Clinical Course of Patients Undergoing Myocardial Revascularization Surgery in a Public Cardiology Referral Hospital in Pará, Brazil

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce. Objective: To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon. Methods: Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014. Results: A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 - 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 - 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 - 39.54, p = 0.001) were predictors of mortality after CABG. Conclusion: A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil

Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main Coronary Artery Disease: A Meta-Analysis of Randomized Trials with Subgroups Evaluation / Uso de Stent vs. Cirurgia de Revascularização Miocárdica em Multiarteriais e Doença de Tronco de Coronária Esquerda: Uma Metanálise de Estudos Randomizados com Avaliação de Subgrupos

Abstract Background: Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial. Objective: To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials. Methods: Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05. Results: In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI. Conclusion: Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.

Resumo Fundamento: A comparação entre a intervenção coronária percutânea (ICP) utilizando stents e cirurgia de revascularização do miocárdio (CRM) permanece controversa. Objetivo: Realizar uma revisão sistemática com metanálise da ICP utilizando stents vs. CRM em estudos clínicos randomizados. Métodos: Foram pesquisadas bases de dados eletrônicas para identificar estudos randomizados comparando a ICP com stents vs. CRM em multiarteriais e lesão de tronco de coronária esquerda desprotegida (LTCED). Foram encontrados quinze estudos, e seus resultados foram agrupados. As diferenças entre os estudos foram consideradas significativas com valor de p < 0,05. Resultados: Nos dados agrupados (n = 12.781), a mortalidade em 30 dias e o acidente vascular cerebral (AVC) tiveram menor incidência com a ICP (1% versus 1,7%, p = 0,01; 0,6% versus 1,7%, p < 0,0001); não houve diferença na mortalidade em um e dois anos (3,3% versus 3,7%, p = 0,25; 6,3% versus 6,0%, p = 0,5). A mortalidade em longo prazo favoreceu a CRM (10,6% versus 9,4%, p = 0,04), particularmente nos estudos realizados na era do stent farmacológico (SF) (10,1% versus 8,5%, p = 0,01). Nos diabéticos (n = 3.274), a mortalidade em longo prazo favoreceu a CRM (13,7% versus 10,3%; p < 0,0001). Em seis estudos de LTCED (n = 4.700) não houve diferença na mortalidade em 30 dias (0,6% versus 1,1%, p = 0,15), mortalidade em um ano (3% versus 3,7%, p = 0,18) e mortalidade em longo prazo (8,1% versus 8,1%) entre ICP e CRM; a incidência de AVC foi menor com a ICP (0,3% versus 1,5%; p < 0,001). Diabetes e um escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP. Conclusão: Comparada à CRM, a ICP com stent apresentou menor mortalidade em 30 dias, maior mortalidade tardia e menor incidência de AVC. Diabetes e escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP.