Mortalidade e morbidade na fila de espera para cirurgia de revascularização do miocárdio: fatores predisponentes e avaliação de desfechos perioperatórios
Mortalidade e morbidade na fila de espera para cirurgia de revascularização do miocárdio: fatores predisponentes e avaliação de desfechos perioperatórios
Data
2016
Autores
Fonseca, Viviane Belídio Pinheiro da
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
As doenças cardiovasculares são a principal causa de morte no Brasil e no mundo. O pilar da terapia da doença arterial coronariana é o tratamento clínico medicamentoso; entretanto, muitos pacientes necessitam de abordagem intervencionista, seja por angioplastia transluminal percutânea ou por cirurgia de revascularização do miocárdio. As filas de espera para cirurgia de revascularização do miocárdio são comuns em diversos países. No Sistema Único de Saúde (SUS) atualmente observa-se um tempo de espera prolongado até a realização do procedimento. O objetivo do estudo foi analisar a mortalidade e a morbidade dos pacientes durante a fila de espera para cirurgia de revascularização do miocárdio (CRVM), identificando os preditores para a ocorrência de eventos, além de avaliar a associação entre o tempo na fila de espera com o resultado cirúrgico (morte e infarto perioperatório). Foram avaliados retrospectivamente, através da análise de prontuários, os casos de 274 pacientes referenciados a CRVM eletiva no Instituto Nacional de Cardiologia (INC) de 01 de março de 2011 a 11 setembro de 2015. As cirurgias foram realizadas no período de 18 de maio de 2011 a 23 de maio de 2016. A mediana do tempo de espera durante a fila foi de 142,7 dias e intervalo interquartílico de 74 a 278 dias. O desfecho primário (morte por qualquer causa) ocorreu em 31 pacientes (11,3%), e o desfecho secundário (conjunto de morte cardíaca, infarto agudo do miocárdio não-fatal e angina instável necessitando de hospitalização imediata) ocorreu em 42 pacientes (15,3%). Houve a documentação de 22 casos de infarto agudo do miocárdio na fila (8%), 8 não-fatais (2,9%) e 14 fatais (5,1%). A mortalidade perioperatória foi de 5,8%. Não houve correlação entre o tempo de espera para cirurgia e a ocorrência de eventos durante a fila ou durante o período perioperatório. O fator de risco estatisticamente significativo para morte em fila foi a presença de fração de ejeção abaixo de 45%; não foram identificados fatores de risco para a ocorrência do desfecho secundário. Conclusão: Pacientes portadores de disfunção ventricular esquerda deverão ser priorizados, com o objetivo de reduzir a mortalidade durante a fila de espera.
Cardiovascular diseases are the leading cause of death in Brazil and in the world. The mainstem treatment of coronary artery disease is optimal medical treatment; however, many patients may require coronary revascularization, either by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG). The waiting lists for coronary artery bypass surgery are frequently long in many countries. At the Sistema Único de Saúde in Brazil, currently there is a long waiting time until the completion of the procedure. The aim of the study was to analyze the mortality and morbidity of patients during the waiting list for CABG, to identify predictors for the occurrence of events, and to evaluate the association between time in queue with perioperative outcomes (death and perioperative infarction). Data from 274 patients referred to elective CABG at the Instituto Nacional de Cardiologia from March 01, 2011 to September 11, 2015 were retrospectively evaluated through the analysis of medical records. Surgeries occurred from May 18, 2011 to May 23, 2016. Median waiting time in queue was 142,7 days (interquartile range: 74 days to 278 days). The primary endpoint (death from any cause) occurred in 31 patients (11,3%), and the secondary endpoint (a composite outcome that included cardiac death, non-fatal acute myocardial infarction and unstable angina requiring immediate hospitalization) occurred in 42 patients (15.3%). There were 22 cases of acute myocardial infarction during waiting time (8%), 8 nonfatal (2.9%) and 14 fatal (5.1%). Perioperative mortality was 5.8%. No correlation was found between waiting time for surgery and occurrence of events in the queue or in the perioperative period. The only risk factor that was statistically significant for events in queue was the presence of an ejection fraction below 45%; no risk factor for the secondary endpoint was identified. Conclusion: Patients with left ventricular dysfunction should be prioritized, in order to reduce mortality during the waiting period.
Cardiovascular diseases are the leading cause of death in Brazil and in the world. The mainstem treatment of coronary artery disease is optimal medical treatment; however, many patients may require coronary revascularization, either by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG). The waiting lists for coronary artery bypass surgery are frequently long in many countries. At the Sistema Único de Saúde in Brazil, currently there is a long waiting time until the completion of the procedure. The aim of the study was to analyze the mortality and morbidity of patients during the waiting list for CABG, to identify predictors for the occurrence of events, and to evaluate the association between time in queue with perioperative outcomes (death and perioperative infarction). Data from 274 patients referred to elective CABG at the Instituto Nacional de Cardiologia from March 01, 2011 to September 11, 2015 were retrospectively evaluated through the analysis of medical records. Surgeries occurred from May 18, 2011 to May 23, 2016. Median waiting time in queue was 142,7 days (interquartile range: 74 days to 278 days). The primary endpoint (death from any cause) occurred in 31 patients (11,3%), and the secondary endpoint (a composite outcome that included cardiac death, non-fatal acute myocardial infarction and unstable angina requiring immediate hospitalization) occurred in 42 patients (15.3%). There were 22 cases of acute myocardial infarction during waiting time (8%), 8 nonfatal (2.9%) and 14 fatal (5.1%). Perioperative mortality was 5.8%. No correlation was found between waiting time for surgery and occurrence of events in the queue or in the perioperative period. The only risk factor that was statistically significant for events in queue was the presence of an ejection fraction below 45%; no risk factor for the secondary endpoint was identified. Conclusion: Patients with left ventricular dysfunction should be prioritized, in order to reduce mortality during the waiting period.
Description
Palavras-chave
Doença coronariana, Revascularização miocárdica, Filas de espera, Coronary disease, Myocardial revascularization, Waiting lists
Citação
Fonseca VBP. Mortalidade e morbidade na fila de espera para cirurgia de revascularização do miocárdio: fatores predisponentes e avaliação de desfechos perioperatórios. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2016.