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Comparison Between Treatment Strategies of Carotid Stenosis in Patients Undergoing Coronary Artery Bypass Grafting
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Bassan, Fernando

; Azevedo, Vitor M P

; Santos, Ana Angélica Alves Pimenta

; Mello, Renan Bernardes de

; Verdolin, Annelise de Almeida

; Bassan, Roberto

Brazilian Journal of Cardiovascular Surgery

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jun 2022, Volume 37 N. 3 Pages 315 - 320

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: In patients undergoing coronary artery bypass grafting (CABG), stroke is a major complication that increases morbidity and mortality. The presence of carotid stenosis (CS) increases risk of stroke, and the optimal treatment remains uncertain due to the lack of randomized clinical trials. The aim of this study is to compare three management approaches to CS in patients submitted to CABG. Methods: From 2005 to 2015, 79 consecutive patients with significant CS submitted to CABG were retrospectively evaluated. Patients were divided in three groups, according to CS treatment: 17 underwent staged carotid endarterectomy (CEA)-CABG, 26 underwent synchronous CEA-CABG, and 36 underwent isolated CABG without carotid intervention. The primary outcomes were composed by 30-day postoperative acute myocardial infarction (MI), 30-day postoperative stroke, and death due to all causes during the follow-up. Results: Patients were evaluated during an average 2.05 years (95% confidence interval = 1.51-2.60) of follow-up. Major adverse cardiac events, including death, postoperative MI, and postoperative stroke, occurred in 76.5% of the staged group, 34.6% of the synchronous group, and 33.3% of the isolated CABG group (P=0.007). As for MI, the rates were 29.4%, 3.85%, and 11.1% (P=0.045), respectively. There was no statistically significant difference in total mortality rates (35.3%, 30.8%, and 25.0%, respectively; P=0,72) and stroke (29.4%, 7.7%, and 8.3%, respectively; P=0,064) between groups. Conclusion: Staged CEA-CABG is associated with higher major adverse cardiac events and MI rate when compared to the strategy of synchronous and isolated CABG, but without statistically difference in total mortality during the entire follow-up.

https://doi.org/10.21470/1678-9741-2020-0425

Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome
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Bassan, Fernando

; Bassan, Roberto

; Esporcatte, Roberto

; Santos, Braulio

; Tura, Bernardo

Arquivos Brasileiros de Cardiologia

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mar 2016, Volume 106 N. 3 Pages 218 - 225

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: O BNP foi exaustivamente avaliado para a determinação do prognóstico em curto e médio prazo em pacientes com síndrome coronariana aguda, mas o seu papel para a mortalidade a longo prazo é incerta. Objetivo: Determinar o papel prognóstico a muito longo prazo do peptídeo natriurético do tipo B (BNP) para a mortalidade por todas as causas em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST (SCASSST). Métodos: Coorte de 224 pacientes consecutivos com SCASSST, prospectivamente atendidos no setor de emergência, em que se mediu o BNP na chegada para estabelecer o prognóstico ao longo do seguimento mediano de 9,34 anos para a mortalidade por todas as causas. Resultados: Diagnosticou-se angina instável em 52,2% e infarto do miocárdio sem supradesnivelamento do segmento ST em 47,8%. A mediana do BNP da admissão foi de 81,9 pg/mL (intervalo IQ = 22,2; 225) e a taxa de mortalidade correlacionou-se com quartis crescentes de BNP: 14,3; 16,1; 48,2; e 73,2% (p < 0,0001). A curva ROC revelou 100 pg/mL como o melhor ponto de corte de BNP para a predição de mortalidade (área sob a curva = 0,789, 95% CI = 0,723-0,854) sendo um forte preditor de mortalidade tardia: BNP < 100 = 17,3% vs. BNP ≥ 100 = 65,0%, RR = 3,76 (IC 95% = 2,49-5,63, p < 0,001). Na análise de regressão logística, idade>72 anos (OR = 3,79, IC 95% = 1,62-8,86, p = 0,002), BNP ≥ 100 pg/mL (OR = 6,24, IC 95% = 2,95-13,23, p < 0,001) e taxa de filtração glomerular estimada (OR = 0,98, IC 95% = 0,97-0,99, p = 0,049) foram preditores independentes de mortalidade tardia. Conclusões: O BNP medido na admissão hospitalar em pacientes com SCASSST é um forte preditor independente de mortalidade por todas as causas de muito longo prazo. Este estudo permite que se levante a hipótese de que o BNP deva ser medido em todos os pacientes com SCASSST no evento-índice para a estratificação de risco a longo prazo.

Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

https://doi.org/10.5935/abc.20160021 1763 downloads

Importância da proteína C-reativa no diagnóstico e no prognóstico intra-hospitalar em pacientes com dor torácica na sala de emergência
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Potsch, Alfredo Antonio

; Siqueira Filho, Aristarco Gonçalves

; Tura, Bernardo Rangel

; Gamarski, Roberto

; Bassan, Roberto

; Nogueira, Mônica Viegas

; Moutinho, Marco Aurélio E.

; Silva, Antônio Cláudio Masetto

; Villacorta, Humberto

; Campos, Augusta Leite

Arquivos Brasileiros de Cardiologia

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sep 2006, Volume 87 N. 3 Pages 275 - 280

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Testar os valores diagnóstico e prognóstico imediatos da proteína C-reativa (PCR) nos pacientes admitidos na sala de emergência (SE) com dor torácica (DT) e sem elevação do segmento ST no eletrocardiograma (ECG). MÉTODOS: De janeiro de 2002 a dezembro de 2003, 980 pacientes consecutivos foram atendidos com DT suspeita de síndrome coronariana aguda na SE (idade = 64,9 ± 14,3 anos, homens = 55%, diabéticos = 18%, ECG normal = 84%). Dosou-se a PCR na admissão, a creatinofosfoquinase MB fração massa (CKMB) e a troponina I seriadas, além de se registrar ECG seriados. As medidas da PCR foram padronizadas (PCR-p) pelo valor do limite superior da normalidade (LSN) do teste utilizado (3,0 mg/L para a PCR de alta sensibilidade-PCR-AS e 0,1 mg/dl para PCR titulada-PCR-t). RESULTADOS: Foi diagnosticado infarto agudo do miocárdio (IAM) em 125 pacientes, e seus valores para a PCR-p foram 1,31 ± 2,90 (mediana = 0,47) versus 0,79 ± 1,39 (0,30) nos sem IAM (p = 0,031). A PCR-p > 1,0 apresentou sensibilidade de 30%, especificidade de 80,4%, valores preditivos positivo e negativo de 6,1% e de 96,7%, para o diagnóstico de IAM. Houve quarenta eventos cardíacos intra-hospitalares (óbitos = dezesseis, revascularizações de urgência = 22, IAM = dois). No 1º quartil da PCR-p (< 0,10) registraram-se três eventos, enquanto no 4º quartil (> 0,93) ocorreram quinze eventos (p = 0,003). Na regressão logística foram preditores independentes para eventos cardíacos a insuficiência ventricular esquerda, o sexo masculino e a PCR-p > 0,32, com razão de chances de 7,6, 2,8 e 2,2, respectivamente. CONCLUSÃO: Nos pacientes atendidos com DT na SE, a PCR-p: 1) Não foi um bom marcador de IAM, apesar de um valor normal praticamente afastar esse diagnóstico; 2) Um valor superior a um terço do seu limite superior da normalidade (LSN) (>1 mg/L da PCR-AS ou >0,33 mg/dl da PCR-t) foi preditor de eventos cardíacos adversos intra-hospitalares.

OBJECTIVE: To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG). METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS) (age = 64.9 ± 14.3, men = 55%, diabetic = 18%, normal ECG = 84%). Serial CRP, creatine kinase MB mass (CKMB-mass) and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP) by the upper limit of normal (ULN) of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]). RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI), and their s-CRP values were 1.31 ± 2.90 (median = 0.47) compared to 0.79 ± 1.39 (0.30) in no-AMI patients (p = 0.031). The s-CRP > 1.0 showed 30% sensitivity and 80% specificity, plus negative and positive predictive values of 6.1% and 96.7%, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction). In the first quartile of the s-CRP (< 0.10), three events were recorded, while in the fourth quartile (> 0.93) 15 events (p = 0.003) occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively) were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP) were predictive of in-hospital adverse cardiac events.

22511 downloads

III Diretriz sobre tratamento do infarto agudo do miocárdio
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Piegas, Leopoldo S.

; Timerman, Ari

; Nicolau, José Carlos

; Mattos, Luiz Alberto

; Rossi Neto, João Manoel

; Feitosa, Gilson S.

; Avezum, Álvaro

; Carvalho, Antonio Carlos C.

; Mansur, Antonio de Pádua

; Timerman, Ari

; Guimarães, Armênio Costa

; Bozza, Augusto Elias Z.

; Markman F., Brivaldo

; Polanczyk, Carisi A.

; Serrano, Carlos Vicente

; Oliveira, César Cardoso de

; Alves, Claudia M. Rodrigues

; Précoma, Dalton Bertolim

; Albuquerque, Denílson Campos de

; Romano, Edson Renato

; Stefanini, Edson

; Knobel, Elias

; Santos, Elisabete S.

; God, Epotamenides M. Good

; Silva, Expedito E. Ribeiro da

; Brito, Fábio Sandoli de

; Reis, Gilmar

; Feitosa, Gilson S.

; Lima, Gustavo Glotz de

; Atie, Jacob

; Rossi Neto, João Manoel

; Marin Neto, José Antonio

; Nicolau, José Carlos

; Saraiva, José Francisco Kerr

; Amino, José Geraldo de Castro

; Piegas, Leopoldo S.

; Maia, Lilia Nigro

; Moreira, Luis Felipe

; Mattos, Luiz Alberto

; Arraes, Magaly

; Coutinho, Mário

; Dutra, Oscar

; Coelho, Otávio Rizzi

; Leães, Paulo Ernesto

; Rossi, Paulo Roberto Ferreira

; Albuquerque, Pedro

; Bassan, Roberto

; Esporcatte, Roberto

; Giraldez, Roberto Rocha

; Meneghelo, Romeu Sérgio

; Ramos, Rui Fernando

; Carvalho, Valéria Bezerra de

; Mathias, Wilson

; Guimarães, Jorge Ilha

Arquivos Brasileiros de Cardiologia

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sep 2004, Volume 83 Suppl. 4 Pages 1 - 86

Abstract: Pt | Text: Pt | PDF: Pt

414576 downloads

Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room
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Macaciel, Renato Machado

; Mesquita, Evandro Tinoco

; Vivacqua, Ricardo

; Serra, Salvador

; Campos, Augusta

; Miranda, Marcelo

; Gamarski, Roberto

; Dohman, Hans

; Bassan, Roberto

Arquivos Brasileiros de Cardiologia

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aug 2003, Volume 81 N. 2 Pages 174 - 181

Abstract: En | Text: En | PDF: En

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

2521 downloads Cited 3 times in SciELO

I Diretriz de Dor Torácica na Sala de Emergência
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Bassan, Roberto

; Pimenta, Lúcia

; Leães, Paulo Ernesto

; Timerman, Ari

; Volschan, André

; Polanczyk, Carisi

; Clare, Cristina

; Silva Júnior, Delcio Gonçalves da

; Mesquita, Evandro Tinoco

; Abreu, Flávio Berriel

; Monteiro Júnior, Francisco das Chagas

; Greque, Gilmar Valdir

; Almeida, Gustavo Luis Gouvea de

; Correa Filho, Harry

; Lima, Luis Eduardo de Magalhães

; Oliveira, Maria das Graças Sousa de

; França Neto, Olímpio Ribeiro

; Gamarski, Roberto

; Silva, Sergio Gouveia de Araújo

; Campodonico Filho, Sidney

; Barbosa Filho, Waldomiro

Arquivos Brasileiros de Cardiologia

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aug 2002, Volume 79 Suppl. 2 Pages 1 - 22

Abstract: Pt | Text: Pt | PDF: Pt

165198 downloads Cited 4 times in SciELO

Chest Pain Units: A Modern Way of Managing Patients with Chest Pain in the Emergency Department
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Bassan, Roberto

Arquivos Brasileiros de Cardiologia

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aug 2002, Volume 79 N. 2 Pages 203 - 209

Abstract: En | Text: En | PDF: En

It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED) in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS). This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI), and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.

5257 downloads Cited 3 times in SciELO

Is female sex an independent predictor of in-hospital mortality in acute myocardial infarction?
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Pimenta, Lúcia

; Bassan, Roberto

; Potsch, Alfredo

; Soares, José Francisco

; Albanesi Filho, Francisco Manes

Arquivos Brasileiros de Cardiologia

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jul 2001, Volume 77 N. 1 Pages 44 - 50

Abstract: En | Text: En | PDF: En

OBJECTIVE: To assess whether female sex is a factor independently related to in-hospital mortality in acute myocardial infarction. METHODS: Of 600 consecutive patients (435 males and 165 females) with acute myocardial infarction, we studied 13 demographic and clinical variables obtained at the time of hospital admission through uni- and multivariate analysis, and analyzed their relation to in-hospital death. RESULTS: Females were older (p<0.001) and had a higher incidence of hypertension (p<0.001). Males were more frequently smokers (p<0.001). The remaining risk factors had a similar incidence among both sexes. All variables underwent uni- and multivariate analysis. Through univariate analysis, the following variables were found to be associated with in-hospital death: female sex (p<0.001), age >70 years (p<0.001), the presence of previous coronary artery disease (p=0.0004), previous myocardial infarction (p<0.001), infarction in the anterior wall (p=0.007), presence of left ventricular dysfunction (p<0.001), and the absence of thrombolytic therapy (p=0.04). Through the multivariate analysis of logistic regression, the following variables were associated with in-hospital mortality: female sex (p=0.001), age (p=0.008), the presence of previous myocardial infarction (p=0.02), and left ventricular dysfunction (p<0.001). CONCLUSION: After adjusting for all risk variables, female sex proved to be a variable independently related to in-hospital mortality in acute myocardial infarction.

2345 downloads

Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room
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Bassan, Roberto

; Gamarski, Roberto

; Pimenta, Lúcia

; Volschan, André

; Scofano, Marcelo

; Dohmann, Hans Fernando

; Araujo, Monica

; Clare, Cristina

; Fabrício, Marcelo

; Sanmartin, Carlos Henrique

; Mohallem, Kalil

; Macaciel, Renato

; Gaspar, Sergio

Arquivos Brasileiros de Cardiologia

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may 2000, Volume 74 N. 5 Pages 412 - 417

Abstract: En | Text: En | PDF: En

PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.

2168 downloads Cited 2 times in SciELO

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Chest pain in the emergency room. Importance of a systematic approach
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Bassan, Roberto

; Scofano, Marcelo

; Gamarski, Roberto

; Dohmann, Hans Fernando

; Pimenta, Lúcia

; Volschan, André

; Araujo, Mônica

; Clare, Cristina

; Fabrício, Marcelo

; Sanmartin, Carlos Henrique

; Mohallem, Kalil

; Gaspar, Sergio

; Macaciel, Renato

Arquivos Brasileiros de Cardiologia

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jan 2000, Volume 74 N. 1 Pages 22 - 29

Abstract: En | Text: En | PDF: En

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

6019 downloads Cited 2 times in SciELO

11.

Cardiovascular changes and cardiac morbidity of menopause. Effects of hormone replacement therapy
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Bassan, Roberto

Arquivos Brasileiros de Cardiologia

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jan 1999, Volume 72 N. 1 Pages 92 - 98

Abstract: En | Text: En | PDF: En

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