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1.
Artigo em Inglês | MEDLINE | ID: mdl-32423731

RESUMO

OBJECTIVE: The present study was conducted to investigate the obesity paradox and assess the effect of body mass index (BMI) on early and late clinical outcomes after cardiac surgery. DESIGN: Cohort study with a retrospective analysis of prospectively collected data. DESIGN: Single-institution cardiology medical center. PARTICIPANTS: The study comprised consecutive patients undergoing cardiac surgery from January 2009 to January 2019. Patients were divided into the following 4 groups defined by BMI: underweight (UW) (≤18.5 kg/m2): 0.5%, n = 27; normal weight (18.5-25 kg/m2): 25.7%, n = 1,393; overweight (OW) (>25-30 kg/m2): 44.7%, n = 2,423; and obese (OB) (≥30 kg/m2): 29.1%, n = 1,576. INTERVENTIONS: No interventions. MEASUREMENTS AND MAIN RESULTS: A multivariate analysis was used to compare clinical outcomes among the different BMI groups. Overall 1-year survival of patients in the BMI categories was determined by the Kaplan-Meier method and compared using the log rank test. The study included 5,419 patients. The BMI groups were significantly different regarding presurgical variables. Mortality according to BMI exhibited a reverse J-shaped relationship: 7.4% in the UW group, 5.2% in the normal weight group, 3.2% in the OW group, and 4.3% in the OB group (p = 0.016). Low- cardiac- output syndrome and bleeding were more frequent in the UW group, whereas mediastinitis and hyperglycemia were more common in the OB group. After adjusting for other risk factors, BMI was not an independent predictor of in-hospital mortality. One-year follow-up was completed in 95% of the patients, and the analysis of long-term mortality did not show a difference among the BMI categories (p log rank = 0.16). CONCLUSION: OW patients had a lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables were taken into account, BMI did not have independent effect on in-hospital and 1-year mortality.

2.
J Thorac Cardiovasc Surg ; 157(6): 2279-2286, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31307140

RESUMO

OBJECTIVE: To compare the performance of the CHADS VASc, POAF, and HATCH scoring systems to predict new-onset atrial fibrillation after cardiac surgery. METHODS: We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery between January 2010 and December 2016. The primary outcome was the development of new-onset postoperative atrial fibrillation during hospitalization. RESULTS: A total of 3113 patients underwent cardiac surgery during the study period: coronary artery bypass graft surgery (45%), valve replacement (24%), combined procedure (revascularization-valve surgery) (15%), and other procedures (16%). Twenty-one percent (n = 654) presented postoperative atrial fibrillation. Median scores in patients with postoperative atrial fibrillation were significantly higher (P < .001). The CHAD2DS2-VASc score demonstrated greater discriminative ability to predict the event (C-statistic, 0.77; 95% confidence interval [CI], 0.75-0.79) versus the POAF score and the HATCH score (C-statistic, 0.71; 95% CI, 0.69-0.73 and C-statistic, 0.70; 95% CI, 0.67-0.72, respectively). All 3 scores presented good calibration according to the Hosmer-Lemeshow test univariate and multivariable analysis demonstrated that the 3 scores were independent predictors of postoperative atrial fibrillation: CHA2DS2-VASc score odds ratio 1.87 (95% CI, 1.64-2.13), POAF score odds ratio 1.18 (95% CI, 1.01-1.36), and HATCH score odds ratio 1.62 (95% CI, 1.37-1.92). CONCLUSIONS: The POAF, CHA2DS2-VASc, and HATCH scoring systems showed good discrimination and calibration to predict postoperative atrial fibrillation in patients undergoing cardiac surgery. Among them, the CHA2DS2-Vasc score presented the best discriminative ability for postoperative atrial fibrillation and has the advantage of being easy to calculate.


Assuntos
Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Idoso , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade
3.
J Thorac Cardiovasc Surg ; 158(5): 1345-1353.e1, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30904256

RESUMO

BACKGROUND: Mortality after coronary artery bypass grafting (CABG) has been reported to be higher in women. The aim of this study was to evaluate whether bilateral internal thoracic artery (BITA) grafting in women has a long-term survival benefit over single internal thoracic artery grafting, possibly equivalent to the male population. METHODS: A retrospective review was undertaken of our prospectively collected database. We included 4406 consecutive patients who underwent isolated CABG, who received their operation between January 2000 and April 2017. From the entire series, 2979 patients (67.6%) received exclusively BITA grafts; 299 (10.1%) were female. The primary end point was follow-up mortality, independently from cause. In-hospital mortality and during follow-up were analyzed. Substratification according to age was performed to answer whether it has an effect. Multivariable Cox proportional hazard analyses was performed to investigate the significant predictors of late mortality. RESULTS: The median follow-up was 5.1 ± 3.9 years. Female BITA patients were older (P < .001), had nonelective surgery (P < .001), more on-pump CABG (P = .015), fewer number of grafts (P < .001) versus male BITA patients. BITA grafting in women had a long-term survival equivalent to that of men (P = .784). In a Cox proportional hazard model, female sex was not an independent risk factor for late death (B, -0.303; hazard ratio, 0.739; 95% confidence interval, 0.470-1.16; P = .189). The stratification analysis showed that the beneficial effect of BITA remained similar among sexes and was not modified by age even after adjusting for confounders. In a risk-adjusted sample, patients older than 65 years with BITA grafting showed superior long-term survival than those with single internal thoracic artery grafting (P = .019). CONCLUSIONS: Although there are some differences between sexes, BITA grafting in women was associated with similar 10-year survival compared with men, and female sex was not an independent risk factor for late death. Among women, the BITA group had better survival, especially those older than 65 years.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/cirurgia , Fatores Sexuais , Fatores Etários , Idoso , Argentina/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida
4.
Rev. argent. cardiol ; 86(4): 32-42, ago. 2018.
Artigo em Espanhol | LILACS-Express | ID: biblio-1003209

RESUMO

RESUMEN Introducción: Existe evidencia de que la reperfusión subóptima tiene impacto pronóstico a corto plazo en los pacientes con síndromes coronarios agudos con elevación del segmento ST, pero hay poca información sobre los factores vinculados a esta. Objetivos: Analizar los factores asociados a la reperfusión subóptima en pacientes con infarto agudo de miocardio con elevación del segmento S T, tratados con angioplastia primaria. Material y métodos: Se analizaron los pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST que recibieron tratamiento de revascularización con angioplastia primaria en el registro SCAR (Síndromes Coronarios Agudos en Argentina). Se analizó la asociación entre las variables clínicas clásicas, de laboratorio y el índice leucoglucémico con la reperfusión subóptima. Se definió reperfusión subóptima como TIMI III angiográfico pos-ATC con descenso del segmento ST en el ECG menor del 50%. Resultados: Se analizaron 258 pacientes con infarto agudo de miocardio con elevación del segmento ST, de los cuales 197 (76,4%) cumplieron los criterios de inclusión. De estos, el 8,6% (n = 17) tuvieron reperfusión subóptima. La incidencia de muerte intrahospitalaria entre los pacientes con reperfusión subóptima fue del 17,6% (n = 3) versus 1,7% (n = 3) en aquellos sin reperfusión subóptima (p = 0,007). En el análisis univariado, las variables asociadas a reperfusión subóptima fueron: diabetes (OR: 3,2 [IC95% 1,09-9,43] p = 0,026), revascularización previa (OR: 5,8 [1,74-19,07] p = 0,008), índice leucoglucé-mico (> 2159) (OR 3,7 [1,32-10,22] p = 0,009), y el tiempo dolor/balón (> 159 min) (OR: 6,9 [0,88-53] p = 0,045). El Killip-Kimbal al ingreso 3-4; la edad, mayor de 70 años; el sexo masculino, la hipertensión arterial, el tabaquismo, el infarto previo 0 anterior y el flujo TIMI 0-1 al ingreso no fueron significativos. Se estableció por curva ROC el mejor punto de corte para el índice leucoglucémico asociado a RSO en 2159 puntos (VPN = 94%), y el de tiempo dolor/balón en 159 min (VPN = 96%). En la regresión logística, solo la revascularización previa (OR: 5,3 [1,53-18,55]) y el índice leucoglucémico (OR: 3,2 [1,11-9,28]) estuvieron asociadas a reperfusión subóptima. Conclusiones: La reperfusión subóptima se asoció significativamente con mayor incidencia de muerte intrahospitalaria; mientras que la revascularización previa y el índice leucoglucémico (>2159) se asociaron con reperfusión subóptima.


ABSTRACT Background: Although there is evidence that suboptimal reperfusion has short-term prognostic impact in patients with ST-segment elevation acute coronary syndromes, there is little information about its associated factors. Objectives: The aim of this study was to analyze the factors associated with suboptimal reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: Patients from the SCAR (Acute Coronary Syndromes in Argentina) registry diagnosed with acute STEMI undergo-ing PCI were included in the study. The association of classical clinical and laboratory variables and the leuko-glycemic index with suboptimal reperfusion was analyzed. Suboptimal reperfusion was defined as post-PCI angiography TIMI III flow with less than 50% ST-segment decrease in the ECG. Results: Overall, 197 patients (76.4%) out of 258 patients with acute STEMI met the inclusion criteria. Among them, 8.6% (n: 17) had suboptimal reperfusion, with an incidence of in-hospital death of 17.6% (n: 3) versus 1.7% (n: 3) in patients without suboptimal reperfusion (p=0.007). In the univariate analysis, variables associated with suboptimal reperfusion were: diabetes [OR: 3.2 (1.09-9.43) p=0.026], previous revascularization [OR: 5.8 (1.74-19.07) p=0.008], leuko-glycemic index (> 2,159) [OR 3.7 (1.32-10.22) p=0.009], and pain-to-balloon time (>159 minutes) [OR: 6.9 (0.88- 53) p=0.045]. Age >70 years, male sex, high blood pressure, smoking, previous or anterior-wall infarction, and Killip and Kimball 3-4 and TIMI 0-1 flow on admission were not significantly different between patients with or without suboptimal reperfusion. Prior to the analysis, the cutoff point for the leuko-glycemic index associated with suboptimal reperfusion was established at 2,159 points by ROC curve analysis (NPV: 94%), and the pain-to-balloon time at 159 min (NPV: 96%). In logistic regression analysis, only previous revascular-ization [OR: 5.3 (1.53 -18.55)] and leuko-glycemic index [OR: 3.2 (1.11-9.28)] were associated with suboptimal reperfusion. Conclusions: Suboptimal reperfusion was significantly associated with a higher incidence of in-hospital death, while previous revascularization and the leuko-glycemic index (>2,159) were factors independently associated with suboptimal reperfusion.

5.
Int J Med Inform ; 114: 76-80, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29673607

RESUMO

OBJECTIVES: Despite the well-documented benefit of implantable cardioverter defibrillator (ICD) in patients with severe left ventricular dysfunction, there is a large number of patients who had not been offered this therapy. The aim of this study is to evaluate the utility of a hybrid decision support system (hCDSS) to improve the adherence to indicate ICD therapy in our institution. METHODS: We conducted a retrospective, observational and single-center study. An hCDSS focused on patients with severe deterioration of the left ventricular function was implemented, creating a mandatory field containing the value of left ejection fraction and three options to choose: >35%, ≤ 35% or unknown. When the option ≤ 35% is checked, an email is automatically sent to the electrophysiology section where the staff can contact the treating physician to discuss the indication of ICD therapy. We measured the number of ICDs implanted before the alert (month 1-21), immediate post and late post alert (month 22-27 and 28-48 months respectively) RESULTS: The rate of ICD implantation increased from 1.76% per month in the pre-intervention period to 4.48% after the intervention (p < 0.001). This increase in the rate of ICD implantation remained stable between the immediate and late post-intervention period (4.6 vs. 4.4; p = .8) CONCLUSION: The implementation of a hybrid decision support system was associated with improved adherence to clinical guidelines for prevention of sudden cardiac death, as evidenced by a rapid and sustained increase in the number of ICD implants in patients with severe left ventricular dysfunction.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Sistemas de Apoio a Decisões Clínicas , Desfibriladores Implantáveis , Guias de Prática Clínica como Assunto/normas , Prevenção Primária/métodos , Disfunção Ventricular Esquerda/terapia , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
6.
Rev. argent. cardiol ; 85(4): 1-8, ago. 2017. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957789

RESUMO

Introducción: Las reinternaciones luego de cirugía cardíaca son un problema relevante para los pacientes y para el sistema de salud en general. Existen pocos datos respecto de la relación entre las reinternaciones después de cirugía cardíaca y el pronóstico evolutivo de los pacientes, ni su impacto en la mortalidad alejada. Objetivo: Analizar la incidencia, factores predictores de las reinternaciones a 30 días luego de cirugía cardíaca y su asociación con la mortalidad alejada. Material y Métodos: Se analizó en forma retrospectiva la base de datos informatizada del servicio de cirugía cardíaca. En el análisis se incluyeron a todos los pacientes sometidos a cirugía cardíaca en forma consecutiva, dados de alta en el período comprendido entre junio del 2010 y mayo del 2013. Se excluyeron a los pacientes operados de trasplante cardíaco. Reinternación se definió como el reingreso hospitalario no planificado dentro de los 30 días transcurridos desde el egreso hospitalario. Mortalidad alejada fue considerada la muerte de causa cardiovascular o no cardiovascular a partir del día 30 posterior al alta hasta finalizar el seguimiento. Resultados: Se incluyeron 1327 pacientes, de los cuales se reinternaron 184 (13,9%). La mediana de seguimiento fue de 826 días (IQ 581 a 1085 días). Los pacientes que se reinternaron presentaban mayor tasa de comorbilidades como EPOC (6,5% vs. 2,1%; p 0,002) e insuficiencia cardíaca (12% vs. 6%; p 0,0064). También, en este grupo se observó mayor incidencia de las complicaciones posoperatorias de fibrilación auricular (35% vs. 19%; p < 0,0001) y de bajo gasto cardiaco posoperatorio (9,2% vs. 4%; p 0,004). Entre las causas más frecuentes de las reinternaciones se identificaron a las infecciones (no mediastinitis) (25%), arritmias e implante de MCP (15,2%), insuficiencia cardíaca (13%), derrame pleural (6,5%), derrame pericárdico (3,8%), fiebre sin foco establecido (3,26%) y mediastinitis (6%), entre otras. Según el análisis de regresión logística los factores que se asociaban con mayor riesgo de reinternación fueron la cirugía cardíaca no CRM (IC 95% 1,55-3,37; p<0,0001), antecedentes de enfermedad respiratoria (IC 95% 1,32-6,6; p 0,0084), fibrilación auricular (OR 1,99; IC 95% 1,34-2,94; p 0,0005) e IMC (OR 1,046; IC 95% 1,008-1,085; p 0,017). En cuanto al punto final, las reinternaciones se asociaron en forma significativa con aumento en la mortalidad a 1 y 3 años: 8,7% vs. 2,3%; p<0,0001 y 13,6% vs. 4,2%, p<0,0001, respectivamente. Conclusiónes: La reinternación a 30 días luego de cirugía cardíaca se asocia en forma significativa con mayor mortalidad alejada de los pacientes operados. La implementación de las medidas asistenciales adecuadas podría reducir la probabilidad de las reinternaciones, y por ende, mejorar el pronóstico de este grupo de pacientes.

7.
Rev. argent. cardiol ; 85(4): 1-8, ago. 2017. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957792

RESUMO

Introducción: Los errores de prescripción son un problema frecuente que amenaza la seguridad de los pacientes internados, especialmente en áreas de cuidados críticos. Objetivo: Evaluar la efectividad de un proyecto de mejora de la calidad para reducir errores de prescripción en pacientes internados por patologías de origen cardiovascular. Material y métodos: Se implementó un proyecto de mejora de la calidad destinado a reducir errores de prescripción intrahos-pitalaria. Los tres componentes principales del proyecto fueron: supervisión obligatoria de las indicaciones, utilización de un software que ordena las indicaciones por sistemas biológicos e implementación de una norma de formato universal de prescripción de medicamentos, que incluyó un diccionario de abreviaturas y de diluciones normalizadas. Con anterioridad a la implementación de estos cambios se midió la cantidad de errores de prescripción semanales, estratificados por área de internación. Se analizó el impacto del proyecto dividiendo las muestras en cuatro períodos consecutivos de 9 semanas cada uno (un período preintervención y tres posintervención) y se comparó luego la cantidad de errores detectados en cada uno de ellos. En cada período se evaluaron de manera aleatoria las indicaciones de 180 pacientes. Resultados: Se analizaron en total 720 prescripciones. La implementación del proyecto de mejora logró reducir la cantidad de errores de manera rápida y sostenida en el tiempo (mediana preintervención de 85, RIC 70-95 y mediana final de 26, RIC 21-37; p = 0,0004). Conclusión: El proyecto de mejora de la calidad implementado permitió reducir significativamente la cantidad de errores de prescripción en pacientes internados por patologías cardiovasculares.

9.
Ann Thorac Surg ; 101(5): 1775-81, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26822347

RESUMO

BACKGROUND: We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease. METHODS: Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659). In patients who underwent BITA grafting, the left internal thoracic artery (LITA) was grafted mainly to the left anterior descending artery, whereas the right internal thoracic artery (RITA) was used more commonly to graft the circumflex (Cx) artery and the right coronary system as T-grafts. A total of 485 pairs of patients were matched using propensity scores. Cox proportional hazard models were generated to examine the association of arterial BITA grafting with mortality. RESULTS: Patients in the BITA group were more likely to be younger (BITA, 63.7 ± 9.1 versus SITA, 65.0 ± 9.9; p < 0.0001). At 30 days, patients who underwent BITA grafting experienced reduced unadjusted mortality (BITA, 1.2% versus SITA, 4.4%; p < 0.0001). At 10 years, patients who underwent BITA grafting experienced superior unadjusted survival (BITA, 82.6% ± 1.8% versus SITA, 76.1% ± 1.3%; p = 0.001). Cox regression analysis in the entire study cohort showed that BITA grafting was associated with improved survival (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.87; p < 0.001). In the propensity-score-adjusted analysis, patients who underwent BITA grafting had similar in-hospital mortality (BITA, 1.6% versus SITA, 2.9%; p = 0.196). Patients who underwent BITA grafting still showed improved survival at 10 years (BITA, 81.0% ± 4.1% versus SITA, 71.8% ± 2.5%; p = 0.039). CONCLUSIONS: This study suggests that coronary artery operations exclusively with BITA grafting in a T-configuration may be associated with better long-term survival than grafting with SITA plus other types of conduits.


Assuntos
Anastomose de Artéria Torácica Interna-Coronária/métodos , Complicações Pós-Operatórias/mortalidade , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Estimativa de Kaplan-Meier , Masculino , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Reoperação , Estudos Retrospectivos , Esternotomia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
10.
Rev. argent. cardiol ; 83(5): 412-419, oct. 2015. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-957654

RESUMO

Introducción: El uso de la arteria mamaria interna (AMI) izquierda en la cirugía de revascularización miocárdica (CRM) se asocia con mejor sobrevida alejada libre de eventos cardíacos tardíos; asimismo, el empleo de la AMI derecha como complemento de la izquierda ha mostrado resultados favorables. Sin embargo, aún no queda claro si la revascularización con doble AMI es una mejor opción para los pacientes a largo plazo. Objetivo: Analizar la sobrevida a largo plazo de pacientes con CRM con doble arteria mamaria interna (2AMI) en comparación con pacientes con una AMI (1AMI) en la enfermedad de múltiples vasos. Material y métodos: Se revisaron CRM consecutivas realizadas entre 1996 y 2014 de pacientes con 2AMI (n = 2.098) y con 1AMI (n = 1.659). Se comparó la sobrevida a largo plazo entre los grupos en forma global y entre 485 pares de pacientes ajustados por un puntaje de riesgo. Se generaron modelos de riesgos proporcionales de Cox. Resultados: Los pacientes con 2AMI eran más jóvenes (63,7 ± 9,1 años 2AMI vs. 65,0 ± 9,9 años 1AMI; p < 0,0001). La mortalidad hospitalaria global fue menor en el grupo 2AMI (1,2% 2AMI vs. 4,4% 1AMI; p < 0,0001). A los 10 años, la sobrevida no ajustada fue superior en el grupo 2AMI (82,6% ± 1,8% 2AMI vs. 76,1% ± 1,3% 1AMI; p = 0,001). El análisis de regresión logística de Cox en el grupo global demostró mayor sobrevida en los pacientes con 2AMI (HR 0,71, IC 95% 0,58-0,87; p < 0,001). En el análisis ajustado por puntaje de riesgo, la mortalidad hospitalaria fue similar en ambos grupos (1,6% 2AMI vs. 2,9% 1AMI; p = 0,196). La sobrevida alejada a los 10 años fue significativamente superior en el grupo de pacientes con 2AMI que en el grupo con 1AMI (81,0% ± 4,1% vs. 71,8% ± 2,5%, respectivamente; p = 0,039). Conclusión: Los pacientes con CRM y 2AMI presentaron mejor sobrevida alejada que los pacientes con 1AMI más otro tipo de conducto.


Background: Utilization of the left internal mammary artery (IMA) in coronary artery bypass graft surgery (CABG) is associated with long-term survival free from late cardiac events; moreover, use of the right IMA as a complement of the left artery has shown favorable results. However, it is not yet clear whether double IMA revascularization is a better long-term option. Objective: The aim of this work was to analyze long-term survival of patients with multi-vessel disease undergoing double IMA (2IMA) compared with single IMA (1IMA) CABG. Methods: Consecutive 2IMA (n=2,098) and 1IMA (n=1,659) CABG surgeries performed between 1996 and 2014 were reviewed, comparing overall long-term survival between groups and between 485 pairs of patients matched by propensity score. Cox proportional hazard models were generated. Results: Patients with 2IMA CABG were younger (2IMA: 63.7±9.1 years vs. 1IMA: 65.0±9.9 years; p<0.0001). Overall in­hospital mortality was lower in the 2IMA group (2IMA: 1.2% vs. 1IMA: 4.4%; p<0.0001). At 10 years, unadjusted survival was higher in the 2IMA group (2IMA: 82.6%±1.8% vs. 1IMA: 76.1%±1.3%; p=0.001). Overall Cox logistic regression analysis showed higher survival in patients with 2IMA CABG (HR 0.71, 95% CI 0.58-0.87; p<0.001). In the propensity score adjusted analysis, in-hospital mortality was similar in both groups (2IMA: 1.6% vs. 1IMA: 2.9%; p=0.196), but the 2IMA group still had higher long-term survival at 10 years (2IMA: 81.0%±4.1% vs. 1IMA: 71.8%±2.5%; p=0.039). Conclusion: Patients with 2IMA CABG evidenced better long-term survival than patients with 1IMA plus another type of conduit.

11.
Rev. argent. cardiol ; 82(6): 487-492, dic. 2014. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-750556

RESUMO

Introducción: En pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST), la angioplastia transluminal coronaria es el método de revascularización más utilizado; sin embargo, la cirugía de revascularización miocárdica es una alternativa terapéutica que permite tratar a este tipo de pacientes con buenos resultados. Objetivos: Comparar la evolución hospitalaria y alejada de los pacientes sometidos a cirugía de revascularización miocárdica según el cuadro clínico de presentación. Material y métodos: Entre enero de 1998 y julio de 2013 se realizó cirugía de revascularización miocárdica aislada en 3.604 pacientes en forma consecutiva. La población se dividió en pacientes con SCASEST (Grupo SCA, n = 2.079) o con angina crónica estable (Grupo ACE, n = 1.525). Se efectuó un análisis de la morbimortalidad posoperatoria y al seguimiento. Resultados: El Grupo ACE tuvo mayor uso de mamaria bilateral (58,2% vs. 50,3%; p = 0,001) y mayor tiempo operatorio (211 min vs. 203 min; p = 0,002). El Grupo SCA presentó más bajo gasto cardíaco posoperatorio (4,5% vs. 3,1%; p = 0,043). La mortalidad hospitalaria fue mayor en los pacientes con SCA (2,8% vs. 1,8%; p = 0,046). Luego de ajustar por puntaje de riesgo no hubo diferencia estadísticamente significativa en la mortalidad hospitalaria (1,3% en ACE vs. 1,6% en SCA; p = 0,681) ni en la tasa de complicaciones posoperatorias. La sobrevida global alejada en el seguimiento a 10 años no fue diferente entre grupos (ACE 85% ± 1,3% vs. SCA 83% ± 1,1%; p = 0,363). El tiempo libre de reintervención a los 10 años fue similar entre ambos grupos (ACE 89,5% ± 1,2% vs. SCA 89,1% ± 0,9%; p = 0,1680). Estos resultados se mantuvieron luego de ajustar por puntaje de riesgo. Conclusiones: Los pacientes sometidos a cirugía de revascularización miocárdica en el contexto de un SCASEST presentaron una mortalidad perioperatoria mayor, pero con una evolución a largo plazo similar a la de los pacientes intervenidos en forma electiva. No hubo diferencias en la mortalidad perioperatoria cuando se ajustó por puntaje de riesgo.


Background: Percutaneous coronary intervention is the revascularization procedure most widely used in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). However, coronary artery bypass graft surgery is a therapeutic alternative which allows treating these patients with a favorable outcome. Objectives: The aim of this study was to compare in-hospital and long-term outcome of patients undergoing coronary artery bypass graft surgery according to their clinical presentation. Methods: Between January 1998 and July 2013, 3604 consecutive patients underwent isolated coronary artery bypass graft surgery. The population was divided in patients with NSTEACS (ACS Group, n = 2079) or with chronic stable angina (CSA Group, n = 1525). Postoperative and at follow-up morbidity and mortality were analyzed. Results: The CSA Group had greater use of double mammary artery (58.2% vs. 50.3%; p = 0.001) and longer operative time (211 min vs. 203 min; p = 0.002). The ACS Group presented lower postoperative cardiac output (4.5% vs. 3.1%; p = 0.043) and higher in-hospital mortality (2.8% vs. 1.8%; p = 0.046). After adjusting for risk score, there were no statistically significant differences in in-hospital mortality (1.3% in CSA vs. 1.6% in ACS; p = 0.681) or in the rate of postoperative complications between the two groups. Overall long-term survival at 10 years was not different between groups (CSA 85% ± 1.3% vs. ACS 83% ± 1.1%; p = 0.363). The time-related freedom from reintervention was similar for both groups (CSA 89.5% ± 1.2% vs. ACS 89.1% ± 0.9%; p = 0.1680). These results did not change after adjusting for risk score. Conclusions: Patients with NSTEACS submitted to coronary artery bypass graft surgery presented greater perioperative mortality, but a long-term outcome similar to patients undergoing elective surgery. No difference in perioperative mortality was found between both groups after adjusting for risk score.

12.
Rev. argent. cardiol ; 82(6): 500-505, dic. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-750558

RESUMO

Introducción: Se conoce que la leucocitosis y la hiperglucemia se correlacionan a corto plazo con peor pronóstico en pacientes con síndrome coronario agudo, pero su novel relación, denominada índice leucoglucémico (ILG), se ha evaluado escasamente. Objetivos: Analizar el valor pronóstico del ILG en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y su valor agregado a los puntajes de riesgo clásicos. Material y métodos: Se analizaron los pacientes con diagnóstico de IAMCEST del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). El punto final analizado fue la muerte o Killip Kimball 3-4 (KK 3-4) en el período hospitalario. Se analizó el ILG tanto como variable continua como en cuartiles según los valores de los percentiles 25, 50 y 75. Resultados: Se analizaron 405 de 476 pacientes con diagnóstico final de IAMCEST. La presencia del punto final fue significativamente creciente por cuartiles de ILG: 0%, 7,60%, 9,30% y 30,60% (p < 0,0001). El área bajo la curva ROC del ILG para el punto final combinado fue de 0,77 [(IC 95% 0,71-0,88); p = 0,0001]; el mejor valor de corte pronóstico fue de 1.000. La presencia de muerte o KK 3-4 fue del 0% y del 13% en los IAMCEST con ILG menor o mayor de 1.000, respectivamente. En un modelo de regresión logística multivariado, el ILG se asoció independientemente con muerte o KK 3-4. El área bajo la curva ROC del puntaje TIMI para IAMCEST fue de 0,58. El agregado del ILG incrementó su capacidad discriminatoria a 0,66 (p = 0,001). Conclusiones: El ILG demostró que es un predictor independiente de mala evolución en el IAMCEST (muerte o KK 3-4), con valor aditivo al puntaje TIMI.


Background: Leukocytosis and hyperglycemia correlate with worse short-term prognosis in patients with acute coronary syndrome, but their new relationship, called leuko-glycemic index (LGI), has been scarcely evaluated. Objectives: The aim of this study was to analyze the prognostic value of LGI in patients with ST-segment-elevation acute myocardial infarction (STEMI) and its added value to classical risk scores. Methods: Patients diagnosed with STEMI from the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry were analyzed. The final endpoint was death or in-hospital Killip-Kimball 3-4 (KK 3-4). The LGI was analyzed as a continu-ous variable and in quartiles according to 25, 50 and 75 percentile values. Results: The study evaluated 405 out of 476 patients with final STEMI diagnosis. Presence of the primary endpoint significantly increased per LGI quartile: 0%, 7.60%, 9.30% and 30.60% (p < 0.0001). The LGI area under the ROC curve for the composite endpoint was 0.77 [(95% CI 0.71-0.88); p = 0.0001]; the best prognostic cut-off value was 1000. Presence of death or KK 3-4 was 0% and 13% in STEMI patients with LGI below or above 1000, respectively In a multivariate logistic regression model, LGI was independently associated with death or KK 3-4. The area under the ROC curve of the TIMI risk score for STEMI was 0.58. The addition of LGI increased its discriminatory capacity to 0.66 (p = 0.001). Conclusions: The LGI was an independent predictor of adverse outcome in STEMI patients (death or KK 3-4), adding prognostic value to the TIMI risk score.

13.
Medicina (B Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25188663

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology's Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists' median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Humanos , Medição de Risco
14.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-734394

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Humanos , Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Medição de Risco
15.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | BINACIS | ID: bin-131433

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.(AU)


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.(AU)

16.
Medicina (B Aires) ; 74(1): 64-8, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24561846

RESUMO

Diabetes mellitus is a chronic metabolic disease characterized by the presence of hyperglycemia. This condition must be detected early in order to establish a proper treatment and prevent its micro and macro vascular complications. The diagnosis of diabetes mellitus is based on the detection of abnormally high levels of glycemia. This task may appear to be simple but should not be underestimated. Misclassifying an individual as a diabetic can expose him/her not only to emotional damage but also to unnecessary diagnostic tests and potentially harmful treatments. Many different clinical situations such as pregnancy or acute critical illness may hamper the interpretation of laboratory findings. In this article, we present an updated review on the main aspects related to diagnosis of diabetes mellitus.


Assuntos
Diabetes Mellitus/diagnóstico , Adolescente , Biomarcadores/sangue , Glicemia/análise , Criança , Diabetes Gestacional/diagnóstico , Feminino , Hemoglobina A Glicada/análise , Índice Glicêmico , Hospitalização , Humanos , Masculino , Gravidez
17.
J Thorac Cardiovasc Surg ; 147(2): 632-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23566513

RESUMO

OBJECTIVE: The aim of our study was to evaluate the long-term outcome of patients exclusively undergoing total arterial revascularization off-pump coronary artery bypass grafting and to compare the performance of the radial artery and the right internal thoracic artery as a second conduit. METHODS: We studied a consecutive series of 1700 patients undergoing off-pump coronary artery bypass grafting, receiving a radial artery or right internal thoracic artery as a second graft for total arterial revascularization, between 2003 and 2010. A total of 1447 patients (85.11%) received bilateral internal thoracic artery grafting, and 253 patients (14.89%) received left internal thoracic artery and radial artery grafting. A propensity score-matched analysis was performed to compare the 2 groups, bilateral internal thoracic artery and left internal thoracic artery and radial artery, relative to overall survival, morbidity, and combined end points event-free survival. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated by Cox regression. RESULTS: In the full unmatched patient population, the postoperative survival (HR, 0.59; 95% CI, 0.38-0.92; P = .021), incidence of reintervention/readmission (HR, 0.42; 95% CI, 0.28-0.61; P < .001), and combined end points (HR, 0.47; 95% CI, 0.35-0.63; P < .001) were significantly better in the bilateral internal thoracic artery group. In the propensity score-matched patient population, the incidence of reintervention/readmission (HR, 0.40; 95% CI, 0.18-0.88; P = .02) and combined end points (HR, 0.54; 95% CI, 0.32-0.92; P = .02) were significantly better in the bilateral internal thoracic artery group compared with the left internal thoracic artery-radial artery group. CONCLUSIONS: The results of our study provide evidence for the superiority of the right internal thoracic artery graft compared with the radial artery as a second conduit in total arterial revascularization off-pump coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Anastomose de Artéria Torácica Interna-Coronária , Artéria Radial/transplante , Idoso , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Readmissão do Paciente , Complicações Pós-Operatórias/cirurgia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Medicina (B.Aires) ; 74(1): 64-8, 2014.
Artigo em Espanhol | BINACIS | ID: bin-133733

RESUMO

Diabetes mellitus is a chronic metabolic disease characterized by the presence of hyperglycemia. This condition must be detected early in order to establish a proper treatment and prevent its micro and macro vascular complications. The diagnosis of diabetes mellitus is based on the detection of abnormally high levels of glycemia. This task may appear to be simple but should not be underestimated. Misclassifying an individual as a diabetic can expose him/her not only to emotional damage but also to unnecessary diagnostic tests and potentially harmful treatments. Many different clinical situations such as pregnancy or acute critical illness may hamper the interpretation of laboratory findings. In this article, we present an updated review on the main aspects related to diagnosis of diabetes mellitus.


Assuntos
Diabetes Mellitus/diagnóstico , Adolescente , Biomarcadores/sangue , Glicemia/análise , Criança , Diabetes Gestacional/diagnóstico , Feminino , Índice Glicêmico , Hemoglobina A Glicada/análise , Hospitalização , Humanos , Masculino , Gravidez
19.
Medicina (B.Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | BINACIS | ID: bin-133491

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiologys Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.

20.
Rev. argent. cardiol ; 81(6): 81-505, dic. 2013. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-734461

RESUMO

Introducción La diabetes mellitus se ha identificado como un fuerte predictor independiente de iniciación y progresión de la enfermedad cardiovascular y se ha reconocido como un factor de riesgo de mortalidad luego de la cirugía coronaria. La cirugía de revascularización miocárdica sin circulación extracorpórea se ha establecido como una alternativa eficaz de revascularización coronaria comparable a la técnica convencional, con resultados que muestran una disminución en la morbilidad del procedimiento y, en pacientes de riesgo alto, una mortalidad posoperatoria menor. Objetivos Comparar los resultados posoperatorios tempranos y alejados de pacientes con y sin diabetes mellitus luego de cirugía de revascularización miocárdica sin circulación extracorpórea con puentes arteriales múltiples y determinar si la hiperglucemia posoperatoria es un predictor independiente de morbimortalidad temprana. Material y métodos Entre enero de 2004 y diciembre de 2008 se efectuó cirugía de revascularización miocárdica sin circulación extracorpórea con puentes arteriales múltiples en 1.002 pacientes en forma consecutiva. La población se dividió en pacientes con diabetes mellitus (n = 234) y sin diabetes mellitus (n = 768). Se efectuó un análisis de las complicaciones posoperatorias y se identificaron predictores independientes de mortalidad hospitalaria. El seguimiento promedio fue de 1.038 ± 517 días y fue completo en el 95,7%. Resultados Los pacientes con diabetes mellitus presentaron mayor incidencia de bajo gasto cardíaco (p = 0,005), fibrilación auricular (p = 0,005) e infección esternal profunda (p = 0,005). Fueron predictores de mortalidad hospitalaria la edad (OR = 1,11), la cirugía no electiva (OR = 5,88) y la glucemia posoperatoria > 200 mg/dl (OR = 6,9). Los pacientes con diabetes mellitus tuvieron menor sobrevida alejada a los 5 años (p = 0,01). Fueron predictores de menor sobrevida alejada la diabetes mellitus (HR = 2,1), la edad (HR = 1,06), la fracción de eyección del ventrículo izquierdo 1,6 mg/dl (HR = 2,46). Conclusiones Los pacientes con diabetes mellitus tuvieron igual mortalidad hospitalaria que los no diabéticos. La presencia de hiperglucemia posoperatoria fue un predictor de mayor mortalidad hospitalaria. La diabetes mellitus y la creatinina > 1,6 mg/dl fueron predictores independientes de menor sobrevida alejada.


Introduction Diabetes mellitus has been identified as a strong independent predictor of cardiovascular disease onset and progression and acknowledged as a mortality risk factor after coronary artery surgery. Off-pump coronary artery bypass grafting has been established as an efficient alternative for coronary revascularization comparable to the conventional technique, with results evidencing a reduction in procedure morbidity and, in high risk patients, lower postoperative mortality. Objective The aims of this study were to compare short and long-term postoperative results of off-pump coronary artery revascularization surgerywith multiple arterial grafts in patients with or without diabetes mellitus and to determine if postoperative hyperglycemia is an independent predictor of early morbidity and mortality. Methods Off-pump coronary artery revascularization surgery with multiple arterial grafts was consecutively performed on 1002 patients between January 2004 and December 2008. The population was divided in diabetes mellitus (n: 234) and non-diabetes mellitus (n: 768) patients. Post-operative complications were analyzed and independent predictors of in-hospital mortality were identified. The average follow-up period of 1038 ± 517 days was completed by 95.7% of patients. Results Diabetes mellitus patients had lower cardiac output (p = 0.005), atrial fibrillation (p = 0.005) and deep sternal wound infection (p = 0.005). Age (OR = 1.11), non-elective surgery (OR = 5.88) and blood glucose level > 200 mg/dL (OR= 6.9) were significant predictors of in-hospital mortality. Five-year survival was lower in diabetes mellitus patients (p = 0.01). Diabetes mellitus (HR = 2.1), age (HR = 1.06), left ventricular ejection fraction 1.6 mg/dL (HR = 2.46) were significant predictors of decreased long-term survival. Conclusions Diabetes mellitus and non-diabetes mellitus patients had similar in-hospital mortality rates. Postoperative hyperglycemia was a predictor of greater in-hospital mortality. Diabetes mellitus and creatinine > 1.6 mg/dL were independent predictors of decreased long-term survival.

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