Quality of life and health status after percutaneous coronary intervention in stable angina patients: results from the real-world practice.

BACKGROUND: Percutaneous coronary interventions (PCI) are associated with quality of life (QoL) and health status improvements in stable angina patients. There are few studies assessing the magnitude of this effect and its predictors in contemporary daily practice. METHODS: Prospective cohort study with stable angina patients submitted to PCI in a tertiary interventional cardiology center. The clinical characteristics and the Seattle Angina Questionnaire (SAQ) were assessed before PCI, and patients were followed-up for 1 year. Mixed linear regression and ANOVA were used to compare SAQ indices, and multivariate analysis to identify predictors of QoL improvement. RESULTS: Between September 2006 and May 2007, 110 patients were included. The mean age of the study population was 62.8 ± 8.7 years, and 62% of the patients were of the male gender. Diabetes mellitus was present in 29%, arterial hypertension in 82%, previous myocardial infarction in 32%, and previous PCI in 29%. Before PCI, only 5% of the patients were free of angina, and this rate improved to 68% in the one-year followup (P < 0.001). There was improvement in all SAQ scales in the one-year followup, which was already shown in the 6-month assessment (P < 0.0001). Quality of life before the procedure was the main predictor of QoL improvement by multivariate analysis (P < 0.001). CONCLUSIONS: Patients with stable angina submitted to PCI in the real-world practice present significant improvement in one-year health status, as assessed by the SAQ. Quality of life before the procedure is the main determinant of improvement in QoL.

Morbimortalidade em octogenários submetidos à cirurgia de revascularização miocárdica / Morbimortality in octogenarian patients submitted to coronary artery bypass graft surgery

FUNDAMENTO: O progressivo aumento da longevidade da população tem levado cada vez mais pacientes octogenários a necessitarem de cirurgia de revascularização miocárdica (CRM), sendo necessário conhecer os riscos e benefícios desse procedimento nessa faixa etária. OBJETIVO: Descrever a morbimortalidade hospitalar de pacientes com idade igual ou superior a 80 anos submetidos à CRM e identificar variáveis que se constituem em seus preditores. MÉTODOS: Foram estudados 140 casos consecutivos entre janeiro de 2002 e dezembro de 2007. Os pacientes possuíam em média 82,5 ± 2,2 anos (80-89), e 55,7 por cento eram do sexo masculino. Na amostra, 72,9 por cento tinham hipertensão arterial, 26,4 por cento diabete, 65,7 por cento lesão grave em três ou mais vasos e 28,6 por cento em tronco da coronária esquerda. Cirurgia associada esteve presente em 35,7 por cento dos pacientes, sendo a valvar aórtica em 26,4 por cento e a mitral em 5,6 por cento. RESULTADOS: A mortalidade foi de 14,3 por cento (CRM isolada 10,0 por cento x 22,0 por cento associada; p = 0,091) e a morbidade de 37,9 por cento (CRM isolada 34,4 por cento x 44,0 por cento associada; p = 0,35). Complicações mais frequentes: baixo débito cardíaco (27,9 por cento), disfunção renal (10,0 por cento) e suporte ventilatório prolongado (9,6 por cento). Na análise bivariada, os maiores preditores de mortalidade foram sepse (RR 10,2 IC 95 por cento: 6,10-17,7), CRM prévia (RR 8,06 IC 95 por cento: 5,16-12,6), baixo débito cardíaco pós-operatório (RR 7,77 IC 95 por cento: 3,03-19,9) e disfunção renal pós-operatória (RR 7,36 IC 95 por cento: 3,71-14,6). Quanto à morbidade, foram preditores tempo de circulação extracorpórea >120 min. (RR: 2,34 IC 95 por cento: 1,62-3,38) e de isquemia > 90 min. (RR: 2,29 IC 95 por cento: 1,56-3,37). CONCLUSÃO: A CRM em octogenários está relacionada a uma morbimortalidade maior do que nos pacientes mais jovens, o que, entretanto, não impede a intervenção se houver indicação...

BACKGROUND: Given the progressive increase in longevity and the need of an increasingly elderly population to undergo myocardial revascularization surgery (MRS), it becomes necessary to know its risks and benefits. OBJECTIVE: To evaluate the in-hospital morbimortality of patients aged 80 and older submitted to MRS and identify its predictor variables. METHODS: A total of 140 consecutive cases were studied between January 2002 and December 2007. The patients' mean age was 82.5 ± 2.2 years (range: 80-89) and 55.7 percent were males. In the sample,72.9 percent had arterial hypertension, 26.4 percent had diabetes, 65.7 percent presented severe lesion in three or more vessels and 28.6 percent presented a severe lesion in the left coronary trunk. An associated surgery was present in 35.7 percent of the cases, with aortic valve in 26.4 percent and mitral valve in 5.6 percent. RESULTS: The mortality rate was 14.3 percent (isolated MRS 10.0 percent vs 22.0 percent with associated procedure; p = 0.091) and the morbidity was 37.9 percent (isolated MRS 34.4 percent vs 44.0 percent with associated procedure; p = 0.35). The most frequent complications were low cardiac output (27.9 percent), renal dysfunction (10.0 percent) and prolonged ventilatory support (9.6 percent). At the bivariate analysis, the most important mortality predictors were sepsis (RR 10.2; 95 percentCI: 6.10-17.7), previous MRS (RR 8.06; 95 percentCI: 5.16-12.6), postoperative low cardiac output (RR 7.77; 95 percentCI: 3.03-19.9) and postoperative renal dysfunction (RR 7.36; 95 percentCI: 3.71-14.6). The morbidity predictors were extracorporeal circulation time > 120 min. (RR: 2.34; 95 percentCI: 1.62-3.38) and time of ischemia > 90 min. (RR: 2.29 95 percentCI: 1.56-3.37). CONCLUSION: The MRS in octogenarians is associated with a higher morbimortality when compared to younger patients, which, however, does not prevent the procedure if the indication is justified by clinical condition.

Morbimortality in octogenarian patients submitted to coronary artery bypass graft surgery.

BACKGROUND: Given the progressive increase in longevity and the need of an increasingly elderly population to undergo myocardial revascularization surgery (MRS), it becomes necessary to know its risks and benefits. OBJECTIVE: To evaluate the in-hospital morbimortality of patients aged 80 and older submitted to MRS and identify its predictor variables. METHODS: A total of 140 consecutive cases were studied between January 2002 and December 2007. The patients' mean age was 82.5 +/- 2.2 years (range: 80-89) and 55.7% were males. In the sample,72.9% had arterial hypertension, 26.4% had diabetes, 65.7% presented severe lesion in three or more vessels and 28.6% presented a severe lesion in the left coronary trunk. An associated surgery was present in 35.7% of the cases, with aortic valve in 26.4% and mitral valve in 5.6%. RESULTS: The mortality rate was 14.3% (isolated MRS 10.0% vs 22.0% with associated procedure; p = 0.091) and the morbidity was 37.9% (isolated MRS 34.4% vs 44.0% with associated procedure; p = 0.35). The most frequent complications were low cardiac output (27.9%), renal dysfunction (10.0%) and prolonged ventilatory support (9.6%). At the bivariate analysis, the most important mortality predictors were sepsis (RR 10.2; 95%CI: 6.10-17.7), previous MRS (RR 8.06; 95%CI: 5.16-12.6), postoperative low cardiac output (RR 7.77; 95%CI: 3.03-19.9) and postoperative renal dysfunction (RR 7.36; 95%CI: 3.71-14.6). The morbidity predictors were extracorporeal circulation time > 120 min. (RR: 2.34; 95%CI: 1.62-3.38) and time of ischemia > 90 min. (RR: 2.29 95%CI: 1.56-3.37). CONCLUSION: The MRS in octogenarians is associated with a higher morbimortality when compared to younger patients, which, however, does not prevent the procedure if the indication is justified by clinical condition.

Morbimortalidade em pacientes acima de 75 anos submetidos à cirurgia por estenose valvar aórtica / Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement

FUNDAMENTO: A maior longevidade observada atualmente ocasionou aumento do número de idosos que necessitam de intervenções cirúrgicas. A estenose aórtica é uma condição frequente nessa faixa etária. OBJETIVO: Avaliar morbidade e mortalidade hospitalar em pessoas de 75 anos ou mais, que tenham sido submetidas à cirurgia de valvuloplastia, ou de troca valvar por estenose aórtica isolada ou associada a outras lesões. MÉTODOS: Foram estudados 230 casos consecutivos entre jan/2002-dez/2007. Os pacientes tinham 79,5 ± 3,7 anos (75 - 94), sendo que 53,9 por cento eram homens. Na amostra, 68,7 por cento tinham hipertensão arterial, 17,9 por cento tinham fibrilação atrial, 15,9 por cento apresentaram obesidade e 14,4 por cento cirurgia cardíaca prévia. Na cirurgia, 87,4 por cento foram submetidos à colocação de prótese aórtica e 12,6 por cento à valvuloplastia aórtica. RESULTADOS: A mortalidade foi de 13,9 por cento (sendo 9,4 por cento de estenose aórtica isolada x 20,9 por cento com procedimento associado; p = 0,023) e a morbidade foi de 30,0 por cento (sendo 25,2 por cento de estenose aórtica isolada x 37,4 por cento com procedimento associado; p = 0,068). As complicações mais frequentes foram: baixo débito cardíaco (20,2 por cento), disfunção renal (9,7 por cento) e suporte ventilatório prolongado (7,9 por cento). Na análise bivariada, os maiores preditores de mortalidade foram: baixo débito cardíaco (RR 10,1, IC95 por cento: 5,02-20,3), uso do balão intra-aórtico (RR 6,6, IC95 por cento: 3,83-11,4), sepse (RR 6,77, IC95 por cento: 1,66-9,48) e disfunção renal pós-operatória (RR 6,21, IC95 por cento: 3,47-11,1). Quanto à morbidade, foram preditores: disfunção renal pré-operatória (RR 2,22, IC95 por cento: 1,25-3,95), fibrilação atrial (RR 1,74, IC95 por cento: 1,16-2,61) e doença pulmonar obstrutiva crônica (DPOC) (RR 1,93, IC95 por cento: 1,25-2,97). CONCLUSÃO: A cirurgia valvar aórtica em idosos está relacionada à morbimortalidade um pouco ...

BACKGROUND: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group. OBJECTIVE: To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. METHODS: We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 ± 3.7 years (75 - 94), and 53.9 percent were men. In the sample, 68.7 percent had hypertension, 17.9 percent had atrial fibrillation, 15.9 percent were obese, and 14.4 percent had undergone previous heart surgery. At surgery, 87.4 percent underwent aortic stent placement, and 12.6 percent underwent aortic valvuloplasty. RESULTS: The mortality rate was 13.9 percent (9.4 percent with isolated aortic stenosis versus 20.9 percent with an associated procedure, p = 0.023) and the morbidity rate was 30.0 percent (25.2 percent with aortic stenosis alone versus 37.4 percent with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2 percent), renal dysfunction (9.7 percent), and prolonged ventilatory support (7.9 percent). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.1, 95 percent CI: 5.02-20.3), use of intra-aortic balloon (RR 6.6, 95 percent CI: 3.83-11.4), sepsis (RR 6.77, 95 percent: 1.66-9.48) and renal dysfunction after surgery (RR 6.21, 95 percent: 3.47-11.1). As for morbidity, the predictors were: pre-operative renal dysfunction (RR 2.22, 95 percent: 1.25-3.95), atrial fibrillation (RR 1.74, 95 percent: 1.16-2.61), and chronic obstructive pulmonary disease (COPD) (RR 1.93, 95 percent: 1.25-2.97). CONCLUSION: Aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, ...

[Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement].

BACKGROUND: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group. OBJECTIVE: To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. METHODS: We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 +/- 3.7 years (75 - 94), and 53.9% were men. In the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. At surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty. RESULTS: The mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.1, 95% CI: 5.02-20.3), use of intra-aortic balloon (RR 6.6, 95% CI: 3.83-11.4), sepsis (RR 6.77, 95%: 1.66-9.48) and renal dysfunction after surgery (RR 6.21, 95%: 3.47-11.1). As for morbidity, the predictors were: pre-operative renal dysfunction (RR 2.22, 95%: 1.25-3.95), atrial fibrillation (RR 1.74, 95%: 1.16-2.61), and chronic obstructive pulmonary disease (COPD) (RR 1.93, 95%: 1.25-2.97). CONCLUSION: Aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, COPD, and sepsis.

Perfil de risco de reestenose em pacientes submetidos a implante de stents coronarianos convencionais / Restenosis risk profile of patients submitted to coronary bare-metal stent implantation

Introdução: O perfil de risco de reestenose de populações tratadas com implante de stents coronarianos em nosso meio não é conhecido. Essa informação tem importância na decisão de incorporar uma estratégia seletiva de implante de stents farmacológicos pelo sistema público de saúde. Objetivos: Avaliar o risco de reestenose antes do procedimento de uma população de pacientes tratados com stents coronarianos convencionais. Método: Estudo observacional de corte transversal, com 4.482 pacientes tratados com 5.336 stents , no período de janeiro de 2000 a dezembro de 2007. O risco de reestenose foi avaliado conforme escore previamente validado, com pontuação de 0 a 5 conforme a presença de diabetes melito (1 ponto), o diâmetro de referência do vaso tratado (menor 3 mm igual 2 pontos, 3-3,5 mm igual 0) e a extensão da lesão (maior 20 mm igual 2 pontos, 10-20 mm igual 1, e menor 10 mm igual 0. Resultados: A média de idade foi de 60,6 mais ou menos 10,6 anos e 32 por cento dos pacientes eram do sexo feminino. O diâmetro de referência do vaso tratado foi de 3,10 maior e menor 0,51 mm, a extensão da lesão foi de 13,2 maior ou menor 5,9 mm e 20 por cento dos pacientes apresentavam diabetes melito. A distribuição dos pacientes conforme os pontos no escore de reestenose...

Background: The restenosis risk of patient populations treated with coronary stent implantation is not well studied. This information has a potential impact on the decision of incorporating a selective strategy of drug-eluting stent implantation by the public health system. Our objective was to evaluate the restenosis risk of a population of patients (pts) treated with bare-metal stents. Methods: Observational study with 4,482 pts treated with 5,336 stents, between January 2000 and December 2007. The restenosis risk was assessed according to a previous validated risk score. Points in the score ranged from 0 to 5 according to diabetes mellitus (1 point), reference vessel diameter (< 3 mm = 2 points, 3-3.5 mm = 1, and > 3.5 mm = 0), and the lesion length (> 20 mm = 2 points, 10-20 mm = 1, and < 10 mm = 0). Results: The mean age was 60.6 ± 10.6 years of age, and 32% were female. The mean reference vessel diameter was 3.10 mm ± 0.51mm, the lesion length was 13.2 mm ± 5.9 mm, and 20% of the pts were diabetics. The distribution of pts according to points in the risk score was the following: score 0 = 4% of the pts; score 1 = 22%; 2 = 34%; 3 = 29%; 4 = 9%; and score 5 = 1% of the pts. Conclusions: The majority of pts presented low or intermediate restenosis risk. The adoption of a selectivestrategy of drug-eluting stent implantation only in those at higher restenosis risk would represent its use in no more than 20% of the procedures.