Prevalência de doença arterial coronariana e avaliação pré-operatória em portadores de valvopatia

Sampaio, Roney Orismar; Jonke, Vívian Masutti; Falcão, João Luiz Alencar Araripe; Falcão, Sandra Nívea dos Reis Saraiva; Spina, Guilherme Sobreira; Tarasoutchi, Flávio; Grinberg, Max

doi:10.1590/s0066-782x2008001500010

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Sampaio et al have reported a prevalence of 3.42% in a sample of 3736 patients with a mean age of 43.7 years. 12 Kruczan et al 11 have shown a global prevalence of obstructive CAD of 15.9%, 6% in patients aged less than 50 years.…”

Section: Discussionmentioning

confidence: 97%

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Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Cazelli¹,

Camargo²,

Kruczan³

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundThe prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement.ObjectivesTo evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score.MethodsCross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance.ResultsThe 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, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations.ConclusionsObstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

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Section: Discussionmentioning

confidence: 97%

“… 7 It usually affects young individuals, who have less risk factors for atherosclerosis, and, thus, lower prevalence of obstructive CAD. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Cazelli¹,

Camargo²,

Kruczan³

et al. 2017

Arquivos Brasileiros De Cardiologia

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“…The fact that preoperative invasive procedures such as coronary artery bypass grafting or percutaneous coronary angioplasty do not reduce perioperative risk in patients with significant stable CAD is highlighted (7,10). These findings also reinforce that the request for these preoperative exams results in over-diagnosis with subsequent unnecessary treatments, without a solid evidence base that the outcome is positive considering benefits, costs, and possible damages (11,14,29).…”

Section: Discussionmentioning

confidence: 94%

“…A common practice emerging from these evaluations is the pursuit of the diagnosis of silent coronary disease (screening), motivated by the belief that this would generate cardiovascular protection for patients. Although this approach generates a sense of safety in patients with negative results, positive results promote a cascade of conduct that not only fail to attenuate the risk of cardiovascular events (7,9,10), but may lead to undesirable outcomes, ranging from suspension of surgery to inappropriate revascularization and adverse events resulting from overdiagnosis and overtreatment (11). Therefore, surgeons and anesthesiologists often consult with cardiologists during this assessment to reduce serious cardiac events (12).…”

Section: Introductionmentioning

confidence: 99%

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Oliveira

Santos

Silva

et al. 2021

Braz J Med Biol Res

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Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low-to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing preanesthesia assessment between May 2015 and May 2016, including those with functional capacity X4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47 ± 16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.

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“…Arrhythmias associated with Valve Disease 215 • In a study in Rio de Janeiro (Southeastern Brazil) including 1412 candidates for cardiac surgery of any indication, 294 cases with primary valvular heart disease of rheumatic and non-rheumatic etiologies were selected. All patients were aged ≥40 years and had coronary angiography performed.…”

Section: Complications and Associated Diseasesmentioning

confidence: 99%

Cardiovascular Statistics – Brazil 2023

Oliveira,

Brant,

Polanczyk

et al. 2023

Preprint

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The publication Cardiovascular Statistics – Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil. The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke. Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Network and an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG).

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Prevalência de doença arterial coronariana e avaliação pré-operatória em portadores de valvopatia

Abstract: SummaryBackground: Coronary angiography has been indicated in the preoperative phase for patients with valvopathy over 35 years of age. However, the actual prevalence of obstructive coronary artery disease (CAD) in this population has been little studied.

Cited by 5 publications

References 17 publications

Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Cardiovascular Statistics – Brazil 2023

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