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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.
  • conferenceObject
    Impact of metabolic syndrome on the outcome of patients with stable coronary artery disease submitted to different types of treatment: 10-year follow-up of the MASS II study
    (2012) LIMA, E. G.; HUEB, W.; RAHMI, R.; VIEIRA, R. D. O.; GARZILLO, C. L.; PEREIRA, A. C.; HUEB, A. C.; REZENDE, P. C.; RAMIRES, J. A. F.; KALIL FILHO, R.
    Purpose: Metabolic syndrome (MetS) is understood as a condition that promotes atherosclerosis and confers an additional risk of adverse cardiovascular eventsin patients with coronary artery disease. The prognosis of this syndrome in this subset of patients in a long term follow up is inconclusive. Evaluate the impact of metabolic syndrome on cardiac death in patients with symptomatic chronic multivessel coronary artery disease. Methods: Patients randomized in MASS II study submitted to coronary artery bypass graft (CABG),angioplasty (PCI) or medical treatment (MT) were evaluated for the presence of MetS and followed prospectively for 10 years. We evaluated the incidence of overall and cardiac death in this period. Results: Criteria for MetS were fulfilled in 283 patients of 583 (54%) randomized to three therapeutic strategies. The presence of MetS was associated with an increased cardiac related death in studied population. During a 10-year follow- up, the probability cardiac mortality free survival was significantly different among patients in the 2 groups (MetS = 81,6% x non-MetS = 91,3% P=0.004). Stratifying patients with MetS by therapeutic approach we identify a statistical difference in cardiac death free survival comparing interventional approaches (CABG and PCI) to MT: 82,4% for CABG; 86,2% for PCI and 75,9% for MT(P=0,003). Besides, there is a group with best prognosis: patients without MetS submitted to CABG presenting 98,7% of patients free of cardiac death in a 10-year follow-up. Conclusion: MetS confers high rates of cardiac death in patients with stable coronary artery disease irrespective of therapeutic strategy used. In patients with MetS, interventional approaches (PCI or CABG) seem to confer more protection against cardiac death in a 10-year follow-up.