Os doentes submetidos a interven&#231;&#227;o percut&#226;nea com DEB na descendente anterior proximal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#160;dts&#41; apresentaram um maior perfil de risco cardiovascular&#44; sendo mais frequentemente diab&#233;ticos e hipertensos &#40;57&#37; de diab&#233;ticos e 92&#37; de hipertensos na ICP da DA <span class="elsevierStyleItalic">versus</span> 38&#37; de diab&#233;ticos e 79&#37; de hipertensos na ICP dos outros vasos&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#44; respetivamente&#41;&#46; Os doentes com hist&#243;ria de enfarte pr&#233;vio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71 dts&#41; foram doentes com mais hist&#243;ria de revasculariza&#231;&#227;o coron&#225;ria pr&#233;via &#40;90&#37; submetidos a ICP pr&#233;via e 32&#37; a CABG <span class="elsevierStyleItalic">versus</span> 64&#37; de ICP pr&#233;via e 11&#37; de CABG nos doentes sem hist&#243;ria de EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001 respetivamente&#41;&#44; pelo que&#44; naturalmente&#44; foram com mais frequ&#234;ncia submetidos a ICP com DEB no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> &#40;68&#37; <span class="elsevierStyleItalic">versus</span> 38&#37; no grupo de dts sem EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Neste subgrupo de doentes com hist&#243;ria de eventos isqu&#233;micos agudos no passado foi mais frequente a presen&#231;a de disfun&#231;&#227;o ventricular esquerda &#40;40&#37; <span class="elsevierStyleItalic">versus</span> 17&#37; nos doentes sem hist&#243;ria de EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Este estudo demonstrou com clareza que a angioplastia com DEB&#44; numa popula&#231;&#227;o de doentes do mundo real com les&#245;es complexas&#44; &#233; eficaz com elevado sucesso angiogr&#225;fico imediato e com baixa taxa de eventos card&#237;acos adversos <span class="elsevierStyleItalic">major</span> a um ano de seguimento&#44; incluindo revasculariza&#231;&#227;o da les&#227;o alvo&#46; Esta t&#233;cnica foi igualmente eficaz no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> pr&#233;via e doen&#231;a coron&#225;ria de novo&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nos &#250;ltimos anos&#44; os bal&#245;es eluidores de f&#225;rmaco t&#234;m-se afirmado como uma alternativa v&#225;lida para o tratamento da reestenose intra-<span class="elsevierStyleItalic">stent</span>&#44; fruto dos bons resultados obtidos nos ensaios cl&#237;nicos efetuados<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; E&#44; apesar de&#44; em termos te&#243;ricos&#44; apresentarem a mesma limita&#231;&#227;o do <span class="elsevierStyleItalic">recoil</span> agudo e do poss&#237;vel <span class="elsevierStyleItalic">remodeling</span> negativo tardio que apresentam os bal&#245;es convencionais&#44; a perda luminal tardia <span class="elsevierStyleItalic">&#40;late lumen loss&#41;</span> dos DEB ao longo do seguimento nos estudos pr&#233;vios efetuados tem sido consistentemente baixa &#40;aproximadamente 0&#44;2<span class="elsevierStyleHsp" style=""></span>mm&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; O PACCOCATH ISR I<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> foi o primeiro estudo aleatorizado a comparar a angioplastia com DEB <span class="elsevierStyleItalic">versus</span> bal&#227;o convencional na reestenose <span class="elsevierStyleItalic">intra-stent</span> e mostrou que a estrat&#233;gia com DEB se associou a uma reduzida incid&#234;ncia de reestenose com uma <span class="elsevierStyleItalic">late lumen loss in-segment</span> de apenas 0&#44;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48<span class="elsevierStyleHsp" style=""></span>mm aos 6 meses&#44; e significativamente inferior &#224; do bal&#227;o convencional &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; O PEPCAD <span class="elsevierStyleSmallCaps">II</span> comparou a seguran&#231;a e efic&#225;cia do tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> met&#225;licos &#40;BMS&#41; com DEB <span class="elsevierStyleItalic">versus</span> angioplastia com <span class="elsevierStyleItalic">stents</span> Taxus&#8482;&#44; revestidos por paclitaxel &#40;DES&#41;&#46; Mais uma vez&#44; o <span class="elsevierStyleItalic">endpoint</span> prim&#225;rio foi a <span class="elsevierStyleItalic">late lumen loss</span> aos 6 meses&#44; que foi inferior no grupo tratado com DEB &#40;0&#44;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;42 <span class="elsevierStyleItalic">versus</span> 0&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; Uma limita&#231;&#227;o apontada para estes estudos tem sido o facto de o <span class="elsevierStyleItalic">end-point</span> prim&#225;rio utilizado ser a <span class="elsevierStyleItalic">late lumen loss</span>&#44; que &#233; apenas um <span class="elsevierStyleItalic">surrogate end-point</span> dos resultados da angioplastia&#46; No caso do PEPCAD <span class="elsevierStyleSmallCaps">II&#44;</span> este &#237;ndice de compara&#231;&#227;o entre duas estrat&#233;gias diferentes &#40;bal&#227;o <span class="elsevierStyleItalic">versus stent</span>&#41; confere desvantagem &#224; estrat&#233;gia de angioplastia com <span class="elsevierStyleItalic">stent</span>&#44; porque o c&#225;lculo da <span class="elsevierStyleItalic">late lumen loss</span> est&#225; diretamente dependente do <span class="elsevierStyleItalic">acute gain</span>&#44; que &#233; sempre superior na ICP com <span class="elsevierStyleItalic">stent</span> &#40;quanto maior o ganho luminal na fase aguda&#44; tamb&#233;m maior vai ser a perda luminal tardia&#41;&#46; Assim&#44; &#233; expect&#225;vel que a estrat&#233;gia de ICP com bal&#227;o esteja associada a menor perda luminal no seguimento<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; No entanto&#44; ambos os estudos mostraram resultados cl&#237;nicos favor&#225;veis com redu&#231;&#227;o de eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;MACE&#41; na estrat&#233;gia de angioplastia com DEB<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; diferen&#231;as que se mant&#234;m num seguimento mais prolongado a 2 anos<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> &#40;46&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 11&#37; DEB&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e a 5 anos<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;59&#44;3&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 27&#44;8&#37; DEB&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; e que se devem maioritariamente a uma redu&#231;&#227;o da necessidade de revasculariza&#231;&#227;o da les&#227;o alvo &#40;38&#44;9&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 9&#44;3&#37; DEB a 5 anos&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; O presente estudo &#233; uma an&#225;lise dos MACE numa <span class="elsevierStyleItalic">cohort</span> de alto risco&#44; com les&#245;es complexas&#46; A incid&#234;ncia combinada de eventos foi de 14&#37; aos 12 meses&#44; superior quando comparada com estudos randomizados pr&#233;vios &#40;9&#37; no PACCOCATH ISR <span class="elsevierStyleSmallCaps">I</span> e <span class="elsevierStyleSmallCaps">II</span> e no PEPCAD <span class="elsevierStyleSmallCaps">II</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;11</span></a>&#46; Por outro lado&#44; n&#227;o encontr&#225;mos diferen&#231;as relativamente &#224; taxa de TLR&#44; que foi de 5&#37; no nosso estudo&#44; compar&#225;vel &#224; dos estudos pr&#233;vios &#40;4&#37; no PACCOCATH ISR <span class="elsevierStyleSmallCaps">I</span> e <span class="elsevierStyleSmallCaps">II</span> e 6&#37; no PEPCAD <span class="elsevierStyleSmallCaps">II</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;11</span></a>&#46; Isto pode ilustrar o facto de a nossa popula&#231;&#227;o ter sido <span class="elsevierStyleItalic">all comers</span>&#44; com inclus&#227;o de doentes com enfarte agudo do mioc&#225;rdio &#40;30&#37;&#41;&#44; disfun&#231;&#227;o ventricular esquerda &#40;21&#37;&#41; e insufici&#234;ncia renal cr&#243;nica &#40;9&#37;&#41;&#44; contextos que s&#227;o normalmente crit&#233;rios de exclus&#227;o de estudos pr&#233;vios&#46; A taxa mais elevada de morte e de enfarte agudo do mioc&#225;rdio no seguimento reflete assim a maior complexidade dos nossos doentes&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a> est&#227;o sumarizados os resultados cl&#237;nicos da estrat&#233;gia de angioplastia com DEB dos principais estudos randomizados e registos at&#233; &#224; data&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Quando compar&#225;mos na nossa popula&#231;&#227;o a efic&#225;cia desta estrat&#233;gia de revasculariza&#231;&#227;o na reestenose intra-<span class="elsevierStyleItalic">stent versus</span> na doen&#231;a coron&#225;ria de novo em pequenos vasos&#44; os resultados foram igualmente bons&#46; No estudo aleatorizado PICCOLETO<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; a angioplastia com DEB em vasos pequenos esteve associada a uma maior percentagem de reestenose angiogr&#225;fica e mais elevada taxa de MACE aos 9 meses do que a angioplastia com <span class="elsevierStyleItalic">stent</span> Taxus&#8482;&#44; o que motivou a interrup&#231;&#227;o precoce do estudo&#46; O DEB utilizado neste estudo foi o DIOR&#8482; de primeira gera&#231;&#227;o&#44; que tem uma farmacocin&#233;tica e bidisponibilidade diferente do <span class="elsevierStyleItalic">Sequent Please</span><span class="elsevierStyleSup">&#174;</span> e com prov&#225;vel poder antirresten&#243;tico inferior<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; No outro extremo&#44; mais recentemente&#44; o estudo aleatorizado BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a> na doen&#231;a coron&#225;ria de novo em les&#245;es com di&#226;metro de refer&#234;ncia &#60;&#160;2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#44; mostrou superioridade do DEB comparativamente ao <span class="elsevierStyleItalic">stent</span> Taxus&#8482; relativamente ao objetivo prim&#225;rio aos 6 meses &#40;<span class="elsevierStyleItalic">late lumen loss</span> 0&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;38<span class="elsevierStyleHsp" style=""></span>mm <span class="elsevierStyleItalic">versus</span> 0&#44;29&#177;0&#44;44<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; com uma baixa taxa de eventos cl&#237;nicos no grupo do DEB &#40;MACE em 7&#44;8&#37; e TLR em 4&#44;4&#37;&#41;&#46; Sabe-se que a interven&#231;&#227;o percut&#226;nea em vasos pequenos se encontra associada a uma taxa de reestenose elevada&#46; Por esse motivo&#44; est&#225; indicado&#44; sempre que poss&#237;vel&#44; o uso de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos capazes de suprimir a hiperplasia da neo&#237;ntima&#46; Dados dos estudos E-SIRIUS<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> e C-SIRIUS<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> mostraram o benef&#237;cio do <span class="elsevierStyleItalic">stent</span> Cypher&#8482; no tratamento de les&#245;es coron&#225;rias de novo longas em vasos pequenos ao reduzirem o risco de reestenose aos 8 meses quando comparado com <span class="elsevierStyleItalic">stents</span> sem f&#225;rmaco &#40;BMS&#41;&#46; Contudo&#44; <span class="elsevierStyleItalic">stents</span> implantados em pequenas art&#233;rias t&#234;m um maior <span class="elsevierStyleItalic">ratio</span> metal-art&#233;ria que pode aumentar o risco de reestenose<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Neste contexto&#44; o facto de os DEB n&#227;o apresentarem estrutura met&#225;lica pode ser uma clara vantagem&#46; Estes bal&#245;es t&#234;m ainda a vantagem de permitirem uma liberta&#231;&#227;o homog&#233;nea do f&#225;rmaco para a parede vascular&#44; ao contr&#225;rio dos DES&#44; cujo f&#225;rmaco est&#225; concentrado nos seus <span class="elsevierStyleItalic">struts</span>&#44; impossibilitando a supress&#227;o da hiperplasia da neo&#237;ntima entre os <span class="elsevierStyleItalic">struts</span> e nas margens do <span class="elsevierStyleItalic">stent</span>&#46; O f&#225;rmaco escolhido para os DEB &#233; o Paclitaxel&#44; que&#44; pelas suas propriedades lipof&#237;licas elevadas&#44; consegue permanecer no vaso at&#233; uma semana sem necessitar de uma estrutura de liberta&#231;&#227;o controlada do f&#225;rmaco associado a uma plataforma met&#225;lica e a um pol&#237;mero&#46; Assim se reduz o risco de inflama&#231;&#227;o cr&#243;nica&#44; trombose e a necessidade de tratamento antiagregante prolongado<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Algumas das limita&#231;&#245;es que t&#234;m sido apontadas ao uso deste tipo de bal&#245;es revestidos por f&#225;rmaco &#233;&#44; por um lado&#44; o facto de ocasionalmente n&#227;o conseguirem atravessar a les&#227;o a ser intervencionada e&#44; por outro&#44; poderem associar-se a dissec&#231;&#227;o ou <span class="elsevierStyleItalic">recoil</span> com um consequente resultado angiogr&#225;fico sub&#243;timo e necessidade de <span class="elsevierStyleItalic">stent</span> em <span class="elsevierStyleItalic">bail-out</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; No nosso estudo&#44; em apenas 3 doentes n&#227;o foi poss&#237;vel atravessar a les&#227;o e obtivemos uma taxa de sucesso angiogr&#225;fico muito elevada com necessidade de <span class="elsevierStyleItalic">bail-out</span> ou <span class="elsevierStyleItalic">stent</span> em apenas 3&#37; das les&#245;es&#44; muito inferior &#224; descrita em estudos pr&#233;vios &#40;28&#37; no estudo PEPCAD <span class="elsevierStyleSmallCaps">I</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; 20&#37; no estudo BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o dos preditores de eventos cardiovasculares <span class="elsevierStyleItalic">major</span> e TLR a um ano&#44; mais uma vez se verificou que s&#227;o as caracter&#237;sticas dos doentes e a sua complexidade que determinam o progn&#243;stico&#46; Vari&#225;veis como o comprimento e o di&#226;metro do bal&#227;o eluidor de f&#225;rmaco utilizado n&#227;o estiveram associados a mais reestenose cl&#237;nica no seguimento&#46; No entanto&#44; numa an&#225;lise cuidada das curvas de sobrevida livre de MACE&#44; verifica-se que as curvas relativas &#224; diabetes e ao comprimento do DEB &#40;vari&#225;veis que s&#227;o reconhecidas como preditoras de TLR em estudos pr&#233;vios<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#41; se afastam ao longo do seguimento&#44; ilustrando diferen&#231;as que poder&#227;o vir a ser significativas com mais tempo de seguimento&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Quanto ao tratamento da reestenose&#44; o estudo PEPCAD-DES<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> mostrou que os resultados do DEB no tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos foram superiores &#224; angioplastia com bal&#227;o convencional &#40;POBA&#41; com menos TLR &#40;15&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 36&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; e menos MACE &#40;16&#44;7&#37; <span class="elsevierStyleItalic">versus</span> 50&#44;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; aos 6 meses&#46; No nosso registo&#44; n&#227;o encontramos uma taxa mais elevada de eventos associados &#224; interven&#231;&#227;o na reestenose de DES&#44; o que confirma a efetividade da estrat&#233;gia de angioplastia com DEB nestes doentes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O estudo tem como limita&#231;&#245;es as que s&#227;o por natureza associadas ao formato de todos os registos&#46; Destacam-se como principais o n&#250;mero reduzido de doentes inclu&#237;dos e o tempo de seguimento ainda curto&#46; Ser&#225; interessante&#44; no futuro&#44; a avalia&#231;&#227;o dos resultados a longo prazo da angioplastia com DEB &#40;para al&#233;m de um ano de seguimento&#41;&#44; no sentido de confirmar a seguran&#231;a e a persist&#234;ncia dos bons resultados j&#225; demonstrados&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclus&#227;o</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este registo nacional com doentes de dois Centros de Cardiologia de Interven&#231;&#227;o mostrou que a interven&#231;&#227;o coron&#225;ria percut&#226;nea com um bal&#227;o eluidor de f&#225;rmaco&#44; em doentes de alto risco com les&#245;es complexas&#44; &#233; eficaz com elevado sucesso angiogr&#225;fico e com baixa taxa de eventos card&#237;acos adversos <span class="elsevierStyleItalic">major</span> a um ano de seguimento&#44; incluindo revasculariza&#231;&#227;o da les&#227;o alvo&#46; Os resultados s&#227;o igualmente bons se a interven&#231;&#227;o for no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> ou na doen&#231;a coron&#225;ria de novo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Responsabilidades &#233;ticas</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Prote&#231;&#227;o dos seres humanos e animais</span><p id="par0175" class="elsevierStylePara elsevierViewall">Os autores declaram que os procedimentos seguidos estavam de acordo com os regulamentos estabelecidos pelos respons&#225;veis da Comiss&#227;o de Investiga&#231;&#227;o Cl&#237;nica e &#201;tica e de acordo com os da Associa&#231;&#227;o M&#233;dica Mundial e da Declara&#231;&#227;o de Hels&#237;nquia&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidencialidade dos dados</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos de seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Direito &#224; privacidade e consentimento escrito</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47;ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflito de interesses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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            1 => "Small coronary vessel disease"
            2 => "In-stent restenosis"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A interven&#231;&#227;o coron&#225;ria percut&#226;nea &#40;ICP&#41; com bal&#227;o eluidor de f&#225;rmaco &#40;DEB&#41; tem vindo a ser utilizada no tratamento da reestenose intra-<span class="elsevierStyleItalic">stent</span> &#40;RIS&#41; e na doen&#231;a coron&#225;ria de pequenos vasos&#46; O objetivo foi avaliar a efic&#225;cia cl&#237;nica desta estrat&#233;gia num registo multic&#234;ntrico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Registo prospetivo de 2 centros com 156 doentes &#40;dts&#41; consecutivos inclu&#237;dos&#44; entre 2009 e 2010&#44; submetidos a ICP com pelo menos um bal&#227;o DEB&#46; Definiu-se como <span class="elsevierStyleItalic">endpoint</span> prim&#225;rio a ocorr&#234;ncia combinada &#40;MACE&#41; de todas as causas de morte&#44; EAM e revasculariza&#231;&#227;o da les&#227;o alvo &#40;TLR&#41; a um ano de seguimento&#46; Determinou-se os preditores independentes de progn&#243;stico atrav&#233;s da an&#225;lise de regress&#227;o de <span class="elsevierStyleItalic">Cox</span>&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram tratadas 184 les&#245;es com 206 DEB&#46; O sucesso do procedimento foi obtido em 98&#37; &#40;150 dts&#41;&#46; A um ano de seguimento&#44; a sobrevida livre de <span class="elsevierStyleItalic">endpoint</span> composto ocorreu em 134 dts e foi de 86&#37; &#40;morte em 6&#37;&#44; EAM em 6&#37; e TLR em 5&#37;&#41;&#46; Os preditores independentes de MACE foram a ICP na art&#233;ria descendente anterior &#40;HR 2&#44;81&#44; 95&#37; IC 1&#44;21-6&#44;51&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e hist&#243;ria pr&#233;via de EAM &#40;HR 3&#44;46&#44; 95&#37; IC 1&#44;35-8&#44;84&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; O di&#226;metro ou comprimento do DEB e a RIS n&#227;o foram preditores de eventos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A ICP com DEB em dts do mundo real e neste cen&#225;rio complexo de les&#245;es &#233; eficaz com baixa taxa de MACE a um ano de seguimento&#44; incluindo TLR&#46; Os resultados s&#227;o igualmente bons se a interven&#231;&#227;o &#233; no contexto de RIS ou na doen&#231;a coron&#225;ria de novo&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Percutaneous coronary intervention &#40;PCI&#41; with paclitaxel drug-eluting balloons &#40;DEBs&#41; is used mainly for treatment of in-stent restenosis &#40;ISR&#41; and small vessel disease&#46; Our objective was to evaluate the clinical efficacy of this strategy in a multicenter registry&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Between 2009 and 2010 a prospective registry from two centers enrolled 156 consecutive patients undergoing PCI with at least one DEB&#46; A primary composite endpoint of major adverse cardiac events &#40;MACE&#41; &#40;all-cause death&#44; myocardial infarction &#91;MI&#93; and target lesion revascularization &#91;TLR&#93;&#41; was assessed at one-year follow-up&#46; Stepwise Cox regression was used to determine independent predictors of outcome&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">DEBs &#40;n&#61;206&#41; were used to treat 184 lesions&#46; Procedural success was obtained in 98&#37; of patients &#40;n&#61;150&#41;&#46; At one-year follow-up&#44; 86&#37; &#40;n&#61;134&#41; were free of the primary endpoint &#40;6&#37; death&#44; 6&#37; non-procedure related MI and 5&#37; TLR&#41;&#46; The independent predictors of MACE at one year were index PCI in the left anterior descending artery &#40;HR 2&#46;81&#44; 95&#37; CI 1&#46;21-6&#46;51&#59; p&#61;0&#46;02&#41; and a history of MI &#40;HR 3&#46;46&#44; 95&#37; CI 1&#46;35-8&#46;84&#59; p&#61;0&#46;01&#41;&#46; ISR and DEB diameter or length were not predictors of events&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">PCI with DEBs in real-world patients with complex lesions is effective&#44; with a low rate of MACE&#44; including TLR&#44; at one-year follow-up&#46; The results are equally good whether the intervention is for ISR or for native coronary disease&#46;</p>"
      ]
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sobrevida a um ano livre de eventos cardiovasculares adversos <span class="elsevierStyleItalic">major</span>&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">93 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Angina inst&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- EAM sem supraeleva&#231;&#227;o de ST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- IMC&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#160;&#177;&#160;sd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria pr&#233;via CV&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- ICP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Doen&#231;a vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Acidente vascular cerebral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Insufici&#234;ncia renal cr&#243;nica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Doen&#231;a coron&#225;ria multivaso&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Apresenta&#231;&#227;o cl&#237;nica&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- S&#237;ndrome coron&#225;ria aguda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Enfarte agudo do mioc&#225;rdio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localiza&#231;&#227;o do vaso alvo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Circunflexa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;731&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Coron&#225;ria direita&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Tronco comum&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&#44;94-17&#44;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Disfun&#231;&#227;o ventricular esquerda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comprimento DEB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;489&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab354981.png"
              ]
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        "descripcion" => array:1 [
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      6 => array:7 [
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CABG&#58; cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica&#59; DEB&#58; bal&#227;o eluidor de f&#225;rmaco&#59; EAM&#58; enfarte agudo do mioc&#225;rdio&#59; IC&#58; intervalo de confian&#231;a&#59; ICP&#58; interven&#231;&#227;o coron&#225;ria percut&#226;nea&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">An&#225;lise univariada</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Hazard-ratio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">EAM pr&#233;vio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">CABG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;07-17&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;039&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ICP Descendente anterior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;91-15&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;068&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;11-20&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52-9&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reestenose intra<span class="elsevierStyleItalic">-stent</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37-6&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;538&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Di&#226;metro DEB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52-13&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;247&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comprimento DEB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;87-1&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;799&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      7 => array:7 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Fontes&#58; Unverdorben et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; Kleber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; Scheller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; Cortese et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; Colombo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&#44; Stella et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; Vaquerizo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; W&#246;ehrle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">DEB&#58; bal&#227;o eluidor de f&#225;rmaco&#59; M&#58; meses&#59; MACE&#58; eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;morte todas as causas&#44; enfarte agudo do mioc&#225;rdio n&#227;o fatal ou revasculariza&#231;&#227;o da les&#227;o alvo&#41;&#59; RIS&#58; reestenose intra-<span class="elsevierStyleItalic">stent</span>&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nome do estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Indica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176; de doentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MACE DEB &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TLR DEB &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PACOCCATH ISR <span class="elsevierStyleSmallCaps">I</span> e II<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;54 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEPCAD II<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;66 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEPCAD I1<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos &#40;di&#226;metro &#60;&#160;2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;82 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PICCOLETO<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;28 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;7&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;1&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos &#40;di&#226;metro &#60;&#160;2&#44;8 mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VALENTINES <span class="elsevierStyleItalic">Registry</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1&#37; 6-9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;4&#37; 6-9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Spanish Registry</span><a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;7&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sequent Please World Wide Registry</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">All comers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;7&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab354977.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Principais estudos e registos no contexto da interven&#231;&#227;o coron&#225;ria percut&#226;nea com DEB</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continued benefit of coronary stenting versus balloon angioplasty&#58; One-year clinical follow-up of Benestent trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Benestent Study Group"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Macaya"
                            1 => "P&#46;W&#46; Serruys"
                            2 => "P&#46; Ruygrok"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1996"
                        "volumen" => "27"
                        "paginaInicial" => "255"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8557891"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drug-eluting balloon&#58; The comeback kid&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Waksman"
                            1 => "R&#46; Pakala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCINTERVENTIONS.109.873703"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Interv"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "352"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Morice"
                            1 => "P&#46;W&#46; Serruys"
                            2 => "J&#46;E&#46; Sousa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa012843"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2002"
                        "volumen" => "346"
                        "paginaInicial" => "1773"
                        "paginaFinal" => "1780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12050336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential solutions to the current problem&#58; Coated balloon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Scheller"
                            1 => "U&#46; Speck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "EuroIntervention"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "numero" => "Suppl C"
                        "paginaInicial" => "C63"
                        "paginaFinal" => "C66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19202699"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Scheller"
                            1 => "C&#46; Hehrlein"
                            2 => "W&#46; Bocksch"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa061254"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "355"
                        "paginaInicial" => "2113"
                        "paginaFinal" => "2124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17101615"
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              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Unverdorben"
                            1 => "C&#46; Vallbracht"
                            2 => "B&#46; Cremers"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.839282"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2009"
                        "volumen" => "119"
                        "paginaInicial" => "2986"
                        "paginaFinal" => "2994"
                        "link" => array:1 [
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              "identificador" => "bib0035"
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Universal definition of myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Thygesen"
                            1 => "J&#46;S&#46; Alpert"
                            2 => "H&#46;D&#46; White"
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.107.187397"
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              ]
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            7 => array:3 [
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical end points in coronary stent trials&#58; A case for standardized definitions"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;E&#46; Cutlip"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.106.685313"
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to use the drug-eluting balloon&#58; recommendations by the German consensus group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;X&#46; Kleber"
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                    0 => array:2 [
                      "doi" => "10.4244/EIJV7SKA21"
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              "identificador" => "bib0050"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Letter by Alfonso et al&#46; regarding article&#44; &#171;Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis&#187;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Alfonso"
                            1 => "M&#46;J&#46; Perez-Vizcayno"
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                      "doi" => "10.1161/CIR.0b013e3181d22b44"
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                        "paginaInicial" => "e33"
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              "identificador" => "bib0055"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1007/s00392-008-0682-5"
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                        "tituloSerie" => "Clin Res Cardiol"
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                        "paginaFinal" => "781"
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            11 => array:3 [
              "identificador" => "bib0060"
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                  "contribucion" => array:1 [
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                      "titulo" => "Long-term follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter"
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                          "etal" => true
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                            2 => "B&#46; Kelsch"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jcin.2012.01.008"
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                        "tituloSerie" => "JACC Cardiovasc Interv"
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                        "volumen" => "5"
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                        "paginaFinal" => "330"
                        "link" => array:1 [
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              "identificador" => "bib0065"
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                    0 => array:2 [
                      "titulo" => "Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels&#44; a prospective randomised clinical trial&#46;The PICCOLETO study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Cortese"
                            1 => "A&#46; Micheli"
                            2 => "A&#46; Picchi"
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              "identificador" => "bib0070"
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                      "titulo" => "Comparison of two different paclitaxel-coated balloon catheters in the porcine coronary restenosis model"
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                          "etal" => true
                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1007/s00392-009-0008-2"
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                        "tituloSerie" => "Clin Res Cardiol"
                        "fecha" => "2009"
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                      "titulo" => "A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels&#58; the BELLO &#40;Balloon Elution and Late Loss Optimization&#41; study"
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                      "doi" => "10.1016/j.jacc.2012.09.020"
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                        "tituloSerie" => "J Am Coll Cardiol"
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            15 => array:3 [
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Artigo Original
Eventos cardiovasculares major após intervenção coronária percutânea com balão eluidor de fármaco: Resultados a um ano de um registo prospetivo multicêntrico
One-year clinical outcomes of percutaneous treatment with drug-eluting balloons: Results from a multicenter registry
Rita Caléa,
Autor para correspondência
ritacale@hotmail.com

Autor para correspondência.
, Pedro Jerónimo Sousab, Ernesto Pereiraa, Pedro Araújo Gonçalvesb, Sílvia Vitorinoa, Hugo Vinhasa, Luís Raposob, Cristina Martinsa, Henrique Mesquita Gabrielb, Rui Campante Telesb, Manuel Sousa Almeidab, Hélder Pereiraa, Miguel Mendesb
a Unidade de Cardiologia de Intervenção, Hospital Garcia de Orta, Almada, Portugal
b Unidade de Cardiologia de Intervenção, Hospital de Santa Cruz, Carnaxide, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A angioplastia coron&#225;ria apenas com bal&#227;o ofereceu uma alternativa v&#225;lida &#224; cirurgia no campo da revasculariza&#231;&#227;o coron&#225;ria<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; No entanto&#44; o risco de oclus&#227;o coron&#225;ria aguda e a elevada reestenose associada ao <span class="elsevierStyleItalic">recoil</span>&#44; ao <span class="elsevierStyleItalic">remodeling</span> negativo e &#224; prolifera&#231;&#227;o celular promoveram a procura constante de novas modalidades terap&#234;uticas com menos risco de restenose<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mais recentemente&#44; o uso <span class="elsevierStyleItalic">de stents</span> eluidores de f&#225;rmacos antiproliferativos &#40;DES&#41; permitiu reduzir&#44; de forma muito eficaz&#44; o risco de reestenose eliminando o <span class="elsevierStyleItalic">recoil</span> e o <span class="elsevierStyleItalic">remodeling</span> negativo e reduzir significativamente a forma&#231;&#227;o de hiperplasia neointimal<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Contudo&#44; preocupa&#231;&#245;es relativas ao risco associado de trombose de <span class="elsevierStyleItalic">stent</span>&#44; &#224; depend&#234;ncia de terap&#234;utica antiagregante dupla prolongada e &#224; manuten&#231;&#227;o de reestenose no contexto de les&#245;es complexas levaram &#224; procura de dispositivos alternativos que apresentassem baixo risco de reestenose&#44; sem os inconvenientes associados aos DES<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Foi este o racional para o desenvolvimento dos bal&#245;es eluidores de f&#225;rmaco &#40;DEB&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">V&#225;rios estudos aleatorizados j&#225; demonstraram a seguran&#231;a e efic&#225;cia desta nova tecnologia no tratamento da reestenose de <span class="elsevierStyleItalic">stent</span> que foi a primeira indica&#231;&#227;o aceite para o uso deste tipo de bal&#245;es na doen&#231;a coron&#225;ria<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Estudos mais recentes t&#234;m alargado a sua indica&#231;&#227;o a outros campos da interven&#231;&#227;o endovascular&#44; nomeadamente&#44; no tratamento de les&#245;es coron&#225;rias de novo em pequenos vasos e na doen&#231;a arterial perif&#233;rica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Deste modo&#44; torna-se importante confrontar os bons resultados obtidos nos ensaios cl&#237;nicos com a pr&#225;tica do &#171;mundo real&#187;&#44; atrav&#233;s de registos cl&#237;nicos multic&#234;ntricos prospetivos do tipo <span class="elsevierStyleItalic">all-comers</span>&#46; O objetivo deste estudo &#233; avaliar a efic&#225;cia cl&#237;nica de uma estrat&#233;gia de interven&#231;&#227;o coron&#225;ria percut&#226;nea com bal&#227;o eluidor de f&#225;rmaco em doentes de um registo multic&#234;ntrico nacional&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Popula&#231;&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudo prospetivo de doentes consecutivos submetidos a ICP com DEB em 2 centros de Cardiologia de Interven&#231;&#227;o nacionais terci&#225;rios&#46; Est&#227;o inclu&#237;dos no registo 220 doentes&#44; mas apenas foram avaliados neste estudo os doentes que foram submetidos a ICP com DEB h&#225; mais de 12 meses&#44; de forma a possibilitar um seguimento cl&#237;nico de pelo menos um ano&#46; Foram eleg&#237;veis doentes com mais de 18 anos e com evid&#234;ncia cl&#237;nica de isquemia mioc&#225;rdica&#46; N&#227;o houve crit&#233;rios de exclus&#227;o relativamente &#224; forma de apresenta&#231;&#227;o da doen&#231;a coron&#225;ria ou &#224; complexidade das les&#245;es&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados foram colhidos prospetivamente e registados numa base de dados inform&#225;tica presente igualmente nas duas unidades de cardiologia de interven&#231;&#227;o &#40;Cardiobase<span class="elsevierStyleSup">&#174;</span>&#44; Infortucano&#8482;&#41;&#46; Todos os doentes deram o seu consentimento informado&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimento de interven&#231;&#227;o coron&#225;ria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Os aspetos t&#233;cnicos relacionados com o procedimento de ICP foram efetuados de acordo com as normas de boa pr&#225;tica habitualmente aceites&#46; A sele&#231;&#227;o da t&#233;cnica e estrat&#233;gia de revasculariza&#231;&#227;o foi por decis&#227;o dos operadores&#44; assim como a escolha do acesso vascular&#44; o uso de inibidores da glicoprote&#237;na <span class="elsevierStyleSmallCaps">ii</span>b&#47;<span class="elsevierStyleSmallCaps">iii</span>a&#44; a necessidade de p&#243;s-dilata&#231;&#227;o ou de coloca&#231;&#227;o de <span class="elsevierStyleItalic">stent</span> em <span class="elsevierStyleItalic">bail out</span>&#46; Foi recomendada a administra&#231;&#227;o de heparina n&#227;o fracionada em forma de b&#243;lus endovenoso numa dose de 70-100&#160;U&#47;kg&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os bal&#245;es eluidores de f&#225;rmaco utilizados encontravam-se revestidos por paclitaxel numa dose de 3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mm<span class="elsevierStyleSup">2</span> &#40;Sequent Please<span class="elsevierStyleSup">&#174;</span>&#44; B-Braun&#8482;&#41; e apresentaram di&#226;metros que variaram entre 2&#44;5-4&#44;0<span class="elsevierStyleHsp" style=""></span>mm e comprimentos entre 10 e 30<span class="elsevierStyleHsp" style=""></span>mm&#46; Recomendou-se um <span class="elsevierStyleItalic">ratio</span> art&#233;ria-bal&#227;o de 1&#58;1 e um tempo de insufla&#231;&#227;o de 60&#160;s&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos os doentes foram medicados na altura da interven&#231;&#227;o com clopidogrel &#40;75<span class="elsevierStyleHsp" style=""></span>mg no caso de tratamento cr&#243;nico com clopidogrel&#160;&#62;&#160;10&#160;d&#44; e 600<span class="elsevierStyleHsp" style=""></span>mg&#44; se n&#227;o&#41;&#46; Depois da ICP&#44; todos os doentes foram medicados com aspirina &#40;&#8804;&#160;150<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; e clopidogrel &#40;75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; por um per&#237;odo m&#237;nimo de 3 meses&#44; seguido de tratamento com monoagrega&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimento cl&#237;nico e <span class="elsevierStyleItalic">endpoint</span> do estudo</span><p id="par0050" class="elsevierStylePara elsevierViewall">O seguimento cl&#237;nico foi efetuado por contacto telef&#243;nico e por consulta dos registos cl&#237;nicos dos doentes&#46; Todos os doentes foram seguidos aos 30&#160;d e por um per&#237;odo m&#237;nimo de um ano ou at&#233; ocorr&#234;ncia de morte&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">endpoint</span> do estudo foi uma combina&#231;&#227;o de morte por todas as causas&#44; EAM n&#227;o fatal e revasculariza&#231;&#227;o da les&#227;o alvo &#40;TLR&#41;&#46; O <span class="elsevierStyleItalic">endpoint</span> foi analisado a um ano de seguimento&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As mortes foram classificadas como card&#237;aca ou n&#227;o card&#237;aca&#44; com todas as mortes consideradas de etiologia card&#237;aca&#44; a menos que uma causa n&#227;o card&#237;aca inequ&#237;voca fosse estabelecida&#46; O EAM foi definido de acordo com a nova defini&#231;&#227;o universal<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; A revasculariza&#231;&#227;o da les&#227;o alvo incluiu reinterven&#231;&#227;o percut&#226;nea ou cir&#250;rgica no segmento previamente tratado envolvendo 5<span class="elsevierStyleHsp" style=""></span>mm dos seus bordos proximal ou distal&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A trombose de <span class="elsevierStyleItalic">stent</span> definitiva ou prov&#225;vel foi definida segundo a defini&#231;&#227;o da <span class="elsevierStyleItalic">Academic Research and Consortium</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Definiu-se como sucesso do dispositivo a capacidade do DEB ultrapassar a les&#227;o e ser expandido com sucesso&#46; O sucesso angiogr&#225;fico foi definido como fluxo TIMI 3 final&#44; com estenose residual inferior ou igual a 30&#37;&#46; O sucesso do procedimento foi definido como o sucesso do dispositivo sem a ocorr&#234;ncia de MACE durante o internamento <span class="elsevierStyleItalic">index</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis cont&#237;nuas foram testadas para a distribui&#231;&#227;o normal atrav&#233;s do teste de <span class="elsevierStyleItalic">Kolmogorov-Smirnov</span> e para a igualdade de vari&#226;ncias pelo teste de <span class="elsevierStyleItalic">Levene</span>&#46; As vari&#225;veis cont&#237;nuas foram apresentadas por m&#233;dia&#160;&#177;&#160;desvio padr&#227;o e comparadas atrav&#233;s do teste <span class="elsevierStyleItalic">T de Student&#46;</span> As vari&#225;veis cont&#237;nuas que n&#227;o seguiram o padr&#227;o da normalidade ou semelhan&#231;a de vari&#226;ncias foram apresentadas por medianas com os respetivos intervalos interquartis e comparadas atrav&#233;s do teste de <span class="elsevierStyleItalic">Mann-Whitney&#46;</span> As vari&#225;veis categ&#243;ricas foram apresentadas sob a forma de percentagem e comparadas utilizando o teste de Qui-quadrado ou de Fisher&#44; 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respetivamente&#46; A incid&#234;ncia cumulativa de eventos adversos foi calculado de acordo com o m&#233;todo de Kaplan-Meier e as diferen&#231;as foram avaliadas pelo teste de <span class="elsevierStyleItalic">log-rank</span>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Foi considerado estatisticamente significativo quando p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; A an&#225;lise estat&#237;stica foi efetuada em <span class="elsevierStyleItalic">software Statistical Pack for Social Sciences</span> &#40;SPSS&#41;&#44; vers&#227;o 17&#46;0 &#40;Institute&#44; Estados Unidos&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas basais</span><p id="par0090" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 156 doentes consecutivos &#40;idade m&#233;dia 66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 anos&#44; 73&#37; sexo masculino&#41; submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea com bal&#245;es revestidos por paclitaxel&#46; As caracter&#237;sticas basais e a apresenta&#231;&#227;o cl&#237;nica da ICP <span class="elsevierStyleItalic">index</span> encontram-se descritas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Trata-se de uma <span class="elsevierStyleItalic">cohort</span> de doentes de elevado risco com 44&#37; de diab&#233;ticos e 83&#37; hipertensos&#46; A maioria dos doentes apresentou doen&#231;a coron&#225;ria conhecida e intervencionada previamente &#40;76&#37; submetidos a ICP anteriormente e 21&#37; a CABG&#41;&#46; Cerca de tr&#234;s quartos da popula&#231;&#227;o apresentou doen&#231;a coron&#225;ria de 2 ou mais vasos e frequentemente a ICP foi no contexto de EAM &#40;30&#37;&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas do procedimento</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nos 156 doentes inclu&#237;dos&#44; foram tratadas 184 les&#245;es com 206 DEB &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; A art&#233;ria descendente anterior foi a mais frequentemente envolvida &#40;43&#37;&#41;&#46; As indica&#231;&#245;es para o uso de DEB foram&#44; de forma equilibrada&#44; a reestenose intra-<span class="elsevierStyleItalic">stent</span> pr&#233;via em 52&#37; &#40;dos quais 30&#37; foram <span class="elsevierStyleItalic">stents</span> met&#225;licos e 70&#37; <span class="elsevierStyleItalic">stents</span> revestidos por f&#225;rmaco&#41; e a doen&#231;a coron&#225;ria de novo em 48&#37;&#44; maioritariamente por doen&#231;a dos pequenos vasos&#46; O padr&#227;o da reestenose intra-<span class="elsevierStyleItalic">stent</span> foi em 48&#37; dos casos difuso&#46; Antes da utiliza&#231;&#227;o do DEB&#44; a maioria dos doentes foi submetida a pr&#233;-dilata&#231;&#227;o &#40;80&#37;&#41;&#46; As medianas do di&#226;metro e do comprimento do DEB foram de 2&#44;5<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo interquartil &#91;IQR&#93; 2&#44;5-3&#44;0&#41; e de 20<span class="elsevierStyleHsp" style=""></span>mm &#40;IQR 15-26&#41;&#44; respetivamente&#46; Cinco les&#245;es foram submetidas a coloca&#231;&#227;o de <span class="elsevierStyleItalic">stent</span> por <span class="elsevierStyleItalic">bail-out</span> &#40;4 por dissec&#231;&#227;o e um por <span class="elsevierStyleItalic">recoil</span> significativo&#41;&#46; O sucesso do dispositivo foi de 98&#37;&#58; em 3 doentes n&#227;o foi poss&#237;vel atravessar a les&#227;o com o DEB&#44; um no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> numa p&#243;stero-lateral &#40;DEB 2&#44;75&#47;15<span class="elsevierStyleHsp" style=""></span>mm&#41; e 2 em doen&#231;a coron&#225;ria de pequenos vasos na circunflexa distal e descendente anterior m&#233;dia &#40;DEB 2&#44;5&#47;15 e 2&#44;5&#47;17<span class="elsevierStyleHsp" style=""></span>mm&#44; respetivamente&#41;&#46; O sucesso angiogr&#225;fico por les&#227;o foi de 98&#37; &#40;2 les&#245;es com fluxo TIMI 2 final e 2 les&#245;es com estenose residual superior a 30&#37;&#41;&#46; O sucesso do procedimento foi de 96&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Preditores do <span class="elsevierStyleItalic">endpoint</span> do estudo</span><p id="par0105" class="elsevierStylePara elsevierViewall">Aos 30&#160;d de seguimento&#44; houve 6 eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;MACE&#41;&#44; 2 mortes de causa cardiovascular&#44; 4 EAM e 2 TLR&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A um ano de seguimento nove doentes &#40;5&#44;8&#37;&#41; faleceram&#44; sete de causa card&#237;aca&#44; nove tiveram um EAM &#40;5&#44;8&#37;&#41; e oito &#40;5&#44;1&#37;&#41; tiveram TLR&#44; com uma incid&#234;ncia combinada de eventos de 14&#44;1&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; N&#227;o houve nenhum caso de trombose de <span class="elsevierStyleItalic">stent</span> definitiva ou prov&#225;vel documentada&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;as na taxa de MACE ou TLR entre os grupos tratados com DEB por reestenose intra-<span class="elsevierStyleItalic">stent</span> ou doen&#231;a coron&#225;ria de novo &#40;13&#44;6&#37; <span class="elsevierStyleItalic">versus</span> 14&#44;7&#37; de MACE&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;846 e 6&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 4&#44;0&#37; de TLR&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;721&#41;&#46; O tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos &#40;DES&#41; com DEB apresentou as mesmas taxas de MACE &#40;14&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 12&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;000&#41; e TLR a um ano &#40;5&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 8&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;633&#41; comparadas com a ICP da reestenose de <span class="elsevierStyleItalic">stents</span> met&#225;licos &#40;BMS&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por an&#225;lise univariada &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">Tabelas 4 e 5</a>&#41;&#44; foram preditores de MACE a um ano a presen&#231;a de EAM e CABG pr&#233;vias&#44; s&#237;ndrome coron&#225;ria aguda na apresenta&#231;&#227;o e ICP da descendente anterior no caso &#237;ndex&#46; A doen&#231;a multivaso esteve tendencialmente associada a mais eventos cardiovasculares adversos a um ano &#40;HR 4&#44;04&#59; 95&#37;IC 0&#44;94-17&#44;28&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;060&#41;&#46; Hist&#243;ria pr&#233;via de CABG foi o &#250;nico preditor de TLR a um ano &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a>&#41;&#46; N&#227;o foram preditores de MACE ou de TLR a 1 ano&#44; a diabetes&#44; a disfun&#231;&#227;o ventricular esquerda&#44; assim como a reestenose intra-<span class="elsevierStyleItalic">stent</span>&#44; o comprimento e o di&#226;metro do DEB&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Ap&#243;s ajuste &#224;s vari&#225;veis demogr&#225;ficas e caracter&#237;sticas cl&#237;nicas basais&#44; a an&#225;lise multivariada identificou a hist&#243;ria pr&#233;via de EAM &#40;HR 3&#44;46&#59; 95&#37; IC&#44; 1&#44;35-8&#44;84&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41; e a ICP da descendente anterior &#40;DA&#41; &#40;HR 2&#44;81&#59; 95&#37; IC&#44; 1&#44;21-6&#44;51&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41; como preditores independentes de MACE a 1 ano &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46; Foram preditores independentes de TLR a um ano a hist&#243;ria pr&#233;via de CABG &#40;HR 5&#44;48&#59; 95&#37; IC&#44; 1&#44;34-22&#44;35&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41; e ICP da DA &#40;HR 4&#44;76&#59; 95&#37; IC&#44; 1&#44;11-20&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Os doentes submetidos a interven&#231;&#227;o percut&#226;nea com DEB na descendente anterior proximal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#160;dts&#41; apresentaram um maior perfil de risco cardiovascular&#44; sendo mais frequentemente diab&#233;ticos e hipertensos &#40;57&#37; de diab&#233;ticos e 92&#37; de hipertensos na ICP da DA <span class="elsevierStyleItalic">versus</span> 38&#37; de diab&#233;ticos e 79&#37; de hipertensos na ICP dos outros vasos&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#44; respetivamente&#41;&#46; Os doentes com hist&#243;ria de enfarte pr&#233;vio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71 dts&#41; foram doentes com mais hist&#243;ria de revasculariza&#231;&#227;o coron&#225;ria pr&#233;via &#40;90&#37; submetidos a ICP pr&#233;via e 32&#37; a CABG <span class="elsevierStyleItalic">versus</span> 64&#37; de ICP pr&#233;via e 11&#37; de CABG nos doentes sem hist&#243;ria de EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001 respetivamente&#41;&#44; pelo que&#44; naturalmente&#44; foram com mais frequ&#234;ncia submetidos a ICP com DEB no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> &#40;68&#37; <span class="elsevierStyleItalic">versus</span> 38&#37; no grupo de dts sem EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Neste subgrupo de doentes com hist&#243;ria de eventos isqu&#233;micos agudos no passado foi mais frequente a presen&#231;a de disfun&#231;&#227;o ventricular esquerda &#40;40&#37; <span class="elsevierStyleItalic">versus</span> 17&#37; nos doentes sem hist&#243;ria de EAM pr&#233;vio&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Este estudo demonstrou com clareza que a angioplastia com DEB&#44; numa popula&#231;&#227;o de doentes do mundo real com les&#245;es complexas&#44; &#233; eficaz com elevado sucesso angiogr&#225;fico imediato e com baixa taxa de eventos card&#237;acos adversos <span class="elsevierStyleItalic">major</span> a um ano de seguimento&#44; incluindo revasculariza&#231;&#227;o da les&#227;o alvo&#46; Esta t&#233;cnica foi igualmente eficaz no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> pr&#233;via e doen&#231;a coron&#225;ria de novo&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nos &#250;ltimos anos&#44; os bal&#245;es eluidores de f&#225;rmaco t&#234;m-se afirmado como uma alternativa v&#225;lida para o tratamento da reestenose intra-<span class="elsevierStyleItalic">stent</span>&#44; fruto dos bons resultados obtidos nos ensaios cl&#237;nicos efetuados<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; E&#44; apesar de&#44; em termos te&#243;ricos&#44; apresentarem a mesma limita&#231;&#227;o do <span class="elsevierStyleItalic">recoil</span> agudo e do poss&#237;vel <span class="elsevierStyleItalic">remodeling</span> negativo tardio que apresentam os bal&#245;es convencionais&#44; a perda luminal tardia <span class="elsevierStyleItalic">&#40;late lumen loss&#41;</span> dos DEB ao longo do seguimento nos estudos pr&#233;vios efetuados tem sido consistentemente baixa &#40;aproximadamente 0&#44;2<span class="elsevierStyleHsp" style=""></span>mm&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; O PACCOCATH ISR I<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> foi o primeiro estudo aleatorizado a comparar a angioplastia com DEB <span class="elsevierStyleItalic">versus</span> bal&#227;o convencional na reestenose <span class="elsevierStyleItalic">intra-stent</span> e mostrou que a estrat&#233;gia com DEB se associou a uma reduzida incid&#234;ncia de reestenose com uma <span class="elsevierStyleItalic">late lumen loss in-segment</span> de apenas 0&#44;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48<span class="elsevierStyleHsp" style=""></span>mm aos 6 meses&#44; e significativamente inferior &#224; do bal&#227;o convencional &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; O PEPCAD <span class="elsevierStyleSmallCaps">II</span> comparou a seguran&#231;a e efic&#225;cia do tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> met&#225;licos &#40;BMS&#41; com DEB <span class="elsevierStyleItalic">versus</span> angioplastia com <span class="elsevierStyleItalic">stents</span> Taxus&#8482;&#44; revestidos por paclitaxel &#40;DES&#41;&#46; Mais uma vez&#44; o <span class="elsevierStyleItalic">endpoint</span> prim&#225;rio foi a <span class="elsevierStyleItalic">late lumen loss</span> aos 6 meses&#44; que foi inferior no grupo tratado com DEB &#40;0&#44;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;42 <span class="elsevierStyleItalic">versus</span> 0&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; Uma limita&#231;&#227;o apontada para estes estudos tem sido o facto de o <span class="elsevierStyleItalic">end-point</span> prim&#225;rio utilizado ser a <span class="elsevierStyleItalic">late lumen loss</span>&#44; que &#233; apenas um <span class="elsevierStyleItalic">surrogate end-point</span> dos resultados da angioplastia&#46; No caso do PEPCAD <span class="elsevierStyleSmallCaps">II&#44;</span> este &#237;ndice de compara&#231;&#227;o entre duas estrat&#233;gias diferentes &#40;bal&#227;o <span class="elsevierStyleItalic">versus stent</span>&#41; confere desvantagem &#224; estrat&#233;gia de angioplastia com <span class="elsevierStyleItalic">stent</span>&#44; porque o c&#225;lculo da <span class="elsevierStyleItalic">late lumen loss</span> est&#225; diretamente dependente do <span class="elsevierStyleItalic">acute gain</span>&#44; que &#233; sempre superior na ICP com <span class="elsevierStyleItalic">stent</span> &#40;quanto maior o ganho luminal na fase aguda&#44; tamb&#233;m maior vai ser a perda luminal tardia&#41;&#46; Assim&#44; &#233; expect&#225;vel que a estrat&#233;gia de ICP com bal&#227;o esteja associada a menor perda luminal no seguimento<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; No entanto&#44; ambos os estudos mostraram resultados cl&#237;nicos favor&#225;veis com redu&#231;&#227;o de eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;MACE&#41; na estrat&#233;gia de angioplastia com DEB<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; diferen&#231;as que se mant&#234;m num seguimento mais prolongado a 2 anos<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> &#40;46&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 11&#37; DEB&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e a 5 anos<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;59&#44;3&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 27&#44;8&#37; DEB&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; e que se devem maioritariamente a uma redu&#231;&#227;o da necessidade de revasculariza&#231;&#227;o da les&#227;o alvo &#40;38&#44;9&#37; bal&#227;o n&#227;o revestido <span class="elsevierStyleItalic">versus</span> 9&#44;3&#37; DEB a 5 anos&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; O presente estudo &#233; uma an&#225;lise dos MACE numa <span class="elsevierStyleItalic">cohort</span> de alto risco&#44; com les&#245;es complexas&#46; A incid&#234;ncia combinada de eventos foi de 14&#37; aos 12 meses&#44; superior quando comparada com estudos randomizados pr&#233;vios &#40;9&#37; no PACCOCATH ISR <span class="elsevierStyleSmallCaps">I</span> e <span class="elsevierStyleSmallCaps">II</span> e no PEPCAD <span class="elsevierStyleSmallCaps">II</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;11</span></a>&#46; Por outro lado&#44; n&#227;o encontr&#225;mos diferen&#231;as relativamente &#224; taxa de TLR&#44; que foi de 5&#37; no nosso estudo&#44; compar&#225;vel &#224; dos estudos pr&#233;vios &#40;4&#37; no PACCOCATH ISR <span class="elsevierStyleSmallCaps">I</span> e <span class="elsevierStyleSmallCaps">II</span> e 6&#37; no PEPCAD <span class="elsevierStyleSmallCaps">II</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;11</span></a>&#46; Isto pode ilustrar o facto de a nossa popula&#231;&#227;o ter sido <span class="elsevierStyleItalic">all comers</span>&#44; com inclus&#227;o de doentes com enfarte agudo do mioc&#225;rdio &#40;30&#37;&#41;&#44; disfun&#231;&#227;o ventricular esquerda &#40;21&#37;&#41; e insufici&#234;ncia renal cr&#243;nica &#40;9&#37;&#41;&#44; contextos que s&#227;o normalmente crit&#233;rios de exclus&#227;o de estudos pr&#233;vios&#46; A taxa mais elevada de morte e de enfarte agudo do mioc&#225;rdio no seguimento reflete assim a maior complexidade dos nossos doentes&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a> est&#227;o sumarizados os resultados cl&#237;nicos da estrat&#233;gia de angioplastia com DEB dos principais estudos randomizados e registos at&#233; &#224; data&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Quando compar&#225;mos na nossa popula&#231;&#227;o a efic&#225;cia desta estrat&#233;gia de revasculariza&#231;&#227;o na reestenose intra-<span class="elsevierStyleItalic">stent versus</span> na doen&#231;a coron&#225;ria de novo em pequenos vasos&#44; os resultados foram igualmente bons&#46; No estudo aleatorizado PICCOLETO<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; a angioplastia com DEB em vasos pequenos esteve associada a uma maior percentagem de reestenose angiogr&#225;fica e mais elevada taxa de MACE aos 9 meses do que a angioplastia com <span class="elsevierStyleItalic">stent</span> Taxus&#8482;&#44; o que motivou a interrup&#231;&#227;o precoce do estudo&#46; O DEB utilizado neste estudo foi o DIOR&#8482; de primeira gera&#231;&#227;o&#44; que tem uma farmacocin&#233;tica e bidisponibilidade diferente do <span class="elsevierStyleItalic">Sequent Please</span><span class="elsevierStyleSup">&#174;</span> e com prov&#225;vel poder antirresten&#243;tico inferior<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; No outro extremo&#44; mais recentemente&#44; o estudo aleatorizado BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a> na doen&#231;a coron&#225;ria de novo em les&#245;es com di&#226;metro de refer&#234;ncia &#60;&#160;2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#44; mostrou superioridade do DEB comparativamente ao <span class="elsevierStyleItalic">stent</span> Taxus&#8482; relativamente ao objetivo prim&#225;rio aos 6 meses &#40;<span class="elsevierStyleItalic">late lumen loss</span> 0&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;38<span class="elsevierStyleHsp" style=""></span>mm <span class="elsevierStyleItalic">versus</span> 0&#44;29&#177;0&#44;44<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; com uma baixa taxa de eventos cl&#237;nicos no grupo do DEB &#40;MACE em 7&#44;8&#37; e TLR em 4&#44;4&#37;&#41;&#46; Sabe-se que a interven&#231;&#227;o percut&#226;nea em vasos pequenos se encontra associada a uma taxa de reestenose elevada&#46; Por esse motivo&#44; est&#225; indicado&#44; sempre que poss&#237;vel&#44; o uso de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos capazes de suprimir a hiperplasia da neo&#237;ntima&#46; Dados dos estudos E-SIRIUS<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> e C-SIRIUS<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> mostraram o benef&#237;cio do <span class="elsevierStyleItalic">stent</span> Cypher&#8482; no tratamento de les&#245;es coron&#225;rias de novo longas em vasos pequenos ao reduzirem o risco de reestenose aos 8 meses quando comparado com <span class="elsevierStyleItalic">stents</span> sem f&#225;rmaco &#40;BMS&#41;&#46; Contudo&#44; <span class="elsevierStyleItalic">stents</span> implantados em pequenas art&#233;rias t&#234;m um maior <span class="elsevierStyleItalic">ratio</span> metal-art&#233;ria que pode aumentar o risco de reestenose<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Neste contexto&#44; o facto de os DEB n&#227;o apresentarem estrutura met&#225;lica pode ser uma clara vantagem&#46; Estes bal&#245;es t&#234;m ainda a vantagem de permitirem uma liberta&#231;&#227;o homog&#233;nea do f&#225;rmaco para a parede vascular&#44; ao contr&#225;rio dos DES&#44; cujo f&#225;rmaco est&#225; concentrado nos seus <span class="elsevierStyleItalic">struts</span>&#44; impossibilitando a supress&#227;o da hiperplasia da neo&#237;ntima entre os <span class="elsevierStyleItalic">struts</span> e nas margens do <span class="elsevierStyleItalic">stent</span>&#46; O f&#225;rmaco escolhido para os DEB &#233; o Paclitaxel&#44; que&#44; pelas suas propriedades lipof&#237;licas elevadas&#44; consegue permanecer no vaso at&#233; uma semana sem necessitar de uma estrutura de liberta&#231;&#227;o controlada do f&#225;rmaco associado a uma plataforma met&#225;lica e a um pol&#237;mero&#46; Assim se reduz o risco de inflama&#231;&#227;o cr&#243;nica&#44; trombose e a necessidade de tratamento antiagregante prolongado<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Algumas das limita&#231;&#245;es que t&#234;m sido apontadas ao uso deste tipo de bal&#245;es revestidos por f&#225;rmaco &#233;&#44; por um lado&#44; o facto de ocasionalmente n&#227;o conseguirem atravessar a les&#227;o a ser intervencionada e&#44; por outro&#44; poderem associar-se a dissec&#231;&#227;o ou <span class="elsevierStyleItalic">recoil</span> com um consequente resultado angiogr&#225;fico sub&#243;timo e necessidade de <span class="elsevierStyleItalic">stent</span> em <span class="elsevierStyleItalic">bail-out</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; No nosso estudo&#44; em apenas 3 doentes n&#227;o foi poss&#237;vel atravessar a les&#227;o e obtivemos uma taxa de sucesso angiogr&#225;fico muito elevada com necessidade de <span class="elsevierStyleItalic">bail-out</span> ou <span class="elsevierStyleItalic">stent</span> em apenas 3&#37; das les&#245;es&#44; muito inferior &#224; descrita em estudos pr&#233;vios &#40;28&#37; no estudo PEPCAD <span class="elsevierStyleSmallCaps">I</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; 20&#37; no estudo BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o dos preditores de eventos cardiovasculares <span class="elsevierStyleItalic">major</span> e TLR a um ano&#44; mais uma vez se verificou que s&#227;o as caracter&#237;sticas dos doentes e a sua complexidade que determinam o progn&#243;stico&#46; Vari&#225;veis como o comprimento e o di&#226;metro do bal&#227;o eluidor de f&#225;rmaco utilizado n&#227;o estiveram associados a mais reestenose cl&#237;nica no seguimento&#46; No entanto&#44; numa an&#225;lise cuidada das curvas de sobrevida livre de MACE&#44; verifica-se que as curvas relativas &#224; diabetes e ao comprimento do DEB &#40;vari&#225;veis que s&#227;o reconhecidas como preditoras de TLR em estudos pr&#233;vios<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#41; se afastam ao longo do seguimento&#44; ilustrando diferen&#231;as que poder&#227;o vir a ser significativas com mais tempo de seguimento&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Quanto ao tratamento da reestenose&#44; o estudo PEPCAD-DES<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> mostrou que os resultados do DEB no tratamento da reestenose de <span class="elsevierStyleItalic">stents</span> farmacol&#243;gicos foram superiores &#224; angioplastia com bal&#227;o convencional &#40;POBA&#41; com menos TLR &#40;15&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 36&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; e menos MACE &#40;16&#44;7&#37; <span class="elsevierStyleItalic">versus</span> 50&#44;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; aos 6 meses&#46; No nosso registo&#44; n&#227;o encontramos uma taxa mais elevada de eventos associados &#224; interven&#231;&#227;o na reestenose de DES&#44; o que confirma a efetividade da estrat&#233;gia de angioplastia com DEB nestes doentes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O estudo tem como limita&#231;&#245;es as que s&#227;o por natureza associadas ao formato de todos os registos&#46; Destacam-se como principais o n&#250;mero reduzido de doentes inclu&#237;dos e o tempo de seguimento ainda curto&#46; Ser&#225; interessante&#44; no futuro&#44; a avalia&#231;&#227;o dos resultados a longo prazo da angioplastia com DEB &#40;para al&#233;m de um ano de seguimento&#41;&#44; no sentido de confirmar a seguran&#231;a e a persist&#234;ncia dos bons resultados j&#225; demonstrados&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclus&#227;o</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este registo nacional com doentes de dois Centros de Cardiologia de Interven&#231;&#227;o mostrou que a interven&#231;&#227;o coron&#225;ria percut&#226;nea com um bal&#227;o eluidor de f&#225;rmaco&#44; em doentes de alto risco com les&#245;es complexas&#44; &#233; eficaz com elevado sucesso angiogr&#225;fico e com baixa taxa de eventos card&#237;acos adversos <span class="elsevierStyleItalic">major</span> a um ano de seguimento&#44; incluindo revasculariza&#231;&#227;o da les&#227;o alvo&#46; Os resultados s&#227;o igualmente bons se a interven&#231;&#227;o for no contexto de reestenose intra-<span class="elsevierStyleItalic">stent</span> ou na doen&#231;a coron&#225;ria de novo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Responsabilidades &#233;ticas</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Prote&#231;&#227;o dos seres humanos e animais</span><p id="par0175" class="elsevierStylePara elsevierViewall">Os autores declaram que os procedimentos seguidos estavam de acordo com os regulamentos estabelecidos pelos respons&#225;veis da Comiss&#227;o de Investiga&#231;&#227;o Cl&#237;nica e &#201;tica e de acordo com os da Associa&#231;&#227;o M&#233;dica Mundial e da Declara&#231;&#227;o de Hels&#237;nquia&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidencialidade dos dados</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos de seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Direito &#224; privacidade e consentimento escrito</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47;ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflito de interesses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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    "fechaRecibido" => "2012-07-08"
    "fechaAceptado" => "2012-09-04"
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            0 => "Bal&#227;o eluidor de f&#225;rmaco"
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          "palabras" => array:3 [
            0 => "Drug-eluting balloon"
            1 => "Small coronary vessel disease"
            2 => "In-stent restenosis"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A interven&#231;&#227;o coron&#225;ria percut&#226;nea &#40;ICP&#41; com bal&#227;o eluidor de f&#225;rmaco &#40;DEB&#41; tem vindo a ser utilizada no tratamento da reestenose intra-<span class="elsevierStyleItalic">stent</span> &#40;RIS&#41; e na doen&#231;a coron&#225;ria de pequenos vasos&#46; O objetivo foi avaliar a efic&#225;cia cl&#237;nica desta estrat&#233;gia num registo multic&#234;ntrico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Registo prospetivo de 2 centros com 156 doentes &#40;dts&#41; consecutivos inclu&#237;dos&#44; entre 2009 e 2010&#44; submetidos a ICP com pelo menos um bal&#227;o DEB&#46; Definiu-se como <span class="elsevierStyleItalic">endpoint</span> prim&#225;rio a ocorr&#234;ncia combinada &#40;MACE&#41; de todas as causas de morte&#44; EAM e revasculariza&#231;&#227;o da les&#227;o alvo &#40;TLR&#41; a um ano de seguimento&#46; Determinou-se os preditores independentes de progn&#243;stico atrav&#233;s da an&#225;lise de regress&#227;o de <span class="elsevierStyleItalic">Cox</span>&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram tratadas 184 les&#245;es com 206 DEB&#46; O sucesso do procedimento foi obtido em 98&#37; &#40;150 dts&#41;&#46; A um ano de seguimento&#44; a sobrevida livre de <span class="elsevierStyleItalic">endpoint</span> composto ocorreu em 134 dts e foi de 86&#37; &#40;morte em 6&#37;&#44; EAM em 6&#37; e TLR em 5&#37;&#41;&#46; Os preditores independentes de MACE foram a ICP na art&#233;ria descendente anterior &#40;HR 2&#44;81&#44; 95&#37; IC 1&#44;21-6&#44;51&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e hist&#243;ria pr&#233;via de EAM &#40;HR 3&#44;46&#44; 95&#37; IC 1&#44;35-8&#44;84&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; O di&#226;metro ou comprimento do DEB e a RIS n&#227;o foram preditores de eventos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A ICP com DEB em dts do mundo real e neste cen&#225;rio complexo de les&#245;es &#233; eficaz com baixa taxa de MACE a um ano de seguimento&#44; incluindo TLR&#46; Os resultados s&#227;o igualmente bons se a interven&#231;&#227;o &#233; no contexto de RIS ou na doen&#231;a coron&#225;ria de novo&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Percutaneous coronary intervention &#40;PCI&#41; with paclitaxel drug-eluting balloons &#40;DEBs&#41; is used mainly for treatment of in-stent restenosis &#40;ISR&#41; and small vessel disease&#46; Our objective was to evaluate the clinical efficacy of this strategy in a multicenter registry&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Between 2009 and 2010 a prospective registry from two centers enrolled 156 consecutive patients undergoing PCI with at least one DEB&#46; A primary composite endpoint of major adverse cardiac events &#40;MACE&#41; &#40;all-cause death&#44; myocardial infarction &#91;MI&#93; and target lesion revascularization &#91;TLR&#93;&#41; was assessed at one-year follow-up&#46; Stepwise Cox regression was used to determine independent predictors of outcome&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">DEBs &#40;n&#61;206&#41; were used to treat 184 lesions&#46; Procedural success was obtained in 98&#37; of patients &#40;n&#61;150&#41;&#46; At one-year follow-up&#44; 86&#37; &#40;n&#61;134&#41; were free of the primary endpoint &#40;6&#37; death&#44; 6&#37; non-procedure related MI and 5&#37; TLR&#41;&#46; The independent predictors of MACE at one year were index PCI in the left anterior descending artery &#40;HR 2&#46;81&#44; 95&#37; CI 1&#46;21-6&#46;51&#59; p&#61;0&#46;02&#41; and a history of MI &#40;HR 3&#46;46&#44; 95&#37; CI 1&#46;35-8&#46;84&#59; p&#61;0&#46;01&#41;&#46; ISR and DEB diameter or length were not predictors of events&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">PCI with DEBs in real-world patients with complex lesions is effective&#44; with a low rate of MACE&#44; including TLR&#44; at one-year follow-up&#46; The results are equally good whether the intervention is for ISR or for native coronary disease&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Comprimento DEB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab354981.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">MACE a um ano</p>"
        ]
      ]
      6 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CABG&#58; cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica&#59; DEB&#58; bal&#227;o eluidor de f&#225;rmaco&#59; EAM&#58; enfarte agudo do mioc&#225;rdio&#59; IC&#58; intervalo de confian&#231;a&#59; ICP&#58; interven&#231;&#227;o coron&#225;ria percut&#226;nea&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t" style="border-bottom: 2px solid black">An&#225;lise univariada</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Di&#226;metro DEB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comprimento DEB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab354978.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">TLR a um ano</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Tabela 7"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Fontes&#58; Unverdorben et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; Kleber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; Scheller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; Cortese et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; Colombo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&#44; Stella et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; Vaquerizo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; W&#246;ehrle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">DEB&#58; bal&#227;o eluidor de f&#225;rmaco&#59; M&#58; meses&#59; MACE&#58; eventos cardiovasculares <span class="elsevierStyleItalic">major</span> &#40;morte todas as causas&#44; enfarte agudo do mioc&#225;rdio n&#227;o fatal ou revasculariza&#231;&#227;o da les&#227;o alvo&#41;&#59; RIS&#58; reestenose intra-<span class="elsevierStyleItalic">stent</span>&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nome do estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Indica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176; de doentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MACE DEB &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TLR DEB &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PACOCCATH ISR <span class="elsevierStyleSmallCaps">I</span> e II<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;54 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEPCAD II<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;66 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEPCAD I1<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos &#40;di&#226;metro &#60;&#160;2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;82 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PICCOLETO<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;28 DEB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;7&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;1&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BELLO<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pequenos vasos &#40;di&#226;metro &#60;&#160;2&#44;8 mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&#37; aos 6 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VALENTINES <span class="elsevierStyleItalic">Registry</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1&#37; 6-9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;4&#37; 6-9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Spanish Registry</span><a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;7&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37; aos 12 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sequent Please World Wide Registry</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">All comers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;7&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&#37; aos 9 M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Principais estudos e registos no contexto da interven&#231;&#227;o coron&#225;ria percut&#226;nea com DEB</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
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              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continued benefit of coronary stenting versus balloon angioplasty&#58; One-year clinical follow-up of Benestent trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Benestent Study Group"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Macaya"
                            1 => "P&#46;W&#46; Serruys"
                            2 => "P&#46; Ruygrok"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1996"
                        "volumen" => "27"
                        "paginaInicial" => "255"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8557891"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drug-eluting balloon&#58; The comeback kid&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Waksman"
                            1 => "R&#46; Pakala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCINTERVENTIONS.109.873703"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Interv"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "352"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Morice"
                            1 => "P&#46;W&#46; Serruys"
                            2 => "J&#46;E&#46; Sousa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa012843"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2002"
                        "volumen" => "346"
                        "paginaInicial" => "1773"
                        "paginaFinal" => "1780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12050336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential solutions to the current problem&#58; Coated balloon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Scheller"
                            1 => "U&#46; Speck"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "EuroIntervention"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "numero" => "Suppl C"
                        "paginaInicial" => "C63"
                        "paginaFinal" => "C66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19202699"
                            "web" => "Medline"
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                    ]
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                ]
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            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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Informação do artigo
ISSN: 08702551
Idioma original: Português
DOI:10.1016/j.repc.2012.09.006
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