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  • article 15 Citação(ões) na Scopus
    Long-term analysis of left ventricular ejection fraction in patients with stable multivessel coronary disease undergoing medicine, angioplasty or surgery: 10-year follow-up of the MASS II trial
    (2013) GARZILLO, Cibele Larrosa; HUEB, Whady; GERSH, Bernard J.; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; HUEB, Alexandre Ciappina; VIEIRA, Ricardo D'Oliveira; FAVARATO, Desiderio; PEREIRA, Alexandre Costa; SOARES, Paulo Rogerio; SERRANO JR., Carlos Vicente; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background Assuming that coronary interventions, both coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), are directed to preserve left ventricular function, it is not known whether medical therapy alone (MT) can achieve this protection. Thus, we evaluated the evolution of LV ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by CABG, PCI, or MT as a post hoc analysis of a randomized controlled trial with a follow-up of 10 years. Methods Left ventricle ejection fraction was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or MT, and re-evaluated after 10 years of follow-up. Results Of the 611 patients, 422 were alive after 10.32 1.43 years. Three hundred and fifty had LVEF reassessed: 108 patients from MT, 111 from CABG, and 131 from PCI. There was no difference in LVEF at the beginning (0.61 0.07, 0.61 0.08, 0.61 0.09, respectively, for PCI, CABG, and MT, P 0.675) or at the end of follow-up (0.56 0.11, 0.55 0.11, 0.55 0.12, P 0.675), or in the decline of LVEF (reduction delta of 7.2 17.13, 9.08 18.77, and 7.54 22.74). Acute myocardial infarction (AMI) during the follow-up was associated with greater reduction in LVEF. The presence of previous AMI (OR: 2.50, 95 CI: 1.404.45; P 0.0007) and during the follow-up (OR: 2.73, 95 CI: 1.255.92; P 0.005) was associated with development of LVEF 45. Conclusion Regardless of the therapeutic option applied, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up.
  • article 52 Citação(ões) na Scopus
    Impact of diabetes on 10-year outcomes of patients with multivessel coronary artery disease in the Medicine, Angioplasty, or Surgery Study II (MASS II) trial
    (2013) LIMA, Eduardo Gomes; HUEB, Whady; GARCIA, Rosa Maria Rahmi; PEREIRA, Alexandre Costa; SOARES, Paulo Rogerio; FAVARATO, Desiderio; GARZILLO, Cibele Larrosa; VIEIRA, Ricardo D'Oliveira; REZENDE, Paulo Cury; TAKIUTI, Myrthes; GIRARDI, Priscyla; HUEB, Alexandre Ciappina; RAMIRES, Jose A. F.; KALIL FILHO, Roberto
    Introduction Diabetes mellitus is a major cause of coronary artery disease (CAD). Despite improvement in the management of patients with stable CAD, diabetes remains a major cause of increased morbidity and mortality. There is no conclusive evidence that either modality is better than medical therapy alone for the treatment of stable multivessel CAD in patients with diabetes in a very long-term follow-up. Our aim was to compare 3 therapeutic strategies for stable multivessel CAD in a diabetic population and non-diabetic population. Methods It was compared medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in 232 diabetic patients and 379 nondiabetic patients with multivessel CAD. Endpoints evaluated were overall and cardiac mortality. Results Patients (n = 611) were randomized to CABG (n = 203), PCI (n = 205), or MT (n = 203). In a 10-year follow-up, more deaths occurred among patients with diabetes than among patients without diabetes (P = .001) for overall mortality. In this follow-up, 10-year mortality rates were 32.3% and 23.2% for diabetics and non-diabetics respectively (P = .024). Regarding cardiac mortality, 10-year cardiac mortality rates were 19.4% and 12.7% respectively (P = .031). Considering only diabetic patients and stratifying this population by treatment option, we found mortality rates of 31.3% for PCI, 27.5% for CABG and 37.5% for MT (P = .015 for CABG vs MT) and cardiac mortality rates of 18.8%, 12.5% and 26.1% respectively (P = .005 for CABG vs MT). Conclusions/interpretation Among patients with stable multivessel CAD and preserved left ventricular ejection fraction, the 3 therapeutic regimens had high rates of overall and cardiac-related deaths among diabetic compared with nondiabetic patients. Moreover, better outcomes were observed in diabetic patients undergoing CABG compared to MT in relation to overall and cardiac mortality in a 10-year follow-up.