Banca de DEFESA: Gustavo de Almeida Alexim

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : Gustavo de Almeida Alexim
DATE: 07/12/2022
TIME: 10:00
LOCAL: Sala de Reuniões nº 03 da FS/UnB
TITLE:

Mortality in patients with severe coronary artery disease assisted by the State Department of Health of the Federal District

KEY WORDS:

Coronary Artery Disease, Optimized Clinical Therapy, Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, Mortality

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: The quantity and intensity of coronary lesions and left ventricular function are important factors in the prognosis of coronary artery disease (CAD), as demonstrated in studies carried out in the 70s and 80s of the 20th century. More recently, the concept of optimized drug therapy (OMT) and the use of metallic stents and later drug-eluting stents in percutaneous coronary intervention (PCI) procedures. A scientific study that evaluated the degree of coronary disease and left ventricular function did not show an improvement in the prognosis of CAD despite the institution of BMT and PCI with the use of stents.4 However, this study excluded patients with trunk injury from its target population. coronary artery disease and left ventricular ejection fraction below 30%. The novelty of this work consists in the lack of data on which type of population and which results (success, survival) are achieved in practice in the Health System of the Federal District. In addition, there is still disagreement about the best therapeutic strategy for CAD. The present study aims to evaluate the prognosis of patients with CAD treated at the public health service according to the severity of coronary disease and left ventricular dysfunction, being, therefore, a more adequate record of the incorporation of BMT concepts into clinical practice. and PCI with Stents, in addition to coronary artery bypass grafting in a general population. Objectives: The primary objective is to evaluate the mortality of patients with coronary artery disease, treated at the public health service of the Federal District. Methods: The records of the Hemodynamics Services of the Tertiary Public Hospitals of the Federal District from January 2013 to December 2015 will be reviewed to survey the target population of the study; individuals with CAD undergoing left heart catheterization with coronary angiography. The medical records of the patients will be accessed in the electronic medical record system and the reports of the coronary angiographies performed will be analyzed in terms of anatomical severity and left ventricular function. Statistical analysis: For clinical characteristics, the distribution of variables and their normality will be checked using histograms, scatter plots and the Kolmongorov-Smirnoff and Shapiro-Wilk tests. For comparison between the mentioned groups, the chi-square tests will be used for categorical variables and the analysis of variance (ANOVA) for non-categorical variables. Results:From January 2013 to December 2015, 7,392 individuals with CAD treated in the public health network of the Federal District underwent CCG. Of these, 750 had stable angina, 1,376 unstable angina, 1,401 acute myocardial infarction without STsegment elevation and 1,689 acute myocardial infarction with ST-segment elevation. One thousand six hundred and eighty-four individuals had diabetes mellitus (DM), 485 being insulin-dependent (IDDM) and 1,199 non-insulin-dependent (NIDMD). Smoking was present in 1,893 individuals, dyslipidemia in 1,084, systemic arterial hypertension in 3,745, family history of CAD in 616, obesity in 336 and atrial fibrillation (AF) in 177. Males predominated in the sample. Optimized drug therapy was the option for 4,642 (62.8%) individuals, of whom 2,786 (37.7%) had significant CAD. Percutaneous coronary intervention was the option for 2,179 (29.5%) subjects and coronary artery bypass graft surgery was the option for 571 subjects (7.7%). Mortality when comparing the type of treatment proposed showed no difference. Mortality was higher in individuals with extensive coronary atherosclerotic disease, regardless of the proposed treatment. Mortality was higher in diabetic subjects when compared to non-diabetic subjects. Mortality was higher in individuals in whom antiplatelet therapy was not adequately prescribed by current standards.Conclusion: Mortality was higher in individuals with extensive coronary artery disease, diabetes mellitus and in those in whom anti-platelet aggregation therapy was not adequate for their clinical condition. There was no difference in mortality when compared to the therapeutic modality adopted.

BANKING MEMBERS:
Presidente - 444.060.701-25 - ANA PATRICIA DE PAULA - ESCS
Externo à Instituição - DANIEL FRANCA VASCONCELOS - UnB
Externa à Instituição - Luis Carlos Vieira Matos - HBDF
Externo à Instituição - Osório Luís Rangel de Almeida - ESCS