Derivação e validação de escore preditivo de doença arterial coronariana obstrutiva em pacientes submetidos a cirurgia valvar primária no Instituto Nacional de Cardiologia nos anos de 2001 a 2014
Derivação e validação de escore preditivo de doença arterial coronariana obstrutiva em pacientes submetidos a cirurgia valvar primária no Instituto Nacional de Cardiologia nos anos de 2001 a 2014
Data
2016
Autores
Cazelli, José Guilherme Marques Coelho de Medeiros
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
A prevalência de doença arterial coronariana (DAC) nos pacientes valvares é semelhantes à da população geral, com associação usual aos fatores de risco tradicionais e ainda assim, a busca por DAC obstrutiva é mais agressiva nos valvulopatas em pré-operatório, determinando a angiografia coronariana invasiva (ACI) a praticamente todos os pacientes adultos, uma vez que acredita-se que a cirurgia de revascularização miocárdica deva ser associada à troca valvar. Objetivos: avaliar a prevalência e identificar fatores associados a DAC obstrutiva em pacientes adultos candidatos à cirurgia cardíaca primariamente valvar entre os anos de 2001 a 2014 no Instituto Nacional de Cardiologia (INC) e elaborar um modelo preditivo de DAC obstrutiva, através de escore derivado de análise multivariada. A partir da estimativa da probabilidade pré-teste de DAC obstrutiva, espera-se melhor estratégia pré-operatória para cada paciente. Métodos: Estudo transversal, avaliando 2.898 pacientes com indicação de cirurgia cardíaca por qualquer etiologia. Destes, foram estudados 712 pacientes valvopatas submetidos à ACI nos 12 meses anteriores à cirurgia. Resultados: A prevalência de DAC obstrutiva foi de 20%. Um modelo preditivo de DAC obstrutiva foi criado a partir de regressão logística multivariada, utilizando as variáveis idade, dor torácica, história familiar de DAC, hipertensão arterial sistêmica, diabetes mellitus, dislipidemia, tabagismo e sexo masculino O modelo demonstrou excelente correlação e calibração (R2=0,98), além de ótima acurácia (ROC de 0,848; IC 95% 0,817 – 0,879) e validação em diferente população valvar (ROC de 0,877; IC95%: 0,830 - 0,923). Conclusões: É possível estimar DAC obstrutiva a partir de dados clínicos com elevada acurácia, o que pode vir a permitir estabelecer estratégias préoperatórias de acordo com a probabilidade pré-teste individual, evitando a indicação indiscriminada de procedimentos desnecessários e invasivos, principalmente nos grupos de menor probabilidade de doença obstrutiva.
The prevalence of coronary artery disease (CAD) in valvular patients is similar to the present on the general population, with a common association with traditional risk factors and yet the search for obstructive CAD is more aggressive in preoperative valvulopathies, determining invasive coronary angiography (ICA) to virtually all adult patients, since it is believed that myocardial revascularization surgery should be associated with valve replacement. Objectives: To evaluate the prevalence and factors associated with obstructive CAD in adult patients candidates for primary valve surgery between 2001 and 2014 at the National Institute of Cardiology and thus derive and validate a predictive obstructive CAD score. Methodology: Cross-sectional study evaluating patients with indication for acquired valve surgery. 712 valvopathic patients submitted to ICA were included in the 12 months prior to surgery. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, hypertension, diabetes, hyperlipidemia, smoking and male sex. The model showed excellent correlation and calibration (R2 = 0.98), as well as excellent accuracy (ROC 0.848, 95% CI 0.817 - 0.879) and validation in a different valve population (ROC 0.877, 95% CI 0.830-0.923). Conclusions: It is possible to estimate obstructive CAD from clinical data with high accuracy, which may allow the establishment of preoperative strategies according to the individual pre-test probability, avoiding the indiscriminate indication of unnecessary and invasive procedures, especially in groups with a lower probability of obstructive disease.
The prevalence of coronary artery disease (CAD) in valvular patients is similar to the present on the general population, with a common association with traditional risk factors and yet the search for obstructive CAD is more aggressive in preoperative valvulopathies, determining invasive coronary angiography (ICA) to virtually all adult patients, since it is believed that myocardial revascularization surgery should be associated with valve replacement. Objectives: To evaluate the prevalence and factors associated with obstructive CAD in adult patients candidates for primary valve surgery between 2001 and 2014 at the National Institute of Cardiology and thus derive and validate a predictive obstructive CAD score. Methodology: Cross-sectional study evaluating patients with indication for acquired valve surgery. 712 valvopathic patients submitted to ICA were included in the 12 months prior to surgery. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, hypertension, diabetes, hyperlipidemia, smoking and male sex. The model showed excellent correlation and calibration (R2 = 0.98), as well as excellent accuracy (ROC 0.848, 95% CI 0.817 - 0.879) and validation in a different valve population (ROC 0.877, 95% CI 0.830-0.923). Conclusions: It is possible to estimate obstructive CAD from clinical data with high accuracy, which may allow the establishment of preoperative strategies according to the individual pre-test probability, avoiding the indiscriminate indication of unnecessary and invasive procedures, especially in groups with a lower probability of obstructive disease.
Description
Palavras-chave
Doença arterial coronariana, Doenças das valvas cardíacas, Angiografia coronariana invasiva, Pré-operatório, Angiotomografia coronariana, Coronary artery disease, Heart valve disease, Invasive coronary angiography, Pre-operative, Coronary computed tomography angiography
Citação
Cazelli JGM. Derivação e validação de escore preditivo de doença arterial coronariana obstrutiva em pacientes submetidos a cirurgia valvar primária no Instituto Nacional de Cardiologia nos anos de 2001 a 2014. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2016.