1
|
Martins EB, Hueb W, Lima EG, Rezende PC, Garzillo CL, Carvalho GF, Carvalho FPC, Linhares Filho JPP, Batista DV, Silva RR, Boros GAB, Azevedo DFC, Serrano Junior CV, Ramires JAF, Kalil Filho R. P1835Application of SYNTAX score I, II and residual SYNTAX as predictors of long-term clinical outcomes after coronary artery bypass grafting. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The evaluation of coronary disease by SYNTAX score I (SSI) is used to grade coronary complexity. Following SSI, two other scores were developed: SYNTAX score II (SSII) and residual SYNTAX score (rSS). Nevertheless, there is still a lack of evidence about the prognostic significance of these scores among patients undergoing CABG.
Purpose
Our aim was to evaluate the relation of the SSI, SSII and rSS score with outcomes in a long-term follow-up after elective CABG.
Methods
This is a single center, registry-based study. Baseline SSI was calculated from patients undergoing CABG by interventional cardiologists. SSI results were considered as usual: <23, 23–32 and >32. SSII and rSRR were then calculated and categorized in tertiles: <21.4, 21.4–29.4 and >29.4 for SSII and 0, 1–5 and >5 for rSS. Primary outcome was a composite of overall death, myocardial infarction, additional revascularization, or stroke (MACCE).
Results
Data were obtained from 559 patients. Median follow-up was 6 years (IQR: 4.9–9.8) and 170 events were documented. The Kaplan-Meier curves (figure 1) showed significant differences of MACCE in higher SSI, SSII and rSS (p=0.039, 0.033, <0.001 respectively). After multivariate adjustment, rSS, ejection fraction (EF) and age were found to be independent predictors of MACCE (p<0.001, 0.034 and 0.006, respectively).
Figure 1
Conclusion
In this sample SSI, II and residual were associated with the occurrence of events. However, just the rSS remained an independent predictor of MACCE together with age and EF.
Collapse
Affiliation(s)
- E B Martins
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - W Hueb
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - E G Lima
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - P C Rezende
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C L Garzillo
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G F Carvalho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - F P C Carvalho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - D V Batista
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R R Silva
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G A B Boros
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - D F C Azevedo
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C V Serrano Junior
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J A F Ramires
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R Kalil Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| |
Collapse
|
2
|
Batista DV, Hueb W, Linhares Filho JPP, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. 2363Impact of chronic kidney disease on diabetic patients with stable coronary disease undergoing surgery, angioplasty or medical treatment in a ten-year follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
3
|
Lima EG, Hueb W, Linhares Filho JPP, Batista DV, Rezende PC, Martins EB, Azevedo DFC, Garzillo CL, Ramires JAF, Kalil Filho R. P3591Very long-term follow-up of diabetic patients with coronary artery disease undergoing angioplasty with conventional and drug-eluting stents. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
4
|
Martins EB, Hueb W, Silva RR, Linhares Filho JPP, Batista DV, Ribas FF, Rezende PC, Lima EG, Azevedo DFC, Ramires JAF, Kalil Filho R. P6361SYNTAX score and outcomes after coronary artery bypass grafting: a long-term follow-up analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F F Ribas
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
5
|
Silva RR, Lima EG, Batista DV, Linhares Filho JPP, Martins EB, Rezende PC, Garzillo CL, Ribas FF, Hueb W, Ramires JAF, Kalil Filho R. P2658Long-term analysis of ventricular functionin patients with stable coronary disease submitted to on-pump or off-pump coronary artery bypass graft in MASS III. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F F Ribas
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
6
|
Linhares Filho JPP, Hueb W, Batista DV, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. P2265Impact of glycated hemoglobin in diabetic patients with coronary artery disease undergoing surgery, angioplasty or clinical treatment in a very long-term follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
7
|
Linhares Filho JPP, Hueb W, Batista DV, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. 3270Prognostic evaluation of elevation of cardiac biomarkers after myocardial revascularization. Long-term follow-up of MASS-V trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| |
Collapse
|
8
|
Daher EF, Silva GB, de Abreu KLS, Mota RMS, Batista DV, Rocha NA, Araújo SMHA, Libório AB. Leptospirosis-associated acute kidney injury: penicillin at the late stage is still controversial. J Clin Pharm Ther 2011; 37:420-5. [PMID: 22017324 DOI: 10.1111/j.1365-2710.2011.01312.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Some antimicrobial agents are active in vitro against Leptospiras. The use of penicillins at the late stage of leptospirosis is still controversial. We aimed to evaluate the use of penicillin in patients with leptospirosis-associated acute kidney injury (AKI). METHODS A retrospective study was conducted of patients with leptospirosis admitted to two hospitals in Fortaleza city, Brazil, between 1985 and 2008. AKI was defined according to the RIFLE and AKIN classifications. Patients were divided in two groups according to whether they were treated with a penicillin or not. RESULTS Two hundred and eighty-seven patients were included, with an average age of 36·8±15·6 years and mostly male (80·8%). One hundred and twelve patients (39%) received a penicillin. Patients treated with a penicillin were younger (32±14 years vs. 39±16 years, P=0·0002) and had a shorter hospital stay (8·4±5·0 vs. 11±7·7 days, P<0·0001). There was no difference in the onset of symptoms before hospital admission between the two groups (6·5±3·0 vs. 7·7±4·7, P=0·33). Systolic blood pressure was lower in the penicillin group (111±21 vs. 119±22 mmHg, P=0·04). AKI, need of dialysis and renal recovery at the time of hospital discharge were more frequent in patients who did not use a penicillin (P<0·05). Mortality was similar in both groups (11·6% vs. 13·7%, P=0·60). CONCLUSION Treatment of leptospirosis with antibiotics, including the penicillin, remains controversial. The main benefit of using penicillin in the present study was a reduction in the length of hospital stay and fewer complications, such as AKI, but its use was not associated with a decrease in mortality. On balance of risks and benefits, we recommend the use of penicillin in late-stage leptospirosis.
Collapse
Affiliation(s)
- E F Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|