RESUMO
BACKGROUND: Vascular complications are still common in the catheterization laboratory setting. However, no risk scores for their prediction have been described. With a view to bridging this gap, the present study sought to develop and validate a score for prediction of vascular complications associated with arterial access in patients undergoing interventional cardiology procedures. METHODS: This prospective multicenter cohort study included adult patients who underwent cardiac catheterization via the femoral or radial route. The outcomes of interest were: access site hematoma; major and minor bleeding; and retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistula requiring surgical repair. Past medical history as well as pre-procedural, intra-procedural, and post-procedural variables were collected. Patients were randomly allocated to the derivation or validation cohorts at a 2:1 ratio. The following equation constituted the score: (>6F introducer sheath×4.0)+(percutaneous coronary intervention×2.5)+(history of vascular complication after prior interventional cardiology procedure×2.0)+(prior use of warfarin or phenprocoumon×2.0)+(female sex×1.5)+(age⩾60 years×1.5). The maximum score is 13.5 points. RESULTS: A score dichotomized at ⩾3 (best cutoff for balancing sensitivity and specificity) was moderately accurate (sensitivity=0.66 (95% confidence interval: 0.59-0.73); specificity=0.59 (95% confidence interval: 0.56-0.61)). Patients with a score ⩾3 were at increased risk of complications (odds ratio: 2.95; 95% confidence interval: 2.22-3.91). CONCLUSIONS: This study yielded a score that is capable of predicting vascular complications and easily applied in daily practice by providers working in the catheterization laboratory setting.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/normas , Complicações Pós-Operatórias/etiologia , Medição de Risco/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
Se hizo un estudio retrospectivo en 59 menores de 2 anos con TBC pulmonar, internados en el Hospital Josefina Martinez de Ferrari durante el periodo 1970-1979. Se encontro desnutricion severa en 55.9% de los casos, antecedente de contacto tuberculoso en 68.8%, principalmente por enfermedad de la madre y falta de vacunacion BCG previa en el 39%. En los no vacunados hubo viraje tuberculinico en 20 de 23 casos. El PPD fue (-) en 35,5% de los vacunados. La extension de las lesiones, fue minima en 33,9% moderada en 39% y avanzada en 27.1% entre estos ultimos 4 casos tenian, cavernas y TBC miliar. En las formas avanzadas el PPD fue negativo en el 56,2% habia desnutricion en el 87% y solo el 18% tenia cicatriz BCG. En las formas minimas ocurrio lo inverso. Se analizaron los sintomas que orientaron el diagnostico y el o los elementos claves en que se fundamento este. La radiologia fue el principal elemento en 2/3 de los casos, el viraje tuberculinico en 20 ninos (34%) y la bacteriologia positiva en 18(30.5%)