WHADY ARMINDO HUEB

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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina

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  • article 1515 Citação(ões) na Scopus
    Strategies for Multivessel Revascularization in Patients with Diabetes
    (2012) FARKOUH, Michael E.; DOMANSKI, Michael; SLEEPER, Lynn A.; SIAMI, Flora S.; DANGAS, George; MACK, Michael; YANG, May; COHEN, David J.; ROSENBERG, Yves; SOLOMON, Scott D.; DESAI, Akshay S.; GERSH, Bernard J.; MAGNUSON, Elizabeth A.; LANSKY, Alexandra; BOINEAU, Robin; WEINBERGER, Jesse; RAMANATHAN, Krishnan; SOUSA, J. Eduardo; RANKIN, Jamie; BHARGAVA, Balram; BUSE, John; HUEB, Whady; SMITH, Craig R.; MURATOV, Victoria; BANSILAL, Sameer; III, Spencer King; BERTRAND, Michel; FUSTER, Valentin
    BACKGROUND In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1 +/- 9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). CONCLUSIONS For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.)
  • 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.
  • article 35 Citação(ões) na Scopus
    The Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) trial: Clinical and angiographic profile at study entry
    (2012) BANSILAL, Sameer; FARKOUH, Michael E.; HUEB, Whady; OGDIE, May; DANGAS, George; LANSKY, Alexandra J.; COHEN, David J.; MAGNUSON, Elizabeth A.; RAMANATHAN, Krishnan; TANGUAY, Jean-Francois; MURATOV, Victoria; SLEEPER, Lynn A.; DOMANSKI, Michael; BERTRAND, Michel E.; FUSTER, Valentin
    Background The optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD) remains uncertain for lack of an adequately powered, randomized trial. The FREEDOM trial was designed to compare contemporary coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI) with drug-eluting stents in diabetic patients with MVD against a background of optimal medical therapy. Methods A total of 1,900 diabetic participants with MVD were randomized to PCI or CABG worldwide from April 2005 to March 2010. FREEDOM is a superiority trial with a mean follow-up of 4.37 years (minimum 2 years) and 80% power to detect a 27.0% relative reduction. We present the baseline characteristics of patients screened and randomized, and provide a comparison with other MVD trials involving diabetic patients. Results The randomized cohort was 63.1 +/- 9.1 years old and 29% female, with a median diabetes duration of 10.2 +/- 8.9 years. Most (83%) had 3-vessel disease and on average took 5.5 +/- 1.7 vascular medications, with 32% on insulin therapy. Nearly all had hypertension and/or dyslipidemia, and 26% had a prior myocardial infarction. Mean hemoglobin A1c was 7.8 +/- 1.7 mg/dL, 29% had low-density lipoprotein <70 mg/dL, and mean systolic blood pressure was 134 +/- 20 mm Hg. The mean SYNTAX score was 26.2 with a symmetric distribution. FREEDOM trial participants have baseline characteristics similar to those of contemporary multivessel and diabetes trial cohorts. Conclusions The FREEDOM trial has successfully recruited a high-risk diabetic MVD cohort. Follow-up efforts include aggressive monitoring to optimize background risk factor control. FREEDOM will contribute significantly to the PCI versus CABG debate in diabetic patients with MVD. (Am Heart J 2012;164:591-9.)
  • 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.
  • article 42 Citação(ões) na Scopus
    The Effect of Age on Outcomes of Coronary Artery Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease
    (2012) FLATHER, Marcus; RHEE, June-Wha; BOOTHROYD, Derek B.; BOERSMA, Eric; BROOKS, Maria Mori; CARRIE, Didier; CLAYTON, Tim C.; DANCHIN, Nicholas; HAMM, Christian W.; HUEB, Whady A.; KING, Spencer B.; POCOCK, Stuart J.; RODRIGUEZ, Alfredo E.; SERRUYS, Patrick; SIGWART, Ulrich; STABLES, Rodney H.; HLATKY, Mark A.
    Objectives This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Background Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain. Methods Individual data from 7,812 patients randomized in 1 of 10 clinical trials of CABG or PCI were pooled. Age was analyzed as a continuous variable in the primary analysis and was divided into tertiles for descriptive purposes (<= 56.2 years, 56.3 to 65.1 years, >= 65.2 years). The outcomes assessed were death, myocardial infarction and repeat revascularization over complete follow-up, and angina at 1 year. Results Older patients were more likely to have hypertension, diabetes, and 3-vessel disease compared with younger patients (p < 0.001 for trend). Over a median follow-up of 5.9 years, the effect of CABG versus PCI on mortality varied according to age (interaction p < 0.01), with adjusted CABG-to-PCI hazard ratios and 95% confidence intervals (CI) of 1.23 (95% CI: 0.95 to 1.59) in the youngest tertile; 0.89 (95% CI: 0.73 to 1.10) in the middle tertile; and 0.79 (95% CI: 0.67 to 0.94) in the oldest tertile. The CABG-to-PCI hazard ratio of less than 1 for patients 59 years of age and older. A similar interaction of age with treatment was present for the composite outcome of death or myocardial infarction. In contrast, patient age did not alter the comparative effectiveness of CABG and PCI on the outcomes of repeat revascularization or angina. Conclusions Patient age modifies the comparative effectiveness of CABG and PCI on hard cardiac events, with CABG favored at older ages and PCI favored at younger ages. (J Am Coll Cardiol 2012;60:2150-7) (C) 2012 by the American College of Cardiology Foundation
  • article 94 Citação(ões) na Scopus
    Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization
    (2018) HEAD, Stuart J.; MILOJEVIC, Milan; DAEMEN, Joost; AHN, Jung-Min; BOERSMA, Eric; CHRISTIANSEN, Evald H.; DOMANSKI, Michael J.; FARKOUH, Michael E.; FLATHER, Marcus; FUSTER, Valentin; HLATKY, Mark A.; HOLM, Niels R.; HUEB, Whady A.; KAMALESH, Masoor; KIM, Young-Hak; MAKIKALLIO, Timo; MOHR, Friedrich W.; PAPAGEORGIOU, Grigorios; PARK, Seung-Jung; RODRIGUEZ, Alfredo E.; III, Joseph F. Sabik; STABLES, Rodney H.; STONE, Gregg W.; SERRUYS, Patrick W.; KAPPETEIN, A. Pieter
    BACKGROUND Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI. OBJECTIVES This study sought to compare rates of stroke after CABG and PCI and the impact of procedural stroke on long-term mortality. METHODS We performed a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents; ERACI II (Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS (Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine, Angioplasty, or Surgery Study) (n = 408), SoS (Stent or Surgery) trial (n = 988), SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial (n = 1,800), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) trial (n = 600), FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900), VA CARDS (Coronary Artery Revascularization in Diabetes) (n = 198), BEST (Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease) (n = 880), NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trial (n = 1,184), and EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial (n = 1,905). The 30-day and 5-year stroke rates were compared between CABG and PCI using a random effects Cox proportional hazards model, stratified by trial. The impact of stroke on 5-year mortality was explored. RESULTS The analysis included 11,518 patients randomly assigned to PCI (n = 5,753) or CABG (n = 5,765) with a mean follow-up of 3.8 +/- 1.4 years during which a total of 293 strokes occurred. At 30 days, the rate of stroke was 0.4% after PCI and 1.1% after CABG (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.20 to 0.53; p < 0.001). At 5-year follow-up, stroke remained significantly lower after PCI than after CABG (2.6% vs. 3.2%; HR: 0.77; 95% CI: 0.61 to 0.97; p = 0.027). Rates of stroke between 31 days and 5 years were comparable: 2.2% after PCI versus 2.1% after CABG (HR: 1.05; 95% CI: 0.80 to 1.38; p = 0.72). No significant interactions between treatment and baseline clinical or angiographic variables for the 5-year rate of stroke were present, except for diabetic patients (PCI: 2.6% vs. CABG: 4.9%) and nondiabetic patients (PCI: 2.6% vs. CABG: 2.4%) (p for interaction = 0.004). Patients who experienced a stroke within 30 days of the procedure had significantly higher 5-year mortality versus those without a stroke, both after PCI (45.7% vs. 11.1%, p < 0.001) and CABG (41.5% vs. 8.9%, p < 0.001). CONCLUSIONS This individual patient-data pooled analysis demonstrates that 5-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and 5 years. The greater risk of stroke after CABG compared with PCI was confined to patients with multivessel disease and diabetes. Five-year mortality was markedly higher for patients experiencing a stroke within 30 days after revascularization. (C) 2018 by the American College of Cardiology Foundation.
  • article 487 Citação(ões) na Scopus
    Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data
    (2018) HEAD, Stuart J.; MILOJEVIC, Milan; DAEMEN, Joost; AHN, Jung-Min; BOERSMA, Eric; CHRISTIANSEN, Evald H.; DOMANSKI, Michael J.; FARKOUH, Michael E.; FLATHER, Marcus; FUSTER, Valentin; HLATKY, Mark A.; HOLM, Niels R.; HUEB, Whady A.; KAMALESH, Masoor; KIM, Young-Hak; MAKIKALLIO, Timo; MOHR, Friedrich W.; PAPAGEORGIOU, Grigorios; PARK, Seung-Jung; RODRIGUEZ, Alfredo E.; III, Joseph F. Sabik; STABLES, Rodney H.; STONE, Gregg W.; SERRUYS, Patrick W.; KAPPETEIN, Arie Pieter
    Background Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. Methods We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics. Findings We included 11 randomised trials involving 11 518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3.8 years (SD 1.4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26 . 0 (SD 9 . 5), with 1798 (22.1%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11.2% after PCI and 9.2% after CABG (hazard ratio [HR] 1.20, 95% CI 1.06-1.37; p=0.0038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11.5% after PCI vs 8.9% after CABG; HR 1.28, 95% CI 1.09-1.49; p=0.0019), including in those with diabetes (15.5% vs 10.0%; 1.48, 1.19-1.84; p=0.0004), but not in those without diabetes (8.7% vs 8.0%; 1.08, 0.86-1.36; p=0.49). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10.7% after PCI vs 10.5% after CABG; 1.07, 0.87-1.33; p=0.52), regardless of diabetes status and SYNTAX score. Interpretation CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies.
  • article 1498 Citação(ões) na Scopus
    Initial Invasive or Conservative Strategy for Stable Coronary Disease
    (2020) MARON, David J.; HOCHMAN, Judith S.; REYNOLDS, Harmony R.; BANGALORE, Sripal; O'BRIEN, Sean M.; BODEN, William E.; CHAITMAN, Bernard R.; SENIOR, Roxy; LOPEZ-SENDON, Jose; ALEXANDER, Karen P.; LOPES, Renato D.; SHAW, Leslee J.; BERGER, Jeffrey S.; NEWMAN, Jonathan D.; SIDHU, Mandeep S.; GOODMAN, Shaun G.; RUZYLLO, Witold; GOSSELIN, Gilbert; MAGGIONI, Aldo P.; WHITE, Harvey D.; BHARGAVA, Balram; MIN, James K.; MANCINI, G. B. John; BERMAN, Daniel S.; PICARD, Michael H.; KWONG, Raymond Y.; ALI, Ziad A.; MARK, Daniel B.; SPERTUS, John A.; KRISHNAN, Mangalath N.; ELGHAMAZ, Ahmed; MOORTHY, Nagaraja; HUEB, Whady A.; DEMKOW, Marcin; MAVROMATIS, Kreton; BOCKERIA, Olga; PETEIRO, Jesus; MILLER, Todd D.; SZWED, Hanna; DOERR, Rolf; KELTAI, Matyas; SELVANAYAGAM, Joseph B.; STEG, P. Gabriel; HELD, Claes; KOHSAKA, Shun; MAVROMICHALIS, Stavroula; KIRBY, Ruth; JEFFRIES, Neal O.; HARRELL JR., Frank E.; ROCKHOLD, Frank W.; BRODERICK, Samuel; FERGUSON JR., T. Bruce; WILLIAMS, David O.; HARRINGTON, Robert A.; STONE, Gregg W.; ROSENBERG, Yves
    Background Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. Methods We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. Results Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). Conclusions Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, .) Patients with stable coronary disease were randomly assigned to an initial invasive strategy with angiography and revascularization if appropriate or to medical therapy alone. At 3.2 years, there was no significant difference between the groups with respect to the estimated rate of ischemic events. The findings were sensitive to the definition of myocardial infarction.
  • article 0 Citação(ões) na Scopus
    Myocardial microstructure assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting
    (2023) DALLAZEN, Anderson Roberto; REZENDE, Paulo Cury; HUEB, Whady; HLATKY, Mark Andrew; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; BOROS, Gustavo Andre Boeing; RIBAS, Fernando Faglioni; RIBEIRO, Matheus de Oliveira Laterza; SCUDELER, Thiago Luis; DANTAS, Roberto Nery; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background: The correlation between the release of cardiac biomarkers after revascularization, in the absence of late gadolinium enhancement (LGE) or myocardial edema, and the development of myocardial tissue damage remains unclear. This study sought to identify whether the release of biomarkers is associated with cardiac damage by assessing myocardial microstructure on T1 mapping after on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB). Methods: Seventy-six patients with stable multivessel coronary artery disease (CAD) and preserved systolic ventricular function were included. T1 mapping, high-sensitive cardiac troponin I (cTnI), creatine kinase myocardial band (CK-MB) mass, and ventricular dimensions and function were measured before and after procedures. Results: Of the 76 patients, 44 underwent OPCAB, and 32 ONCAB; 52 were men (68.4%), and the mean age was 63 +/- 8.5 years. In both OPCAB and ONCAB the native T1 values were similar before and after surgeries. An increase in extracellular volume (ECV) values after the procedures was observed, due to the decrease in hematocrit levels during the second cardiac resonance. However, the lambda partition coefficient showed no significant difference after the surgeries. The median peak release of cTnI and CK-MB were higher after ONCAB than after OPCAB [3.55 (2.12-4.9) vs. 2.19 (0.69-3.4) ng/mL, P=0.009 and 28.7 (18.2-55.4) vs. 14.3 (9.3-29.2) ng/mL, P=0.009, respectively]. Left ventricular ejection fraction (LVEF) was similar in both groups before and after surgery. Conclusions: In the absence of documented myocardial infarction, T1 mapping did not identify structural tissue damage after surgical revascularization with or without cardiopulmonary bypass (CPB), despite the excessive release of cardiac biomarkers.
  • article 11 Citação(ões) na Scopus
    Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease
    (2020) REZENDE, Paulo Cury; HLATKY, Mark Andrew; HUEB, Whady; GARCIA, Rosa Maria Rahmi; SELISTRE, Luciano da Silva; LIMA, Eduardo Gomes; GARZILLO, Cibele Larrosa; SCUDELER, Thiago Luis; BOROS, Gustavo Andre Boeing; RIBAS, Fernando Faglioni; SERRANO, Carlos Vicente; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Question Are longitudinal glycated hemoglobin values associated with cardiovascular events in patients with type 2 diabetes and stable multivessel coronary artery disease? Findings In this cohort study of 725 patients with type 2 diabetes and multivessel coronary artery disease, a 1-point increase in glycated hemoglobin values during follow-up was independently associated with higher risk of the combined outcome of death, myocardial infarction, or ischemic stroke, after adjustment for baseline clinical factors. Meaning Longitudinal increase of glycated hemoglobin was associated with higher rates of cardiovascular events in patients with type 2 diabetes and multivessel coronary artery disease, and the mechanisms underlying this association require further investigation. This cohort study examines whether longitudinal variation of glycated hemoglobin (HbA(1c)) is associated with cardiovascular events in patients with diabetes and multivessel coronary artery disease (CAD). Importance Glycated hemoglobin (HbA(1c)) values are used to guide glycemic control, but in patients with type 2 diabetes and multivessel coronary artery disease (CAD), the association of the longitudinal values of HbA(1c) with cardiovascular outcomes is unclear. Objective To assess whether longitudinal variation of HbA(1c) is associated with cardiovascular events in long-term follow-up among patients with diabetes and multivessel CAD. Design, Setting, and Participants This cohort study included 888 patients with type 2 diabetes and multivessel CAD in the Medicine, Angioplasty, or Surgery Study (MASS) Registry of the Heart Institute of the University of Sao Paulo from January 2003 to December 2007. Data were analyzed from January 15, 2018, to October 15, 2019. Exposure Longitudinal HbA(1c) values. Main Outcomes and Measures The combined outcome of all-cause mortality, myocardial infarction, and ischemic stroke. Results Of 888 patients with type 2 diabetes and multivessel CAD, 725 (81.6%; median [range] age, 62.4 [55.7-68.0] years; 467 [64.4%] men) had complete clinical and HbA(1c) information during a median (interquartile range) follow-up period of 10.0 (8.0-12.3) years, with a mean (SD) of 9.5 (3.8) HbA(1c) values for each patient. The composite end point of death, myocardial infarction, or ischemic stroke occurred in 262 patients (36.1%). A 1-point increase in the longitudinal value of HbA(1c) was significantly associated with a 14% higher risk of the combined end point of all-cause mortality, myocardial infarction, and ischemic stroke (hazard ratio, 1.14; 95% CI, 1.04-1.24; P = .002) in the unadjusted analysis. After adjusting for baseline factors (ie, age, sex, 2-vessel or 3-vessel CAD, initial CAD treatments, ejection fraction, and creatinine and low-density lipoprotein cholesterol levels), a 1-point increase in the longitudinal value of HbA(1c) was associated with a 22% higher risk of the combined end point (hazard ratio, 1.22; 95% CI, 1.12-1.35; P < .001). Conclusions and Relevance Longitudinal increase of HbA(1c) was independently associated with higher rates of cardiovascular events in patients with type 2 diabetes and multivessel CAD.