Avaliação do valor preditivo da angiotomografia de coronárias para eventos cardiovasculares nos pacientes submetidos a cirurgias vasculares
Data
2024-12-17
Autores
Lima, Vinícius Magaton 
Orientadores
Mancuso, Frederico José Neves
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As cirurgias vasculares possuem prevalência elevada de desfechos cardíacos adversos no período perioperatório. A angiotomografia de coronárias apresenta alto valor preditivo negativo e alta acurácia para o diagnóstico da doença arterial coronariana. Objetivo: Avaliar o valor preditivo da angiotomografia de coronárias para eventos cardiovasculares em curto prazo em pacientes submetidos à cirurgia vascular. Métodos: Estudo longitudinal, retrospectivo, realizado em hospital terciário. Oitenta e dois pacientes realizaram angiotomografia de coronárias para avaliação pré-operatória de cirurgia vascular. Os pacientes (n = 42) com redução luminal coronariana significativa (obstrução ≥ 50%) foram encaminhados para cineangiocoronariografia. Os pacientes submetidos diretamente à cirurgia (n = 40) foram avaliados até o terceiro dia pós-operatório ou alta hospitalar quanto ao desfecho primário combinado de morte cardiovascular e infarto agudo do miocárdio e aos desfechos secundários de tempo de internação hospitalar e injúria miocárdica. Resultados: A idade média foi de 65,7 ± 9,2 anos, 80% eram hipertensos, 60% dislipidêmicos, 35% diabéticos e 45% tabagistas. Pelo índice de risco do Estudo Multicêntrico de Avaliação Perioperatória (EMAPO), 5% dos pacientes eram de alto risco, 45% de risco intermediário e 42,5% de baixo risco. Os pacientes foram submetidos à endarterectomia de carótidas, correção de aneurisma de aorta abdominal ou revascularização de membros inferiores. Não houve desfecho primário no pós-operatório. A elevação dos níveis de troponina acima do percentil 99 foi observada em 42,5% dos pacientes (n = 17), porém apenas um paciente apresentou elevação da troponina acima de duas vezes o limite superior da normalidade. O tempo de internação após a cirurgia vascular foi de 4,5 ± 3,0 dias. Não houve diferença no tempo de internação entre aqueles com e sem injúria miocárdica (4,6 ± 2,9 vs. 4,5 ± 3,2, respectivamente; p = 0,44). Conclusão: A angiotomografia de coronárias sem lesões obstrutivas moderadas ou importantes foi preditora de ausência de eventos cardiovasculares em pacientes submetidos a cirurgia vascular.
Introduction: Vascular surgeries have a high prevalence of adverse cardiac outcomes in the perioperative period. Coronary computed tomography angiography has a high negative predictive value and high accuracy for diagnosing coronary artery disease. Objective: To evaluate the predictive value of coronary computed tomography angiography for short-term cardiovascular events in patients undergoing vascular surgery. Methods: A longitudinal, retrospective study conducted in a tertiary hospital. 82 patients underwent coronary computed tomography angiography for preoperative assessment for vascular surgery. Patients (n = 42) with significant coronary luminal reduction (≥ 50% obstruction) were referred for coronary angiography. Patients who underwent surgery directly (n = 40) were evaluated up to the third postoperative day or discharge regarding the combined primary outcome of cardiovascular death and acute myocardial infarction, as well as secondary outcomes of length of hospital stay and myocardial injury. Results: The mean age was 65.7 ± 9.2 years, 80% were hypertensive, 60% dyslipidemic, 35% diabetic, and 45% smokers. According to the risk index of the Multicenter Study of Perioperative Assessment (EMAPO), 5% of patients were at high risk, 45% at intermediate risk, and 42.5% at low risk. Patients underwent carotid endarterectomy, abdominal aortic aneurysm repair, or lower limb revascularization. There were no primary outcomes in the postoperative period. Elevation of troponin levels above the 99th percentile occurred in 42.5% of patients (n = 17). Only one patient had troponin level above two times the upper limit of normal. The length of stay after vascular surgery was 4.5 ± 3.0 days. There was no difference in length of stay between those with and without myocardial injury (4.6 ± 2.9 vs. 4.5 ± 3.2, respectively; p = 0.44). Conclusion: Coronary angiography without moderate or severe obstructive lesions was predictive of the absence of cardiovascular events in patients undergoing vascular surgery.
Introduction: Vascular surgeries have a high prevalence of adverse cardiac outcomes in the perioperative period. Coronary computed tomography angiography has a high negative predictive value and high accuracy for diagnosing coronary artery disease. Objective: To evaluate the predictive value of coronary computed tomography angiography for short-term cardiovascular events in patients undergoing vascular surgery. Methods: A longitudinal, retrospective study conducted in a tertiary hospital. 82 patients underwent coronary computed tomography angiography for preoperative assessment for vascular surgery. Patients (n = 42) with significant coronary luminal reduction (≥ 50% obstruction) were referred for coronary angiography. Patients who underwent surgery directly (n = 40) were evaluated up to the third postoperative day or discharge regarding the combined primary outcome of cardiovascular death and acute myocardial infarction, as well as secondary outcomes of length of hospital stay and myocardial injury. Results: The mean age was 65.7 ± 9.2 years, 80% were hypertensive, 60% dyslipidemic, 35% diabetic, and 45% smokers. According to the risk index of the Multicenter Study of Perioperative Assessment (EMAPO), 5% of patients were at high risk, 45% at intermediate risk, and 42.5% at low risk. Patients underwent carotid endarterectomy, abdominal aortic aneurysm repair, or lower limb revascularization. There were no primary outcomes in the postoperative period. Elevation of troponin levels above the 99th percentile occurred in 42.5% of patients (n = 17). Only one patient had troponin level above two times the upper limit of normal. The length of stay after vascular surgery was 4.5 ± 3.0 days. There was no difference in length of stay between those with and without myocardial injury (4.6 ± 2.9 vs. 4.5 ± 3.2, respectively; p = 0.44). Conclusion: Coronary angiography without moderate or severe obstructive lesions was predictive of the absence of cardiovascular events in patients undergoing vascular surgery.
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Citação
LIMA, Vinícius Magaton. Avaliação do valor preditivo da angiotomografia de coronárias para eventos cardiovasculares nos pacientes submetidos a cirurgias vasculares. 2024. 70 f. Dissertação (Mestrado em Cardiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.
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