Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale.

OBJECTIVE: To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. METHODS: Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. RESULTS: We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. CONCLUSION: In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale

Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-Bang questionnaires and the Epworth sleepiness scale using polysomnography as gold standard.

Objectives: Obstructive sleep apnea (OSA) affects approximately one third of the population and can reach 90% prevalence in the elderly. There are screening tools to track the disease, however, their performance may differ according to population characteristics. This study aims to determine sensitivity, specificity, predictive value, likelihood ratio, and accuracy of the Berlin (BQ) and STOP-Bang (S-Bang) questionnaires and the Epworth sleepiness scale (ESS), comparing their performances, using polysomnography (PSG) as a gold standard, in a sample of elderly. Material and Methods: The study was cross-sectional, retrospective, included patients aged 60 or older who underwent PSG type 1, regardless of the BQ, S-Bang and ESS results, during the period of June 1, 2017 to April 30, 2019. OSA diagnosis was by PSG in which the hypopnea apnea index was greater than or equal to 5. Results: Sixty-two patients were evaluated; the prevalence of OSA was 72.58%. The mean age in the sample with OSA was 73.0±8.4 years and without it was 74.7±8.1 years. The sample was predominantly female, 58.1% with OSA. The BQ showed the best results for specificity, predictive value, likelihood ratio and accuracy. S-Bang had the best result for sensitivity and ESS showed the worst results. The BQ odds ratio showed that an individual with a positive BQ has 335% more chance of developing OSA. Conclusion: The QB showed the best performance in the measures for identifying OSA, for a sample of elderly individuals, with a predominance of females and a high prevalence of the disease.

Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-Bang questionnaires and the Epworth Sleepiness Scale using polysomnography as gold standard.

Objectives: Obstructive sleep apnea (OSA) affects approximately one third of the population and can reach 90% prevalence in the elderly. There are screening tools to track the disease, however, their performance may differ according to population characteristics. This study aims to determine sensitivity, specificity, predictive value, likelihood ratio and accuracy of the Berlin (BQ) and STOP-Bang (S-Bang) questionnaires and the Epworth Sleepiness Scale (ESS), comparing their performances, using polysomnography (PSG) as a gold standard, in a sample of elderly. Methods: The study was cross-sectional, retrospective, included patients aged 60 or older who underwent PSG type 1, regardless of the BQ, S-Bang and ESS results, during the period of June 1, 2017 to April 30, 2019. OSA diagnosis was by PSG in which the hypopnea apnea index was greater than or equal to 5. Results: Sixty- two patients were evaluated; the prevalence of OSA was 72.58%. The mean age in the sample with OSA was 73.0 sd 8.4 years and without it was 74.7 sd 8.1 years. The sample was predominantly female, 58.1% with OSA. The BQ showed the best results for specificity, predictive value, likelihood ratio and accuracy. S-Bang had the best result for sensitivity and ESS showed the worst results. The BQ odds ratio showed that an individual with a positive BQ has 335% more chance of developing OSA. Conclusion: The QB showed the best performance in the measures for identifying OSA, for a sample of elderly individuals, with a predominance of females and a high prevalence of the disease.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010. / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010.

BACKGROUND: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. OBJECTIVES: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). METHODS: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. RESULTS: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). CONCLUSIONS: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010 / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010

Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Resumo Fundamento: A intervenção coronariana percutânea (ICP) é o tratamento invasivo mais frequentemente realizado na doença isquêmica do coração (DIC). Estudos capazes de prover informação sobre a sua efetividade são importantes. Objetivo: Avaliar a sobrevida em até 15 anos de pacientes submetidos a ICP no estado do Rio de Janeiro (ERJ). Métodos: Bases de dados administrativas (1999-2010) e de óbitos (1999-2014) dos residentes com idade ≥ 20 anos do ERJ submetidos a uma única ICP paga pelo Sistema Único de Saúde (SUS) entre 1999-2010 foram relacionadas. Os pacientes foram agrupados em 20-49, 50-69 ou ≥ 70 anos, e as ICP em primária (ICP-P), sem stent (ICP-SS) e com stent convencional (ICP-CS). As probabilidades de sobrevida em 30 dias, um ano e 15 anos foram estimadas pelo método de Kaplan-Meier. Modelos de regressão de risco de Cox foram utilizados para comparar riscos entre sexo, faixas etárias e tipos de ICP. Resultados dos testes com um valor de p < 0,05 foram considerados estatisticamente significativos. Resultados: Foram analisados os dados de 19.263 pacientes (61±11 anos, 63,6% homens). A sobrevida de homens vs. mulheres em 30 dias, um ano e 15 anos foram: 97,3% (97,0-97,6%) vs. 97,1% (96,6-97,4%), 93,6% (93,2-94,1%) vs. 93,4% (92,8-94,0%), e 55,7% (54,0-57,4%) vs. 58,1% (55,8-60,3%), respectivamente. Idade ≥ 70 anos foi associada à menor taxa de sobrevida em todos os períodos. A ICP-CS foi associada a uma sobrevida maior do que a ICP-SS até dois anos de acompanhamento, e após este período ambos os procedimentos apresentaram taxas de sobrevida semelhantes (HR 0,91, IC 95% 0,82-1,00). Conclusões: Mulheres apresentaram maiores taxas de sobrevida em 15 anos após ICP, e o uso de stent convencional não esteve associado a um aumento de sobrevida em longo prazo.

Anthropometric Profile, Serum Leptin, Antioxidant Vitamins, LEPR Q223R Polymorphism and Cardiovascular Risk Factors in Adolescents.

Cardiovascular disease (CVD) risk factors, such as bad eating habits, are typical in adolescence and lead to the consumption of meals that are not always sufficient in vitamins A, E, ß-carotene, excess calories and elevated serum leptin levels. The purpose of this research is to study the relationship between vitamin A deficiency (VAD), ß-carotene deficiency (ßcD), vitamin E deficiency (VED) and to explore the association of leptin receptor Q223R polymorphisms with obesity and other risk factors for CVD. Method: This observational study included 237 adolescents recruited from Adolescents Reference Center, Brazil. It was collected: socioeconomic and clinical data, laboratory and molecular samples. Results: The average age was 14.93 ± 2.18 years, 66.2 % were girls, 38.0 % had high levels of total cholesterol (TC) between 10-14 years Triceps (TSF) and subscapular skinfolds (SSF) measurements were inversely correlated with VAD. There was also an association between VAD, ßcD and high triglyceride (TG) levels. Adolescents with the RR genotype presented a trend toward higher levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), TC, TG, low density lipoprotein (LDLC), leptin and low levels of high-density lipoprotein (HDL-c). Conclusion: The girls had higher levels of leptin than boys. Abdominal fat, ßcD and VED were observed in adolescents with VAD. Individuals with RR genotype have drawn attention to cardiovascular risk factors such as high rate of LDLC and reduced rate of HDLc. Thus, it is possible that individuals with this genotype may be more susceptible to the presence of cardiovascular risk factors.

Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study.

BACKGROUND: Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival. METHODS: This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707). RESULTS: Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001). CONCLUSIONS: Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.

Tendências e Letalidade Hospitalar dos Procedimentos de Revascularização Miocárdica Pagos pelo SUS no Estado do Rio de Janeiro, 1999-2010 / Trends and Hospital Mortality in Myocardial Revascularization Procedures Covered by the Brazilian Unified Health System in Rio de Janeiro State from 1999 to 2010

As doenças isquêmicas do coração (DIC) são causas de morte relevantes no Estado do Rio de Janeiro (ERJ). A cirurgia de revascularização do miocárdio (CRVM) e a angioplastia coronariana (AC) objetivam reduzir agravos causados pelas DIC. É preciso conhecer a eficiência desses procedimentos para decisões clínica e gerenciais. Objetivo: Descrever evolução temporal e letalidade hospitalar de CRVM e AC de 1999 a 2010 no ERJ. Métodos: Estudo de dados referentes às CRVM e AC dos bancos de dados das Autorizações de Internação Hospitalar pagas pelo Sistema Único de Saúde, de 1999 a 2010 no ERJ, com informações sobre diagnóstico, idade, sexo, data e duração da internação, tipo de alta hospitalar. Foram realizadas estatísticas descritivas e regressão linear para análise de tendências. Resultados: Em 34 413 pacientes com média de idade 61±10 anos, foram realizados 38 509 procedimentos, sendo 66,3% AC e 65,4% homens. Ocorreu aumento anual de 15,8% das AC e de 3,2% das CRVM. O diagnóstico de DIC aguda foi registrado em 60,6% das internações relacionadas a AC e 57,9% das relacionadas a CRVM. As medianas de duração de internação foram de 2 dias nas AC e 10 nas CRVM. As letalidades hospitalares encontradas nas AC e nas CRVM foram de 1,8% e 6,8%, respectivamente, maiores nos indivíduos com 70 anos ou mais, nas mulheres e nas DIC agudas. Conclusão: Houve um aumento nos procedimentos de revascularização miocárdica no ERJ, principalmente nas AC com stent, divergindo de outras regiões do mundo. Além disso, a letalidade hospitalar após a AC e a CRVM foram superiores às encontradas em outros locais e em estudos controlados.

Background: Ischemic heart diseases (IHD) are important causes of deaths in the state of Rio de Janeiro (RJ). Coronary artery bypass grafting (CABG) and coronary angioplasty (CA) procedures aim to mitigate the effects of IHD. Awareness of the efficiency of these procedures is crucial for clinical and administrative decision making. Objective: To describe temporal evolution and hospital mortality of CABG and CA performed in RJ from 1999 to 2010. Methods: Study on data of CA and CABG, covered by the Brazilian Unified Health System in RJ from 1999 to 2010, obtained from the Authorization for Hospital Admission database, concerning diagnosis, age, sex, admission date and hospital internment duration, and type of hospital discharge. Trends analysis was performed by descriptive statistics and linear regression analysis. Results: In 34,413 patients with mean age of 61±10 years, 38,509 procedures were performed, 66.3% CA and 65.4% in men. There was an annual increase by 15.8% in CA and 3.2% in CABG. The diagnosis of acute IHD was recorded in 60.6% of admissions related to CA, and in 57.9% of admissions related to CABG. Median hospital stay was 2 days in CA and 10 days in CABG. Hospital mortality was 1.8% and 6.8% in CA and CABG, respectively, and was higher in patients aged 70 years or older, in women and in acute IHD. Conclusion: The number of myocardial revascularizations in RJ, especially CA with stent, has increased which differs from other regions of the world. In addition, post-CA and post-CABG hospital mortality was higher than that reported in other locations and controlled studies.

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes / Sobrevida e Fatores Preditores de Letalidade em Hemodiálise: Polimorfismos D/I do Gene da Enzima Conversora da Angiotensina I e o M235T do Angiotensinogênio

Background: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene. .

Fundamento: Os pacientes em hemodiálise continuam tendo um significativo aumento na morbiletalidade, especialmente a causada por doenças cardiovasculares. A análise dos fatores genéticos ligados ao sistema renina-angiotensina que influenciam na sobrevivência destes pacientes poderá ajudar na busca por melhores resultados. Objetivo: Avaliar a sobrevida em hemodialisados e sua associação com polimorfismo dos genes do sistema reninaangiotensina: deleção/inserção do gene que codifica a enzima conversora da angiotensina I e o M235T do angiotensinogênio. Métodos: Estudo observacional desenhado para ver o papel dos genes do sistema renina-angiotensina. Foram analisados 473 pacientes tratados com hemodiálise crônica em quatro unidades de diálise do Estado do Rio de Janeiro. As taxas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças entre as curvas avaliadas pelos testes de: Tarone-Ware, Peto-Prentice e Log-rank. Foram utilizados também modelos de regressão logística e multinomial. Um valor de p ≤ 0,05 foi considerado estatisticamente significativo. O comitê de ética aprovou este estudo. Resultados: A idade média dos pacientes foi de 45,8%. A taxa de sobrevida global foi de 48% em 11 anos. As principais causas de óbito foram: doenças do aparelho circulatório (34 %) e infecções (15%). A análise de regressão logística encontrou significância estatística para as seguintes variáveis: idade, o TT do angiotensinogênio e a renda familiar acima de cinco salários mínimos, esta última como fator de proteção (p valor: 0,000038, 0,08261 e 0,03089, respectivamente). Conclusões: Nossos dados sugerem que o risco de letalidade em pacientes em hemodiálise pode ser influenciado também pelo polimorfismo ...

Survival and predictive factors of lethality in hemodialysis: D/I polymorphism of the angiotensin I-converting enzyme and of the angiotensinogen M235T genes.

BACKGROUND: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. OBJECTIVE: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. METHODS: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. RESULTS: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. CONCLUSIONS: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

Sobrevida de hemodialisados e sua associação com os polimorfismos dos genes da ECA e do angiotensinogênio / Survival rate for hemodialysis patients and association with angiotensionogen and ACE gene polymorphisms

Fundamentos: A letalidade dos pacientes em hemodiálise(HD) é alta. Apenas os fatores de risco cardiovascular tradicionais não são capazes de explicar essa elevada taxa.Objetivo: Avaliar a sobrevida e sua associação com o polimorfismo dos genes do sistema renina-angiotensina(SRA): inserção/deleção da ECA e o M235T do angiotensinogênio em pacientes em hemodiálise. Métodos: Analisaram-se inicialmente 473 pacientes tratados com HD crônica em quatro unidades de diálise do estado do Rio de Janeiro. Curvas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças avaliadas pelos testes de Tarone-Ware e de Peto-Prentice. Resultados: Na população de 82 pacientes, com tempo de HD até um ano que se encontrava em equilíbrio de Hardy-Weinberg, a média de idade foi 53±15 anos, sendo 55% homens. A taxa de sobrevida global foi 74% e 44%em cinco e 11 anos, respectivamente. Principais causas de óbito foram: doenças do aparelho circulatório 41%, infecções 15% e diabetes mellitus 15%. A regressão logística mostrou uma tendência (p=0,0844) de menor sobrevida para o polimorfismo TT com razão de chances de 3,931 (IC 95%: 0,128 a 1,231).Conclusões: Os dados sinalizaram uma tendência de que o risco de letalidade em pacientes em HD pode ser influenciado não só por fatores de risco cardiovascular bem conhecidos como idade e diabetes mellitus, mas também pelo polimorfismo TT do angiotensinogênio.

Background: The lethality rate for hemodialysis (HD)patients is high, which cannot be explained by traditional cardiovascular risk factors alone. Objective: To assess the survival rate and its association with the polymorphism of reninangiotensin system genes: ACE insertion/deletion and angiotensinogen M235T in HD patients. Methods: The initial analysis encompassed 473 chronic patients treated at four dialysis units in Rio de Janeiro State. The survival curves were calculated by the Kaplan-Meier method, with the differences between them evaluated by the Tarone-Ware and Peto-Prentice Tests. Results: For the population of 82 patients with up to1 year of HD in Hardy–Weinberg equilibrium, themean age was 53±15 years, of whom 55% were men.The overall survival rates were 74% and 44% at 5 and11 years respectively. The major causes of death were circulatory system diseases (41%), infections (15%)and diabetes mellitus (15%). The logistic regression models presented a trend (p=0.0844) towards a shorter survival time for the TT polymorphism with an oddsratio of 3.931 (95% CI: 0.128 to 1.231). Conclusions: The data indicate a possibility that the lethality risk of HD patients may be influenced not only by well-known cardiovascular risk factors sucha sageand diabetes mellitus, butalsob y angiotensinogen TT polymorphism.

Sobrevida nas reperfusões miocárdicas cirúrgicas e nas angioplastias coronarianas pagas por seguros de saúde e privados no Estado do Rio de Janeiro, 2000 a 2007 / Survival in coronary artery bypass grafts and coronary angioplasties paid privately or by health insurance in Rio de Janeiro State: 2000-2007

Fundamentos: A cirurgia de revascularização miocárdica (RVM) e a angioplastia coronariana (AC) são procedimentos comuns na prática clínica, que precisam ser continuamente avaliados. Objetivos: Estudar a sobrevida nos indivíduos submetidos à RVM ou AC no Estado do Rio de Janeiro (ERJ), pagas por seguros de saúde e privados, no período de 2000 a 2007. Métodos: Estudo utilizando bancos de dados para identificar os indivíduos submetidos aos procedimentos e aqueles que morreram, para estimar a sobrevida. As informações sobre RVM e AC provieram das Comunicações de Internação Hospitalar (CIH) e sobre óbitos das Declarações de Óbitos. Foi realizado relacionamento probabilístico entre os bancos com o programa RecLink para identificar os indivíduos que morreram após os procedimentos. Resultados: Apenas 980 procedimentos foram notificados em oito anos em 937 indivíduos residentes no ERJ. No interior do ERJ foram realizadas 32,4 por cento das RVM dos 509 indivíduos submetidos ao procedimento, enquanto as demais foram feitas em outros estados, 66,6 por cento em São Paulo (SP). Foram identificados 428 indivíduos com AC, 71,7 por cento realizadas no interior do ERJ e as demais nos outros estados, 22,8 por cento em SP. Não foi encontrada qualquer...

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003 / Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003 / Letalidad y complicaciones de la cirugía de revascularización miocárdica en el Rio de Janeiro, de 1999 a 2003

FUNDAMENTO: A cirurgia de revascularização do miocárdio (RVM) é um procedimento consolidado no tratamento das doenças isquêmicas do coração (DIC), requerendo constante avaliação. OBJETIVO: Avaliar a qualidade na RVM, através das características clínicas dos pacientes, taxas de letalidade até um ano após a alta hospitalar, causas básicas de morte e complicações pós-operatórias, em quatro hospitais públicos do Município do Rio de Janeiro, de 1999 a 2003. MÉTODOS: Foram selecionados aleatoriamente prontuários de pacientes submetidos à RVM. Informações sobre características clínicas, complicações e óbitos foram coletadas retrospectivamente dos prontuários e das declarações de óbitos. As taxas de letalidade foram estimadas nos períodos intra-hospitalar e até um ano pós-alta. RESULTADOS: As prevalências das características pré-operatórias foram: mulher: 31,9 por cento, hipertensão arterial: 90,7 por cento, dislipidemia: 67,4 por cento, diabete: 37,2 por cento, tabagismo: 22,9 por cento, obesidade: 18,3 por cento, doença pulmonar obstrutiva crônica: 8,2 por cento, acidente vascular encefálico prévio: 5,8 por cento, arteriopatia extracardíaca: 12,7 por cento, elevação da creatinina: 4,1 por cento, estado crítico pré-operatório: 3,7 por cento, infarto agudo do miocárdio recente: 23,5 por cento, angina instável: 40,8 por cento, síndrome coronariana aguda: 50,0 por cento, RVM prévia: 2,4 por cento, disfunção ventricular esquerda: 27,3 por cento, lesão de tronco da coronária esquerda: 3,9 por cento e associada com lesão em outro sistema: 19,8 por cento. As taxas de letalidade nos hospitais variaram de 7,0 por cento a 14,3 por cento no período intra-hospitalar e de 8,5 por cento a 20,2 por cento até um ano pós-alta. As DIC representaram as causas de mais de 80 por cento dos óbitos. O grupo de complicações pós-operatórias mais frequente foi de hemorragia ou baixo débito pós-procedimento. Sessenta por cento dos óbitos apresentaram cinco ou mais complicações enquanto que 40 por cento dos sobreviventes nenhuma. CONCLUSÃO: As taxas de letalidade e de complicações foram elevadas. Mesmo nos sobreviventes as complicações foram mais frequentes do que o esperado.

BACKGROUND: Coronary artery bypass grafting (CABG) is a consolidated procedure for the treatment of ischemic heart diseases (IHDs), which requires continuous assessment. OBJECTIVE: To assess the quality of CABG surgery by reviewing patients' clinical characteristics, mortality rates up to one year after hospital discharge, primary causes of death and postoperative complications, at four public hospitals in Rio de Janeiro from 1999 to 2003. METHODS: CABG patient charts were randomly selected. A retrospective review was conducted to collect data on clinical characteristics, complications and deaths from patient medical charts and statements of death (SDs). Mortality rates were estimated for the hospitalization period and for up to one year after hospital discharge. RESULTS: The prevalence of preoperative patient characteristics were: women: 31.9 percent; arterial hypertension: 90.7 percent; dyslipidemia: 67.4 percent; diabetes: 37.2 percent; current smoking status: 22.9 percent; obesity: 18.3 percent; chronic obstructive pulmonary disease: 8.2 percent; prior stroke: 5.8 percent; extracardiac artery disease: 12.7 percent; elevation of creatinine levels: 4.1 percent; critical preoperative status: 3.7 percent; recent acute myocardial infarction: 23.5 percent; unstable angina: 40.8 percent; acute coronary syndrome: 50.0 percent; prior CABG: 2.4 percent; left ventricular dysfunction: 27.3 percent; left main coronary artery lesion: 3.9 percent; and associated with lesion in another system: 19.8 percent. In-hospital mortality rates ranged from 7.0 percent to 14.3 percent, and up to one year after hospital discharge from 8.5 percent to 20.2 percent. Ischemic heart disease (IHD) accounted for more than 80 percent of the deaths, and the most frequent complications after surgery were hemorrhage or post-procedural low cardiac output. Sixty percent of the patients who died had five or more complications, whereas 40 percent of those who survived had none. CONCLUSION: Mortality and complication rates were high. Even among those patients who survived, complications were more frequent than expected.

FUNDAMENTO: La cirugía de revascularización del miocardio (RVM) es un procedimiento consolidado en el tratamiento de las enfermedades isquémicas del corazón (EIC), requiriendo constante evaluación. OBJETIVO: Evaluar la calidad en la RVM, a través de las características clínicas de los pacientes, tasas de letalidad hasta un año tras el alta hospitalaria, causas básicas de muerte y complicaciones posoperatorias, en cuatro hospitales públicos del Municipio del Rio de Janeiro, de 1999 a 2003. MÉTODOS: Se seleccionaron aleatoriamente prontuarios de pacientes sometidos a RVM. Informaciones sobre características clínicas, complicaciones y óbitos se recolectaron retrospectivamente de los prontuarios y de las declaraciones de defunción. Las tasas de letalidad se estimaron en los períodos intrahospitalarios y hasta un año posalta. RESULTADOS: Las prevalencias de las características preoperatorias fueron: mujer: Un 31,9 por ciento, hipertensión arterial: un 90,7 por ciento, dislipidemia: un 67,4 por ciento, diabetes: un 37,2 por ciento, aquismo: un 22,9 por ciento, obesidad: un 18,3 por ciento, enfermedad pulmonar obstructiva crónica: un 8,2 por ciento, accidente vascular encefálico previo: un 5,8 por ciento, arteriopatía extracardíaca: un 12,7 por ciento, elevación de la creatinina: un 4,1 por ciento, estado crítico preoperatorio: un 3,7 por ciento, infarto agudo de miocardio reciente: un 23,5 por ciento, angina inestable: un 40,8 por ciento, síndrome coronario agudo: el 50 por ciento, RVM previa: un 2,4 por ciento, disfunción ventricular izquierda: un 27,3 por ciento, lesión de tronco da coronaria izquierda: un 3,9 por ciento y asociada con lesión en otro sistema: un 19,8 por ciento. Las tasas de letalidad en los hospitales variaron del 7 por ciento a un 14,3 por ciento en el período intrahospitalario y de un 8,5 por ciento a un 20,2 por ciento hasta un año pos la dada de alta. Las EIC representaron las causas de más del 80 por ciento de los óbitos. El grupo de complicaciones posoperatorias más frecuente fue de hemorragia o bajo débito posprocedimiento. Sesenta por ciento de las muertes presentaron cinco o más complicaciones mientras que el 40 por ciento de los supervivientes presentaron ninguna. CONCLUSIÓN: Las tasas de letalidad y de complicaciones se elevaron. Aun en los supervivientes las complicaciones fueron más frecuentes que lo esperado.

Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003.

BACKGROUND: Coronary artery bypass grafting (CABG) is a consolidated procedure for the treatment of ischemic heart diseases (IHDs), which requires continuous assessment. OBJECTIVE: To assess the quality of CABG surgery by reviewing patients' clinical characteristics, mortality rates up to one year after hospital discharge, primary causes of death and postoperative complications, at four public hospitals in Rio de Janeiro from 1999 to 2003. METHODS: CABG patient charts were randomly selected. A retrospective review was conducted to collect data on clinical characteristics, complications and deaths from patient medical charts and statements of death (SDs). Mortality rates were estimated for the hospitalization period and for up to one year after hospital discharge. RESULTS: The prevalence of preoperative patient characteristics were: women: 31.9%; arterial hypertension: 90.7%; dyslipidemia: 67.4%; diabetes: 37.2%; current smoking status: 22.9%; obesity: 18.3%; chronic obstructive pulmonary disease: 8.2%; prior stroke: 5.8%; extracardiac artery disease: 12.7%; elevation of creatinine levels: 4.1%; critical preoperative status: 3.7%; recent acute myocardial infarction: 23.5%; unstable angina: 40.8%; acute coronary syndrome: 50.0%; prior CABG: 2.4%; left ventricular dysfunction: 27.3%; left main coronary artery lesion: 3.9%; and associated with lesion in another system: 19.8%. In-hospital mortality rates ranged from 7.0% to 14.3%, and up to one year after hospital discharge from 8.5% to 20.2%. Ischemic heart disease (IHD) accounted for more than 80% of the deaths, and the most frequent complications after surgery were hemorrhage or post-procedural low cardiac output. Sixty percent of the patients who died had five or more complications, whereas 40% of those who survived had none. CONCLUSION: Mortality and complication rates were high. Even among those patients who survived, complications were more frequent than expected.

Letalidade hospitalar e tardia após angioplastias coronarianas com stents convencionais e farmacológicos / In-hospital and late mortality after coronary angioplasty with bare metal and drug eluting stents

Avanços nas intervenções coronarianas com cateter, especialmente com o uso dos stents convencionais (SC) e farmacológicos (SF), têm melhorado a eficácia e a segurança da revascularização percutânea. Analisar a letalidade hospitalar e tardia das angioplastias coronarianas realizadas no período de 2002 a 2005, com implante de SF e SC. Foram selecionados pacientes no período de junho 2002 a dezembro 2005 tratados por intervenção coronariana percutânea com implante exclusivo de SC ou SF em hospitais privados do Rio de Janeiro e Niterói...

Diferença nas taxas de letalidade e nas principais causas de óbito, entre homens e mulheres, por revascularização miocárdica cirúrgica / Differences in lethality rates and the main causes of death among men and women, due to surgical revascularization of the myocardium

Fundamentos:Parece haver diferenças na revascularização cirúrgica do miocárdio(RVM), com pior resultados nas mulheres. Objetivo: Avaliar a diferença na letalidade e no percentual de óbitos relacionados ao aparelho circulatório, diabetes mellitus e procedimento(ApCDMC), intra-hospitalar até um 1 ano pós-alta, entre homens e mulheres, submetidos à RVM, pelo sistema único de saúde, no estado do Rio de Janeiro(ERJ), de 1999 a 2003. Métodos:Os dados sobre RVM provieram dos bancos de autorização de internação hospitalar e declaração de óbito do ERJ. O relacionamento probalístico entre foi realizado através do RecLink. Excluiram-se RVM com trocas valvares.Consideraram-se 4 períodos de tempo(em dias): intra-hospitalar, até 30, de 31-180 e de 181-365 dias pós-alta; e 3 faixas etárias (em anos):20-49, 50-69 e >=70 anos percentuais de óbitos e taxas de letalidade por: sexo, faixas etárias, causas do ApCDM e períodos. Resultados: Encontrados 5180 pacientes submetidos à RVM, sendo que 675 morreram até um ano pós-alta. A letalidade intra-hospitalar foi 9,7 por cento nas mulheres e 7,2 por cento nos homens. As letalidades nos períodos de 0-30 dias, 31-180 e 181-365 dias pós-alta foram, respectivamente, nas mulheres: 11,8 por cento, 13,9por cento e 15,5 por cento, e nos homens 9,2 por cento, 10,9 por cento e 11,8 por cento. O percentual de óbitos por causa da ApCDM foi mais frequente nos homens jovens e nas mulheres mais idosas. Conclusões: As taxas de letalidade intra-hospitalar e até um ano pós-alta nas RVM foram mais elevadas nas mulheres no período masi afastado do procedimento, enquanto os homens morreram mais precocemente por essas causas.

Associação da troponina I e da disfunção miocárdica com a mortalidade em idosos com choque séptico / Association of Troponin I and myocardial dysfunction with mortality in elderly patients with septic shock

Objetivo: Avaliar a associação da troponina I e da disfunção miocárdica com mortalidade no choque séptico. Métodos: Coorte de 67 pacientes consecutivos com idade acima de 65 anos, no período de 32 meses, tendo diagnóstico de choque séptico com monitoração da artéria pulmonar. O escore APACHE II foi calculado em todos os pacientes. A mensuração da troponina I foi realizada nas primeira 24 horas de internação e quando havia evolução para disfunção miocárdica. A troponina I foi o teste considerada positiva quando o nível sérico apresentava-se acima de 0,5mg/ml. A disfunção miocárdica foi definida pelos critérios de Le Gall et al. Para análise estatística empregou-se o teste do qui-quadrado, o teste 1 e a análise de sobrevida de kaplan-Meier, considerando-se valor inferior a 5 por cento como nível de significância. Resultados: A média da idade foi 80 anos e do APACHE II foi 19. Houve 39 óbitos (58 por cento) e a disfunção miocárdica ocorreu em 46 por cento dos pacientes. A troponina I foi positiva em 22 dos 31 pacientes que evoluíram com disfunção...

Objective: To evaluate the association between troponin I and myocardial dysfunction with mortality in septicshock. Methods: The cohort followed up for 32 months, monitoring the pulmonary arteries of 67 patientsover 65 years old diagnosed with septic shock. APACHE II scoring was calculated for all patients. Troponin I levels were taken in the first 24 hoursafter admission and when myocardial dysfunction occurred. Troponin I was considered positive for serum levels over 0.5ng/ml. Myocardial dysfunction was defined by Le Gall’s criteria1. Statistical treatment was provided through chisquare test, t test and analysis of the Kaplan- Meier survival curve, with under 5% consideredstatistically significant. Results: The average age was eighty years old and the average APACHE II score was 19. There were 39 deaths (58%), with myocardial dysfunction present in 46% of the patients. Troponin I was positive in 22 out of 31 patients with myocardial dysfunction. Although myocardialdysfunction demonstrated a borderline p-value (p=0.049) when analyzed by the chi-square test, it presented nocorrelation with mortality through the survival curve analysis (p=0.25). Troponin I was associated not onlywith mortality showed by the chi-square test (p=0.006), but also with the survival curve analysis (p=0.021). There was an association with mortality when positive troponin I was present in myocardial dysfunction.

[Hospital case fatality associated with coronary angioplasty in Rio de Janeiro State, Brazil, 1999-2003]. / Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003.

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.