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Master's Dissertation
DOI
https://doi.org/10.11606/D.98.2020.tde-26122019-123852
Document
Author
Full name
Marina Macedo Kuenzer Bond
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Santos, Magaly Arrais dos (President)
Gomes, Walter José
Campagnucci, Valquiria Pelisser
Farsky, Pedro Silvio
Title in Portuguese
O impacto da angioplastia coronariana prévia na cirurgia de revascularização do miocárdio: na morbimortalidade hospitalar, na qualidade de vida e sobrevivência em um ano
Keywords in Portuguese
Análise de Sobrevida
Indicadores de Morbimortalidade
Intervenção Coronária Percutânea
Qualidade de Vida
Revascularização Miocárdica
Abstract in Portuguese
Introdução: É crescente o número de pacientes com doença arterial coronariana e angioplastia (ATC) prévia que realizam cirurgia de revascularização do miocárdio (CRM). Estudos demonstraram que a presença de stent aumenta os fatores inflamatórios locais, porém o impacto da ATC prévia nos resultados da CRM ainda é controverso. Objetivo: Primariamente, avaliar o impacto da ATC prévia na qualidade de vida (QV) dos pacientes submetidos à CRM. Secundariamente, avaliar esse impacto na morbimortalidade hospitalar e sobrevida em um ano. Métodos: Estudo prospectivo, longitudinal, com pacientes submetidos à CRM isolada de julho de 2016 a junho de 2017. Os pacientes foram divididos em dois grupos, com e sem ATC prévia. As características clínicas e cirúrgicas, os exames, e as intercorrências foram registradas. Foi realizada a avaliação da QV através do questionário Quality of Life in Cardiovascular Surgery (QLCS) com um, seis e doze meses após a cirurgia. Foi utilizado para análise estatística o teste de Mann Whitney para variáveis quantitativas, o teste Exato de Fisher para as qualitativas e o teste ANOVA não paramétrico para QLCS, curva de Kaplan-­Meier para sobrevivência, e modelo de Cox univariado, com seu hazard risk e intervalo de confiança de 95%. Em seguida, foi realizada análise com propensity matching score. Foi considerado significativo P < 0,05. Resultados: Dos 434 pacientes, 70 pacientes tiveram ATC prévia (16%). Nas características iniciais da amostra a presença de infarto agudo do miocárdio prévio (P = 0,02) e a classe de angina (CCS) (P = 0,04) foram significativas. Dos 394 sobreviventes, 362 completaram o seguimento (92%). A presença de ATC prévia não afetou a QV (P = 0,69), as médias encontradas em um, seis e doze meses no QLCS foram 17,8 (± 3,8), 18,8 (± 3,3), 19,5 (± 3,4) no grupo sem ATC prévia e 17,1 (± 4,1), 18,6 (± 3,6), 19,6 (± 3,6) no com ATC prévia. Os grupos se comportaram de maneira semelhante, com melhora progressiva da QV durante doze meses de seguimento (P < 0,0001). Os desfechos secundários, não apresentaram diferença estatística significativa entre os grupos para: infarto peri-­operatório (P = 0,08), acidente vascular cerebral (P = 1,0), ECCM (P = 0,36), e tempo de internação (P = 0,22), mortalidade intra-­hospitalar (P = 0,11), mortalidade no primeiro ano (P = 0,26), curva de sobrevivência em um ano (P = 0,29). O HR foi de 1,5 com IC (95%)=[0,69 - 3,33]. A mortalidade hospitalar foi de 11,4% no grupo com ATC prévia e 5,8% no grupo sem ATC prévia, aproximadamente o dobro. A incidência de infarto peri-­operatório foi maior no grupo com stent (7,2% vs. 2,8%). Resultados similares foram obtidos na análise com propensity matching score. Conclusão: Este estudo, o qual é o primeiro estudo na literatura mundial a avaliar o impacto da ATC prévia na QV dos pacientes submetidos à CRM, não demonstrou diferença significativa entre os grupos, porém, em comum a melhora progressiva na QV. Foram demonstradas maior taxa de mortalidade hospitalar e infarto peri­operatório no grupo com stent prévio.
Title in English
The impact of previous coronary angioplasty on coronary artery bypass grafting: hospital morbidity and mortality, quality of life and survival at one year
Keywords in English
Indicators of Morbidity and Mortality
Myocardial Revascularization
Percutaneous Coronary Intervention
Quality of life
Survival Analysis
Abstract in English
Introduction: The number of patients with previous coronary artery disease and percutaneous coronary intervention (PCI) who undergo coronary artery bypass grafting (CABG) is increasing. Studies have shown that the presence of stent increases local inflammatory factors, but the impact of previous PCI on CABG results is still controversial. Objective: To evaluate the impact of previous PCI on quality of life (QoL) of patients undergoing CABG. Secondarily, to evaluate this impact on hospital morbidity and mortality, and survival at one year. Methods: Prospective, longitudinal study with patients submitted to isolated CABG from July 2016 to June 2017. Patients were divided into two groups, with and without previous PCI. Clinical and surgical characteristics, examinations and intercurrences were recorded. The QoL was evaluated through the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire at one, six and twelve months after surgery. It was used the Mann Whitney test for quantitative variables, Fisher's exact test for qualitative variables and the non-­parametric ANOVA test for QLCS, Kaplan-­Meier survival curve, and univariate Cox model with its hazard risk and interval confidence intervals of 95%. Subsequently, analysis with propensity matching score was performed. P < 0.05 was considered significant. Results: Of the 434 patients, 70 patients had previous PCI (16%). In the initial characteristics of the sample, the presence of previous acute myocardial infarction (P = 0.02) and angina class (CCS) (P = 0.04) were significant. Of the 394 survivors, 362 completed follow-­up (92%). The presence of previous PCI did not affect the QoL (P = 0.69), the means found at one, six and twelve months in the QLCS were 17.8 (± 3.8), 18.8 (± 3.3), 19.5 (± 3.4) in the group without previous PCI and 17.1 (± 4.1), 18.6 (± 3.6), 19.6 (± 3.6) in the previous PCI group. The groups behaved in a similar way, with progressive improvement of QoL for twelve months of follow-­up (P < 0.0001). Secondary outcomes did not present a significant statistical difference between the groups for perioperative infarction (P = 0.08), stroke (P = 1.0), MACCE (P = 0.36), and length of hospital stay (P = 0.22), in-­hospital mortality (P = 0.11), mortality in the first year (P = 0.26), survival curve at one year (P = 0.29). HR was 1.5 with CI (95%) = [0.69-­3.33]. Hospital mortality was 11.4% in the previous PCI group and 5.8% in the group without prior PCI, approximately the double. The incidence of perioperative infarction was higher in the stent group (7.2% vs. 2.8%). Similar results were obtained in the analysis with propensity matching score. Conclusion: This study, witch is the first study in the world literature to evaluate the impact of prior PCI on the QoL of patients submitted to CABG, did not show a significant difference between the groups, but with a progressive improvement in the QoL. There was a higher rate of hospital mortality and perioperative infarction in the group with previous stent.
 
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Publishing Date
2020-02-27
 
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