Coronary artery bypass graft surgery in Brazil from 2008 to 2017

Khalil, Kalil Hussein; Vervoort, Dominique; Roever, Leonardo; Pires, Marcos Alfredo de Andrade; Lima, Jaqueline Maria; Salles, Felipe Borsu de; Khalil, Giovana Munhoz; Nicz, Pedro Felipe Gomes; Mejía, Omar Asdrúbal Vilca; Okino, Arnaldo Akio; Lima, Ricardo de Carvalho

doi:10.1111/jocs.15328

Cited by 7 publications

(10 citation statements)

References 8 publications

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“…4 Recently, the outcomes of coronary artery bypass graft (CABG) in the Brazilian public health system (SUS) from January 2008 to December 2017 have been published. 5 The aim of this study is to evaluate the outcomes of CABG over the next years (2018 to 2020) in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Khalil¹,

Vervoort

Roever³

et al. 2021

Journal of Cardiac Surgery

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Introduction The coronavirus disease 2019 (COVID‐19) pandemic has been a worldwide challenge, and efforts to “flatten the curve,” including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID‐19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. Methods This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. Results We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central‐west regions. Conclusion The COVID‐19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID‐19 cases. There was also an increase in the national CABG death rate.

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Section: Introductionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Khalil¹,

Vervoort

Roever³

et al. 2021

Journal of Cardiac Surgery

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“…20 , 21 In Brazil, 11% of 226 697 CABG procedures between 2008 and 2017 were operated off pump. 22 Therefore, a wide variation in the use of OPCAB exists globally. Over time, changes in the preference for OPCAB in specific patient cohorts were also observed.…”

Section: Discussionmentioning

confidence: 99%

Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes

Deo

Elgudin

Shroyer

et al. 2022

JAHA

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Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on‐pump (ONCAB) use and long‐term outcome has not been reported, nor has their long‐term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005–2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as‐treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow‐up period was 6.6 (3.5–10) years. An inverse probability weighted Cox model was used to compare all‐cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005–2009) to 8% (2015–2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P <0.01). The ONCAB 5‐, 10‐, and 15‐year survival rates were 82.9% (82.5–83.3), 60.4% (59.8–61.1), and 37.2% (36.1–38.4); correspondingly, OPCAB rates were 80.7% (79.7–81.7), 57.4% (56–58.7), and 34.1% (31.7–36.6) ( P <0.01). OPCAB was associated with increased risk‐adjusted all‐cause mortality (hazard ratio, 1.15 [1.13–1.18]; P <0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05–1.28]; P <0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all‐cause mortality and myocardial infarction rates were higher in the OPCAB cohort.

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“…The availability of CABG worldwide has decreased over the last 15 years with the PCI to CABG ratio increasing ( 27 , 28 ). This changing landscape is associated with the good short-term results of PCI, as well as advances in PCI techniques and armamentarium with drug-elution stents, intravascular ultrasounds, etc.…”

Section: Discussionmentioning

confidence: 99%

“…This changing landscape is associated with the good short-term results of PCI, as well as advances in PCI techniques and armamentarium with drug-elution stents, intravascular ultrasounds, etc. In parallel, CABG usually demands more medical resources and favors longer periods of hospitalization ( 27 ). Consistently, in our study, the vast majority of patients underwent PCI (89.8 vs 10.2% treated with CABG) (9:1 PCI to CABG ratio).…”

Section: Discussionmentioning

confidence: 99%

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Clinical and economic impact of coronary artery bypass graft and percutaneous coronary intervention in young individuals with acute coronary syndromes and multivessel disease: A real-world comparison in a middle-income country

Alexim

Rocha

Dobri

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIn recent decades, the world watched a dramatic increase in the incidence of acute coronary syndromes (ACS) among young individuals (≤55 years-old) and a relative decrease in the elderly. The management of ACS in young patients with multivessel disease still needs to be elucidated, as these individuals maintain a long life expectancy.Research QuestionTo compare clinical outcomes and care costs in individuals with premature ACS and multivessel disease undergoing coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).Methods and ResultsParticipants included all individuals ≤55 years-old admitted with ACS to public hospitals in Brasília (Brazil) between 2013 and 2015 and who underwent cardiac catheterization with SYNTAX score ≥23 or Duke category 6. Outcomes were adjudicated with death certificates and data from medical records. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), defined as death due to cardiovascular causes, recurrent hospitalizations due to cardiovascular ischemic events, and incident heart failure New York Heart Association III-IV. As secondary outcome we assessed indirect and direct costs by evaluating the cost of lost productivity (in international dollars (Int$) per year) due to illness and death, outpatient costs and costs with new hospitalizations. Multivariate and principal components (PC) adjusted analyzes were performed.ResultsAmong 1,088 subjects (111 CABG and 977 PCI) followed for 6.2 years (IQR: 1.1), 304 primary events were observed. MACE was observed in 20.7% of the CABG group and 28.8% of the PCI group (p = 0.037). In multivariate analyses, PCI was associated with a hazard ratio (HR) = 1.227 (95% CI: 1.004–1.499; p = 0.0457) for MACE, and in PC-adjusted HR = 1.268 (95% CI: 1.048–1.548; p = 0.0271) compared with CABG. Despite direct costs were equivalent, the cost due to the loss of labor productivity was higher in the PCI group (Int$ 4,511 (IQR: 18,062)/year vs Int$ 3,578 (IQR: 13,198)/year; p = 0.049], compared with CABG.ConclusionsAmong young individuals with ACS and multivessel disease, surgical strategy was associated with a lower occurrence of MACE and lower indirect costs in the long-term.

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Coronary artery bypass graft surgery in Brazil from 2008 to 2017

Cited by 7 publications

References 8 publications

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes

Clinical and economic impact of coronary artery bypass graft and percutaneous coronary intervention in young individuals with acute coronary syndromes and multivessel disease: A real-world comparison in a middle-income country

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