RESUMO OBJETIVOS: Comparar a cirurgia de revascularização versus implante de stent em nossa instituição, e comparar as amostras estudadas para eventos cardíacos e cerebrovasculares adversos. MÉTODO: Um estudo observacional de coorte. Foram analisados 202 pacientes submetidos a revascularização miocárdica em nossa instituição entre 17 de janeiro e 31 de julho de 2009. Os pacientes foram estratificados em: Grupo G1-stent, os pacientes que receberam stents; e Grupo G2-operatório de CRM, os pacientes submetidos a revascularização do miocárdio por by-pass. Um script contendo 62 itens clínicos, hemodinâmicos e cirúrgicos foi usado para a coleta de dados dos prontuários médicos. RESULTADOS: As mulheres representaram um percentual maior de G1-stent versus G2-Revascularização (44% versus 26%), diabéticos predominaram no G2-Revascularização, 46% versus 29% no G1-stent. Três ou mais ramos coronarianos apresentaram maior percentual em G2-Revascularização, 55% vs, 9.0%; no grupo G1-stent, 64% apresentavam apenas envolvimento de uma artéria coronária. Procedimentos não eletivos foram mais frequentes para G1-stent (21% contra 9%). A função renal no pós-operatório apresentou-se pior no grupo G2-Revascularização (15% contra 2%). Pacientes G1-stent tiveram menor tempo hospitalização. A recorrência de angina foi maior nos pacientes do G1-stent (11% contra 2%), sem diferença significativa na mortalidade hospitalar. A qualidade de vida no pós-operatório aumentou de 45% para 55% em G2-Revascularização. CONCLUSÃO: A revascularização cirúrgica é o melhor procedimento para pacientes com doença coronariana múltipla, especialmente em pacientes diabéticos: permite a revascularização significativamente mais completa, reduz o número de reinternações por causas cardíacas, reduzindo o retorno da angina e melhora a qualidade de vida após cirurgia, com taxas hospitalares e de mortalidade tardia semelhantes aos obtidos por meio de implante de stent.

OBJECTIVES: To compare coronary artery bypass to stenting in our institution, and to compare the studied samples for major adverse cardiac and cerebrovascular outcomes. METHOD: An observational cohort study. We analyzed 202 patients undergoing coronary artery surgical revascularization versus stenting in our institution between January 17 and July 31, 2009; patients were stratified into: Group G1-STENT, patients who received stents; and Group G2-CABG, patients submitted to coronary artery by-pass grafting. A script containing 62 clinical, hemodynamic and surgical items was used for data collection from medical records. RESULTS: Womenmade up a higher percentage of G1-STENT 44%versus 26% in G2-CABG. Diabetics predominated in G2-CABG, 46% versus 29% in G1-STENT. Three or more coronary branches showed a higher percentage in G2- CABG, 55% vs, 9.0%; in G1-STENT, 64% had only one coronary branch involvement. Non-elective procedures were higher for G1-STENT (21%vs. 9%).Worse postoperative renal function occurred inG2-CABG (15% vs. 2%). G1-STENT patients had shorter hospital time. Recurrence of angina was higher in patients in G1-STENT (11% vs. 2%) with no significant difference in hospital mortality. Postoperative quality of life increased from 45% to 55% in G2-CABG. CONCLUSIONS: Surgical revascularization is the best procedure for patients with multi vessel coronary disease, especially in diabetic patients: it allows a significantly more complete revascularization, reduces the number of readmissions due to cardiac causes, reduces the recurrence of angina and improves quality of life after surgery, with hospital and late mortality rates similar to those obtained through stenting.

INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support.