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Doctoral Thesis
DOI
10.11606/T.5.2019.tde-03012019-092509
Document
Author
Full name
Diogo Freitas Cardoso de Azevedo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2018
Supervisor
Committee
Hueb, Whady Armindo (President)
Garcia, Rosa Maria Rahmi
Ramires, Jose Antonio Franchini
Silva, Expedito Eustáquio Ribeiro da
Title in Portuguese
Relação do SYNTAX Score com a liberação dos biomarcadores cardíacos após procedimentos de revascularização em pacientes portadores de doença arterial coronariana estável
Keywords in Portuguese
Angiografia coronária
Angioplastia
Biomarcadores
Doença da artéria coronariana
Necrose miocárdica
Revascularização miocárdica
Abstract in Portuguese
Introdução: A liberação anormal de biomarcadores de injúria miocárdica após o procedimento de revascularização é, geralmente, associada a eventos clínicos adversos. Todavia, a elevação dos biomarcadores cardíacos após o procedimento de revascularização não foi associada à gravidade angiográfica da doença arterial coronariana (DAC). O objetivo do presente estudo é investigar a relação entre a complexidade angiográfica da DAC, avaliada pelo SYNTAX Score (SXScore), e a elevação dos biomarcadores cardíacos após procedimentos de revascularização. Métodos: Trata-se de uma análise post-hoc do estudo MASS V, unicêntrico, prospectivo e observacional de pacientes com DAC estável submetidos a procedimentos de revascularização. Foram realizadas dosagens seriadas de troponina I ultra (TnI-u) e creatinoquinase (CK) -MB antes e após os procedimentos. Os SXScores foram calculados antes dos procedimentos de revascularização, por cardiologistas intervencionistas, que desconheciam as características clínicas e laboratoriais dos pacientes. Resultados: Dos 202 pacientes estudados, 136 foram submetidos à revascularização do miocárdio (CRM) e 66, à intervenção coronária percutânea (ICP). A mediana do SXScore nos pacientes revascularizados foi 20,00 (IQR 15,00-26,00), sendo 39,00 (IQR 35,00-44,00) no grupo SXScore alto e 19,0 (IQR 14,00-24,00) no grupo SXScore baixo/intermediário (p < 0,0001). Houve correlações significativas entre o SXScore e as medianas dos picos de TnI-u (r = 0,18, p = 0,009) e CK-MB (r = 0,24, p = 0,001), após procedimentos de revascularização. As medianas dos picos de TnI (p = 0,034) e CK-MB (p = 0,004), após procedimentos, foram maiores nos pacientes com SXScore alto ( >= 33) as aos daqueles com SXScore baixo/intermediário ( < 33). Além disso, a liberação de TnI em 6 horas (p = 0,002), 12 horas (p = 0,008) e 24 horas (p = 0,039), foi maior no grupo SXScore alto que no grupo SXscore baixo/intermediário ( < 33), bem como a liberação de CK-MB em 6 horas (p < 0,0001), 12 horas (p < 0,0001), 24 horas (p = 0,001), 36 horas (p = 0,007), 48 horas (p = 0,008) e 72 horas (p = 0,023), nos mesmos grupos. Após análise multivariada em um modelo incluindo variáveis clínicas, angiográficas, demográficas e laboratoriais, o SXScore alto permaneceu como preditor independente da liberação de CK-MB e TnI acima da mediana. Conclusão: O aumento da liberação de biomarcadores cardíacos foi significativamente associado à extensão da aterosclerose identificada pelo SYNTAX Score. Além disso, o SYNTAX Score alto demonstrou ser preditor independente para a elevação da CKMB acima da mediana mesmo quando ajustado a covariáveis
Title in English
Relationship between SYNTAX Score with the release of cardiac biomarkers after periprocedural revascularization for stable multivessel coronary disease
Keywords in English
Angioplasty
Biomarkers
Coronary angiography
Coronary artery disease
Myocardial necrosis
Myocardial revascularization
Abstract in English
Background: Abnormal cardiac biomarkers release after revascularization procedure has been associated with worse clinical outcomes. However, levels of myocardial biomarkers after revascularization procedural have not been associated with the severity of coronary artery disease (CAD). Our aim was to investigate the relationship between angiographic complexity of CAD as assessed by SYNTAX Score (SXScore) and cardiac biomarkers elevation after revascularization procedures. Methods: This is a post-hoc analyses of MASS V trial, which was a single-center, prospective and observational study among patients with stable CAD who underwent revascularization procedures. High sensitivity troponin (TnI) and creatinekinase (CK) -MB were assessed before and after procedures. Baselines SXscores were calculated by angiographic laboratory investigators blinded to patient characteristics. Results: Of the 202 patients studied, 136 underwent coronary artery bypass grafting (CABG) and 66 percutaneous coronary intervention (PCI). The median SXScore was 20.00 (IQR 15.00-26.00) in revascularized patients, 39.00 (IQR 35.00-44.00) in the high SXscore group and 19.0 (IQR 14.0024.00) in low/mid SXScore group (p < 0.0001). There were positive correlations between SXScore and median peaks after procedural TnI (r =0.18, p=0.009) and CK-MB (r =0.24, p=0.001) levels. In patients with high X (>= 33) k f procedural TnI(p=0.034) and CK-MB (p=0.004) levels were higher than low/mid SXScore( < 33) and the release of TnI at 6 hours (p = 0.002), 12 hours (p=0.008) and 24 hours (p=0.039), was higher in high SXScore group than low/mid SXScore ( < 33), as well as, the release of CK-MB at 6 hours (p < 0.0001), 12 hours (p < 0.0001), 24 hours (p=0.001), 36 hours (p=0.007), 48 hours (p=0.008) and 72 hours (p=0.023), in the same groups. After multivariate analysis, in a model including clinical, angiographic, demographic and laboratorial variables, high SXScore was a significant independent correlate of release of CK-MB and TnI peaks higher than median. Conclusion: The increase of release of cardiac biomarkers was significantly associated with the extent of atherosclerosis identified by the SYNTAX Score. Besides, high SYNTAX Score remained an independent predictor for elevation of CKMB above the median even when adjusted for covariates
 
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Publishing Date
2019-01-04
 
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