COMPLICAÇÕES EM PACIENTES SUBMETIDOS À INTERVENÇÃO CORONÁRIA PERCUTÂNEA / COMPLICATIONS IN PATIENTS SUBMITTED TO PERCUTANEOUS CORONARY INTERVENTION

ZanettiniA, Silva JC, Boeno MG, Carretta MB.

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COMPLICATIONS IN PATIENTS SUBMITTED TO PERCUTANEOUS CORONARY INTERVENTION COMPLICAÇÕES EM PACIENTES SUBMETIDOS À INTERVENÇÃO CORONÁRIA PERCUTÂNEA

COMPLICACIONES EN PACIENTES SOMETIDOS A INTERVENCIÓN CORONARIA PERCUTÁNEA

Angélica Zanettini1_{; Juliane Christofari da Silva}2_{; Mateus}

Guilherme Boeno3_{; Marisa Basegio Carretta}4 ABSTRACT

Objective: To identify the profile of patients and the most common complications in individuals undergoing

percutaneous coronary intervention. Methods: This is a descriptive cross-sectional study. It was performed with 200 patients undergoing percutaneous coronary intervention in a hospital in southern Brazil. Data were collected from patients' electronic medical records, from June to September 2018, using an instrument developed by the researchers.

Results: The average age was 65.2 years old. There was a male prevalence (142 cases - 71%). It was identified that

53 (26.5%) patients had previously undergone percutaneous coronary intervention, 162 (81%) had a diagnosis of arterial hypertension and 62 (31%) had diabetes mellitus. There were 40 cases (20%) of complications as a result of the procedure, and the main ones were the hematoma at the puncture site (42.5%), bleeding after removal of the introducer (12.5%), and decreased renal function (20%). Conclusion: the patient profile was composed of elderly men with previous chronic diseases. The main complications resulting from the coronary intervention were: hematoma at the puncture site and decreased renal function. Care protocols are needed to guide care to the patient after the intervention to reduce the complications.

Descriptors: Cardiovascular Diseases; Percutaneous Coronary Intervention; Nursing Care. RESUMO

Objetivo: identificar o perfil dos pacientes e as complicações mais comuns entre indivíduos submetidos à intervenção

coronária percutânea. Métodos: estudo descritivo de corte transversal. Realizado com 200 pacientes de um hospital público do Sul do Brasil. Os dados foram coletados do prontuário eletrônico dos pacientes, no período de junho a setembro de 2018, utilizando-se um instrumento elaborado pelos pesquisadores. Resultados: a média de idade foi de 65,2 anos. Houve prevalência do sexo masculino (142 casos – 71%). Identificou-se que 53 (26,5%) pacientes já haviam realizado intervenção coronária percutânea anteriormente, 162 (81%) possuíam o diagnóstico de hipertensão arterial e 62 (31%) o de diabetes mellitus. Foi evidenciada a ocorrência de 40 casos (20%) de complicações, sendo o hematoma no local da punção (42,5%), sangramento após retirada do introdutor (12,5%) e diminuição da função renal (20%) as principais delas. Conclusão: o perfil dos pacientes era composto por homens, idosos, com doenças crônicas prévias. As principais complicações decorrentes da intervenção coronariana foram: hematoma no local da punção e diminuição da função renal. São necessários protocolos assistenciais que possam direcionar o cuidado ao paciente após a intervenção a fim de reduzir a ocorrência de complicações.

Descritores: Doenças Cardiovasculares; Intervenção Coronária Percutânea; Cuidados de Enfermagem. RESUMEN

Objetivo: identificar el perfil de los pacientes y las complicaciones más frecuentes entre sujetos sometidos a

intervención coronaria percutánea. Métodos: estudio descriptivo transversal. Realizado con 200 pacientes de un hospital del sur de Brasil. Los datos se recopilaron de los registros médicos electrónicos de los pacientes, de junio a septiembre de 2018, utilizando un instrumento desarrollado por los investigadores. Resultados: la edad promedio fue de 65,2 años. Hubo prevalencia de varones (142 casos - 71%). Se identificó que 53 (26,5%) pacientes habían sido previamente sometidos a intervención coronaria percutánea, 162 (81%) tenían diagnóstico de hipertensión arterial y 62 (31%) diabetes mellitus. Se evidenció la ocurrencia de 40 casos (20%) de complicaciones, siendo el hematoma en el sitio de punción (42,5%), sangrado después de la extracción del introductor (12,5%) y disminución de la función renal (20,0%) los principales. Conclusión: el perfil de los pacientes estuvo compuesto por hombres, ancianos, con enfermedades crónicas previas. Las principales complicaciones derivadas de la intervención coronaria fueron: hematoma en el sitio de punción y disminución de la función renal. Se necesitan protocolos de atención que puedan dirigir la atención al paciente después de la intervención para reducir la aparición de complicaciones.

Descriptores: Enfermedades Cardiovasculares; Intervención Coronaria Percutánea; Cuidados de Enfermería. ____________________

1 _{Nurse. Cardiology Specialist. Professor of the Nursing Department at the Universidade Federal da Fronteira Sul (UFFS).}

E-mail: angeliica.zanettini@gmail.com

2 _{Nurse at the Hospital das Clínicas of Passo Fundo. Cardiology Specialist. E-mail: julianecs04@gmail.com} 3 _{Graduating in Nursing from Universidade Federal da Fronteira Sul. E-mail: mateusguilhermeb@gmail.com} 4 _{Nurse at the Hospital das Clínicas in Passo Fundo. Master in Human Aging. E-mail: marisa.diniz@hcpf.com.br}

Corresponding author: Angélica Zanettini. Endereço: Rua Cap. Araújo, 20 - Centro, Passo Fundo - RS, Brazil.

INTRODUCTION

Cardiovascular diseases are one of the main causes of death in Brazil and different parts of the world(1)_{. Also, they are responsible} for a high rate of hospitalization, which mainly burdens the Unified Health Care System. The two main groups of cardiovascular diseases (CVDs) are ischemic heart diseases (IHD) and cerebrovascular diseases (CVD)(1)_.

CVDs can be prevented by behavioral changes in risk factors such as smoking, overweight, obesity, physical inactivity, and excessive alcohol consumption. However, some patients are unable to do these habits in their life due to genetic factors and other pathologies such as diabetes mellitus (DM), systemic arterial hypertension (SAH), among others. This potentiates the emergence of cardiological events, which are sometimes treated with invasive procedures such as catheterization, angioplasty, and even surgery, depending on the cardiac involvement(2,3)_.

Due to this epidemiological expression associated with insidious and growing clinical evidence of Coronary Artery Disease (CAD) and its associated morbidity and mortality, invasive treatment methods have been developed. Thus, the Hemodynamics departments have

developed important therapeutic and

interventionist skills in their procedures(4)_. Percutaneous Coronary Intervention (PCI) is an efficient therapeutic option, indicated by the presence of cardiac ischemia. It is a procedure that aims at arterial reperfusion and the restoration of blood flow, to minimize the damage caused by ischemia of the heart muscle. The technique consists of the introduction of an arterial catheter, in which the contrast is instilled when the catheter reaches its destination and several images are obtained for evaluation. The catheter has a balloon and can be covered by a metallic coronary intraarterial mesh, called a stent, at its distal end. It is put inside the occluded vessel and afterward, the balloon is inflated to obtain arterial clearance(4,5)_.

To identify the need for intervention, cineangiocoronariography is the currently most indicated exam. It is an effective diagnostic method with several benefits such as the reduction of hospital stay and hospital costs. However, not all patients can perform it because it is only indicated in cases of stable angina, unstable angina, and AMI(6)_.

In addition to the benefits, the procedure also has a potential risk for some complications, such as hematoma at the

puncture site, trauma resulting from

catheterization, clot formation, vasospasm, and acute myocardial infarction (AMI)(4)_.

Although PCI is performed daily by the authors of this study, little is discussed about its possible complications, hindering to know the outcome of patients undergoing this procedure. Therefore, knowing the incident complications and the greater clinical relevance in this context is important because it is possible to evaluate and document the impacts that the intervention has on the subjects submitted to it.

In this sense, it is important to have indicators that can show quantitatively, in an objective way, the possible damage produced or resulting from a service provided. From the indicators, we can qualify the assistance provided. When evaluating a service offered, the probability of favorable results is increased, which consequently improves patient safety(4)_. Also, the nurse professional in the

hemodynamics unit must know the

procedures, their benefits, risks, and possible complications, so that they can intervene with assistance plans that focus on the main care to meet the demands of patients in the sector. Their role is to develop, organize and standardize care for patients undergoing catheterization and angioplasty procedures, that is, to create a care plan that values individualities to favor the team's performance and, consequently, the results(7)_.

Therefore, this study aimed to identify the profile of patients and the most common

complications in individuals undergoing

percutaneous coronary intervention.

METHODS

This is a descriptive cross-sectional study, with a data quantitative approach. The research was carried out at the hemodynamics department of a macro-regional reference public hospital in medium and high complexity in the north of the state of Rio Grande do Sul (Brazil).

We analyzed 200 medical records that met the following inclusion criteria: being a patient submitted to PCI during the period of data collection, regardless of gender, and being 18 years old or older. Data collection was carried out between June and September 2018, through access to the manual registration of patients. This record remained only inside the procedure room (it consisted only of the patient's name and the type of procedure), after this first selection/identification, the electronic medical record was located in the MV2000 system to collect the other necessary information. We excluded 32 medical records for presenting incomplete data on the outcome.

For data collection, we used an elaborated instrument by the main researcher of this

ZanettiniA, Silva JC, Boeno MG, Carretta MB.

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study, constituted in five parts. The first referred to the patients' sociodemographic characteristics, such as education level, age, and gender. The second was related to the clinical characteristics of the patient before the procedure. Stable angina was defined as the stability of the pain trigger pattern in the last two months; unstable angina, such as the worsening of the intensity and/or frequency of the angina pattern in the last two months before the procedure; AMI without ST-segment elevation was defined as chest pain with enzymatic alteration; AMI with ST-elevation defined by chest pain with ST-segment elevation on the electrocardiogram, AMI with

previous thrombolysis, ischemic

cardiomyopathy, positive stress

echocardiogram for myocardial injury and preoperative evaluation(8)_.

In the third part of the instrument, we evaluated the associated comorbidities that the patient already had such as previous PCI, SAH, DM, smoking, or if the patient had managed to quit smoking. In the fourth part, we evaluated the access route of the procedure performed: brachial, femoral, and radial.

Finally, the fifth part of the instrument evaluated the complications from the procedure. Major cardiovascular complications were defined as: the occurrence of vascular

dissection, retroperitoneal hematoma,

bleeding during the removal of the introducer, bleeding after the removal of the introducer, arteriovenous fistula, AMI, cardiopulmonary arrest (CPA), pseudoaneurysm, cardiogenic shock, and death. Minor complications were classified as decreased renal function, persistent pain, hematoma at the puncture site, edema and ischemia of the limb, allergic reaction to contrast, and urinary retention(9, 10)_. The data collected were tabulated and analyzed using descriptive statistics in Excel XP 2013®. For the presentation of the analyzed data, we used tables of absolute and relative frequency, means, and standard deviation (SD).

We sent the project to the Ethics and Research Committee (CEP) of the Universidade de Passo Fundo (UPF), to be assessed according to Resolution 466/2012 of the National Health Council (CNS). They approved the project with the opinion number

2,686,521/2018. Under number: CAAE

87146418.6.0000.5342. The informed consent was waived because it is a documentary study that used only medical records, using the Consent Term for Data Use.

RESULTS

According to the data analysis, we identified that in 200 individuals submitted to

PCI, there was a predominance of males (142 - 71.0%). The mean age was 65.2 years old (SD: 10.10). Regarding their education level, most of them had completed elementary education (39 - 19.5%), but 154 patients (77%) did not have this information in the medical record.

Regarding the previous history, 53 (26.5%) had previously undergone PCI, 162 (81%) had a diagnosis of hypertension, and 62 (31%) diabetes mellitus. Regarding smoking, 58 patients (29%) were active smokers and 47 (23.5%) had already been smokers. Regarding clinical presentation, most patients were classified as having stable angina (57-28.5%), followed by AMI with ST-segment elevation (36 - 18.0%) (Table 01).

Table 01: Distribution of the sociodemographic

profile and health profile of patients undergoing PCI, Passo Fundo, RS, 2018. CHARACTERISTICS n % Gender Male 142 71.0 Female 58 29.0 Education level Complete elementary education 39 19.5

Complete high school 04 2.0

Complete higher education 03 1.5 No information in the medical

record 154 77.0 Comorbidities Arterial hypertension 162 81.0 Diabetes mellitus 62 31.0 Smoking Active smoker 58 29.0 Ex-smoker 47 23.5 Non-smoking 95 47.5

Previous history of PCI*

Yes 53 26.5

No 147 73.5

Clinical presentation

Stable angina 57 28.5

Unstable angina 34 17.0

AMI** with ST elevation 36 18.0 AMI** without ST elevation 27 13.5 Legend: * PCI: Percutaneous Coronary Intervention; ** AMI: Acute Myocardial Infarction.

In the choice of access route, 159 (79.5%) patients underwent the procedure through the radial artery, 35 (17.5%) through the femoral artery, and six (3%) through the brachial artery. Regarding the treated vessel, in 79

(39.5%) cases, the intervention was

performed in the Anterior Descending Artery (ADA), followed by the Right Coronary Artery (RCA) with 63 (31.5%) interventions. Eight (4%) lesions of the Left Coronary Artery (LCA), 36 (18%) Circumflex Artery (CXA), two (1%) in the RCD saphenous vein, and one (0.5%) in the CXA saphenous vein were treated. Three (1.5%) lesions were treated in the Posterior Dominance (PD) branch and only one (0.5%) in the Posterior-Lateral branch (PL). The same

goes for Diagonal Artery (DGA) and Marginal Artery (MGA). Only two (1%) patients received treatment for three or more vessels at the same time. There was no information in the electronic medical record regarding the treated coronary artery of three (1.5%) patients.

The complications after the procedure appeared in 40 (20%) patients. Table 2 shows data on the clinical and demographic characteristics of these patients.

Table 02: Clinical and demographic characteristics of

patients undergoing PCI who suffered complications, Passo Fundo, RS, 2018.

Variables n* = 40

Males, n (%) 21 (52.5)

Average age, years old 65.8 ± 9.58

Arterial hypertension, n (%) 34 (85) Diabetes mellitus, n (%) 07 (17.5) Smoking, n (%) 16 (40) Ex-smoking, n (%) 10 (25) PCI** previous, n (%) 07 (17.5) Stable angina, n (%) 09 (22.5)

AMI*** ST without elevation, n (%) 06 (15) AMI*** ST with elevation, n (%) 11 (27.5) Legend: *n: number of patients; ** PCI: Percutaneous Coronary Intervention; ***AMI: Acute Myocardial Infarction.

Among the most prevalent minor complications, the hematoma was found at the puncture site (17 cases - 42.5%), followed by decreased renal function (8 cases - 20.0%). The major complications identified were bleeding after removal of the introducer (05 cases - 12.5%) and CRA and death (03 cases - 7.5%) were the most common, as shown in table 03.

Table 03: Distribution of major complications among

patients undergoing percutaneous coronary intervention, Passo Fundo, RS, 2018.

VARIABLES n* % Minor complications

Puncture site hematoma 17 42.5

Decreased kidney function 08 20.0

Persistent pain 04 10.0

Edema of the limb 02 5.0

Urinary retention 02 5.0

Major complications

Bleeding after removal of the introducer 05 12.5

CRA** 03 7.5

Death 03 7.5

Bleeding during the removal of the introducer

02 5,0

Vascular dissection 02 5,0

Cardiogenic shock 02 5,0

Cardiac tamponade 01 2,5

Allergic reaction to contrast 01 2,5

3 or more complications 03 7,5

Legend: *n: number of patients (40 cases); **CRA: Cardiorespiratory Arrest.

DISCUSSION

In this study, most patients submitted to PCI were male. This fact was also evidenced in recent research carried out with 72 patients submitted to PCI and coronary artery bypass graft surgery in a public hospital located in the interior of Bahia, in which 58.0% of the sample were men(11)_.

This fact can be in part justified because women have a natural protective factor against CVDs and only after experiencing the process of physiological changes in the climacteric they are more likely to develop such diseases(2)_{. In} this sense, we believe that there is a protection of the vasculature due to the action of endogenous estrogens. Therefore, women develop CVDs later than men; however, this risk increases after menopause (12)_{. In this}

study, most women were already

postmenopausal.

The study population was in an age group in which there is a higher prevalence of coronary heart disease, which can be related to the fact that SAH was the main comorbidity identified, both isolated and associated with DM. Also, the epidemiological transition has enabled a long time of exposure to risk factors, resulting in a greater probability of clinical manifestation of these diseases that are associated with CVDs(13)_.

In this sense, some risk factors are known to trigger CVDs such as SAH, smoking, dyslipidemia, obesity, DM, family history, and a sedentary lifestyle. The knowledge that involves the relationship between risk factors and prevention of heart disease has been widely discussed, and the results of many studies show the impact of the identification and control of these factors in the treatment of CAD(14,15)_.

We identified in this study that the radial artery was the most prevalent access route for PCI. This corroborates with studies that point to this access route as the gold standard in coronary intervention due to its benefits, such as reduced complications of the puncture site, early ambulation of the patient in the

postoperative period, and reduced

hospitalization time(16,17)_.

In this study, ADA was the most treated coronary with approximately 40% of cases. This is similar to the results of a retrospective study carried out with 158 diabetic patients who had cardiovascular disease and the need for intervention. The study revealed that in 44.2% of the patients, there was a proximal lesion of the ADA and 9% had an LCA lesion(18)_. The available data on clinical outcomes in isolated proximal revascularization of ADA are from studies that compared PCI with CABG. A study using data from the New York State PCI

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notification system identified the results of a combined propensity analysis of coronary artery bypass grafting versus drug-eluting stent implantation for revascularization of isolated proximal ADA. Mortality rates over three years did not differ. However, restenosis was approximately 50% lower with CABG(19)_.

Regarding the intervention of three or more vessels at the same time, only a small portion of the patients was treated. This is because, according to the recommendation of Ordinance 726/1999(20)_{, only in emergencies,}

in cases of multivessel impairment,

concomitant treatment of the guilty lesion and the others in the same procedure may occur.

We identified that 20.0% of the patients had complications after the procedure. The most common minor complications were the occurrence of hematoma at the puncture site, followed by decreased renal function. These findings corroborate the results of a multicenter cohort study carried out in two cities in southern Brazil, which evaluated 2,696 patients. It found that the most common

vascular complication was the minor

hematoma, responsible for 5% of

complications(21)_{. Also, renal dysfunction has} been identified in the literature as a recurrent complication, which is generally associated with a previous history of CVDs and kidney problems(22)_.

Regarding the decrease in renal function, the contrast-induced nephropathy (CIN) after PCI affects 0 to 20% of cases, depending on the presence of risk factors that include advanced age, heart failure, DM, renal failure chronic, and contrast volume used. To reduce risks, current guidelines recommend that in patients with creatinine clearance below 60 ml min, we need to use moisturize with 0.9% saline for 3 hours to 12 hours before and six to 24 hours after PCI and reduce the amount of contrast(23)_.

The major complications of bleeding after removal of the introducer was observed in five patients (12.5%). This complication is identified in the literature as having a high incidence, which sometimes defines the effectiveness of the therapeutic method chosen, which may be a complication related to the puncture site of access via the radial and femoral artery(24)_{. The reduction of this} complication is associated with established standard interventions that bring manual compression for 30 minutes by a qualified professional, and compressive dressing in 24 hours, after the PCI, as appropriate management to minimize the possibility of this complication(24)_.

In the main unit of this study, the nursing team performed the usual care and the following specific procedures to avoid complications: after the procedure was over,

radially, the introducer was removed and compression with a pneumatic bracelet (TERUMO®). In patients undergoing brachial puncture, the introducer was removed and a compressive dressing with swab and micropore was performed. In patients who underwent femoral puncture, compression was performed mechanically and after a 5 kg weight was placed in the inguinal region for 30 minutes. Afterward, it was replaced by a 3 kg sandbag, with a time of 3 hours.

Além disso, é importante salientar o papel do enfermeiro como educador e supervisor, pois, além do conhecimento técnico, é detentor do conhecimento teórico, podendo atuar como agente disseminador e implementador de medidas educativas na tentativa de orientar e estimular mudanças, como por exemplo, medidas que possam facilitar o preenchimento obrigatório das informações ao prontuário. A função de supervisor favorece ao engajamento positivo junto as relações interpessoais da equipe de trabalho, de forma a garantir a qualidade na assistência prestada(25)_.

Also, it is important to highlight the role of the nurse as an educator and supervisor, as, in addition to technical knowledge, he is the holder of theoretical knowledge, and can act as a disseminator and implementer of educational measures in an attempt to guide and encourage changes, such as, for example, measures that can facilitate the mandatory filing of information in the medical record. The

supervisor function favors positive

engagement with the interpersonal

relationships of the work team, to guarantee the quality of the assistance provided(25)_.

The research obtained relevant data on the fragility in the registration of information in the electronic medical record of the patient, being an obstacle to guarantee the care provided and having direct impacts on teaching and research in the health area. The records enable to evaluate care through notes. Therefore, there is a positive relationship between the record and the quality of care, which reflects the quality of care for individuals(26)_.

According to Resolution 1,638/2002 of the Federal Council of Medicine, the patient's medical record is a single document composed of a set of information, signs, and images recorded by the multidisciplinary health team, resulting from events, facts, and situations related to the patients' health and their assistance. Also, the medical record has a legal, confidential, and scientific character, allowing communication between different health professionals, and the continuity of care provided(27)_.

According to Federal Nursing Council Resolution 429/2012(28)_{, it is the responsibility} and duty of nursing professionals to register, in

the patient's medical record and other documents specific to the area, whether in traditional (paper) or electronic means, the information of the care process and the management of work processes, necessary to ensure continuity and quality of care.

The research carried out had important limitations regarding the registration in the electronic medical record. The information was often incomplete, both by the medical team and the nursing team. The sample size can also be considered a limiting factor since when presented in a small number and a non-probabilistic sample, it allows considering the results found only for the population under investigation.

CONCLUSION

The results of this study show that the profile of patients undergoing PCI is characterized as being mostly composed of men, with a mean age of 65.2 years old and with a previous diagnosis of chronic diseases, with emphasis on SAH and DM. We evidenced

the occurrence of 40 cases (20%) of complications as a result of the procedure. The main complication was the hematoma at the puncture site and decreased renal function. Both complications suggest weakness in technical management and cause a review of patient safety protocols.

From the identification of this profile, nurses must be attentive to cases of complications, implementing care to minimize them. Also, nurses should seek to promote a culture of adequate record in the medical records, when realizing that a nursing record is a tool that can guide the care provided, in a way that facilitates communication between the multidisciplinary team.

The findings of this research have the potential to contribute to the development of guidelines that can direct care and reduce the occurrence of complications after PCI, and to the development of care protocols. We suggest further research in the area that seeks to expand the identification of risk factors for the complications and to be statistically tested to confirm causality.

Individual contribution of the authors: ZanettiniA, Silva JC, Boeno MG: They participated in the design and writing of the project; data collection, analysis, and interpretation; writing of the article and final approval of the version to be published. Carretta MB: They contributed to the writing of the article and relevant critical analysis of the intellectual content and approval of the final version to be published. All authors declare to be responsible for all aspects of the paper, ensuring its accuracy and integrity.

Submitted: 07/07/2020 Accepted: 08/23/2020

REFERENCES

1. Malachias MVB, Souza WKSB, Plavnik FL, Rodrigues CIS, Brandão AA, Neves MFT et al. VII Diretriz Brasileira de Hipertensão Arterial: Sociedade Brasileira de Cardiologia. Arq. Bras. Cardiol [Internet].

2016; 107(3Supl3): 1-83 [Acesso em: 13 set. 2018]. Disponível em:

http://publicacoes.cardiol.br/2014/diretrizes/2016/05_HIPERTENSAO_ARTERIAL.pdf

2. Rocha RM, Martins WA. Manual de prevenção cardiovascular. 1ª ed. São Paulo: Planmark; Rio de Janeiro: SOCERJ - Sociedade de Cardiologia do Estado do Rio de Janeiro; 2017. [Acesso em: 15 out.

2018]. Disponível em:

https://socerj.org.br/antigo/wp-content/uploads//2017/05/Manual_de_Prevencao_Cardiovascular_SOCERJ.pdf.

3. Paganin AC, Beghetto MG, Feijo MK, Matte R, Sauer JM, Rabelo-Silva ER. Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study. Rev.

Latino-Am. Enfermagem. 2018; 26:e3060. [Acesso em: 18 jul 2020]. DOI:

http://dx.doi.org/10.1590/1518-8345.2672.3060.

4. Feres F, Costa RA, Siqueira D, Costa-Júnior JR, Chamié D, Staico R et al. Diretriz da Soc Bras de Cardiol e da Soc Bras de hemodinâmica e Cardiol Intervencionista sobre intervenção coronária percutânea. Arq. Bras. Cardiol [Internet]. 2017; 109(1 Supl1): 1-81. [Acesso em: 5 set. 2018]. http://dx.doi.org/10.5935/abc.20170111

ZanettiniA, Silva JC, Boeno MG, Carretta MB.

44

5. Lópes-Esparza J, Chiquete E, Pichardo O, Amancha-Gabela M, Díaz-Pacheco C, Vargas O, et al. Manejo endovascular de estenosis vertebral intracraneal com stent coronário balón expandible: reporte de dos casos y revision de la literatura. Acta Neurol Colomb [Internet]. 2018; 34(3):

184-8. [Acesso em: 18 jul 2020]. Disponível em:

http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-87482018000300184&lang=pt 6. Souto ALM, Souto RM, Teixeira ICR, Naicif MS. Myocardial Viability on Cardiac Magnetic Resonace. Soc Bras de Cardiol. 2017;108 (5): 196-9. [Acesso em: 15 jul. 2020]. Disponível em: http://publicacoes.cardiol.br/portal/portal-publicacoes//Pdfs/ABC/2017/10805/10805011.pdf. 7. Régis AP, Rosa GCD, Lunelli T. Cuidados de enfermagem no cateterismo cardíaco e angioplastia coronariana: desenvolvimento de um instrumento. Rev Cient Enferm. 2017; 7 (21): 3-20. [Acesso em: 15 jul 2020] Disponível em: https://www.recien.com.br/index.php/Recien/article/view/238/325 8. Santos ES, Timerman A. Dor torácica na sala de emergência: quem fica e quem pode ser liberado? Rev Soc Cardiol Estado de São Paulo [Internet]. 2018;28(4): 394-402. [Acesso em: 14 ago 2020].

Disponível em: http://dx.doi.org/10.29381/0103-8559/20182804394-402

9. Tang L, Hu x, Tang J, Zhou S, Fang Z. Manejo percutâneo da dissecção aórtica coronária como complicação de angiografia ou intervenção coronária percutânea diagnóstica. Soc Bras de Cardiol

[Internet]. 2017; 109(3):259-63. [Acesso em: 13 ago 2020]. Disponível em:

https://doi.org/10.5935/abc.20170105

10. Gomes ET, Silva TT, Santos MS. Complicações da intervenção coronária percutânea: inferência dos diagnósticos de enfermagem. Enferm Brasil [Internet]. 2018; 17(6): 694-701. [Acesso em: 13 ago 2020]. Disponível em: https://doi.org/10.33233/eb.v17i6.1306

11. Guimarães CF, Guimarães AA, Teixeira KA. Prevalência de Hipertensão Arterial e tabagismo entre pacientes submetidos a revascularização do miocárdio. Rev Parana Enferm [Internet]. 2020;

3(1):4-10. Disponível em: http://seer.fafiman.br/index.php/REPEN/article/view/577/542

12. Fabricio V, Oishi JC, Biffe BG, Ruffoni LDG, Silva KA, Nonaka KO, et al. Resveratrol tratment normalized the endotelial function and blood pressure in ovarietomized reats. Soc Bras de Cardiol

[Internet]. 2017; 108(2): 116-21. Disponível em: https://doi.org/10.5935/abc.20170012

13. Mann DL, Zipes DP. Braunwald: Tratado de doenças cardiovasculares. Rio de Janeiro: Ed: Elsevier; 2017; 5267 p.

14. Kang YP, Chen LY, Kang, TD, Liu WX. Características clínicas e eventos adversos em pacientes com síndrome coronária aguda e história de doença arterial periférica. Soc Bras de Cardiol. [Internet]. 2019; 113(3): 367- 72. [Acesso em 18 de Jul. 2020] Disponível em: http://dx.doi.org/10.5935/abc.20190150

15. Lima MSM, Dantas RAN, Mendes NPN, Alves LCM, Silva TTM, Brito AGR, et al. Clinical-epidemiological aspects of patients submitted to Percutaneous Coronary Intervention in a university

hospital. Rev Bras Enferm [Internet]. 2018;71(6):2883-90. DOI:

http://dx.doi.org/10.1590/0034-7167-2018-0012.

16. Andrade PB, Nogueira EF, Rinaldi FS, Bienert IRdC, Barbosa RA, Bergonso MH, et al. Comparações entre vias de acesso femoral e radial em procedimentos Coronários invasivos após cirurgia de revascularização miocárdica. Rev Bras Cardiol Invasiva [Internet]. 2015; 23(1): 8-11.

[Acesso em 18 de Jul. 2020] Disponível em:

https://www.sciencedirect.com/science/article/pii/S010418431500003X

17. Córdova ESM, Santos LR, Toebe D, Moraes MAP, Souza EN. Incidence of hemorrhagic complications with use of a radial compression device: a cohort study. Rev Esc Enferm USP

[Internet]. 2018;52:e03410. Disponível em:

http://dx.doi.org/10.1590/S1980-220X2017041003410.

18. Torres RFA, Bezerra SL, Lima MBJ, Cunha TLC, Cury MM, Silva GBG et al., Avaliação de desfechos após intervenção coronária percutânea com implante de stents farmacológicos em diabéticos multiarteriais: impacto incremental dos escores SYNTAX e SYNTAX residual em resultados clínicos de longo prazo. Rev Bras de Cardio Invasiva [Internet]. 2016; 24(1-4) 25-29. [Acesso em 18 de Jul.

2020] Disponível em: https://www.sciencedirect.com/science/article/pii/S0104184316300121. 19. Hannan EL, Zhong Y, Walford G, Holmes DR, Venditti FJ, Berger PB, et al. Coronary Artery Bypass graft surgery versus drug-eluting stents for patients with isolated proximal left anterior descending disease. J Am Colleg Cardiol [Internet]. 2014; 64(25): 2718-26. [Acesso em: 13 out. 2018].

Disponível em: https://www.onlinejacc.org/content/64/25/2717

20. Brasil. Portaria N°726, de 6 de dezembro de 1999: Departamento nacional de auditoria do SUS. Coordenação de sistemas de informação. Alta complexidade cardiovascular. Ministério da Saúde; 1999.

21. Paganin AC, Beghettio MG, Feijó MK, Matte R, Sauer JR, Silva ERR. Complicações vasculares em pacientes submetidos a procedimentos cardiológicos endovasculares: coorte multicêntrica. Rev Lat-Am. Enfermagem; [Internet]. 2018; 26:e3060. [Acesso em: 19 ago 2020] Disponível em: http://dx.doi.org/10.1590/1518-8345.2672.3060

22. Brandão END. Complicações da Intervenção Coronária Percutânea: uma revisão integrativa [Monografia]. Belo Horizonte (MG): Universidade Federal de Minas Gerais; 2019.

23. Mariani J, Fazzio FR, Bernardi FLM, Falcão BdAA, Bezerra CG, Filho AE, et al. Utilização minimizada de contraste na intervenção coronária percutânea guiada pelo ultrassom intravascular. Seguimento de 1 ano de estudo randomizado MOZART. Rev Bras de Med invasiva [Internet]. 2015; 23(4): 247-50. [Acesso em: 15 jul 2020]. Disponível em: https://www.elsevier.es/en-revista-

revista-brasileira-cardiologia-invasiva-233-articulo-utilizacao-minimizada-contraste-na-intervencao-S0104184317300103..

24. Silva LF, Gomes FA. Segurança do paciente na retirada dos introdutores – revisão integrativa [Trabalho de Conclusão de Residência]. Universidade Federal de Uberlândia; 2019.

25. Silva JP, Gonçalves MFC, Andrade LS, Monteiro EMLM, Silva MAI. Promoção da saúde na educação básica: percepções dos alunos de licenciatura em enfermagem. Rev Gaúcha Enferm [Internet]. 2018; 39:e2017- 0237. [Acesso em: 15 jul 2020]. Disponível em: https://doi.org/10.1590/1983- 1447.2018.2017-0237.

26. Brasil. Resolução n° 0514/2016: Dispõe sobre guia de recomendações para registros de enfermagem no prontuário do paciente, 2016.

27. Brasil. Resolução nº 1.638/2002: Define prontuário médico e torna obrigatória a criação da Comissão de Revisão de Prontuários nas instituições de saúde [internet]. Seção 1, p 184-5. Conselho Federal de Medicina; 2002.

28. Brasil. Resolução nº 429/2012: Dispõe sobre o registro das ações profissionais no prontuário do paciente, e em outros documentos próprios da enfermagem, independente do meio de suporte - tradicional ou eletrônico. Publicada no DOU nº 110, p 288. COFEN; 2012.

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