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Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery / Prevalência e Predição de Doença Arterial Coronariana Obstrutiva em Pacientes Submetidos a Cirurgia Valvar Primária
Cazelli, José Guilherme; Camargo, Gabriel Cordeiro; Kruczan, Dany David; Weksler, Clara; Felipe, Alexandre Rouge; Gottlieb, Ilan.
  • Cazelli, José Guilherme; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
  • Camargo, Gabriel Cordeiro; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
  • Kruczan, Dany David; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
  • Weksler, Clara; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
  • Felipe, Alexandre Rouge; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
  • Gottlieb, Ilan; Instituto Nacional de Cardiologia. Rio de Janeiro. BR
Arq. bras. cardiol ; 109(4): 348-356, Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-887953
ABSTRACT
Abstract

Background:

The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement.

Objectives:

To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score.

Methods:

Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance.

Results:

The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI 0.817-0.879) and validation (ROC of 0.877; 95%CI 0.830 - 0.923) in different valve populations.

Conclusions:

Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.
RESUMO
Resumo Fundamento A prevalência de doença arterial coronariana (DAC) nos pacientes valvares é semelhante à da população geral, com associação usual aos fatores de risco tradicionais. Ainda assim, a busca por DAC obstrutiva é mais agressiva nos valvulopatas em pré-operatório, determinando a angiografia coronariana invasiva (ACI) a praticamente todos os pacientes adultos, uma vez que se acredita que a cirurgia de revascularização miocárdica deva ser associada à troca valvar.

Objetivos:

Avaliar a prevalência de DAC obstrutiva e identificar fatores a ela associados em adultos candidatos à cirurgia cardíaca primariamente valvar entre os anos de 2001 a 2014 no Instituto Nacional de Cardiologia (INC) e elaborar um modelo preditivo de DAC obstrutiva através de escore derivado de análise multivariada. A partir da estimativa da probabilidade pré-teste de DAC obstrutiva, espera-se melhor estratégia pré-operatória para cada paciente.

Métodos:

Estudo transversal avaliando 2.898 pacientes com indicação de cirurgia cardíaca por qualquer etiologia. Desses, foram estudados 712 pacientes valvopatas submetidos à ACI nos 12 meses anteriores à cirurgia. Diferenças com valor de p < 0,05 foram consideradas estatisticamente significativas.

Resultados:

A prevalência de DAC obstrutiva foi de 20%. Um modelo preditivo de DAC obstrutiva foi criado a partir de regressão logística multivariada, utilizando as variáveis idade, dor torácica, história familiar de DAC, hipertensão arterial sistêmica, diabetes mellitus, dislipidemia, tabagismo e sexo masculino. O modelo demonstrou excelente correlação e calibração (R2 = 0,98), além de ótima acurácia (ROC de 0,848; IC95% 0,817 - 0,879) e validação em diferente população valvar (ROC de 0,877; IC 95% 0,830 - 0,923).

Conclusões:

É possível estimar DAC obstrutiva a partir de dados clínicos com elevada acurácia, o que pode vir a permitir estabelecer estratégias pré-operatórias de acordo com a probabilidade pré-teste individual, evitando a indicação indiscriminada de procedimentos desnecessários e invasivos, principalmente nos grupos de menor probabilidade de DAC obstrutiva. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Coronary Artery Disease / Risk Assessment / Heart Valve Diseases Type of study: Diagnostic study / Etiology study / Evaluation studies / Observational study / Prevalence study / Prognostic study / Risk factors / Screening study Limits: Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2017 Type: Article Affiliation country: Brazil Institution/Affiliation country: Instituto Nacional de Cardiologia/BR

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Full text: Available Index: LILACS (Americas) Main subject: Coronary Artery Disease / Risk Assessment / Heart Valve Diseases Type of study: Diagnostic study / Etiology study / Evaluation studies / Observational study / Prevalence study / Prognostic study / Risk factors / Screening study Limits: Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2017 Type: Article Affiliation country: Brazil Institution/Affiliation country: Instituto Nacional de Cardiologia/BR