RESUMEN
INTRODUÇÃO: A doença cardiovascular continua estabelecida como a principal causa de óbito no Brasil e também em São Paulo, tendo como fator de risco cardinal o crescimento de depósitos gordurosos nas artérias coronárias, as chamadas placas de aterosclerose. O tratamento para doença aterosclerótica coronária (DAC) inclui intervenções bem consolidadas na prática, sendo a cirurgia de revascularização miocárdica (CRM) uma das mais importantes medidas terapêuticas no contexto hospitalar, principalmente em pacientes portadores de lesões triarteriais ou com diabetes associada. Nesse sentido, a CRM vem apresentando importantes avanços em relação à redução da mortalidade e morbidade inerentes ao procedimento cirúrgico, principalmente através das inovações tecnológicas dos últimos anos. Sendo assim, o seguinte trabalho se objetiva a analisar a mortalidade da revascularização miocárdica em pacientes com DAC supracitadas, para uma melhoria da assistência hospitalar e das políticas públicas de saúde, pleiteando uma mortalidade hospitalar cada vez menor. MÉTODOS: Estudo de caráter epidemiológico, descritivo e transversal. Foi realizada coleta de dados através do banco informativo de saúde DATASUS (TABNET), correspondente aos óbitos de pacientes submetidos a revascularização miocárdica entre os anos de 2013 a 2023 no município de São Paulo. As variáveis utilizadas são: raça/cor, sexo e faixa etária. RESULTADOS: Analisando os dados coletados, é notável que o ano de maior incidência de óbitos foi 2014 com 123 óbitos, representando aproximadamente 13,91% do total do período estudado. A raça mais afetada foi a branca, com 65% dos óbitos. Já a faixa etária mais acometida foi entre 65 e 69 anos, totalizando 22,05% dos óbitos. Em relação ao sexo, a prevalência é masculina, caracterizando 58,37% dos óbitos. CONCLUSÕES: Em relação à abordagem terapêutica analisada nos últimos 10 anos no município de São Paulo, foi verificada uma maior mortalidade no sexo masculino, em idades avançadas e na raça branca. Além disso, é importante destacar que houve uma redução significativa nas taxas de desfecho cardiovascular primário nos pacientes submetidos ao procedimento. Esse cenário reforça a projeção da CRM como um tratamento cada vez mais seguro e eficiente no contexto das doenças coronarianas.
Asunto(s)
Revascularización Miocárdica/mortalidadRESUMEN
Abstract Background Prolonged mechanical ventilation (MV) after cardiac surgery imposes a significant burden on the patient in terms of morbidity and financial hospital costs. Objective To develop a risk score model to predict prolonged MV in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods This was a historical cohort study of 4165 adult patients undergoing CABG between January 1996 and December 2016. MV for periods ≥ 12 hours was considered prolonged. Logistic regression was used to examine the relationship between risk predictors and prolonged MV. The variables were scored according to the odds ratio. To build the risk score, the database was randomly divided into 2 parts: development data set (2/3) with 2746 patients and internal validation data set (1/3) with 1419 patients. The final score was validated in the total database and the model's accuracy was tested by performance statistics. Significance was established at p < 0.05. Results Prolonged MV was observed in 783 (18.8%) patients. Predictors of risk were age ≥ 65 years, urgent/emergency surgery, body mass index ≥ 30 kg/m2, chronic kidney disease, chronic obstructive pulmonary disease, and cardiopulmonary bypass time ≥ 120 minutes. The area under the ROC curve was 0.66 (95% CI, 0.64-0.68; p<0.001), the Hosmer-Lemeshow chi-square test was χ2: 3.38 (p=0.642), and Pearson's correlation was r = 0.99 (p<0.001), indicating the model's satisfactory ability to predict the occurrence of prolonged MV. Conclusion Selected variables allowed the construction of a simplified risk score for daily practice, which may classify the patients as having low, moderate, high, and very high risk. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Respiración Artificial/métodos , Guías de Práctica Clínica como Asunto , Revascularización Miocárdica/rehabilitación , Respiración Artificial/efectos adversos , Estudios Prospectivos , Estudios de Cohortes , Factores de Riesgo de Enfermedad Cardiaca , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidadRESUMEN
Changes in ventilatorymechanics and their consequent pulmonary complications are common after surgical procedures, particularly in cardiac surgery (CS), and may be associated with both preoperative history and surgical circumstances. This study aims to compare ventilatory mechanics in the moments before and after cardiac surgery (CS), describing how pulmonary complications occurred. An experimental, uncontrolled study was conducted, of the before-and-after type, and with a descriptive and analytical character. It was carried out in a private hospital in the city of Salvador, Bahia, Brazil, and involved 30 adult patients subjected to CS. In addition to clinical and epidemiological variables, minute volume (VE), respiratory rate (RR), tidal volume (VT), forced vital capacity (FVC), maximum inspiratory pressure (MIP), and peak expiratory flow (PEF) were also recorded. Data were collected in the following moments: preoperative (PRE-OP) period, immediate postoperative (IPO) period, and 1stpostoperative day (1stPOD). The sample was aged 48.1 ± 11.8 years old and had a body mass index of 25.5 ± 4.9 kg m-2; 60% of the patients remained on mechanical ventilation for less than 24 hours (17.5 [8.7-22.9] hours). There was a significant reduction in VT, FVC, MIP and PEF when PRE-OP versus IPO, and PRE-OP versus 1stPOD were compared (p < 0.05). There were no significant changes between IPO and the 1stPOD. The highest incidence of pulmonary complications involved pleural effusion (50% of the patients). This study showed that patients subjected to CS present significant damage to ventilatory parameters after the surgery, especially in the IPO period and on the 1stPOD. It is possible that the extension of this ventilatory impairment has led to the onset of postoperative pulmonary complications.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Cirugía Torácica , Mecánica Respiratoria , Pacientes/estadística & datos numéricos , Derrame Pleural/complicaciones , Estándares de Referencia , Respiración Artificial , Respiración Artificial/mortalidad , Tabaquismo/diagnóstico , Índice de Masa Corporal , Frecuencia Respiratoria , Presión Arterial , Frecuencia Cardíaca , Hipertensión/complicaciones , Enfermedades Pulmonares/complicaciones , Revascularización Miocárdica/mortalidadRESUMEN
INTRODUCCIÓN: La cirugía sin circulación extracorpórea (CEC) es una variante de la técnica convencional. Existe controversia sobre sus beneficios, seguridad y resultados a largo plazo. OBJETIVO: Describir resultados inmediatos y alejados (a 5 años) de cirugía sin CEC y compararlos a cirugía con CEC. MATERIALES y MÉTODOS: Estudio descriptivo-analítico, con revisión de base de datos del equipo, protocolos quirúrgicos, fichas clínicas, seguimiento clínico y/o entrevista telefónica y en registro civil de pacientes operados entre enero de 2006 y diciembre de 2008. Total 658 cirugías coronarias aisladas, 466 (70,8%) con CEC y 192 (29,2%) sin CEC. Se realizó técnica de Propensity Score Matching para identificar grupos de pacientes similares y comparar resultados entre ambas técnicas. RECSULTADOS: Mortalidad operatoria en 1,0% en el grupo sin CEC y 2,1% en el grupo con CEC (p = 0,411). En seguimiento alejado: Supervivencia a 1, 3 y 5 años de 97,4%, 95,3% y 92,2% respectivamente sin CEC vs 97,9%, 96,3% y 92,7% respectivamente con CEC (p = 0,824). Mayor-Adverse-Cardiac-and-Cerebrovascular-Events (MACCE) 28 (17,3%) sin CEC vs 26 (16,0%) (p = 0,71). Infarto agudo al miocardio (IAM) 3 (1,9%) sin CEC vs 6 (3,7%) (p = 0,33), accidente vascular encefálico (AVE) 6 (3,7%) sin CEC vs 3 (1,9%) (p = 0,3) y reintervención 4 (2,5%) sin CEC vs 3 (1,9%) (p = 0,703). Recurrencia de angina 9 (5,6%) sin CEC vs 10 (6,2%) (p = 0,813). CONCLUSIONES: En nuestra serie de paciente ambas técnicas fueron comparables en resultados inmediatos y alejados.
INTRODUCTION: Coronary artery bypass grafting (CABG) without extracorporeal circulation (off pump) is a technical alternative to conventional surgery. There is ongoing controversy about its benefits, safety and results. AIM: To describe immediate and late results of off pump CABG and compare it with conventional surgery. MATERIALS AND METHOD: Descriptive-analytic, study with review of surgical protocols, clinical charts, civil registry for survival and telephonic follow up of patient who underwent CABG in our center between January 2006 and December 2008. In total 658 isolated CABG cases, 466 (70.8%) on pump and 192 (29.2%) off pump. A Propensity Score Matching was used to match off pump CABG patients with those undergoing On Pump CABG. RESULTS: Mortality was 1.0% in off pump and 2.1% in on pump patients (p = 0.411). At follow up: 1.3 and 5 year survival was 97.4%, 95.3% and 92.2% respectively in off pump patients and 97.9%, 96.3% and 92.7% respectively in On Pump patients (p = 0.824). Mayor-adverse-Cardiac-and-Cerebrovascular-events (MACCE) in 28 (17.3%) off pump vs 26 (16.0%) (p = 0.71) on pump, myocardial infarction in 3 (1.9%) off pump vs 6 (3.7%) on pump (p = 0.33), stroke in 6 (3.7%) off pump vs 3 (1.9%) on pump (p = 0.3) and coronary reintervention in 4 (2.5%) off pump vs 3 (1.9%) on pump patients (p = 0.703). Recurrence of angina in 9 (5.6%) off pump vs 10 (6.2%). CONCLUSIONS: In our experience both techniques had similar results.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Coronaria/cirugía , Puente de Arteria Coronaria Off-Pump/métodos , Puntaje de Propensión , Análisis de Supervivencia , Entrevistas como Asunto , Estudios de Seguimiento , Resultado del Tratamiento , Puente de Arteria Coronaria Off-Pump/mortalidad , Circulación Extracorporea , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidadRESUMEN
Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce. Objective: To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon. Methods: Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014. Results: A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 - 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 - 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 - 39.54, p = 0.001) were predictors of mortality after CABG. Conclusion: A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias , Brasil/epidemiología , Hospitales Públicos , Revascularización Miocárdica/mortalidad , Comorbilidad , Factores Sexuales , Factores de Riesgo , Factores de Edad , Resultado del Tratamiento , Síndrome Coronario Agudo/complicaciones , Estudio Observacional , Infecciones/complicaciones , Angina Inestable/complicaciones , Infarto del Miocardio , Infarto del Miocardio/complicacionesRESUMEN
BACKGROUND: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). OBJECTIVES: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. METHODS: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). RESULTS: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. CONCLUSION: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.
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Síndrome Coronario Agudo , Reserva del Flujo Fraccional Miocárdico/fisiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/cirugía , Humanos , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidad , Pronóstico , Medición de Riesgo , Factores de Tiempo , Tiempo de TratamientoRESUMEN
Abstract Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.
Resumo Fundamento: Existem dados limitados sobre o prognóstico do adiamento do tratamento das lesões em pacientes com síndrome coronária com base na reserva de fluxo fracionada (FFR). Objetivos: Realizar uma revisão sistemática da evidência atual sobre o prognóstico do adiamento do tratamento de lesões em pacientes com SCA com base na FFR, comparando-o com o prognóstico em pacientes sem SCA. Métodos: Pesquisamos as bases de dados do Medline, EMBASE, e Cochrane Library por estudos publicados entre janeiro de 2000 e setembro de 2017 que compararam o prognóstico do adiamento da revascularização das lesões com base na FFR em pacientes com SCA em comparação a pacientes sem SCA. Conduzimos uma metanálise do risco relativo de quatro desfechos primários: mortalidade, mortalidade cardiovascular, infarto do miocárdio (IM) e revascularização do vaso-alvo (TVR). Resultados: Identificamos sete estudos que incluíram um total de 5107 pacientes. A metanálise mostrou que não houve diferença quanto à mortalidade [risco relativo (RR) = 1,44; IC95%, 0,9-2,4), mortalidade cardiovascular (RR = 1,29; IC95% = 0,4-4,3) e TVR (RR = 1,46; IC95% = 0,9-2,3) após adiamento da revascularização com base na FFR entre pacientes com SCA e pacientes sem SCA. Tal adiamento foi associado com risco adicional de IM (RR = 1,83; IC95% = 1,4-2,4) em pacientes com SCA. Conclusão: O valor prognóstico da FFR na SCA não é tão bom como em pacientes estáveis. Os resultados mostram um risco aumentado de IM, mas não de mortalidade, mortalidade cardiovascular, e TVR em pacientes com SCA.
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Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/mortalidad , Pronóstico , Factores de Tiempo , Medición de Riesgo , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidadRESUMEN
OBJECTIVE: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. METHODS: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). RESULTS: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). CONCLUSION: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.
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Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/cirugía , Revascularización Miocárdica/métodos , Anciano , Puente de Arteria Coronaria/métodos , Ecocardiografía , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/mortalidad , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/mortalidad , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Volumen Sistólico/efectos de la radiación , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Previous evidence suggests that acute treatment with statins reduce atherosclerotic complications, including periprocedural myocardial infarction, but currently, there are no large, adequately powered studies to define the effects of early, high-dose statins in patients with acute coronary syndrome (ACS) and planned invasive management. OBJECTIVES: The main goal of Statins Evaluation in Coronary procedUres and REvascularization (SECURE-PCI) Trial is to determine whether the early use of a loading dose of 80 mg of atorvastatin before an intended percutaneous coronary intervention followed by an additional dose of 80 mg 24 hours after the procedure will be able to reduce the rates of major cardiovascular events at 30 days in patients with an ACS. DESIGN: The SECURE-PCI study is a pragmatic, multicenter, double-blind, placebo-controlled randomized trial planned to enroll around 4,200 patients in 58 different sites in Brazil. The primary outcome is the rate of major cardiovascular events at 30 days defined as a composite of all-cause mortality, nonfatal acute myocardial infarction, nonfatal stroke, and coronary revascularization. SUMMARY: The SECURE PCI is a large randomized trial testing a strategy of early, high-dose statin in patients with ACS and will provide important information about the acute treatment of this patient population.
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Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/cirugía , Atorvastatina/uso terapéutico , Intervención Coronaria Percutánea/métodos , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/mortalidad , Anciano , Anticolesterolemiantes/uso terapéutico , Brasil , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidad , Intervención Coronaria Percutánea/mortalidad , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Pronóstico , Modelos de Riesgos Proporcionales , Medición de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Abstract Objective: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. Methods: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). Results: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). Conclusion: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/cirugía , Revascularización Miocárdica/métodos , Valores de Referencia , Volumen Sistólico/efectos de la radiación , Factores de Tiempo , Ecocardiografía , Puente de Arteria Coronaria/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Mortalidad Hospitalaria , Medición de Riesgo , Aneurisma Cardíaco/mortalidad , Aneurisma Cardíaco/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Revascularización Miocárdica/mortalidadRESUMEN
Introducción y objetivos: existe tendencia a procurar un aumento de los beneficios de la cirugía de revascularización mediante el uso de ambas arterias mamarias internas (DAMI). Nuestro objetivo fue analizar los resultados nacionales a largo plazo del uso de DAMI en una población de pacientes con ángor estable con indicación de revascularización aislada. Métodos: se recabaron los datos de pacientes operados desde 2006 a 2015 en Uruguay. Se extrajeron variables demográficas, operatorias y de seguimiento. Evaluamos mortalidad operatoria, mediastinitis y sobrevida. Estratificamos la población por edad en menor o mayor o igual a 65 años. Para disminuir la heterogeneidad entre grupos realizamos comparación mediante puntaje de propensión (PS) en menores de 65 años. Resultados: se incluyeron 2.791 pacientes. Los pacientes con DAMI eran más jóvenes (57,3?8,5 vs 65,9?8,6 años, p=0,001), con menor porcentaje de sexo femenino (15,6% vs 28,2%, p=0,001), menor incidencia de hipertensión (74,1% vs 79,8%, p=0,012) y menor Euroscore (1,35 vs 4,23, p=0,001). En ³65 años, DAMI resultó ser predictor independiente de mortalidad operatoria y peor sobrevida. En ?λτ;65 años pareados por PS, los pacientes con DAMI tuvieron mayor sobrevida, pero DAMI no fue predictor independiente para la misma. La revascularización completa en pacientes con una mamaria igualó la sobrevida a DAMI. La incidencia de mediastinitis fue similar en ambos grupos en todos los casos. Conclusiones: el uso de DAMI resultó perjudicial en pacientes 65 años. Dicha técnica ofrece mejores resultados en pacientes menores de 65 años, aunque su beneficio como predictor independiente parecería estar confundido por otras variables como la edad y la revascularización completa.
Introduction and objectives: there is a tendency to increase the benefits of surgery in coronary artery disease using both internal mammary arteries (BIMA). Our objective was to evaluate our long term national results in patients with stable coronary artery disease who receive isolated coronary artery bypass grafts (CABG) using BIMA. Methods: patients operated between 2006 and 2015 were included. Patients' demographic, operative and postoperative variables were extracted. The outcomes were operative mortality, deep sternal infection and survival. Our population was stratified by age in ?λτ; and ³ 65 years old. In order to decreased group heterogeneity, propensity match (PM) was performed. Results: 2.791 patients were included. Patients with BIMA were younger (57.3?8,5 vs 65,9?8,6 years old, p=0,001), lower incidence of females (15,6% vs 28,2%, p=0,001), of hypertension (74,1% vs 79,8%, p=0,012) and lower Euroscore (1,35 vs 4,23, p=0,001). In patients ³ 65 years old, BIMA was an independent predictor for worse operative mortality and survival. In PM patients ?λτ; 65 years old, BIMA was associated with improved survival but failed to be an independent predictor for it. Patients who received single internal mammary artery and had complete revascularization had similar survival to BIMA patients. Deep sternal infection was similar between groups in both strata. Conclusions: the use of BIMA was found to be an independent predictor for worse outcomes in patients ³ 65 years old. BIMA has better results for patients ?λτ; 65 years old although its independent benefit is confused by other variables such as age and complete revascularization.
Asunto(s)
Humanos , Masculino , Cirugía Torácica , Arterias Mamarias/cirugía , Revascularización Miocárdica/mortalidad , Tasa de Supervivencia , Factores de Riesgo , Factores de EdadRESUMEN
As doenças isquêmicas do coração (DIC) são causas de morte relevantes no Estado do Rio de Janeiro (ERJ). A cirurgia de revascularização do miocárdio (CRVM) e a angioplastia coronariana (AC) objetivam reduzir agravos causados pelas DIC. É preciso conhecer a eficiência desses procedimentos para decisões clínica e gerenciais. Objetivo: Descrever evolução temporal e letalidade hospitalar de CRVM e AC de 1999 a 2010 no ERJ. Métodos: Estudo de dados referentes às CRVM e AC dos bancos de dados das Autorizações de Internação Hospitalar pagas pelo Sistema Único de Saúde, de 1999 a 2010 no ERJ, com informações sobre diagnóstico, idade, sexo, data e duração da internação, tipo de alta hospitalar. Foram realizadas estatísticas descritivas e regressão linear para análise de tendências. Resultados: Em 34 413 pacientes com média de idade 61±10 anos, foram realizados 38 509 procedimentos, sendo 66,3% AC e 65,4% homens. Ocorreu aumento anual de 15,8% das AC e de 3,2% das CRVM. O diagnóstico de DIC aguda foi registrado em 60,6% das internações relacionadas a AC e 57,9% das relacionadas a CRVM. As medianas de duração de internação foram de 2 dias nas AC e 10 nas CRVM. As letalidades hospitalares encontradas nas AC e nas CRVM foram de 1,8% e 6,8%, respectivamente, maiores nos indivíduos com 70 anos ou mais, nas mulheres e nas DIC agudas. Conclusão: Houve um aumento nos procedimentos de revascularização miocárdica no ERJ, principalmente nas AC com stent, divergindo de outras regiões do mundo. Além disso, a letalidade hospitalar após a AC e a CRVM foram superiores às encontradas em outros locais e em estudos controlados.
Background: Ischemic heart diseases (IHD) are important causes of deaths in the state of Rio de Janeiro (RJ). Coronary artery bypass grafting (CABG) and coronary angioplasty (CA) procedures aim to mitigate the effects of IHD. Awareness of the efficiency of these procedures is crucial for clinical and administrative decision making. Objective: To describe temporal evolution and hospital mortality of CABG and CA performed in RJ from 1999 to 2010. Methods: Study on data of CA and CABG, covered by the Brazilian Unified Health System in RJ from 1999 to 2010, obtained from the Authorization for Hospital Admission database, concerning diagnosis, age, sex, admission date and hospital internment duration, and type of hospital discharge. Trends analysis was performed by descriptive statistics and linear regression analysis. Results: In 34,413 patients with mean age of 61±10 years, 38,509 procedures were performed, 66.3% CA and 65.4% in men. There was an annual increase by 15.8% in CA and 3.2% in CABG. The diagnosis of acute IHD was recorded in 60.6% of admissions related to CA, and in 57.9% of admissions related to CABG. Median hospital stay was 2 days in CA and 10 days in CABG. Hospital mortality was 1.8% and 6.8% in CA and CABG, respectively, and was higher in patients aged 70 years or older, in women and in acute IHD. Conclusion: The number of myocardial revascularizations in RJ, especially CA with stent, has increased which differs from other regions of the world. In addition, post-CA and post-CABG hospital mortality was higher than that reported in other locations and controlled studies.
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Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/cirugía , Revascularización Miocárdica/mortalidad , Sistema Único de Salud/ética , Mortalidad HospitalariaRESUMEN
Abstract Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. Conclusion: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.
Resumo Fundamento: A revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com doença coronariana multiarterial. Contudo, o procedimento ainda apresenta elevada morbimortalidade. O uso da circulação extracorpórea (CEC) pode impactar de maneira negativa na evolução intra-hospitalar desses pacientes. Objetivos: Avaliar a diferença entre as técnicas com ou sem CEC na evolução intra-hospitalar de pacientes dialíticos submetidos a cirurgia de revascularização do miocárdio. Métodos: Estudo unicêntrico de 102 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2014. Resultados: 63 pacientes foram operados com CEC e 39 sem o uso de CEC. Foi observada alta prevalência de fatores de risco cardiovascular em ambos grupos, porém sem diferença estatisticamente significante entre eles. O grupo "com CEC" apresentou maior número de coronárias revascularizadas (2,4 vs 1,7; p <0,0001), maior necessidade de hemocomponentes (77,7% vs 25,6%; p <0,0001) e apoio inotrópico (82,5% vs 35,8%; p <0,0001). Na evolução pós-operatória, o grupo "sem CEC" apresentou menor necessidade de drogas vasoativas (61,5% vs 82,5%; p = 0,0340), maior taxa de extubação em sala cirúrgica (58,9% vs 23,8%, p = 0,0006), menor tempo de ventilação mecânica (13,0 horas vs 36,3 horas, p = 0,0217), menor taxa de infecções (7,6% vs 28,5%; p = 0,0120) e menor tempo de internação em UTI (5,2 dias vs 8,1 dias; p = 0,0054) em comparação ao grupo "com CEC". Não houve diferença de mortalidade entre os grupos. Conclusão: O uso da CEC na revascularização do miocárdio em pacientes dialíticos resultou em maior morbidade no período perioperatório em comparação ao procedimento realizado sem CEC, contudo, sem diferença de mortalidade.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Diálisis Renal/métodos , Circulación Extracorporea/métodos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/mortalidad , Revascularización Miocárdica/métodos , Complicaciones Posoperatorias , Factores de Tiempo , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/mortalidad , Reproducibilidad de los Resultados , Factores de Riesgo , Diálisis Renal/mortalidad , Resultado del Tratamiento , Mortalidad Hospitalaria , Estadísticas no Paramétricas , Circulación Extracorporea/mortalidad , Centros de Atención Terciaria , Hospitales Universitarios , Unidades de Cuidados Intensivos , Tiempo de Internación , Revascularización Miocárdica/mortalidadRESUMEN
Introdução: Apesar da estreita relação do tabagismo com o desenvolvimento da doença aterosclerótica, pouco se sabe sobre as características clínicas e os desfechos relacionados à intervenção coronária percutânea (ICP) em tabagistas com síndrome coronariana aguda no Brasil. O objetivo deste estudo foi analisar o perfil clínico, angiográfico e do procedimento, além de desfechos hospitalares, em pacientes tabagistas e não tabagistas com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) submetidos à ICP primária ou de resgate. Métodos: Estudo transversal do registro da Central Nacional de Intervenções Cardiovasculares (CENIC) entre 2006 e 2016. A população do estudo incluiu pacientes com idade ≥ 18 anos que apresentassem IAMCST submetidos à ICP primária ou de resgate. Resultados: Foram incluídos 20.319 pacientes, dos quais 6.880 (34,4%) eram tabagistas. O grupo de pacientes tabagistas era significativamente mais jovem, do sexo masculino e com menor prevalência de comorbidades. À angiografia, os tabagistas apresentaram maior complexidade, com maior prevalência de trombos, de lesões longas ou fluxo TIMI 0/1. Durante o procedimento, os tabagistas receberam stent farmacológico em menor proporção e a tromboaspiração foi mais frequente, bem como o sucesso do procedimento (94,2% vs. 92,1%; p < 0,0001). Na análise univariada, pacientes tabagistas apresentaram menor mortalidade (2,9% vs. 4,5%; p < 0,0001) e menos eventos cardíacos adversos maiores (3,3% vs. 4,8%; p < 0,0001). No entanto, após análise multivariada, o tabagismo não se associou a menor risco de mortalidade. Conclusões: Embora os desfechos clínicos associados à ICP tenham sido favoráveis aos pacientes tabagistas, a análise multivariada não demonstrou efeito protetor do tabagismo. Tais resultados são devidos às diferenças encontradas nas características clínicas e angiográficas entre pacientes tabagistas e não tabagistas
Background: Despite the close association between smoking and atherosclerotic disease development, little is known about the clinical characteristics and outcomes related to percutaneous coronary intervention (PCI) in smokers with acute coronary syndrome in Brazil. This study aimed to analyze the clinical, angiographic, and procedural profile, in addition to in-hospital outcomes, in smokers and non-smokers with acute myocardial infarction with ST-segment elevation (STEMI) submitted to primary or rescue PCI. Methods: Cross-sectional study of the Central Nacional de Intervenções Cardiovasculares (CENIC) registry between 2006 and 2016. The study population included patients aged ≥ 18 years who presented with STEMI and were submitted to primary or rescue PCI. Results: A total of 20,319 patients were included, of whom 6,880 (34.4%) were smokers. The group of smokers was significantly younger, male, and with a lower prevalence of comorbidities. At angiography, smokers showed greater complexity, with a higher prevalence of thrombi, long lesions or TIMI flow 0/1. During the procedure, smokers received a lower proportion of drug-eluting stents and thrombus aspiration was more frequent, as well as procedural success (94.2% vs. 92.1%; p < 0.0001). In the univariate analysis, smokers showed lower mortality (2.9% vs. 4.5%; p < 0.0001) and fewer major adverse cardiac events (3.3% vs. 4.8%; p < 0.0001). However, after multivariate analysis, smoking was not associated with a lower risk of mortality. Conclusions: Although the clinical outcomes associated with the PCI were favorable to smokers, the multivariate analysis did not show a protective effect of smoking. Such results are due to differences in clinical and angiographic characteristics between smokers and non-smokers
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Tabaquismo/mortalidad , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio , Angiografía/métodos , Factores Sexuales , Estudios Transversales , Factores de Riesgo , Análisis de Varianza , Factores de Edad , Diabetes Mellitus/mortalidad , Síndrome Coronario Agudo/complicaciones , Stents Liberadores de Fármacos , Revascularización Miocárdica/mortalidadRESUMEN
BACKGROUND: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. OBJECTIVES: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. METHODS: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. RESULTS: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. CONCLUSION: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.
Asunto(s)
Circulación Extracorporea/métodos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Revascularización Miocárdica/métodos , Diálisis Renal/métodos , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/cirugía , Circulación Extracorporea/mortalidad , Femenino , Mortalidad Hospitalaria , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Fallo Renal Crónico/mortalidad , Tiempo de Internación , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/mortalidad , Complicaciones Posoperatorias , Diálisis Renal/mortalidad , Reproducibilidad de los Resultados , Factores de Riesgo , Estadísticas no Paramétricas , Centros de Atención Terciaria , Factores de Tiempo , Resultado del TratamientoRESUMEN
Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.
Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.
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Humanos , Revascularización Miocárdica/educación , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/enfermería , Revascularización Miocárdica/estadística & datos numéricos , Revascularización Miocárdica/métodos , Revascularización Miocárdica/mortalidad , Revascularización Miocárdica/rehabilitación , Enfermedad Coronaria/cirugía , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/enfermería , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/historia , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/patología , Enfermedad Coronaria/rehabilitaciónRESUMEN
Introdução: Historicamente, pacientes com cirurgia de revascularização do miocárdio (CRM) prévia submetidos à intervenção coronária percutânea (ICP) primária têm pior prognóstico que pacientes semCRM prévia. No entanto, análises mais contemporâneas contestam esses achados. Nosso objetivo foi avaliar os desfechos clínicos de 30 dias em pacientes com e sem CRM prévia submetidos à ICP primária. Métodos: Estudo de coorte prospectivo extraído do banco de dados do Instituto de Cardiologia do RioGrande do Sul, contendo 1.854 pacientes submetidos à ICP primária. Resultados: Pacientes com CRM prévia (3,8%) mostraram perfil clínico, em geral, mais grave. O tempo deinício dos sintomas até a chegada ao hospital foi menor nesse grupo (2,50 horas [1,46-3,66] vs. 3,99 horas[1,99-6,50]; p < 0,001) e o tempo porta-balão foi semelhante (1,33 hora [0,85-2,07] vs. 1,16 hora [0,88-1,58];p = 0,12). O acesso femoral foi mais usado no grupo com CRM prévia (91,5% vs. 62,5%; p < 0,001). O uso de tromboaspiração manual foi menor nesse grupo (16,9% vs. 31,1%; p = 0,007), mas não houve diferença no uso de inibidor da glicoproteína IIb/IIIa (28,2% vs. 32,4%; p = 0,28). O sucesso angiográfico foi menor no grupo com CRM prévia (80,3% vs. 93,3%; p = 0,009). Aos 30 dias, pacientes com CRM prévia apresentaram taxas similares de eventos cardíacos adversos maiores (14,1% vs. 11,2%; p = 0,28), e a mortalidade, embora numericamente mais alta, não foi estatisticamente significativa (13,2% vs. 7,0%; p = 0,07).Conclusões: Nessa análise contemporânea, pacientes com CRM prévia submetidos à ICP primária apresentaram perfil clínico mais grave e menor sucesso angiográfico, porém não mostraram diferenças nos desfechos clínicos em 30 dias.
Background: Historically, patients with prior coronary artery bypass graft (CABG) surgery undergoing primary percutaneous coronary intervention (PCI) have a worse prognosis than patients without prior CABG. However, more contemporary analyses have contested these findings. This studys aim was to evaluate the 30-day clinical outcomes in patients with and without prior CABG submitted to primary PCI. Methods: Prospective cohort study, extracted from the database of Instituto de Cardiologia do Rio Grandedo Sul, containing 1,854 patients undergoing primary PCI. Results: Patients with prior CABG (3.8%) showed, in general, a more severe clinical profile. The time of symptom onset until arrival at the hospital was shorter in this group (2.50 hours [1.46 to 3.66] vs. 3.99 hour [1.99 to 6.50]; p < 0.001), while the door-to-balloon time was similar (1.33 hour [0.85 to 2.07] vs.1.16 hour [0.88 to 1.58]; p = 0.12). Femoral access was more often used in the group with prior CABG(91.5% vs. 62.5%; p < 0.001). Manual thrombus aspiration was less often performed in this group (16.9% vs. 31.1%; p = 0.007), but there was no difference regarding the use of glycoprotein IIb/IIIa inhibitors (28.2% vs. 32.4%, p = 0.28). Angiographic success was lower in the group with prior CABG (80.3% vs. 93.3%; p = 0.009). At 30 days, patients with prior CABG had similar rates of major adverse cardiac events (14.1%vs. 11.2%; p = 0.28), and mortality, although numerically higher, was not statistically significant (13.2%vs. 7.0%, p = 0.07). Conclusions: In this contemporary analysis, patients with prior CABG undergoing primary PCI had amore severe clinical profile and lower angiographic success, but showed no differences regarding 30-day clinical outcomes.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Atención Terciaria de Salud/métodos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/métodos , Pacientes , Revascularización Miocárdica/mortalidad , Angiografía/métodos , Análisis de Varianza , Cirugía Torácica/métodos , Estudios de Cohortes , Factores de Riesgo , Inhibidores de Agregación Plaquetaria/administración & dosificación , StentsRESUMEN
Fundamentos: A prevalência de doenças cardiovasculares é muito alta e cirurgias cardíacas são comuns em centros terciários de atenção cardiovascular. Objetivo: Avaliar a mortalidade cirúrgica e comparar com a mortalidade esperada pelo EuroSCORE em pacientesde centro terciário de atenção cardiovascular. Métodos: Trata-se de coorte histórica que avaliou pacientes submetidos a cirurgias cardíacas em 2011 e 2012, emhospital terciário de referência em cardiologia no sul do Brasil. O desfecho principal foi a mortalidade por qualquer causa durante a internação hospitalar. Os desfechos secundários foram a mortalidade de acordo com o procedimento cirúrgico, o EuroSCORE total e de acordo com o procedimento, a mortalidade ajustada por EuroSCORE e o perfil de risco dos pacientes. Resultados: Foram incluídos 364 pacientes. Cirurgia de revascularização do miocárdio (CRM) isolada foi oprocedimento realizado em 59,9% dos pacientes, o procedimento valvar (PV) isolado (troca ou plastia valvar) em33,0% e a CRM + PV em 7,1% dos pacientes. A mortalidade observada foi 14,2%, sendo 5,2% nas primeiras 24 horas. A mortalidade esperada pelo EuroSCORE, por sua vez, foi 5,7±7,4%. A mortalidade ajustada foi, assim, 2,5 vezes superior à esperada, mas dentro do intervalo de dois desvios-padrão da mortalidade esperada. A mortalidade associada aos procedimentos combinados, entretanto, foi 5,2 vezes superior a do EuroSCORE esperado e superior ao intervalo de dois desvios-padrão do EuroSCORE. Conclusão: Pacientes submetidos à cirurgia cardíaca no centro estudado apresentaram mortalidade superior à esperada, em especial aqueles submetidos a procedimentos combinados.
Background: The prevalence of cardiovascular diseases is very high and cardiac surgeries are common in tertiary centers for cardiovascular care. Objective: Evaluate the surgical mortality and compare the mortality level expected by EuroSCORE in patients from tertiary centers for cardiovascular care. Methods: Historical cohort study evaluating patients who have under gone cardiac surgeries in 2011 and 2012, at a renowned tertiary cardiology hospital in southern Brazil. The primary outcome was all-cause mortality during hospitalization. Secondary outcomes were surgery-related mortality, total and procedure-related EuroSCOREs, the adjusted mortality rate by EuroSCORE and the risk profile of patients. Results: The study comprised 364 patients. Coronary artery bypass graft (CABG) surgery alone was the procedure performed in 59.9% of patients, followed by the valve procedure (VP) (valve replacement or repair) in 33.0%, and CABG + VP in 7.1% of patients. The mortality rate was 14.2%, with 5.2% in the first 24 hours. The mortality rate expected by EuroSCORE, in turn, was 5.7 ± 7.4%. The adjusted mortality rate was thus 2.5 times higher than the expected, however within the range of two standard deviations of the expected mortality rate. Mortality associated with combined procedures, however, was 5.2 times higher than theEuroSCORE expected, and higher than the range of two standard deviations of EuroSCORE. Conclusion: Patients undergoing cardiac surgery at the center under study showed higher mortality than the expected rate, especially those undergoing combined procedures.
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Humanos , Masculino , Femenino , Anciano , Cirugía Torácica/tendencias , Implantación de Prótesis de Válvulas Cardíacas/métodos , Procedimientos Quirúrgicos Operativos/efectos adversos , Revascularización Miocárdica/mortalidad , Centros de Atención Terciaria , Análisis de Varianza , Brasil/epidemiología , Estudios de Cohortes , Enfermedades Cardiovasculares/epidemiología , Incidencia , Factores de RiesgoRESUMEN
AIMS: To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. METHODS AND RESULTS: Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). CONCLUSION: The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.