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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
BACKGROUND: Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. METHODS: This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. RESULTS: Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. CONCLUSIONS: Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.
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Rehabilitación Cardiaca/métodos , Presión de las Vías Aéreas Positiva Contínua , Puente de Arteria Coronaria/rehabilitación , Ejercicio Físico , Adulto , Anciano , Brasil , Ejercicios Respiratorios , Terapia por Ejercicio , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Fuerza Muscular , Revascularización Miocárdica/rehabilitación , Periodo Posoperatorio , Calidad de Vida , Factores de Tiempo , CaminataRESUMEN
Antecedentes: el aumento de la incidencia y prevalencia de las enfermedades cardiovasculares debido a los malos estilos de vida, disminución de ejercicio, un déficit de dieta balanceada, acompañada del estrés, alto consumo de alcohol y tabaco han sido responsables de que las afecciones cardiacas se incrementen. Gracias a la tecnología y avances científicos han surgido procedimientos cuyo objetivo ha sido prolongar y mejorar la calidad de vida; en este caso, la revascularización miocárdica (RVM) es un evento quirúrgico con denotación de ser una cirugía mayor, que tiene serias connotaciones a nivel físico, mental y emocional. Esta cirugía tiene unos periodos de recuperación, este estudio se enfatizó en el tardío periodo después del alta hospitalario, en el cual el individuo continúa su recuperación enfrentándose a su realidad. Desde este punto de vista, fue posible explorar cuáles son las vivencias de los pacientes que cursaron con un postoperatorio tardío de RVM, cuál fue su sentir respecto a su estado de salud, su relación con el personal de salud, cuáles son sus problemas y sus dudas. Estos conocimientos de los significados de vivir de esta población pueden generar posteriormente teorías de mediano rango que permita individualizar los cuidados a estos individuos, y nuevas estrategias que estén en la vanguardia de desarrollo tecnológico para modernizar el cuidado, sin perder la esencia del ser humano. Objetivo: comprender los significados que le atribuyen los pacientes a la experiencia vivida de la revascularización miocárdica en el postoperatorio tardío, atendidos durante el año 2017 y 2018 en la Clínica Mediláser en la ciudad Neiva (Huila). Metodología: investigación cualitativa con enfoque fenomenológico interpretativo o hermenéutico. La población de estudio fueron los pacientes que se encontraron entre el cuarto mes del postoperatorio tardío de RVM de la Clínica Mediláser. Se seleccionaron mediante un muestreo teórico; el tamaño de la muestra fue definido mediante el criterio de saturación de la información. La información fue obtenida mediante entrevistas a profundidad y los datos se analizaron con la propuesta de Heidegger, Diekelman, Allen y Tanner; en secuencia simultánea. Resultados: para los participantes del estudio, el significado de la experiencia de la postoperatorio de RVM está enmarcado en cuatro grandes temas: "Afrontando la recuperación", "Asumiendo cambios y complicaciones", "Retomando de nuevo mi vida" y "Fortalezas para vencer esta travesía". Conclusiones: en este estudio, las narraciones de las personas que viven un postoperatorio tardío de RVM permite un desplazamiento de la mirada puramente biológica fisiológica y farmacológica del postoperatorio tardío hacia una comprensión de la experiencia humana que subyace y resulta de la experiencia misma, atravesando otras dimensiones. Los resultados aportan a la comprensión del fenómeno desde la mirada particular de los pacientes revascularizados, exaltando la importancia del acompañamiento multidisciplinario, incluyendo a Enfermería para continuar con su cuidado después del alta médica.
Introduction: the increase in the incidence and prevalence of cardiovascular diseases due to poor lifestyles, decreased exercise, a balanced diet deficit, accompanied by stress, high consumption of alcohol and tobacco; It has been responsible for heart conditions to increase. Thanks to technology and scientific advances have emerged procedures whose goal has been to prolong and improve the quality of life, in this case myocardial revascularization (RVM) is a surgical event with denoting major surgery, which has serious connotations at the physical level, mental and emotional. This surgery has a period of recovery, this study was emphasized in the late period after hospital discharge in which the individual continued his recovery facing his reality. From this point of view, it was possible to explore the experiences of the patients who attended a late post-operative period of MVR, what their feelings were with regard to their health status, their relationship with health personnel, their problems and their Doubts. This knowledge of the meanings of living of this population can later generate mid-range theories that allow individualizing the care of these individuals, and new strategies that are at the forefront of technological development to modernize care without losing the essence of the human being. Objective: to understand the meanings attributed by patients to the experience of myocardial revascularization in the late postoperative period, attended during 2017 and 2018 at the Mediláser Clinic in the city of Neiva (Huila). Methodology: qualitative research with interpretive or hermeneutical phenomenological approach. The study population was the patients who were between the fourth month of the late postoperative period of MVR of the Mediláser Clinic. They were selected by means of a theoretical sampling. The size of the sample was defined by the criterion of saturation of the information. The information was obtained through in-depth interviews and the data was analyzed with the proposal of Heidegger, Diekelman, Allen and Tanner, in simultaneous sequence. Results: For the participants of the study, the meaning of the post-operative experience of RVM is framed in 4 major themes: "Coping with recovery", "Assuming changes and complications", "Taking up my life again" and "Strengths for overcome this journey." Conclusions: In this study, the narratives of people who live a late postoperative period of MVR allow a shift from the purely biological - physiological and pharmacological look of the late postoperative to an understanding of the human experience that underlies and results from the experience itself. crossing other dimensions, the results contribute to the understanding of the phenomenon from the particular view of revascularized patients extolling the importance of multidisciplinary accompaniment, including nursing to continue with their care after medical discharge.
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Humanos , Masculino , Femenino , Adaptación Psicológica , Revascularización Miocárdica/rehabilitación , Periodo Posoperatorio , Investigación CualitativaRESUMEN
Objetivo: analisar as mudanças provocadas pela Cirurgia de Revascularização Miocárdica (CRM) e o cuidado de si de indivíduos revascularizados. Método: pesquisa qualitativa realizada com dez indivíduos pós CRM, em um hospital escola do Sul do Brasil. Os dados foram coletados em 2013, por meio de entrevista narrativa e submetidos à análise temática. Projeto aprovado por Comitê de Ética e Pesquisa Resultados: da análise emergiu a categoria, mudanças provocadas pela CRM e o cuidado de si de indivíduos revascularizados com as subcategorias: agora eu me cuido; a mão dupla do cuidado; a imposição do cuidado; a valorização da vida; mudança de atitude nos relacionamentos; e, a família mais próxima. Conclusão: após a cirurgia, os indivíduos passam a repensar suas atitudes consigo e com as outras pessoas, valorizando sua vida, a saúde e a família. Os bens materiais e problemas que permeiam o cotidiano tornam-se menos relevantes, procurando assumir atitudes que lhe tragam prazer e bem-estar.
Objective: to examine changes brought about by myocardial revascularization surgery (coronary artery bypass graft, CABG) and self-care by revascularized individuals. Method: in this qualitative study of ten individuals post-CABG at a teaching hospital in southern Brazil, data were collected by narrative interview and submitted to thematic analysis. Results: analysis revealed the category "changes caused by CABG, and revascularized individuals self-care" with the subcategories "now I take care of myself"; "care as two-way process"; "care as imposition"; "valuing life"; "changed attitude in relationships"; and "closest relatives". Conclusion: after surgery, individuals begin to rethink their attitudes to themselves and other people, valuing their life, health and family. Material possessions and everyday problems become less relevant, and individuals endeavor to act in ways that bring pleasure and well-being.
Objetivo: analizar los cambios producidos por la cirugía de revascularización miocárdica (CRM) y el cuidado de sí de los individuos revascularizados. Método: investigación cualitativa realizada con diez individuos después de CRM, en un hospital universitario en el sur de Brasil. Los datos fueron recolectados por medio de una entrevista narrativa y sometidos al análisis temático. Resultados: del análisis surgió la categoría cambios causados por el CRM y el cuidado de sí de los pacientes revascularizados con subcategorías: ahora me cuido; la doble vía del cuidado; la imposición del cuidado; la valorización de la vida; la actitud en los relacionamientos y la familia más cerca. Conclusión: Después de la cirugía, las personas comienzan a replantearse sus actitudes con usted y otras personas, valorando su vida, la salud y la familia. Materiales y mercancías temas que permean la vida cotidiana se vuelve menos relevante, buscando tomar acciones que dan placer y bienestar.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Actitud Frente a la Salud , Automanejo , Revascularización Miocárdica/rehabilitación , Atención de Enfermería , Epidemiología Descriptiva , Investigación Cualitativa , Enfermería CardiovascularRESUMEN
A doença arterial coronariana (DAC) é a principal causa de mortalidade e morbidade entre os portadores de diabetes mellitus (DM). O DM aumenta o risco de DAC e é um preditor independente dos piores resultados após qualquer método de revascularização coronária: intervenção coronária percutânea (ICP) ou cirurgia de revascularização miocárdica (CRM). O tratamento da DAC em diabéticos possui características importantes e sua respectiva presença deve ser utilizada na escolha do método de intervenção, especialmente nos pacientes multiarteriais e/ou com lesão de tronco de coronária esquerda. Além da terapia medicamentosa rigorosa ser um dos pilares fundamentais, a decisão sobre a estratégia de revascularização deve ser tomada por uma equipe multiprofissional e multidisciplinar ("Heart Team"), baseando-se em elementos do quadro clínico, da anatomia coronária, carga isquêmica, função ventricular esquerda, risco cirúrgico hospitalar e do próprio paciente.
Coronary artery disease (CAD) is the leading cause of mortality and morbidity among patients with Diabetes Mellitus (DM). DM increases the risk of CAD and is an independent predictor of poorer outcomes after any method of coronary revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The treatment of CAD in diabetics has important characteristics, and its presence should not be used in the choice of intervention method, especially in multiarterial patients and/or patients with unprotected left main stem disease. In addition to rigorous drug therapy being one of the fundamental pillars, the decision on the type of revascularization strategy should be made by a multiprofessional and multidisciplinary team ("Heart Team"), based on the clinical presentation, coronary anatomy, ischemic burden, left ventricular function, in-hospital surgical risk and individual patient risk.
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Humanos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/historia , Accidente Cerebrovascular/mortalidad , Diabetes Mellitus/epidemiología , Revascularización Miocárdica/rehabilitación , Angioplastia Coronaria con Balón/métodos , Stents/historiaRESUMEN
Resumen: Introducción: La rehabilitación cardiovascular ha demostrado tener efectos beneficiosos en pacientes con antecedentes de patología coronaria. Objetivos: Identificar los factores que determinan el resultado de un programa de rehabilitación cardiovascular (PRC) aplicado a pacientes coronarios revascularizados. Métodos: 67 pacientes sometidos a cirugía de bypass o angioplastia fueron evaluados en su capacidad funcional mediante el test de marcha de 6 minutos (TM) al inicio y al completar el programa de rehabilitación cardiovascular. La distancia recorrida en el test de marcha fue correlacionada con la edad, capacidad funcional previa al PRC, tiempo en completar el pro-grama, tiempo que media entre la intervención y el inicio del programa, duración del programa y tipo de revascularización. Además, se comparó el incremento de la capacidad funcional entre los pacientes que fueron derivados a 36 sesiones con los referidos a solo 12. Resultados: 67 pacientes cumplieron los criterios para evaluación del PRC. Globalmente, se observó una mejoría de 12% (511,4 a 573,4 m) en la distancia del TM (p<0.001)). El mayor beneficio, en términos de distancia en el TM se obtuvo al efectuar un programa con más sesiones (36 vs 12) con valores de 20% y 8%, respectivamente (p<0.002). El poder terminar el PRC de 36 sesiones más rápidamente (entre 10 y 13 semanas vs entre 14 y 24 semanas se asoció a una mayor incremente en el TM con valores de 19% vs 10%, respectivamente (p<0,003). El incremento en el TM no difirió entre 3 grupos de edad (desde 49 a 85 años); en el tiempo que transcurre entre la intervención y el inicio del PRC (antes vs después de la 8a semana post revascularización), al tipo de revascularización a la que fue sometido el paciente (cirugía o angioplastía) y a la capacidad funcional previa que estos presentan al inicio del PRC. Conclusión: El PRC es efectivo en mejorar significativamente la capacidad funcional de pacientes revascularizados, especialmente cuando el número de sesiones del programa es mayor y cuando se realiza con una frecuencia de al menos 3 veces por semana. El PRC es igualmente efectivo en pacientes enviados a rehabilitación en forma más precoz, como también lo es en sujetos más añosos. Estos efectos fueron independientes del tipo de revascularización.
Abstracts: Introduction : Background: Cardiovascular Rehabilitation Programs (CRP) have been shown to produce be-neficial effects in patients with coronary artery disease. Aim: to identify factors associated to CRP success in patients who underwent myocardial revascularization Methods: 67 patients who underwent coronary artery bypass surgery (CABG) or percutaneous coronary artery angioplasty (PTCA) were evaluated for functional capacity by means of a standard 6 min walking test (6mWT), before and after completion of the CRP. Distance covered during the test was correlated with age, prior functional class, time employed to complete CRP, time from coronary intervention and CRP initiation, CRP duration and type of revascularization. In addition, patients referred for a 36 sessions CRP were compared to those referred to only 12 sessions. Results: 67 patients met inclusion criteria. Overall, there was a 12% increase (511,4 to 573,4 m) in 6mWT distance (p<0.001). The greatest benefit was obtained with the 36 session CRP as compared to a 12 session CRP (20 vs 8% (p<0.002). Also, completion of a 36 session CRP between 10 and 13 weeks compared to 14 to 24 weeks revealed a greater benefit in the former group (19% vs 10%, respectively (p<0.003). There was no difference in 6minWT distance in 3 groups of age (extending from 49 to 85 years-old); In addition, time from intervention to initiation of CRP (before vs after 8 weeks), type of revascularization or functional capacity at the beginning of CRP showed any difference in 6mWT distance. Conclusion: CRP is a highly effective intervention to improve functional capacity in patients following myocardial revascularization, more so when more sessions are employed and when at least 3 sessions per week are implemented. The program is equally effective in patients starting CRP early after revascularization, and benefit is independent from patient age.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/rehabilitación , Rehabilitación Cardiaca/métodos , Revascularización Miocárdica/rehabilitación , Factores de Tiempo , Enfermedad de la Arteria Coronaria/fisiopatología , Ejercicio Físico/fisiología , Factores de Edad , Prueba de Esfuerzo , Marcha/fisiologíaRESUMEN
OBJECTIVE: to evaluate the quality of life of patients who underwent revascularization surgery. METHOD: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL). RESULTS: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009). CONCLUSION: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.
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Procedimientos Quirúrgicos Cardíacos/normas , Revascularización Miocárdica/psicología , Revascularización Miocárdica/rehabilitación , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Procedimientos Quirúrgicos Cardíacos/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta de Reducción del Riesgo , Encuestas y CuestionariosRESUMEN
ABSTRACT Objective: to evaluate the quality of life of patients who underwent revascularization surgery. Method: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL). Results: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009). Conclusion: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.
RESUMEN Objetivo: evaluar la calidad de vida de los pacientes sometidos a cirugía de revascularización. Método: estudio descriptivo, transversal, con abordaje cuantitativo llevado a cabo con 75 pacientes. Se empleó el cuestionario WHOQOL-Bref para evaluar la calidad de vida (CV). Resultados: Los pacientes tuvieron CV regular, necesitando mejoras en todos los dominios. Los pacientes de baja renta presentaron peores índices de CV en el dominio medioambiental (p=0,021), así como presentaron los provenientes de la ciudad de Recife y región en el dominio relaciones sociales (p=0,021). Los pacientes fumadores (p=0,047), diabéticos (p=0,002) y de la clase alta (p=0,035) tuvieron peores valores de CV en el dominio físico. Los pacientes con problemas renales presentaron peores índices de CV en los dominios físico (p=0,037), psicológico (p=0,008), relaciones sociales (p=0,006) y en el puntaje total (p=0,009). Conclusión: para mejorar la CV hay que cambiar la conducta individual, y es muy importante la participación de los profesionales de salud en la planificación de estrategias de abordaje a estos pacientes, en especial en la educación en salud.
RESUMO Objetivo: avaliar a qualidade de vida de pacientes submetidos à cirurgia de revascularização. Método: estudo descritivo, transversal, com abordagem quantitativa realizado com 75 pacientes. Foi utilizado o questionário WHOQOL-Bref para avaliação da qualidade de vida (QV). Resultados: Pacientes apresentaram avaliação da QV regular, com necessidade de melhora em todos os domínios. Pacientes de baixa renda tiveram pior avaliação da QV no domínio meio ambiente (p=0,021), e os procedentes de Recife/região metropolitana, no domínio relações sociais (p=0,021). Pacientes tabagistas (p=0,047), diabéticos (p=0,002) e etilistas (p=0,035) apresentaram pior avaliação da QV no domínio físico. Pacientes renais apresentaram pior avaliação da QV nos domínios físico (P=0,037), psicológico (p=0,008), relações sociais (p=0,006) e no escore total (p=0,009). Conclusão: a melhoria da QV depende de um processo de mudança de comportamento individual e a participação dos profissionais de saúde é essencial para elaborar estratégias de abordagem desses pacientes, principalmente no tocante à educação em saúde.
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Humanos , Masculino , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Calidad de Vida/psicología , Procedimientos Quirúrgicos Cardíacos/normas , Revascularización Miocárdica/psicología , Revascularización Miocárdica/rehabilitación , Brasil , Estudios Transversales , Encuestas y Cuestionarios , Conducta de Reducción del Riesgo , Procedimientos Quirúrgicos Cardíacos/métodos , Persona de Mediana EdadAsunto(s)
Humanos , Infarto del Miocardio/cirugía , Revascularización Miocárdica/rehabilitación , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/fisiopatología , Anestesia/historia , Ecocardiografía Transesofágica/métodos , Electrocardiografía , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Factores de RiesgoRESUMEN
Introduction: Coronary artery bypass grafting (CABG) does not have an effect on the etiopathogenic factors of atherosclerosis, thus, it is crucial to control risk factors. Objective: To analyze the effect of a cardiac rehabilitation (CR) program on cardiovascular risk factors, the Framingham risk score (FRS) and levels of C-reactive protein (CRP) of patients undergoing CABG. Methods: A descriptive, cross-sectional and retrospective study was conducted with a sample of 49 patients, who were participating in a program (24 weeks). Body mass index (BMI), waist circumference (WC), FRS, risk (%) of developing coronary artery disease in 10 years (CAD risk), serum levels of LDL-c, triglycerides (TG) and CRP were assessed. Results: The variables BMI, WC, LDL-c, TG, CRP levels, FRS and CAD risk showed significant reductions (p<0,001). Conclusion: The program was effective in reducing cardiovascular risk factors, FRS, as well as the decrease in CRP levels.
Introdução: A cirurgia de revascularização do miocárdio (CRM) não atua nos fatores etiopatogênicos da aterosclerose, dessa forma o controle destes fatores torna-se crucial. Objetivo: Analisar o efeito de um programa de reabilitação cardíaca (RC) sobre fatores de risco cardiovasculares, Escore de Framingham (EF) e níveis de proteína C reativa (PCR) de pacientes submetidos à CRM. Métodos: Trata-se de um estudo transversal e retrospectivo com uma amostra 49 pacientes participantes de um programa de RC (24 semanas). Índice de massa corporal (IMC), circunferência da cintura (CC), EF, risco de desenvolvimento de doença arterial coronariana em 10 anos (risco DAC), níveis séricos de LDL-c, triglicerídeos (TG) e PCR foram avaliados. Resultados: As variáveis IMC, CC, LDL-c, TG, PCR, Pontuação no EF e o risco DAC apresentaram reduções significativas (p<0,001). Conclusão: O programa foi eficaz na redução de fatores de risco cardiovascular, no EF, bem como na diminuição dos níveis de PCR.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Rehabilitación Cardiaca , Revascularización Miocárdica/rehabilitación , Proteína C-Reactiva , Estudios Transversales , Estudios Retrospectivos , Prevención Secundaria , Factores de Riesgo de Enfermedad CardiacaRESUMEN
Introdução: A Reabilitação Cardiovascular usualmente é realizada em âmbito ambulatorial e hospitalar e pode ser expandido para academias. Objetivos: Avaliar a qualidade de vida de cardiopatas submetidos ao treinamento físico em curto prazo supervisionado por fisioterapeutas e educadores físicos em uma academia. Métodos: Foram avaliados 10 cardiopatas de ambos os sexos, média de faixa etária de 63.1±10,10 anos. Foram submetidos ao treinamento aeróbio em esteira ou bicicleta ergométrica, em intensidade moderada e um treinamento resistido em circuito em uma academia. O treinamento foi realizado por 45 dias, 2 vezes semanais, com duração de 1 hora. A aplicação do questionário de qualidade de vida SF-36 foi realizada antes e após o treinamento. Resultados: Com relação à força, houve melhora significante após a intervenção proposta. Foram constatadas melhoras em todos os aspectos da qualidade de vida. Conclusões: O treinamento físico realizado em academia melhorou a qualidade de vida de cardiopatas em curto período de reabilitação.
Introduction: Cardiovascular Rehabilitation is usually performed on an outpatient and hospital settings and can be expanded to gym. Aims: To assess the quality of life of cardiac patients undergoing short-term physical training, supervised by physical therapists and physical educator at a gym. Methods: We evaluated 10 cardiac patients of both sexes, average age 63.1 ± 10.10 years. They were submitted to aerobic training on a treadmill or stationary bike, at moderate intensity and resistance training circuit. The training was conducted for 45 days, 2 times weekly, 1 hour. The application of the SF-36 quality of life questionnaire was conducted before and after training. Results: In the strength data, there was significant improvement after the intervention proposal. improvements were noted in all aspects of quality of life. Conclusions: Physical training conducted in a gym improved the quality of life of cardiac patients in a short period of rehabilitation.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Rehabilitación Cardiaca/métodos , Estudios Prospectivos , Modalidades de Fisioterapia , Entrenamiento Aeróbico , Revascularización Miocárdica/rehabilitaciónRESUMEN
Introdução: Técnicas respiratórias são fundamentais no pós-operatório de cirurgia cardíaca a fim de reduzir complicações pós-operatórias. Objetivos: Comparar duas técnicas de fisioterapia respiratória no clearance mucociliar, força muscular respiratória e obstrução de vias aéreas após cirurgia cardíaca. Métodos: Foram avaliados 32 pacientes submetidos à cirurgia de revascularização do miocárdio, alocados para o grupo respiração por pressão positiva intermitente ou para o grupo exercício de respiração profunda. As avaliações foram compostas de: força muscular respiratória (pressão expiratória máxima e da pressão inspiratória máxima), pico de fluxo respiratório e clearance mucociliar (através do teste do tempo de transito da sacarina, expresso em minutos); e realizadas em três momentos: pré-operatório e pós-operatório antes e após a aplicação das técnicas. Resultados: Na análise do transporte mucociliar, força muscular respiratória e pico de fluxo expiratório, a comparação entre os momentos antes e após a aplicação das técnicas não apresentaram diferenças significativas (transporte mucociliar: p = 0,3844, Pimáx p = 0,2244; Pemáx p = 0,4968; Peak flow p = 0,8383). Nas análises individuais de cada grupo, puderam ser observadas diferenças significativas nas variáveis de força muscular respiratória e pico de fluxo expiratório (p<0.0001). Conclusão: Não foram observadas diferenças significativas entre as técnicas, porém foram eficientes no clearance mucociliar, força muscular e pico de fluxo expiratório quando avaliadas separadamente.
Introduction: Respiratory techniques are fundamental in the postoperative period of cardiac surgery in order to reduce postoperative complications. Objectives: The aim of this study was to compare two techniques of respiratory physiotherapy in mucociliary clearance, respiratory muscle strength and airway obstruction after cardiac surgery. Methods: Thirty-two patients undergoing coronary artery bypass grafting were assigned to the intermittent positive pressure group or to the deep breathing exercise group. The evaluations were composed of: respiratory muscle strength (maximal expiratory pressure and maximal inspiratory pressure), peak respiratory flow and mucociliary clearance (through the saccharine transit time test, expressed in minutes); And performed in three moments: preoperative and postoperative before and after the application of the techniques. Results: In the analysis of mucociliary transport, respiratory muscle strength and peak expiratory flow, the comparison between the moments before and after the application of the techniques did not present significant differences (mucociliary transport: p = 0.3844, Pimax p = 0.2244; = 0.4968; Peak flow p = 0.8383). In the individual analyzes of each group, significant differences were observed in the variables of respiratory muscle strength and peak expiratory flow (p <0.0001). Conclusion: There were no significant differences between the techniques, but were efficient in mucociliary clearance, muscle strength and peak expiratory flow when evaluated separately.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Terapia Respiratoria/métodos , Revascularización Miocárdica/rehabilitación , Ápice del Flujo Espiratorio , Depuración Mucociliar , Respiración de Presión Positiva Intrínseca , Obstrucción de las Vías Aéreas/prevención & control , Ventilación no InvasivaRESUMEN
INTRODUCTION: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. OBJECTIVE: Identify predictors of clopidogrel following CABG. METHODS: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. RESULTS: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). CONCLUSION: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Asunto(s)
Puente de Arteria Coronaria/rehabilitación , Revascularización Miocárdica/rehabilitación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/mortalidad , Ticlopidina/análogos & derivados , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Puente Cardiopulmonar/rehabilitación , Clopidogrel , Puente de Arteria Coronaria/métodos , Quimioterapia Combinada/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , North Carolina , Alta del Paciente/estadística & datos numéricos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/normas , Cuidados Posoperatorios/mortalidad , Complicaciones Posoperatorias/tratamiento farmacológico , Periodo Posoperatorio , Prevalencia , Pronóstico , Tasa de Supervivencia , Ticlopidina/administración & dosificación , Ticlopidina/normas , Ticlopidina/uso terapéuticoRESUMEN
Abstract Introduction: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. Objective: Identify predictors of clopidogrel following CABG. Methods: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. Results: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). Conclusion: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Asunto(s)
Humanos , Masculino , Femenino , Complicaciones Posoperatorias/mortalidad , Ticlopidina/análogos & derivados , Inhibidores de Agregación Plaquetaria/uso terapéutico , Puente de Arteria Coronaria/rehabilitación , Revascularización Miocárdica/rehabilitación , Alta del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/mortalidad , Complicaciones Posoperatorias/tratamiento farmacológico , Periodo Posoperatorio , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/normas , Puente Cardiopulmonar/rehabilitación , Aspirina/administración & dosificación , Aspirina/uso terapéutico , North Carolina , Puente de Arteria Coronaria/métodos , Tasa de Supervivencia , Quimioterapia Combinada/mortalidad , Clopidogrel , Revascularización Miocárdica/métodosRESUMEN
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.
Asunto(s)
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: Este estudo teve como objetivo comparar a incidência de fibrilação atrial apósrevascularização do miocárdio entre pacientes que tiveram a pressão venosa central rigorosamente controladanas primeiras 48-72 horas de pós-operatório e pacientes que não tiveram controle rigoroso. Método: Estudoobservacional, do tipo caso-controle, realizado na Santa Casa de Misericórdia de Ponta Grossa. O caso foicomposto por 80 pacientes avaliados prospectivamente submetidos a revascularização miocárdica entre 2012e 2014, os quais tiveram a pressão venosa central avaliada de duas em duas horas, nas primeiras 72 horas depós-operatório, sendo administrada uma ampola de furosemida cada vez que a pressão atingiu o ponto de cortepreestabelecido de forma randomizada em 15 cmH2O ou 20 cmH2O. Já o controle foi composto por 184 pacientesavaliados retrospectivamente submetidos a revascularização miocárdica entre 2009 e 2012, antes do início darandomização, nos quais o controle da pressão venosa central foi menos rigoroso, ficando a necessidade de usode diurético a critério dos intensivistas. Avaliou-se a incidência de fibrilação atrial nas primeiras 72 horas depós-operatório nos dois grupos. Resultados: A incidência de fibrilação atrial foi menor no grupo caso (11,25%, 9em 80), comparativamente ao grupo controle (23,35%, 43 em 184) (P = 0,03). Outras variáveis estudadas foramsemelhantes entre os grupos, exceto o clearance de creatinina, que foi maior no grupo controle. Conclusão: Opresente estudo demonstra que o controle da pressão venosa central nas primeiras 72 horas de pós-operatório écapaz de reduzir a incidência de fibrilação atrial após revascularização do miocárdio.
Background: This study was aimed at comparing the incidence of atrial fibrillation after coronaryartery bypass grafting among patients who have had central venous pressure strictly controlled within thefirst 48-72 hours after surgery and patients who did not have a strict control. Method: Observational, casecontrolstudy, performed at Santa Casa de Misericórdia de Ponta Grossa. The case included 80 prospectivelyevaluated patients submitted to myocardial revascularization between 2012 and 2014, who had central venouspressure evaluated every two hours, in the first 72 hours after surgery. Patients received a vial of furosemide everytime the pressure reached the pre-established cutoff randomly set as 15 or 20 cmH2O. The control included 184retrospectively evaluated patients undergoing myocardial revascularization between 2009 and 2011 prior to thebeginning of randomization; in this group central venous pressure control was less rigorous, requiring use ofdiuretics at the discretion of the intensivists. The incidence of atrial fibrillation in the first 72 hours after surgerywas evaluated in both groups. Results: The incidence of atrial fibrillation was lower in the case group (11.25%,9 in 80) than in the control group, (23.35%, 43 in 184) (P = 0.03). Other studied variables were similar betweenthe groups except for the creatinine clearance, which was higher in the control group. Conclusion: The presentstudy demonstrates that the central venous pressure control within the first 72 hours after surgery reduces theincidence of atrial fibrillation after coronary artery bypass grafting.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fibrilación Atrial/clasificación , Presión Venosa Central/fisiología , Revascularización Miocárdica/rehabilitación , Comorbilidad , Cuidados Posoperatorios/enfermería , Unidades de Cuidados Intensivos , Estudio ObservacionalRESUMEN
INTRODUCTION: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. OBJECTIVES: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. METHODS: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. RESULTS: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. CONCLUSION: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.
Asunto(s)
Ejercicios Respiratorios/métodos , Tiempo de Internación , Revascularización Miocárdica/métodos , Cuidados Preoperatorios/métodos , Músculos Respiratorios/fisiología , Adulto , Anciano , Femenino , Humanos , Capacidad Inspiratoria/fisiología , Masculino , Persona de Mediana Edad , Fuerza Muscular , Ejercicios de Estiramiento Muscular/métodos , Revascularización Miocárdica/rehabilitación , Periodo Preoperatorio , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Frecuencia Respiratoria/fisiología , Estadísticas no Paramétricas , Volumen de Ventilación Pulmonar/fisiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Fundamentos: Durante o pós-operatório da cirurgia de revascularização do miocárdio (CRM), o repouso prolongado no leito aumenta a possibilidade de ocorrer complicações sistêmicas decorrentes do imobilismo. Objetivo: Verificar o comportamento das variáveis hemodinâmicas e no pico de fluxo expiratório (peack flow) em pacientes idosos, em pós-operatório de CRM submetidos a três tipos diferentes de intervenção fisioterapêutica. Métodos: Estudados 30 idosos estratificados em três grupos: Grupo A - mobilização com cicloergômetro; Grupo B - mobilização sem uso do cicloergômetro, mas com fisioterapia e Grupo C - sem qualquer mobilização, mas com ventilação não invasiva (VNI), sendo analisados o comportamento da frequência cardíaca (FC), frequência respiratória (FR), pressão arterial (PA), saturação periférica de oxigênio (SpO2) e pico de fluxo expiratório (peack flow). Para a variação dos resultados intragrupos, nas fases pré e pós-teste utilizou-se o teste de Wilcoxon; para a comparação intergrupos nas fases pré e pós-teste utilizou-se o teste de Kruskal-Wallis. Considerou-se significância estatística p<0,05.Resultados: Observou-se aumento significativo para os valores peack flow em todos os grupos (pré e pós-teste); redução significativa da PAS no grupo A, aumento da FC e da FR no grupo B (pré e pós-teste). Na análise intergrupos, observou-se redução da PAD no grupo C, com significado estatístico.
Background: During the post-operative phase after coronary artery bypass (CAB) surgery, prolonged bed rest increases the possibility of systemic complications resulting from immobilization. Objective: To ascertain the behavior of peak expiratory flow and hemodynamic variables among elderly patients during the CAB postoperative period undergoing three types of physiotherapy interventions. Methods: Thirty elderly patients were studied, divided into three groups: Group A - mobilization with an ergometric bicycle; Group B - mobilization without an ergometric bicycle but with physiotherapy; and Group C - no mobilization but with non-invasive ventilation, analyzing the heart rate (HR), respiration rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO2)and expiratory peak flow. The Wilcoxon test was used for variations in the intra-group results for the pre- and post-test phases, using the Kruskal-Wallis test for the inter-group comparison of the pre and post-test phases, with a statistical significance of p<0.05.Results: A significant increase was observed in the peak flow values for the three groups (pre- and post-test);with a significant reduction in the systolic blood pressure for group A and higher heart rates and respiration rates in group B. The inter-group analysis presented a statistically significant reduction in the diastolic blood pressure for group C.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Cuidados Posoperatorios/rehabilitación , Ejercicios Respiratorios/métodos , Ápice del Flujo Espiratorio/fisiología , Revascularización Miocárdica/rehabilitación , Circulación Sanguínea/fisiología , Unidades de Cuidados IntensivosRESUMEN
Fundamentos: Pacientes dialíticos apresentam alto risco aterosclerótico, sendo previsto aumento nas indicações de revascularização miocárdica (RM) nesse grupo.Objetivos: Avaliar características clínicas, laboratoriais, ecoDopplercardiográficas e cineangiocoronariográficas de pacientes dialíticos e do subgrupo com indicação de RM.Métodos: Foram analisados 94 pacientes dialíticos submetidos à cineangiocoronariografia, estratificados em dois grupos: com e sem doença coronariana (DAC). Resultados: 94 pacientes, 57,4 % homens, média de idade 53,9±10,1 anos, 95,7 % hemodialíticos, mediana do tempo diálise 60,0 meses. Ao ecoDopplercardiograma a fração de ejeção média foi 61,07±12,06 % (n=84); função diastólica normal em 16,9 %, tipo I em 63,9 %, tipo II em 12,0 % e tipo III em 7,2 %. A população estudada foi estratificada em dois grupos: com DAC (n=47) e sem DAC (n=47). No grupo com DAC, 27,7 % eram triarteriais, 12,8 % uniarteriais e 9,6 % biarteriais, sendo mais frequente: DAC prévia (17,0 % vs. 2,1 %; p=0,003), calcificação parietal à cineangiocoronariografia (76,6 % vs. 10,6 %; p<0,001) e uso prévio de betabloqueadores (55,3 % vs. 27,7 %; p=0,007). Nos pacientes não diabéticos, aqueles com disfunção diastólica tiveram quatro vezes mais chance de coronariopatia (OR 4,26 IC 1,03-23,55; p=0,048). Houve elevada indicação de RM nos coronariopatas (61,7 %), com indicação cirúrgica em 51,7 % dos revascularizáveis. Conclusões: DAC prévia, calcificação parietal na cineangiocoronariografia e uso prévio de betabloqueadores foram mais frequentes nos coronariopatas. Disfunção diastólica ao ecoDopplercardiograma foi o único preditor independente para DAC em pacientes dialíticos. Indicação de RM foi elevada nos coronariopatas.
Background: Dialysis patients are at high risk for atherosclerosis, with increased indications for myocardial revascularization (MR) in this group. Objectives: To assess clinical, laboratory, echoDoppercardiographic and coronary angiography parameters among dialysis patients and in a subgroup with MR indications. Methods: 94 dialysis patients undergoing coronary angiography were analyzed and divided into two groups: with and without coronary artery disease (CAD). Results: 94 patients; 57.4% men, mean age 53.9±10.1 years, 95.7% on hemodialysis, median dialysis time of 60.0 months. Mean ejection fraction in echocardiography: 61.07±12.06% (n=84), normal diastolic function in 16.9%, type I diastolic dysfunction in 63.9%, type II in 12.0% and type III in 7.2%. The population was divided into two groups: with CAD (n = 47) and without CAD (n = 47). In the CAD group, 27.7% had three-vessel, 12.8% one-vessel and 9.6% two-vessel disease, with prior CAD (17.0% vs. 2.1%; p=0.003), parietal calcification in coronary angiography (76.6% vs. 10.6%; p<0.001), with prior use of beta-blockers (55.3% vs. 27.7%; p=0.007) being more frequent in the CAD group. Among non-diabetic patients, those with diastolic dysfunction were four times more likely to have CAD (OR 4.26 CI 1.0323.55; p=0.048). There was a high level (61.7%) of MR indications among CAD patients, with surgery indicated for 51.7% of those suitable for revascularization. Conclusions: Prior CAD, parietal calcification in coronary angiography and prior use of beta-blockers were more frequent in the CAD group. Diastolic dysfunction in the echoDopplercardiograms was the only independent CAD predictor among dialysis patients, with MR indications high for coronary heart disease patients.