Abstract
OBJETIVOS: Determinar quais variáveis pré e transoperatórias são preditoras independentes de infarto do miocárdio (IAM) no período perioperatório de Cirurgia de Revascularização do Miocárdio (CRM), em um hospital geral da cidade de Porto Alegre, RS, Brasil. MÉTODO: Estudo de coorte retrospectivo com análise do banco de dados de cirurgia cardíaca do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, com 1471 pacientes consecutivos que realizaram CRM com circulação extracorpórea (CEC), entre janeiro de 1998 e dezembro de 2002. RESULTADOS: Quatorze por cento dos pacientes da amostra apresentaram IAM perioperatório. As variáveis que se mostraram preditoras independentes para IAM perioperatório nesta amostra foram: reoperação (RC: 2,070 - p=0,036), lesão de tronco de coronária esquerda (TCE) (RC: 1,692 - p=0,006), sexo feminino (RC: 1,572 - p=0,034), angina instável pré-operatória (RC: 1,533 - p=0,011), maior número de enxertos (RC: 1,336 - p=0,001) e tempo de CEC prolongado (RC: 1,013 - p<0,001). CONCLUSÕES: As variáveis reoperação, lesão de TCE, sexo feminino, angina instável pré-operatória, maior número de enxertos e tempo de CEC prolongado mostraram-se preditoras independentes para a ocorrência de IAM no período perioperatório de CRM, nesta amostra de pacientes operados em um hospital geral da cidade de Porto Alegre, RS, Brasil.
Highlights
Thrombotic complications are considered the main causes of mortality in myocardial revascularization surgeries (MR)
The studied population was patients submitted to MR in isolation in Hospital São Lucas of the Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS) – Brazil
The variables included in the equation were gender, age, presence of left coronary artery trunk (LCT) injury, preoperative unstable angina (UA), associated coronary endarterectomy, reoperation, number of vascular grafts and cardiopulmonary bypass (CPB) time
Summary
Thrombotic complications are considered the main causes of mortality in myocardial revascularization surgeries (MR). The consequences of perioperative AMI can vary from minor enzymatic increases without clinical relevance to states of low heart output or malignant tachyarrhythmias, followed by death or reduced survival over the long term [1]. This explains the amount of effort out in to attempt to avoid this complication. Many North-American and European studies have demonstrated the main pre- and trans-operative factors that predict perioperative AMI; in Brazil, this data is unknown. This information is of great importance because, if this risk is identified and adequately controlled in the pre- and trans-operative periods, it will be possible to reduce this severe complication
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