ABSTRACT Introduction: Due to Brazilian population aging, prevalence of aortic stenosis, and limited number of scores in literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Methods: This is an observational historical cohort study with analysis of 802 aortic stenosis patients who underwent valve replacement at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, from 1996 to 2018. With the aid of logistic regression, a weighted risk score was constructed based on the magnitude of the coeficients β of the logistic equation. Two performance statistics were obtained: area under the receiver operating characteristic curve and the chi-square (χ2) of Hosmer-Lemeshow goodness-of-fit with Pearson’s correlation coeficient between the observed events and predicted as a model calibration estimate. Results: The risk predictors that composed the score were valve replacement surgery combined with coronary artery bypass grafting, prior renal failure, New York Heart Association class III/IV heart failure, age > 70 years, and ejection fraction < 50%. The receiver operating characteristic curve area was 0.77 (95% confidence interval: 0.72-0.82); regarding the model calibration estimated between observed/predicted mortality, Hosmer-Lemeshow test χ2 = 3,70 (P=0.594) and Pearson’s coeficient r = 0.98 (P<0.001). Conclusion: We propose the creation of a simple score, adapted to the Brazilian reality, with good performance and which can be validated in other institutions.

ABSTRACT Introduction: Due to Brazilian population aging, prevalence of aortic stenosis, and limited number of scores in literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Methods: This is an observational historical cohort study with analysis of 802 aortic stenosis patients who underwent valve replacement at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, from 1996 to 2018. With the aid of logistic regression, a weighted risk score was constructed based on the magnitude of the coeficients β of the logistic equation. Two performance statistics were obtained: area under the receiver operating characteristic curve and the chi-square (χ2) of Hosmer-Lemeshow goodness-of-fit with Pearson’s correlation coeficient between the observed events and predicted as a model calibration estimate. Results: The risk predictors that composed the score were valve replacement surgery combined with coronary artery bypass grafting, prior renal failure, New York Heart Association class III/IV heart failure, age > 70 years, and ejection fraction < 50%. The receiver operating characteristic curve area was 0.77 (95% confidence interval: 0.72-0.82); regarding the model calibration estimated between observed/predicted mortality, Hosmer-Lemeshow test χ2 = 3,70 (P=0.594) and Pearson’s coeficient r = 0.98 (P<0.001). Conclusion: We propose the creation of a simple score, adapted to the Brazilian reality, with good performance and which can be validated in other institutions.

Abstract Background There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity. Objective To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8. Methods The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant. Results Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups. Conclusion Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0.

Resumo Fundamento Existem dados limitados sobre a evolução clínica de lesões coronarianas não tratadas de acordo com sua gravidade funcional no mundo real. Objetivo Este estudo teve como objetivo avaliar os resultados clínicos de até 5 anos em pacientes com lesões revascularizadas com reserva de fluxo fracionada (FFR) ≤ 0,8 e em pacientes com lesões não revascularizadas com FFR > 0,8. Métodos A avaliação pelo FFR foi realizada em 218 pacientes seguidos por até 5 anos. Os participantes foram classificados com base na FFR no grupo isquêmico (≤ 0,8, grupo intervenção, n = 55), no grupo FFR normal-baixa (> 0,8-0,9, n = 91) e no grupo FFR normal-alta (> 0,9, n = 72). O desfecho primário foram eventos cardíacos adversos maiores (ECAMs), um composto de morte, infarto do miocárdio e necessidade de nova revascularização. O nível de significância adotado neste estudo foi alfa = 0,05; deste modo, resultados com valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A maioria dos participantes era do sexo masculino (62,8%) com média de idade de 64,1 anos. Diabetes estava presente em 27%. À angiografia coronariana, a gravidade da estenose avaliada foi de 62%, 56,4% e 54,3% nos grupos isquêmico, FFR normal-baixa e FFR normal-alta, respectivamente (p < 0,05). O período médio de acompanhamento foi de 3,5 anos. A incidência ECAM foi de 25,5%, 13,2% e 11,1%, respectivamente (p = 0,037). Não houve diferença na incidência de ECAM entre os grupos FFR normal-baixa e FFR normal-alta (p = NS). Conclusão Pacientes com FFR indicativa de isquemia apresentaram piores desfechos quando comparados aos dos grupos não isquêmicos. Entre os grupos que apresentaram valores de FFR considerados normal-baixo e normal-alto, não houve diferença na incidência de eventos. Há necessidade de estudos de longo prazo e com grande número de pacientes para melhor avaliar os desfechos cardiovasculares em pacientes portadores de estenose coronariana moderada com valores de FFR entre 0,8 e 1,0.

RESUMO Objetivo Avaliar o efeito de um programa de intervenção educacional nas condições de risco à saúde com base na avaliação das condições higiênicas e na qualidade dos alimentos comercializados em cantinas escolares. Métodos Este é um estudo comunitário, controlado, paralelo, randomizado, dois braços. As escolas de Ensino Fundamental e Médio, públicas e privadas, que possuíam cantinas, foram convidadas a participar. Este estudo foi realizado em 27 cantinas escolares do norte e noroeste do Rio Grande do Sul, sul do Brasil. Representantes da comunidade escolar das cantinas do grupo intervenção receberam um programa educacional composto por um treinamento a distância de 160 horas. Os principais desfechos avaliados foram avaliação das condições higiênicas e composição dos alimentos vendidos nas cantinas escolares. Todos os resultados foram analisados como intenção de tratar e per protocolo. Para análise dos dados contínuos, com distribuição normal, utilizou-se a análise de covariância e o Modelo Linear Generalizado. O nível de significância estatística considerado foi p<0,05 para um intervalo de confiança de 95%. Resultados Não foi observada diferença estatisticamente significativa entre o grupo intervenção e o grupo controle nos desfechos estudados. Houve redução de 76,2 pontos no escore das condições higiênicas de manipulação (IC 95%: -205 a 357; p=0,581). Em relação à composição dos cardápios, a diferença entre os grupos foi de 0,48% (IC 95%: -2,69 a 3,64; p=0,760) para os alimentos ultraprocessados, 0,23% (IC 95%: -1,13 a 1,60; p=0,740) para os alimentos processados e 1,02% (IC 95%: -2,59 a 4,64; p=0,581) para os alimentos in natura. Conclusão Não há evidências suficientes para concluir que a intervenção teve impacto positivo em nenhum dos desfechos estudados.

ABSTRACT Objective To assess the effect of an educational intervention program focused on health risk conditions, based on an assessment of the hygiene and quality of food sold in school cafeterias. Methods This is a controlled, parallel, randomized, two-arm, community study. Public and private schools with cafeterias were invited to participate. This study was conducted in 27 school cafeterias in northern and northwestern Rio Grande do Sul, a state in southern Brazil. Representatives of the school communities in the intervention group received an educational program consisting of 160-hour distance training. The most relevant outcomes were the assessment of the hygienic conditions and composition of the menus sold in school cafeterias. All outcomes were analyzed as intention-to-treat and per-protocol. For the analysis of continuous data with normal distribution, an analysis of covariance and the Generalized Linear Model were used. The level of statistical significance considered was p<0.05 for a 95% CI. Results No statistically significant difference was observed between the intervention group and the control group in the studied outcomes. There was a reduction of 76.2 points in the score for hygienic handling conditions (95% CI: -205 to 357; p=0.581). Regarding menu composition, the difference between groups was 0.48% (95% CI: -2.69 to 3.64; p=0.760) for ultra-processed foods, 0.23% (95% CI: -1.13 to 1.60; p=0.740) for processed foods, and 1.02% (95% CI: -2.59 to 4.64; p=0.581) for fresh foods. Conclusion There is not enough evidence to conclude that the intervention had a positive impact on any of the outcomes studied.

Abstract Introduction: Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity. The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass. Methods: A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model’s performance was then validated using data from the remainder of the patients (n=1,604). The model’s accuracy was tested using the area under the receiver operating characteristic (ROC) curve. Results: The prevalence of stroke during the postoperative period was 3% (n=149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66 - 0.75). Conclusion: We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.

Abstract Background Prolonged mechanical ventilation (MV) after cardiac surgery imposes a significant burden on the patient in terms of morbidity and financial hospital costs. Objective To develop a risk score model to predict prolonged MV in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods This was a historical cohort study of 4165 adult patients undergoing CABG between January 1996 and December 2016. MV for periods ≥ 12 hours was considered prolonged. Logistic regression was used to examine the relationship between risk predictors and prolonged MV. The variables were scored according to the odds ratio. To build the risk score, the database was randomly divided into 2 parts: development data set (2/3) with 2746 patients and internal validation data set (1/3) with 1419 patients. The final score was validated in the total database and the model's accuracy was tested by performance statistics. Significance was established at p < 0.05. Results Prolonged MV was observed in 783 (18.8%) patients. Predictors of risk were age ≥ 65 years, urgent/emergency surgery, body mass index ≥ 30 kg/m2, chronic kidney disease, chronic obstructive pulmonary disease, and cardiopulmonary bypass time ≥ 120 minutes. The area under the ROC curve was 0.66 (95% CI, 0.64-0.68; p<0.001), the Hosmer-Lemeshow chi-square test was χ2: 3.38 (p=0.642), and Pearson's correlation was r = 0.99 (p<0.001), indicating the model’s satisfactory ability to predict the occurrence of prolonged MV. Conclusion Selected variables allowed the construction of a simplified risk score for daily practice, which may classify the patients as having low, moderate, high, and very high risk. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Foi realizado um estudo ecológico, buscando verificar a possível associação entre o índice de mortos em acidentes de trânsito (IMV) e as variáveis em estudo: a taxa de mortalidade infantil (TMI), a proporção de condutores jovens envolvidos em acidentes de trânsito com vítimas (PCJ-ATV) e a proporção de residentes jovens (PRJ), no período de 1995 a 1998, nas capitais das Unidades da Federação e Distrito Federal. Os resultados revelam que existe importante associação entre o IM-V e o indicador social taxa de mortalidade infantil (r = 0,57; p = 0,002), ou seja, quanto menos desenvolvida for uma sociedade, maior tende a ser sua mortalidade no trânsito. Quanto à PCJ-ATV não foi encontrada associação relevante entre este indicador e o IM-V (r = -0,27; p = 0,184). Entretanto, a forte associação observada entre a PRJ e IM-V (r = 0,59; p = 0,002), indica que pode existir relação entre a mortalidade no trânsito e adolescência.

This ecological study evaluates the association between fatality rates in traffic accidents (FR-V) and the study variables: infant mortality rate (IMR), proportion of young drivers involved in motor vehicle accidents (MVA) with casualties, and the proportion of young residents from 1995 to 1998 in the Brazilian State capitals and the Federal District. There was an important association between the MVA fatality rate and IMR (r = 0.57; p = 0.002), that is, the less developed a society, the higher its traffic mortality rate. No significant association was found between the proportion of young drivers in MVA with casualties and the MVA fatality rate (r = -0.27; p = 0.184). Nevertheless, the strong association observed between the proportion of young residents and the MVA mortality rate (r = 0.59; p = 0.002) suggests a possible correlation between traffic mortality and adolescence.

Foi realizado um estudo ecológico, buscando verificar a possível associação entre o índice de mortos em acidentes de trânsito (IMV) e as variáveis em estudo: a taxa de mortalidade infantil (TMI), a proporção de condutores jovens envolvidos em acidentes de trânsito com vítimas (PCJ-ATV) e a proporção de residentes jovens (PRJ), no período de 1995 a 1998, nas capitais das Unidades da Federação e Distrito Federal. Os resultados revelam que existe importante associação entre o IM-V e o indicador social taxa de mortalidade infantil (r = 0,57; p = 0,002), ou seja, quanto menos desenvolvida for uma sociedade, maior tende a ser sua mortalidade no trânsito. Quanto à PCJ-ATV não foi encontrada associação relevante entre este indicador e o IM-V (r = -0,27; p = 0,184). Entretanto, a forte associação observada entre a PRJ e IM-V (r = 0,59; p = 0,002), indica que pode existir relação entre a mortalidade no trânsito e adolescência.

This ecological study evaluates the association between fatality rates in traffic accidents (FR-V) and the study variables: infant mortality rate (IMR), proportion of young drivers involved in motor vehicle accidents (MVA) with casualties, and the proportion of young residents from 1995 to 1998 in the Brazilian State capitals and the Federal District. There was an important association between the MVA fatality rate and IMR (r = 0.57; p = 0.002), that is, the less developed a society, the higher its traffic mortality rate. No significant association was found between the proportion of young drivers in MVA with casualties and the MVA fatality rate (r = -0.27; p = 0.184). Nevertheless, the strong association observed between the proportion of young residents and the MVA mortality rate (r = 0.59; p = 0.002) suggests a possible correlation between traffic mortality and adolescence.