Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 297
Filtrar
1.
Am J Cardiol ; 123(10): 1602-1609, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30832963

RESUMO

To assess the frequency and costs of revascularization procedures in patients with stable ischemic heart disease (SIHD) initiating ranolazine versus traditional antianginals. Adults (≥18 years) with a diagnosis of SIHD who initiated ranolazine or a traditional antianginal (beta-blocker [BB], calcium channel blocker [CCB], or long-acting nitrate [LAN]) as second or third line therapy between 2008 and 2016, were selected from the IBM MarketScan Databases. Inverse probability weighting based on propensity score was employed to balance the ranolazine and traditional antianginals cohorts on patient clinical characteristics. Outcomes assessed were frequency and total cost of revascularization procedures over a 12-month follow-up. A total of 108,741 patients with SIHD were included. Of these, 18% initiated treatment with ranolazine, 21% received BBs, 24% received CCBs, and 37% were treated with LANs. Revascularization rates were significantly lower in ranolazine patients (11%) than in BB (16%) and LAN (14%) patients (both p <0.001), and more comparable to CCB patients (10%; p = 0.007). Compared with BB and LAN, those in the ranolazine cohort were less likely to have a revascularization procedure during hospitalization and had a shorter length of stay if hospitalized (all p <0.001). The mean healthcare costs associated with revascularization were lower in ranolazine patients ($2,933) than in BB ($4,465) and LAN ($3,609) patients (p <0.001), but similar to CCB patients ($2,753; p = 0.29). In conclusion, ranolazine treatment in patients with SIHD was associated with fewer revascularization procedures and lower associated healthcare costs compared with patients initiating BB or LAN, and comparable to patients initiating CCBs.


Assuntos
Custos de Cuidados de Saúde , Isquemia Miocárdica/terapia , Revascularização Miocárdica/tendências , Nitroglicerina/uso terapêutico , Ranolazina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Preparações de Ação Retardada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/economia , Revascularização Miocárdica/economia , Estudos Retrospectivos , Bloqueadores dos Canais de Sódio/uso terapêutico , Resultado do Tratamento , Estados Unidos , Vasodilatadores/uso terapêutico , Adulto Jovem
2.
Int J Cardiol ; 277: 47-53, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30093138

RESUMO

BACKGROUND: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. METHODS: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. RESULTS: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498-0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175-0.942, p = 0.036). CONCLUSIONS: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.


Assuntos
Doenças Assintomáticas/terapia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/terapia , Revascularização Miocárdica/tendências , Idoso , Doenças Assintomáticas/mortalidade , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Isquemia Miocárdica/mortalidade , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Sistema de Registros , Tomografia Computadorizada de Emissão de Fóton Único/mortalidade , Tomografia Computadorizada de Emissão de Fóton Único/tendências , Resultado do Tratamento
3.
Int J Cardiol ; 277: 42-46, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30107947

RESUMO

BACKGROUND: Fractional Flow Reserve (FFR) in Stable Ischemic Heart Disease (SIHD) is universally accepted, while in Acute Coronary Syndromes (ACS) is less established. Aims of this retrospective study were: to compare in patients undergoing FFR assessment the prognostic impact of ACS vs SIHD, to evaluate the clinical relevance of the modality of utilization and timing of FFR assessment and to assess the different outcomes associated with an FFR> or ≤0.80. METHODS: Major cardiac adverse events were assessed at a follow up of 16.4 ±â€¯10.5 months in 543 patients with SIHD and 231 with ACS needing functional evaluation. FFR was used for lesions of ambiguous significance in the absence of a clear culprit vessel (first intention, FI) and for incidental lesions in the presence of a clear culprit vessel (second intention, SI). The decision to perform FFR and the identification of the stenosis needing functional assessment were left to the operator's discretion. Revascularization was performed when FFR was ≤0.80. RESULTS: SIHD and ACS patients were not significantly different for principal clinical characteristics. ACS patients had significantly more events than SIHD, due to an excess of death and myocardial infarction. This was confirmed when FFR was used as FI, in particular if FFR was >0.80. On the contrary, when FFR was used as SI, event rates were similar between ACS and SIHD patients, regardless of FFR value. CONCLUSIONS: Our study shows that using FFR the risk of recurrent events in ACS is significantly higher than in SIHD. This different outcome is confined to those patients in whom FFR is utilized for lesions of ambiguous significance in the absence of a clear culprit vessel.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Revascularização Miocárdica/métodos , Síndrome Coronariana Aguda/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/tendências , Estudos Retrospectivos
5.
J Cardiothorac Vasc Anesth ; 33(5): 1187-1194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30581107

RESUMO

OBJECTIVES: The authors sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass and hypothesized that off-pump would be comparable with on-pump. The primary outcome of interest was survival, and secondary outcomes were need for reintervention for revascularization or new diagnosis of myocardial infarction occurring any time after surgery during the 8- to 12-year follow-up period. DESIGN: Retrospective cohort analysis. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: All patients undergoing primary isolated coronary bypass between January 1, 2004, and December 31, 2008 (n = 555). INTERVENTIONS: Coronary artery bypass on-pump (n = 238) or off-pump (n = 317). MEASUREMENTS AND MAIN RESULTS: Demographic and clinical variables were documented, including information on mortality, new myocardial infarction, and need for reintervention in the 8- to 12-year period after surgery. The on-pump and off-pump groups were similar regarding all demographic and clinical variables (p > 0.05), except for higher incidence of prior percutaneous coronary intervention in the off-pump group. There were more perioperative complications in the on-pump group (p = 0.007) and a greater number of grafts used (p = 0.000). Kaplan-Meier survival analysis demonstrated no significant difference (p > 0.05) in overall survival, reintervention-free survival, or postoperative myocardial infarction-free survival between patients who underwent bypass grafting on-pump or off-pump over extended follow-up averaging 10years. CONCLUSIONS: The present study's data did not show differences in key long-term outcomes between patients who underwent revascularization with or without cardiopulmonary bypass, supporting the idea that both methods achieve similar late results regarding overall survival, need for reintervention, and postoperative myocardial infarction.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/tendências , Hospitais de Veteranos/tendências , Revascularização Miocárdica/tendências , Vigilância da População , Veteranos , Idoso , Estudos de Coortes , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Vigilância da População/métodos , Estudos Retrospectivos , Resultado do Tratamento
7.
J Am Coll Cardiol ; 72(23 Pt A): 2826-2837, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30522646

RESUMO

BACKGROUND: Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease. OBJECTIVES: This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization. RESULTS: A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively). CONCLUSIONS: In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/cirurgia , Revascularização Miocárdica/tendências , Intervenção Coronária Percutânea/tendências , Idoso , Doença da Artéria Coronariana/fisiopatologia , Diabetes Mellitus/fisiopatologia , Stents Farmacológicos/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
J Am Coll Cardiol ; 72(7): 754-765, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30092952

RESUMO

BACKGROUND: The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. OBJECTIVES: This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. RESULTS: CKD was present in 361 of 1,869 randomized patients (19.3%) in whom baseline estimated glomerular filtration rate was available. Patients with CKD had higher 3-year rates of the primary endpoint compared with those without CKD (20.8% vs. 13.5%; hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 1.22 to 2.09; p = 0.0005). ARF within 30 days occurred more commonly in patients with compared with those without CKD (5.0% vs. 0.8%; p < 0.0001), and was strongly associated with the 3-year risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95% CI: 2.73 to 7.73; p < 0.0001). ARF occurred less commonly after revascularization with PCI compared with CABG both in patients with CKD (2.3% vs. 7.7%; HR: 0.28; 95% CI: 0.09 to 0.87) and in those without CKD (0.3% vs. 1.3%; HR: 0.20; 95% CI: 0.04 to 0.90; pinteraction = 0.71). There were no significant differences in the rates of the primary composite endpoint after PCI and CABG in patients with CKD (23.4% vs. 18.1%; HR: 1.25; 95% CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%; HR: 0.97; 95% CI: 0.73 to 1.27; pinteraction = 0.38). CONCLUSIONS: Patients with CKD undergoing revascularization for LMCAD in the EXCEL trial had increased rates of ARF and reduced event-free survival. ARF occurred less frequently after PCI compared with CABG. There were no significant differences between PCI and CABG in terms of death, stroke, or MI at 3 years in patients with and without CKD. (EXCEL Clinical Trial [EXCEL]; NCT01205776).


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Insuficiência Renal Crônica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/tendências , Intervenção Coronária Percutânea/tendências , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/epidemiologia , Resultado do Tratamento
9.
Circ Cardiovasc Qual Outcomes ; 11(6): e004492, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29903936

RESUMO

BACKGROUND: Because specialty care accounts for half of Medicare expenditures, improving its value is critical to the success of Medicare accountable care organizations (ACOs) in curbing spending growth. However, whether ACOs have reduced low-value specialty care without compromising use of high-value services remains unknown. METHODS AND RESULTS: Using national Medicare data, we identified 2 cohorts: beneficiaries for whom the value of coronary revascularization is lower (those with ischemic heart disease without angina, congestive heart failure, or recent admission for acute myocardial infarction) and beneficiaries for whom its value is higher (those with recent acute myocardial infarction admission). We then determined the provider groups who cared for the cohorts, distinguishing between those participating (n=298) and those not participating in a Medicare ACO (1329). After measuring the provider groups' use of coronary artery bypass grafting and percutaneous coronary intervention among the 2 cohorts, we fit multivariable models to test the statistical significance of rates of change in low- and high-value revascularization after ACO participation. During the pre-ACO period, participating and nonparticipating provider groups had similar rates of low- and high-value revascularization. Our multivariable model results show that rates of change for low- and high-value coronary revascularization were not altered by a provider group's participation in a Medicare ACO (lower value: difference, -0.04 per year; 95% confidence interval, -0.11 to 0.03; higher value: difference, 0.96 per year; 95% confidence interval, -0.46 to 2.4). CONCLUSIONS: We found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.


Assuntos
Organizações de Assistência Responsáveis/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Medicare/economia , Isquemia Miocárdica/economia , Isquemia Miocárdica/terapia , Revascularização Miocárdica/economia , Padrões de Prática Médica/economia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Humanos , Masculino , Modelos Econômicos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Revascularização Miocárdica/tendências , Padrões de Prática Médica/tendências , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
10.
Circ J ; 82(8): 2136-2142, 2018 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-29899202

RESUMO

BACKGROUND: We investigated whether the outcome of revascularization differed from the outcome of medical therapy in chronic kidney disease (CKD) and non-CKD patients with chronic total occlusion (CTO).Methods and Results:A total of 2,010 patients with CTO who underwent revascularization (n=1,355), including percutaneous coronary intervention (n=878) and coronary artery bypass grafting (n=477), or had medical therapy alone (n=655) were examined. The primary outcome was all-cause death during follow-up. Among the non-CKD patients (n=1,679), revascularization had a lower incidence of all-cause death (adjusted hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.41-0.72, P<0.001) compared with medical therapy. Among the CKD patients (n=331), the difference in the incidence of all-cause death was not as marked between the 2 treatments (adjusted HR 0.71, 95% CI 0.48-1.06, P=0.09). There was a significant interaction between kidney function and treatment strategy (revascularization vs. medical therapy) on all-cause death (P for interaction=0.014). CONCLUSIONS: Based on the clinical outcomes, in CTO patients with preexisting CKD, revascularization via PCI or bypass surgery might not be as effective as in non-CKD patients.


Assuntos
Ponte de Artéria Coronária/métodos , Oclusão Coronária/terapia , Revascularização Miocárdica/tendências , Intervenção Coronária Percutânea/métodos , Insuficiência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Oclusão Coronária/tratamento farmacológico , Oclusão Coronária/etiologia , Oclusão Coronária/cirurgia , Feminino , Fármacos Hematológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/mortalidade , Resultado do Tratamento
11.
Int J Cardiol ; 261: 42-46, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29657055

RESUMO

BACKGROUND: Totally endoscopic coronary artery bypass (TECAB) has emerged as an alternative to other minimally invasive techniques. However, limited TECAB results are available to date. The purpose of this systematic review is to examine the existing literature to give an objective estimate of the outcomes of TECAB using a meta-analytical approach. METHODS: A comprehensive online review was performed in Ovid MEDLINE®, Ovid EMBASE and The Cochrane Library from 2000 to July 2017. Eligible studies included single arm TECAB studies as well as comparative studies (TECAB vs minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event rates and odds ratios (ORs) for operative mortality, perioperative myocardial infarction (MI), perioperative stroke, graft patency and repeat revascularization were estimated. Single arm and pairwise comparisons were performed. RESULTS: Seventeen single arm TECAB articles (3721 patients, weighted mean follow-up 3.3years) were included. The pooled event rate was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28% (95%CI: 1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for perioperative stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization and 94.8% (95%CI: 89.3-97.5%) for early graft patency (weighted mean follow-up 10.1months). On pairwise meta-analysis 376 patients (263 TECAB and 113 MIDCAB) were included. No difference in operative mortality (OR=0.25, 95%CI: 0.02-2.83), perioperative MI (OR=3.09, 95%CI: 0.37-26.12) or perioperative stroke (OR=1.33, 95%CI: 0.17-10.26) was found between the two techniques. CONCLUSIONS: TECAB has an acceptably low operative risk and a good early patency rate. The incidence of perioperative MI requires further investigation. The dearth of data comparing TECAB to open approaches compels the need for future comparative trials.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Endoscopia/métodos , Revascularização Miocárdica/métodos , Ponte de Artéria Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Endoscopia/tendências , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Revascularização Miocárdica/tendências , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Resultado do Tratamento
12.
Int J Cardiol ; 257: 7-11, 2018 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-29506741

RESUMO

BACKGROUND: The prevalence of coronary artery spasm (CAS) inducible by intracoronary injection of acetylcholine (ACh) is high in survivors of acute myocardial infarction (AMI). Although there is a potential risk of sudden cardiac death in patients with CAS, the prognostic value of CAS was not clear. Thus, this study examined the effect of CAS on long-term prognosis in survivors of AMI in a prospective manner. METHODS: The study included a total of 437 patients with AMI who underwent a CAS provocation test using ACh. All patients were followed prospectively for 5years or until the occurrence of the primary composite endpoint that consisted of cardiac death and acute coronary syndrome (ACS). RESULTS: CAS was induced in 195 (45%) of the study patients. During the follow-up period, 30 patients had a recurrent event (4 had cardiac death and 26 had ACS). Kaplan-Meier estimates in time-to-first-event analysis demonstrated a similar probability of the primary endpoint in patients with and without inducible CAS (p=0.13, log-rank test). The rate of each component of the composite endpoint was also comparable between the 2 patient groups. In Cox proportional hazards risk analysis, treatment with calcium channel blockers (CCBs) negatively predicted the primary endpoints in patients with inducible CAS (HR, 0.21; 95% CI, 0.08-0.55, p<0.01). CONCLUSIONS: The presence of inducible CAS did not increase the incidence of the cardiac events in AMI survivors. Treatment with CCBs may improve outcomes in AMI survivors with inducible CAS. CLINICAL TRIAL REGISTRATION: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000021340, unique identifier: UMIN000018432.


Assuntos
Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/métodos , Sobreviventes , Acetilcolina/efeitos adversos , Idoso , Vasoespasmo Coronário/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/efeitos dos fármacos , Eletrocardiografia/métodos , Eletrocardiografia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Revascularização Miocárdica/tendências , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/efeitos adversos
13.
Int J Cardiol ; 260: 24-30, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29525068

RESUMO

BACKGROUND: Plasma concentrations of natriuretic peptides have been shown to predict prognosis in heart failure (HF) patients with left ventricle (LV) dysfunction. It is still unclear if measurements after cardiac surgery are associated with any effect on the outcome. We aimed to prospectively investigate the longitudinal profile of serial evaluations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in ischemic HF patients undergoing Surgical Ventricular Reconstruction (SVR) and how NT-proBNP levels at different time-points are associated with the outcome. METHODS: One hundred and forty-three patients (122 men, 64 ±â€¯9 years old) with post-infarction LV remodeling referred to our Center for SVR had an assessment of NT-proBNP levels before surgery and 6, 12 and 18 months after surgery. The analysis was performed using the logarithm of the biomarker and joint modeling of serial measurements through mixed models together with Cox regression to analyze time to event data. RESULTS: The average level of the biomarker decreased by about 50% during the first year after the operation. Time-varying NT-proBNP levels were associated with the hazard of: 1% increase in NT-proBNP during the follow-up was associated with 1.5% increase of the risk of the composite event (95% CI: 1.0%, 2.6%) and with 4.2% increase of the risk of death (95% CI: 2.2%, 8.2%). CONCLUSIONS: Serial profiles (either in increasing or in decreasing) at different time points are associated with a modulation of the risk of adverse events and, therefore, are important indicators for monitoring the evolution of the disease, even after cardiac surgery.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/cirurgia , Revascularização Miocárdica/tendências , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Procedimentos Cirúrgicos Reconstrutivos/tendências , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica , Estudos Prospectivos
14.
Int J Cardiol ; 261: 49-53, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29548537

RESUMO

INTRODUCTION: The diagnosis of ALCAPA syndrome is sporadic in adulthood, of the limited cases in the literature most are incidental or without symptoms. There is a broad spectrum of clinical manifestations of ALCAPA syndrome however, including sudden cardiac death. CASES: We present herewith a series of 12 consecutive patients with ALCAPA, all diagnosed in adulthood (between 18 and 73 years of age). Five patients developed symptoms (breathlessness) after the fourth decade of life, 3 were undiagnosed despite a history of previous mitral valve repair, one presented with heart failure, one with resuscitated cardiac arrest, whereas two patients were asymptomatic. We review in this paper, the clinical history, diagnostic approach and therapeutic choices of ALCAPA syndrome. CONCLUSION: ALCAPA syndrome is not confined to childhood, late diagnosis in adulthood has a varied clinical presentation. ALCAPA syndrome should be particularly considered as a potential, albeit uncommon cause of mitral regurgitation and/or dilated cardiomyopathy.


Assuntos
Síndrome de Bland-White-Garland/diagnóstico por imagem , Síndrome de Bland-White-Garland/cirurgia , Diagnóstico Tardio/tendências , Revascularização Miocárdica/tendências , Adolescente , Adulto , Idoso , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Innovations (Phila) ; 13(1): 23-28, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29462051

RESUMO

OBJECTIVE: The primary objective was to investigate the long-term survival of patients who underwent single-vessel coronary revascularization with minimally invasive direct coronary artery bypass surgery with or without hybrid revascularization. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting or by percutaneous coronary intervention and the incidence of myocardial infarction or recurrent angina. METHODS: This is a retrospective study of prospectively collected data of patients who underwent minimally invasive direct coronary artery bypass procedure in our center between January 2001 and December 2015. Procedures were performed either through small left anterolateral thoracotomy or lower midline sternotomy. RESULTS: A total of 182 patients were identified: 100 underwent minimally invasive direct coronary artery bypass to the left anterior descending artery and 82 underwent hybrid revascularization (percutaneous coronary intervention to coronary arteries other than the left anterior descending artery along with minimally invasive direct coronary artery bypass to the left anterior descending artery). The mean ± SD age was 62 ± 10.1 years. Preoperatively 82% were male, and 72.5% patients had good left ventricular function. The median follow-up period was 10.9 years. There was no in-hospital or 30-day mortality. The 10-year actuarial survival was 84.8%. Freedom from repeat revascularization was 98.9% at 1 year and 89.9% at 10 years. At follow-up, freedom from myocardial infarction was 96.7% whereas freedom from angina was 92.9%. CONCLUSIONS: Within the limitations imposed by retrospective analyses, our study demonstrates excellent long-term outcome in patients undergoing minimally invasive direct coronary artery bypass with or without hybrid revascularization. For isolated left anterior descending artery disease minimally invasive direct coronary artery bypass should be considered, whereas hybrid revascularization (percutaneous coronary intervention and minimally invasive direct coronary artery bypass) should be considered for multivessel disease.


Assuntos
Angina Pectoris/epidemiologia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Infarto do Miocárdio/epidemiologia , Idoso , Angina Pectoris/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Infarto do Miocárdio/complicações , Revascularização Miocárdica/tendências , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Esternotomia/métodos , Análise de Sobrevida , Toracotomia/métodos , Resultado do Tratamento
16.
Int J Cardiol ; 254: 59-63, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29407133

RESUMO

BACKGROUND: We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored. METHODS: A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized. RESULTS: Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22). CONCLUSIONS: The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.


Assuntos
Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/mortalidade , Idoso , Ponte de Artéria Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/tendências , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA