Search

FUNDAMENTO: Conhecer fatores de risco e manifestações clínicas da doença arterial coronariana (DAC) permite-nos intervir de maneira mais eficaz junto a uma determinada população. OBJETIVO: Identificar perfis clínicos e angiográficos dos pacientes submetidos a cateterismo cardíaco, atendidos em um hospital terciário e tratados por meio de intervenções coronarianas percutâneas (ICP). MÉTODOS: Casuística de 1.282 pacientes submetidos a 1.410 cateterismos cardíacos, selecionados de mar/2007-mai/2008 em um banco de dados de um hospital geral para diagnóstico de doença arterial coronariana (DAC). Fatores de risco, indicação do exame, detalhes técnicos da ICP e desfechos intra-hospitalares foram prospectivamente coletados. RESULTADOS: Foram 688 (54,0%) pacientes do sexo masculino, com média de idade de 65,4 ± 10,9 anos, sendo 20,0% acima dos 75 anos. O quadro clínico confirmado com mais frequência foi o de síndrome coronariana aguda (SCA) sem supradesnivelamento do segmento ST (SST) (38,7%). A DAC multiarterial ocorreu em 46,4%, foi indicada ICP em 464 pacientes, sendo tratadas 547 lesões-alvo (tipo B2 ou C, em 86,0%), sendo destas, 14,0% tratadas com stent farmacológico. Dentre os IAM com SST, ICP primária foi realizada em 19,0% dos pacientes, sendo que, destes, 77,0% foram transferidos dos hospitais de origem tardiamente (ICP tardia) e não receberam trombolítico prévio, e 4,0% realizaram ICP de resgate. Foi obtido sucesso angiográfico em 94,2% das ICPs. Aconteceu óbito em 5,6% dos pacientes, tendo estes uma média de idade de 75,2 ± 10,2 anos. CONCLUSÃO: Observamos predomínio de idosos (estando 20,1% > 75 anos) e do sexo masculino. Dos fatores de risco para DAC, os mais frequentes foram hipertensão arterial sistêmica e dislipidemia. Ocorreu predomínio da SCA. A idade > 75 anos, DAC multiarterial e a insuficiência renal crônica foram os preditores de óbito intra-hospitalar. BACKGROUND: Knowing the risk factors and clinical manifestations of coronary artery disease (CAD) allows us to intervene more effectively with a particular population. OBJECTIVE: To identify clinical and angiographic profiles of patients undergoing cardiac catheterization, treated at a tertiary hospital and treated by percutaneous coronary interventions (PCI). METHODS: The study of 1,282 patients who underwent 1,410 cardiac catheterizations, selected from March/2007 to May/2008 from a database in a general hospital for diagnosis of coronary artery disease (CAD). Risk factors, indication for examination, technical details of PCI and in-hospital outcomes were prospectively collected. RESULTS: There were 688 (54.0%) males, mean age 65.4 ± 10.9 years and 20.0% above 75 years age. The most frequent clinical condition was acute coronary syndrome (ACS) without ST-segment elevation (STS) (38.7%). The multi artery CAD occurred in 46.4%, PCI was indicated in 464 patients, 547 target lesions were treated (type B2 or C, 86.0%), and of these, 14.0% treated with drug eluting stents. Among those with AMI with STS, primary PCI was performed in 19.0% of the patients, from these, 77.0% were transferred from the origin hospitals late (late PCI) and had not received prior thrombolytic, and 4.0% had PCI rescue. Angiographic success was achieved in 94.2% of PCIs. Death occurred in 5.6% of patients, with average age of 75.2 ± 10.2 years. CONCLUSION: The prevalence of elderly (20.1% being > 75 years) and male was observed. From the risk factors for CAD, the most common were systemic hypertension and dyslipidemia. There was a predominance of ACS. Age > 75 years old, multiarterial CAD and chronic renal failure were predictors of in-hospital deaths. FUNDAMENTO: Conocer factores de riesgo y manifestaciones clínicas de la enfermedad arterial coronaria (EAC) nos permite intervenir de manera más eficaz en una determinada población. OBJETIVO: Identificar perfiles clínicos y angiográficos de los pacientes sometidos a cateterismo cardíaco, atendidos en un hospital terciario y tratados por medio de intervenciones coronarias percutáneas (ICP). MÉTODOS: Casuística de 1.282 pacientes sometidos a 1.410 cateterismos cardíacos, seleccionados de mar/2007-may/2008 en un banco de datos de un hospital general para diagnóstico de enfermedad arterial coronaria (EAC). Factores de riesgo, indicación del examen, detalles técnicos de la ICP y desenlaces intrahospitalarios fueron prospectivamente colectados. RESULTADOS: Fueron 688 (54,0%) pacientes del sexo masculino, con media de edad de 65,4 ± 10,9 años, siendo 20,0% encima de los 75 años. El cuadro clínico confirmado con más frecuencia fue el de síndrome coronario agudo (SCA) sin supradesnivel del segmento ST (SST) (38,7%). La EAC multiarterial ocurrió en 46,4%, fue indicada ICP en 464 pacientes, siendo tratadas 547 lesiones-blanco (tipo B2 o C, en 86,0%), siendo de éstas, 14,0% tratadas con stent farmacológico. Entre los IAM con SST, ICP primaria fue realizada en 19,0% de los pacientes, siendo que, de éstos, 77,0% fueron transferidos de los hospitales de origen tardíamente (ICP tardía) y no recibieron trombolítico previo, y 4,0% realizaron ICP de rescate. Fue obtenido éxito angiográfico en 94,2% de las ICPs. Sucedió óbito en 5,6% de los pacientes, teniendo éstos una media de edad de 75,2 ± 10,2 años. CONCLUSIÓN: Observamos predominio de añosos (siendo 20,1% > 75 años) y del sexo masculino. De los factores de riesgo para EAC, los más frecuentes fueron hipertensión arterial sistémica y dislipidemia. Ocurrió predominio de la SCA. La edad > 75 años, EAC multiarterial y la insuficiencia renal crónica fueron los predictores de óbito intrahospitalario.

knowing the risk factors and clinical manifestations of coronary artery disease (CAD) allows us to intervene more effectively with a particular population.to identify clinical and angiographic profiles of patients undergoing cardiac catheterization, treated at a tertiary hospital and treated by percutaneous coronary interventions (PCI).the study of 1,282 patients who underwent 1,410 cardiac catheterizations, selected from March/2007 to May/2008 from a database in a general hospital for diagnosis of coronary artery disease (CAD). Risk factors, indication for examination, technical details of PCI and in-hospital outcomes were prospectively collected.there were 688 (54.0%) males, mean age 65.4 ± 10.9 years and 20.0% above 75 years age. The most frequent clinical condition was acute coronary syndrome (ACS) without ST-segment elevation (STS) (38.7%). The multi artery CAD occurred in 46.4%, PCI was indicated in 464 patients, 547 target lesions were treated (type B2 or C, 86.0%), and of these, 14.0% treated with drug eluting stents. Among those with AMI with STS, primary PCI was performed in 19.0% of the patients, from these, 77.0% were transferred from the origin hospitals late (late PCI) and had not received prior thrombolytic, and 4.0% had PCI rescue. Angiographic success was achieved in 94.2% of PCIs. Death occurred in 5.6% of patients, with average age of 75.2 ± 10.2 years.the prevalence of elderly (20.1% being75 years) and male was observed. From the risk factors for CAD, the most common were systemic hypertension and dyslipidemia. There was a predominance of ACS. Age75 years old, multiarterial CAD and chronic renal failure were predictors of in-hospital deaths.

Introdução: Embora o eletrocardiograma (ECG) seja utilizado rotineiramente para detecção da hipertrofia ventricular esquerda (HVE), os critérios utilizados apresentam baixa sensibilidade. Poucos estudos que embasam a prática clínica incluíram pacientes idosos e a performance diagnóstica do ECG nesta população é incerta. Recentemente proposto, o critério de Peguero-Lo Presti (PLP) apresentou uma maior acurácia que critérios tradicionais do ECG, mas não incluiu uma amostra representativa de idosos. Ademais, poucos estudos avaliaram a performance diagnóstica do ECG em pacientes com bloqueio de ramo esquerdo (BRE). Objetivo: i) comparar a performance do critério de PLP com critérios tradicionais do ECG em pacientes idosos; ii) avaliar a capacidade do ECG para detectar HVE em pacientes com BRE; iii) analisar a utilidade clínica do ECG em ambos os cenários (com BRE e sem BRE). Métodos: Entre janeiro de 2017 e março de 2018, 4.621 pacientes foram avaliados, com inclusão de 660 pacientes (592 na análise sem BRE e 68 com BRE) com ECG e ecocardiograma realizado com intervalo menor que 180 dias. Duas análises totalmente separadas foram realizadas de acordo com a presença ou não de BRE (definido pelo critério de Strauss). Para pacientes sem BRE, a performance diagnóstica, através da avaliação de sensibilidade, especificidade, escore F1 e área sob a curva (AUC) do critério de PLP foi comparada a dos critérios de Cornell voltagem (CV), Sokolow-Lyon (SL) e Rohmilt-Estes (com cortes de 4 e 5 pontos, RE4 e RE5, respectivamente). Em pacientes com BRE, sensibilidade, especificidade, valores preditivos, razões de verossimilhança, AUC e escore Brier de dez critérios do ECG foram analisados para avaliar o desempenho no diagnóstico da HVE. Nos dois cenários (com e sem BRE), HVE foi definida pelo ecocardiograma transtorácico e uma análise de curva de decisão foi feita para avaliar a utilidade clínica do ECG. Resultados: Em pacientes sem BRE, o critério de PLP obteve a maior sensibilidade comparado ao SL, CV (p < 0,001) e RE5 (p = 0,042), nominalmente a maior AUC (0,70 [IC 95% 0,65-0,74) dos critérios analisados e a maior acurácia diagnóstica avaliada pelo escore F1 (58,3%). Os critérios de SL e CV apresentaram maior especificidade que PLP (0,93 [IC 95% 0,89-0,95] e 0,90 [IC 95% 0,86-0,93], versus 0,82 [IC 95% 0,78-0,86], respectivamente; p < 0,05 para ambas as comparações). Em pacientes com BRE, nenhum dos dez critérios obteve desempenho diagnóstico satisfatório evidenciado pelo desequilíbrio entre sensibilidade e especificidade, e com baixo poder de discriminação (AUC entre 0,54 e 0,67). A análise da curva de decisão evidenciou que para os limiares de probabilidade testados, houve benefício líquido do ECG somente na população sem BRE, e o critério de PLP apresentou o maior benefício líquido. Conclusão: O critério de PLP obteve a maior acurácia diagnóstica e capacidade de informar a decisão de solicitar ou não exame complementar para avaliação de HVE, em pacientes idosos e sem BRE. Na subpopulação com BRE, nenhum dos critérios eletrocardiográficos tem capacidade discriminatória suficiente para recomendar seu uso para diagnóstico da HVE nem utilidade clínica Background: Electrocardiography (ECG) criteria has low sensitivity for left ventricular hypertrophy (LVH) detection and data in patients with advanced age patients is limited. The recently published Peguero-Lo Presti (PLP) criteria had improved accuracy compared with other ECG criteria but with very few patients 70 years. Also, overall performance of ECG criteria in patients with left bundle branch block (LBBB) is also unknown. Methods: Retrospective single-center study including patients 70 years with ECG and echocardiogram less than 180 days apart from January 2017 to March 2018. From 4,621 screened patients, 660 were included, 592 without and 68 with LBBB, yielding two entirely separate analysis. LBBB was defined according to Strauss criteria. For patients without LBBB, the Peguero-Lo Presti (PLP) criteria was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively), with sensitivities and specificities compared by the Mc Nemars test, and diagnostic performance by the F1 score and diagnostic area under the receiver operating characteristic curve (AUC). For patients with LBBB defined by the stricter criteria proposed by Strauss - sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to evaluate diagnostic performance of the ECG. For both analyses, LVH defined by the echocardiogram was the gold standard and a decision curve analysis was performed to evaluate the clinical benefit of the ECG to inform decision-making. Objective: i) to compare the PLP diagnostic performance to more traditional ECG criteria in patients 70 years; ii) to analyse the overall performance of ECG criteria to diagnose LVH in patients with LBBB; and iii) to evaluate the clinical applicability of ECG criteria for LVH detection in patients with and without LBBB. Results: In patients without LBBB, the PLP had increased sensitivity compared with both the SL, CV (p < 0.001 for both comparisons) and RE5 (p=0.042), also AUC of the PLP was higher than the CV, RE and SL (respectively, 0.70 [95%CI 0.65-0.74] vs 0.66 [95%CI 0.62-0.71] vs 0.64 [95%CI 0.60-0.69 vs 0.67 [95%CI: 0.62-0.71]). SL and CV had higher specificity compared to the PLP (respectively, 0.93 [95%CI 0.89-0.95] vs 0.90 [95%CI 0.86-0.93] vs 0.82 [95%CI 0.78-0.86], all p < 0.05). Overall, the PLP criteria had the highest F1 accuracy score (58.3). In patients with LBBB, none of the tested ECG criteria provided an accurate discrimination of LVH (AUC range, 0.54 to 0.67) nor had a balanced tradeoff between sensitivity and specificity, indicating poor overall performance. In the decision curve analysis, for most probability threshold range, ECG criteria had net benefit only in patients without LBBB, with the PLP achieving the highest net benefit in this scenario. Conclusions: In older individuals without LBBB, the Peguero-Lo Presti criteria had the highest diagnostic accuracy, can potentially be used to inform the clinical decision to ordering for echocardiogram ordering, but cannot rule out LVH consistently due to low sensitivity. in patients with LBBB defined by stricter criteria, ECG-based criteria for LVH diagnosis lack diagnostic accuracy or clinical utility