Fatores prognósticos na revascularização do miocárdio em pacientes idosos

Abstract

O receio em nosso meio, em se retardar, erroneamente, a revascularização do miocárdio (RM) em pacientes idosos determinou a realização deste estudo. Um total de 361 pacientes foram, consecutivamente, submetidos a RM entre 1992 e 1995, no InCór, dos quais 30,7% eram mulheres, 69,3% homens; 36,7% encontravam-se em classe funcional III/IV. Foi realizada análise univariada com 19 fatores perioperatórios e, a seguir, multivariada (regressão logística) com as variáveis que mostraram associação significativa (p < 0,005). Os fatores prognósticos da morbidade operatória foram: diabete melito, ICC, angina instável. Os pós-operatórios foram: acidente vascular cerebral, insuficiência renal, infecção e suporte respiratório prolongado. Concluímos que a revascularização do miocárdio pode ser realizada em pacientes com idade avançada, acompanhada de excelentes resultados (baixa mortalidade operatória) especialmente pacientes em classe funcional de ICC não muito avançada, propiciando melhora significativa da qualidade de vida.<br>The trend in Brazil of erroneously delaying myocardial revascularization in the elderly determined this study. Three hundred consecutive elderly patients (mean age: 73,92, standard deviation: 3.32). Between October 1992 and July 1995, 361 consecutive patients underwent isolated coronary artery bypass grafting, of whom 111 (30,7%) were females and 250 (69,35) males. There were 128 (35,5%) diabetic patients and 128 (36,7%) were in NYHA III/IV. Univariate analysis per-operatory of 19 factors followed by multivariate logistic regression analysis of the significant variables (p 0.005) were done. Major complication ocurred in 178 (49.3%) and were independent predictors of operative morbidity: Diabetes mellitus, NYHA funcional classification, urgent cases and DP2. There were 33 (9,1%) in hospital deaths, and diabetes mellitus, NYHA functional classification, unstable pre-operative angina and cerebral vascular acidents, renal failure, infection and insufficiency respiratory failure were independent predictors of operative mortality. We concluded that coronary artery bypass grafting is possible in elderly patients with a favorable outcome, especially when done in patients with normal to moderately depressed left ventricular function

Fatores de risco em septuagenários ou mais idosos submetidos à revascularização do miocárdio e ou operações valvares

“…Although our mortality for CABG was significantly higher than that observed by authors from developed countries [12,13] or even other domestic studies [8], the rate of older patients who presented postoperative complications was also relatively high for these authors. However, the mortality rate for the older patients who underwent isolated valve operation was similar to that observed by other authors [14].…”

“…However, to find explanations for the increased mortality in CABG in our study, we compared the experiences of other authors [8,12,13]. This was not simple, because many factors are involved.…”

“…Meanwhile, major surgeries in elderly populations, such as cardiac surgeries (especially those 70 years of age or older), are associated with high morbidity and mortality [4], while aging simultaneously results in the reduction of functional reserves of various organs and systems [5]. The prevalence of other comorbidities among the elderly is high [6][7][8].…”

Avaliação de uma escala de risco em pacientes submetidos à cirurgia de revascularização do miocárdio: análise de 400 casos

“…Baseando-se na definição descrita, a partir de 1980 teve início o desenvolvimento de escalas de risco que visavam sobretudo a avaliação da mortalidade operatória 10,[26][27][28][29][30] . Dentre os parâmetros mais comuns para análise do pré-operatório, encontram-se a idade [31][32][33][34][35][36] , o sexo 11,37-40 , a função do VE [41][42][43][44] , as doenças co-mórbidas 45,46 , a angiografia coronária com aterosclerose proximal ou distal 47,48 . Foram incluídas também cirurgias de urgência (relacionada intimamente com a angiografia coronária e a função do VE 49 ) e doenças cirúrgicas valvares que comprometem a função ventricular esquerda (EAO, IMt) 12,50 .…”

Fatores de risco para mortalidade em octogenários submetidos a cirurgia de revascularização miocárdica

“…One of the most widely used risk scores today, the EuroSCORE 7,8 , applies a significant weight to age over 60 years in the final calculation of mortality risk. However, it seems reasonable to consider all the elderly patients as a homogeneous group, and age, by itself, as a determinant of greater risk 9,10 . The objective of this study was to identify other risk factors, besides age, in a group of octogenarians who underwent CABG at the Heart Institute of Pernambuco.…”