ABSTRACT
BACKGROUND: The angiographic characteristics associated with saphenous vein graft degeneration and the high-risk profile of these patients increase the probability of adverse outcomes during and after percutaneous coronary intervention. This study set out to analyze the clinical and angiographic profile of patients, procedural characteristics, and hospital outcomes of percutaneous coronary intervention performed in saphenous vein grafts, and to investigate predictors of in-hospital mortality in this group. METHODS: A retrospective, observational study based on records kept by Central Nacional de Intervenções Cardiovasculares (CENIC) between 2006 and 2016. A comparative analysis of the adverse outcomes periprocedural acute myocardial infarction, need for urgent coronary artery bypass grafting, and all-cause mortality was performed according to different time periods (2006-2008, 2009-2011 and 2012-2016). RESULTS: A total of 2,361 patients were included in the analysis. The prevalence of periprocedural acute myocardial infarction and mortality did not differ between time periods. No patient in this sample required urgent coronary artery bypass grafting. Simple logistic regression analysis revealed the following inhospital mortality predictors: advanced age, ST-segment elevation acute myocardial infarction, Killip class 3/4, long lesions, thrombi-containing lesions, three-vessel disease and periprocedural acute myocardial infarction. According to multiple logistic regression analysis, age (OR 1.07; 95%CI 1.021.13; p=0.01), smoking (OR 3.26; 95%CI 1.13 9.39; p=0.03), ST-segment elevation acute myocardial infarction (OR 10.36; 95%CI 3.96-27.07; p<0.01) and periprocedural acute myocardial infarction (OR 86.08; 95%CI 15.81-468.63; p<0.01) were correlated with mortality outcomes. CONCLUSION: Identification of in-hospital mortality predictors may contribute to improve procedural planning for adverse events prevention in patients undergoing percutaneous coronary intervention of saphenous vein grafts. (AU)
Subject(s)
Saphenous Vein , Stents , Mortality , Percutaneous Coronary Intervention , Myocardial RevascularizationABSTRACT
Background: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. Objective: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies. Methods: We evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI). Conclusion: The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients. .
Fundamento: A classificação ou índice de gravidade de insuficiência cardíaca em pacientes com infarto agudo do miocárdio (IAM) foi proposta por Killip e Kimball com o objetivo de avaliar o risco de mortalidade hospitalar e o potencial benefício do tratamento especializado em unidades coronárias (UCO) na década de 1960. Objetivos: Validar a classificação de Killip para mortalidade total em longo prazo e comparar o valor prognóstico em pacientes com IAM sem elevação do segmento ST (IAMSEST) em relação àqueles com elevação do segmento ST (IAMCEST), na era pós-reperfusão e de terapia antitrombótica moderna. Métodos: Foram avaliados 1906 pacientes com IAM confirmado, admitidos em UCO entre 1995 e 2011, com seguimento médio de cinco anos, para avaliação da mortalidade total. Curvas de Kaplan-Meier foram construídas para comparação da sobrevida por classe Killip e IAMSEST versus IAMCEST. Modelos de regressão de risco proporcional de Cox foram construídos para determinar a associação independente entre a classe Killip e a mortalidade, com análises de sensibilidade por tipo de IAM. Resultados: As proporções de óbitos e as distribuições das curvas de sobrevida foram diferentes conforme a classe Killip >1 (p <0,001) e similares entre IAMSEST e IAMCEST. Os modelos de risco identificaram a classificação de Killip como preditor significante, sustentado, consistente e independente de covariáveis relevantes (Wald χ2 16,5 [p = 0,001], IAMSEST) e (Wald χ2 11,9 [p = 0,008], IAMCEST). Conclusão: A classificação de Killip e Kimball desempenha papel prognóstico relevante na mortalidade em seguimento médio de cinco anos pós-IAM e, de modo similar, entre pacientes com IAMSEST e IAMCEST. .
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Myocardial Infarction/mortality , Risk Assessment/methods , Follow-Up Studies , Heart Rate/physiology , Hospital Mortality , Myocardial Infarction/therapy , Predictive Value of Tests , Prognosis , Prospective Studies , Reproducibility of Results , Risk Factors , Severity of Illness Index , Survival Analysis , Time FactorsABSTRACT
BACKGROUND: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. OBJECTIVE: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies. METHODS: We evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. RESULTS: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI). CONCLUSION: The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.
Subject(s)
Myocardial Infarction/mortality , Risk Assessment/methods , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Heart Rate/physiology , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Predictive Value of Tests , Prognosis , Prospective Studies , Reproducibility of Results , Risk Factors , Severity of Illness Index , Survival Analysis , Time Factors , Young AdultABSTRACT
A frequência cardíaca de repouso (FCR) elevada é um importante preditor de mortalidade na população geral e, principalmente, nos indivíduos com doença cardiovascular. Vários mecanismos fisiopatológicos plausíveis propostos demonstram que o aumento da FCR determina não só isquemia miocárdica em pacientes com baixa reserva coronariana, mas também maior tensão de cisalhamento sobre as coronárias, aterogênese e efeitos arrítmicos. A modulação da FCR com medidas farmacológicas e não farmacológicas é uma realidade em portadores de insuficiência cardíaca (IC), doenças arterial coronária (DAC) estável e síndromes coronárias agudas (SCA), com benefícios em morbimortalidade...