DESIDERIO FAVARATO

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  • article 33 Citação(ões) na Scopus
    Cost-Effectiveness Analysis for Surgical, Angioplasty, or Medical Therapeutics for Coronary Artery Disease 5-Year Follow-Up of Medicine, Angioplasty, or Surgery Study (MASS) II Trial
    (2012) VIEIRA, Ricardo D'Oliveira; HUEB, Whady; HLATKY, Mark; FAVARATO, Desiderio; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; SOARES, Paulo Rogerio; HUEB, Alexandre Ciappina; PEREIRA, Alexandre Costa; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background-The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, n = 203), percutaneous coronary intervention (PCI, n = 205), or medical treatment alone (MT, n = 203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies. Methods and Results-We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT; $19 967.00 for PCI; and $18 263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.01) and versus CABG (P<0.01) and CABG versus PCI (P<0.01). The event-free plus angina-free costs were $16 553.00, $25 831.00, and $24 614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (P=0.04), and versus CABG (P<0.001); there was no difference between CABG and PCI (P>0.05). Conclusions-In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI.
  • conferenceObject
    Long-term outcomes of patients with coronary artery disease and type 2 diabetes mellitus with chronic kidney disease undergoing surgery, angioplasty, or medical treatment
    (2014) LIMA, E. G.; HUEB, W.; REZENDE, P. C.; GARZILLO, C. L.; SCUDELER, T. L.; FAVARATO, D.; COSTA, L. M. A.; HUEB, A. C.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • article 14 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
    ON-PUMP VERSUS OFF-PUMP CORONARY ARTERY BYPASS SURGERY IN PATIENTS WITH ADVANCED AGE: FIVE-YEAR FOLLOW-UP OF MASS III TRIAL
    (2013) MELO, Rodrigo M. V.; HUEB, Whady; OIKAWA, Fernando T. C.; COSTA, Leandro; SERRANO, Carlos; GARZILLO, Cibele; REZENDE, Paulo; LIMA, Eduardo; FAVARATO, Desiderio; HUEB, Alexandre; RAMIRES, Jose; KALIL-FILHO, Roberto
    Background: Advanced age is associated with increased mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG), which may be a consequence of cardiopulmonary bypass. We aim to evaluate cardiac events and long-term clinical outcome in patients with advanced age and stable coronary artery disease (CAD) undergoing off-pump (OPCAB) and on-pump (ONCAB) CABG. Methods: The MASS III was a single-center randomized trial that evaluate 308 patients with stable CAD and preserved ventricular function assigned for: 155 to off-pump and 153 to on-pump CABG. Of this, 176 (58.3%) patients had 60 years or older at the time of randomization (90 of-pump and 86 on-pump). Primary composite end points were death, myocardial infarction, further revascularization, or stroke. Results: The two randomized groups were well-matched for baseline demographic, clinical, and angiographic characteristics. The mean age was 67.2 (±5.0) years. In hospital analysis ONCAB patients had a higher incidence of postoperative stroke or myocardial infarction: 13 (15.1%) vs 5 (5.6%); p=0.036. After 5-year follow-up, there were no significant differences between both strategies of CABG in the composite end points 29.1% vs 27.8%; (Hazard Ratio 1.07; CI 0.62 – 1.87; p=0.8) for ONCAB and OPCAB respectively. Conclusion: In this advanced age population, off-pump surgery did not add benefit in clinical outcome at 5-year 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.
  • article 20 Citação(ões) na Scopus
    Accuracy of Myocardial Biomarkers in the Diagnosis of Myocardial Infarction After Revascularization as Assessed by Cardiac Resonance: The Medicine, Angioplasty, Surgery Study V (MASS-V) Trial
    (2016) HUEB, Whady; GERSH, Bernard J.; COSTA, Leandro Menezes Alves da; OIKAWA, Fernando Teiichi Costa; MELO, Rodrigo Morel Vieira de; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; NOMURA, Cesar Higa; VILLA, Alexandre Volney; HUEB, Alexandre Ciappina; STRUNZ, Celia Maria Cassaro; FAVARATO, Desiderio; TAKIUTI, Myrthes Emy; ALBUQUERQUE, Cicero Piva de; SILVA, Expedito Eustaquio Ribeiro da; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background. The lack of a correlation between myocardial necrosis biomarkers and electrocardiographic abnormalities after revascularization procedures has resulted in a change in the myocardial infarction (MI) definition. Methods. Patients with stable multivessel disease who underwent percutaneous or surgical revascularization were included. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance and late gadolinium enhancement were performed before and after procedures. MI was defined as more than five times the 99th percentile upper reference limit for cTnI and 10 times for CK-MB in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), respectively, and new late gadolinium enhancement for cardiac magnetic resonance. Results. Of the 202 patients studied, 69 (34.1%) underwent on-pump CABG, 67 (33.2%) off-pump CABG, and 66 (32.7%) PCI. The receiver operating characteristic curve showed the accuracy of cTnI for on-pump CABG, off-pump CABG, and PCI patients was 21.7%, 28.3%, and 52.4% and for CK-MB was 72.5%, 81.2%, and 90.5%, respectively. The specificity of cTnI was 3.6%, 9.4%, and 42.1% and of CK-MB was 73.2%, 86.8%, and 96.4%, respectively. Sensitivity of cTnI was 100%, 100%, and 100% and of CK-MB was 69.2%, 64.3%, and 44.4%, respectively. The best cutoff of cTnI for on-pump CABG, off-pump CABG, and PCI was 6.5 ng/mL, 4.5 ng/mL, and 4.5 ng/mL (162.5, 112.5, and 112.5 times the 99th percentile upper reference limit) and of CK-MB was 37.5 ng/mL, 22.5 ng/mL, and 11.5 ng/mL (8.5, 5.1, and 2.6 times the 99th percentile upper reference limit), respectively. Conclusions. Compared with cardiac magnetic resonance, CK-MB was more accurate than cTnI for diagnosing MI. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI. (C) 2016 by The Society of Thoracic Surgeons
  • conferenceObject
    Impact of Chronic Kidney Dysfunction Among Patients With Stable Coronary Artery Disease: Ten-Year Follow-Up of Mass II Trial
    (2016) LIMA, Eduardo G.; HUEB, Whady; GARZILLO, Cibele L.; FAVARATO, Desiderio; HUEB, Alexandre C.; REZENDE, Paulo C.; SILVA, Expedito E.; GARCIA, Rosa M.; SCUDELER, Thiago L.; RAMIRES, Jose A.; KALIL FILHO, Roberto
  • article 18 Citação(ões) na Scopus
    Impact of Chronic Kidney Disease on Long-Term Outcomes in Type 2 Diabetic Patients With Coronary Artery Disease on Surgical, Angioplasty, or Medical Treatment
    (2016) LIMA, Eduardo Gomes; HUEB, Whady; GERSH, Bernard J.; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; FAVARATO, Desiderio; HUEB, Alexandre Ciappina; GARCIA, Rosa Maria Rahmi; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background. Coronary artery disease (CAD) among patients with diabetes and chronic kidney disease (CKD) is not well studied, and the best treatment for this condition is not established. Our aim was to compare three therapeutic strategies for CAD in diabetic patients stratified by renal function. Methods. Patients with multivessel CAD that underwent coronary artery bypass graft (CABG), angioplasty (percutaneous coronary intervention [PCI]), or medical therapy alone (MT) were included. Data were analyzed according to glomerular filtration rate in three strata: normal (>90 mL/min), mild CKD (60 to 89 mL/min), and moderate CKD (30 to 59 mL/min). End points comprised overall rate of mortality, acute myocardial infarction, and need for additional revascularization. Results. Among patients with normal renal function (n = 270), 122 underwent CABG, 72 PCI, and 76 MT; among patients with mild CKD (n = 367), 167 underwent CABG, 92 PCI, and 108 MT; and among patients with moderate CKD (n = 126), 46 underwent CABG, 40 PCI, and 40 MT. Event-free survival was 80.4%, 75.7%, 67.5% for strata 1, 2, and 3, respectively (p = 0.037). Survival rates among patients with no, mild, and moderate CKD are 91.1%, 89.6%, and 76.2%, respectively (p = 0.001) (hazard ratio 0.69; 95% confidence interval 0.51 to 0.95; p = 0.024 for stratum 1 versus 3). We found no differences for overall number of deaths or acute myocardial infarctions irrespective of strata. The need of new revascularization was different in all strata, favoring CABG (p < 0.001, p < 0.001, and p = 0.029 for no, mild, and moderate CKD, respectively). Conclusions. Mortality rates were higher in patients with mild and moderate CKD. Higher event-free survival was observed in the CABG group among patients with no and mild CKD. Besides, CABG was associated with less need for new revascularization compared with PCI and MT in all renal function strata. This trial was registered at http://www.controlled-trials.com as ISRCTN66068876. (C) 2016 by The Society of Thoracic Surgeons
  • conferenceObject
    PERFORMANCE OF LEFT VENTRICULAR EJECTION FRACTION ON PATIENTS WITH STABLE MULTIVESSEL CORONARY DISEASE SUBMITTED TO MEDICINE, ANGIOPLASTY OR SURGERY: 10 YEARS FOLLOW-UPFROM MASS II TRIAL
    (2012) GARZILLO, Cibele L.; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; FAVARATO, Desiderio; SOARES, Paulo; HUEB, Alexandre Ciappina; STOLF, Noedir A. G.; RAMIRES, Jose; KALIL-FILHO, Roberto
    Background Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are assumed as effective therapeutic options for the protection of the ischemic myocardium. However, it is not established if those procedures are effective for left ventricular ejection fraction (LVEF) preservation. In this setting, we evaluated the evolution of LVEF in patients with stable multivessel coronary disease, submitted to CABG, PCI or medical treatment (MT) alone, after ten years of follow-up. Methods Echocardiography was performed on patients participants of MASS II trial, previously to randomization for CABG, PCI or MT, and after 10 years. LVEF was measured by the biplane method (Simpson), when regional wall-motion abnormalities were present, or by the Teichholz method. Results After a follow-up of 10.32 (±1.43) years, 350 patients had LVEF reassessed: 108 patients on MT, 111 on CABG and 131 on PCI group. Main baseline characteristics and the occurrence of AMI were similar among the three groups. There was no difference of LVEF either at the beginning (0.61 + 0.07, 0.61 + 0.08 e 0.61 + 0.09 respectively for PCI, CABG and MT, p=0.675) and the end of follow up (0.56 + 0.11, 0.55 + 0.11 e 0.55 + 0.12 respectively for PCI, CABG and MT, p=0.675). The impact of other variables over LVEF evolution, such as gender, age, diabetes and arterial pattern, were also analyzed, and no relevance was demonstrated. However, the presence of previous AMI (OR 2.50, 95% CI 1.40-4.45; p= 0.0007) and the occurrence of AMI during follow up (OR 2.73, 95% IC 1.25-5.92; p=0.005) were associated with an increased risk of developing LVEF < 45%. Also, AMI during follow-up was responsible for a greater reduction of LVEF (reduction delta of 18.29 ± 21.22% and 6.63 ± 18.91%, respectively for patients with and without AMI, p=0.001). Conclusion Thus, compared with PCI or CABG patients, patients in the medical group with unprotected coronary artery disease by mechanical revascularization without adverse cardiac events showed no differences in the left ventricular function after 10 years of follow up. Moreover, whatever of interventional therapeutic strategies applied, the left ventricular function remained unchanged in absence of MACE. ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m. Session Title: Fresh CABG: Good for SIHD? Abstract Category: 3. Chronic CAD/Stable Ischemic Heart Disease: Therapy Presentation Number: 1208-410
  • article 55 Citação(ões) na Scopus
    Effect of Complete Revascularization on 10-Year Survival of Patients With Stable Multivessel Coronary Artery Disease MASS II Trial
    (2012) VIEIRA, Ricardo D'Oliveira; HUEB, Whady; GERSH, Bernard J.; LIMA, Eduardo Gomes; PEREIRA, Alexandre Costa; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; HUEB, Alexandre Ciappina; FAVARATO, Desiderio; SOARES, Paulo Rogerio; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background-The importance of complete revascularization remains unclear and contradictory. This current investigation compares the effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease (CAD) who were randomly assigned to percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Methods and Results-This is a post hoc analysis of the Second Medicine, Angioplasty, or Surgery Study (MASS II), which is a randomized trial comparing treatments in patients with stable multivessel CAD, and preserved systolic ventricular function. We analyzed patients who underwent surgery (CABG) or stent angioplasty (PCI). The survival free of overall mortality of patients who underwent complete (CR) or incomplete revascularization (IR) was compared. Of the 408 patients randomly assigned to mechanical revascularization, 390 patients (95.6%) underwent the assigned treatment; complete revascularization was achieved in 224 patients (57.4%), 63.8% of those in the CABG group and 36.2% in the PCI group (P = 0.001). The IR group had more prior myocardial infarction than the CR group (56.2% X 39.2%, P = 0.01). During a 10-year follow-up, the survival free of cardiovascular mortality was significantly different among patients in the 2 groups (CR, 90.6% versus IR, 84.4%; P = 0.04). This was mainly driven by an increased cardiovascular specific mortality in individuals with incomplete revascularization submitted to PCI (P = 0.05). Conclusions-Our study suggests that in 10-year follow-up, CR compared with IR was associated with reduced cardiovascular mortality, especially due to a higher increase in cardiovascular-specific mortality in individuals submitted to PCI.