IJCS | Volume 31, Nº5, September / October 2018

530 Bachur et al. Angiographic characteristics of patients with AMI Int J Cardiovasc Sci. 2018;31(5)527-531 Original Article Discussion The latest advances in the treatment of AMI in centers of invasive cardiology allow angioplasty to be performed in the first hours as an immediate resource method for coronary reperfusion. 9 The early myocardial revascularization operation is indicated when there is consensus on the risks and benefits of the procedure, such as the time to revascularization after AMI. The success of the procedure is related to the preoperative risk factors such as: sex, age, Q-wave infarction and presence of cardiogenic shock. In a study by Jante et al, 10 it was verified that these risk factors determine a poor prognosis for revascularized patients exposed to them. Evaluating percutaneous coronary intervention, there is a limitation to its efficacy and safety since there is the possibility of uncontrolled acute occlusion of the vessel under treatment and coronary restenosis. The rate of occurrence of these can be reduced by using the pharmacological stent. In 1977, in a study by Gonçalves et al, 4 restenosis rates using the balloon catheter alone ranged from 30 to 50%, up to the sixthmonth after the procedure. The stent was the first percutaneous device that promoted significant reductions in rates of coronary restenosis. According to Serruys et al, 11 there was a reduction of 30 to 35%, demonstrated in controlled multicenter studies. Powel 12 analyzed the coronary angiography of patients undergoing surgery, and found that only 6% of these patients would be candidates for pharmacological stent use. However, evaluating patients with chronic coronary occlusion, 46% would be candidates for myocardial revascularization. The use of coronary stents inAMI is a recent therapeutic option, which aims at immediate and also long term results. 10 To become an ideal option, results should be obtained with greater efficiency and spending less money, what is difficult because, as all implementation processes, demands significant additional costs, so the evaluation of the economic impact in the private sector as well as in the public sector is extremely important. 13 According to the study by Rassi Jr. et al, 13 the calculation for replacement of the conventional stent by the pharmacological one would involve additional costs of about R$ 24 million, increasing in the SUS budget of 12.8%. Data from 2003 were used for this calculation when 30,666 coronary angioplasty procedures with conventional stent were performed by SUS. Analyzing the cost-effectiveness of the initial hospitalization for implantation of the pharmacological stent with the use of Rapamycin, Quadro et al 14 demonstrated an increase of only US$ 309 in clinical cost in nine months, avoiding US$ 1,650 cost for a new revascularization. Clinical success was observed because of the decreasing rate in emergency myocardial revascularization surgery or death by the procedure. The incorporationofnewtechnologies inBrazildepends on comparative studies, aiming the reimbursement or financing of the pharmacological stent, in both the private and public sectors. The adoption of this technology in both systems is still low due to its high cost. 15 Following the history of the evolution of the treatment and the resources spent for infarcted patients it is possible to observe, from the data of the present study, that it is necessary to raise awareness of risk factors, especially HTN, in an attempt to prevent future cardiovascular events. The lack of data in the spreadsheets can be considered a bias, such as the death index, since the lesion of greater prevalence in the individuals analyzed in this study was in the ADA. In terms of an immediate resource in the AMI treatment, the implantation of the pharmacological stent shows an effective evolution. Conclusions According to the results of the present study, a higher prevalence of infarction occurred in the ADA artery, with the rescue angioplasty procedure being performed, placing the stent, and an increasing incidence of the pharmacological stent placement. High blood pressure and smoking still appear as risk factors present in the sample, reinforcing the need for emphasis onmedication adherence, changes in lifestyle, weight control and post- infarction follow-up in this sample. Author contributions Conception and design of the research: Kallás Bachur CK. Acquisition of data: Bachur JA. Analysis and interpretation of the data: Machado JP. Statistical analysis: Veiga EV. Writing of themanuscript: Candido SS. Critical revision of the manuscript for intellectual content: : Barbosa R, Carraro JG, Gonçalves DF, Tonello MGM. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.