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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  • conferenceObject
    Impact of chronic kidney disease on diabetic patients with stable coronary disease undergoing surgery, angioplasty or medical treatment in a ten-year follow-up
    (2018) BATISTA, D. V.; HUEB, W.; LINHARES FILHO, J. P. P.; SILVA, R. R.; LIMA, E. G.; REZENDE, P. C.; MARTINS, E. B.; GARZILLO, C. L.; AZEVEDO, D. F. C.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • conferenceObject
    SYNTAX score and outcomes after coronary artery bypass grafting: a long-term follow-up analysis
    (2018) MARTINS, E. B.; HUEB, W.; SILVA, R. R.; LINHARES FILHO, J. P. P.; BATISTA, D. V.; RIBAS, F. F.; REZENDE, P. C.; LIMA, E. G.; AZEVEDO, D. F. C.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • 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 4 Citação(ões) na Scopus
    Behavior of Ultrasensitive C-Reactive Protein in Myocardial Revascularization with and without Cardiopulmonary Bypass
    (2018) ABRANTES, Rafael Diniz; HUEB, Alexandre Ciappina; HUEB, Whady; JATENE, Fabio B.
    Objective: To analyze the inflammation resulting from myocardial revascularization techniques with and without cardiopulmonary bypass, based on ultrasensitive C-reactive protein (US-CRP) behavior. Methods: A prospective non-randomized clinical study with 136 patients was performed. Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery bypass-ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary artery bypass-OPCAB). All study participants had blood samples collected for analysis of glucose, triglycerides, creatinine, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and creatinephosphokinase (CPK) in the preoperative period. The samples of creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after surgery. We also analyzed the preoperative biological variables of each patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body mass index, previous myocardial infarction, myocardial fibrosis). All angiographically documented patients with >70% proximal multiarterial stenosis and ischemia, documented by stress test or classification of stable angina (class II or III), according to the Canadian Cardiovascular Society, were included. Reoperations, combined surgeries, recent acute myocardial infarction, recent inflammatory disease, deep venous thrombosis or recent pulmonary thromboembolism, acute kidney injury or chronic kidney injury were not included. Results: Correlation values between the US-CRP curve and the ONCAB group, the treatment effect and the analyzed biological variables did not present expressive results. Laboratory variables were evaluated and did not correlate with the applied treatment (P>0.05). Conclusion: The changes in the US-CRP at each moment evaluated from the postoperative period did not show any significance in relation to the surgical technique applied.
  • conferenceObject
    Abnormal Release of Cardiac Biomarkers in the Presence of Myocardial Edema Evaluated by Cardiac Magnetic Resonance After Uncomplicated Revascularization Procedures
    (2018) RIBAS, Fernando F.; REZENDE, Paulo C.; BOROS, Gustavo A.; DALLAZEN, Anderson R.; LINHARES FILHO, Jaime P.; NOMURA, Cesar H.; ROCHITTE, Carlos E.; VILLA, Alexandre V.; LIMA, Eduardo G.; CARVALHO, Guilherme F.; HUEB, Whady; RAMIRES, Jose A.; KALIL FILHO, Roberto
  • article 0 Citação(ões) na Scopus
  • conferenceObject
    Cost-effectiveness analysis of on-pump and off-pump coronary artery bypass grafting for patients with multivesselcoronary artery disease: a Markov model based on data from the MASS III trial
    (2018) SCUDELER, T. L.; HUEB, W.; SOAREZ, P. C. De; CAMPOLINA, A. G.; HUEB, A. C.; REZENDE, P. C.; LIMA, E. G.; GARZILLO, C. L.; RIBAS, F. F.; TAKIUTI, M. E.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • conferenceObject
    Impact of glycated hemoglobin in diabetic patients with coronary artery disease undergoing surgery, angioplasty or clinical treatment in a very long-term follow-up
    (2018) LINHARES FILHO, J. P. P.; HUEB, W.; BATISTA, D. V.; SILVA, R. R.; LIMA, E. G.; REZENDE, P. C.; MARTINS, E. B.; GARZILLO, C. L.; AZEVEDO, D. F. C.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • article 4 Citação(ões) na Scopus
    Cost-effectiveness of on-pump and off-pump coronary artery bypass grafting for patients with coronary artery disease: Results from the MASS III trial
    (2018) SCUDELER, Thiago Luis; HUEB, Whady A.; FARKOUH, Michael E.; MARON, David J.; SOAREZ, Patricia Coelho de; CAMPOLINA, Alessandro Goncalves; TAKIUTI, Myrthes Emy; REZENDE, Paulo Cury; GODOY, Lucas Colombo; HUEB, Alexandre Ciapinina; LIMA, Eduardo Gomes; GARZILLO, Cibele Larroza; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background: Recent trials have reported similar clinical outcomes between on-pump and off-pump coronary artery bypass graft (CABG). However, long-term cost-effectiveness of these strategies is unknown. Methods: A prespedfied economic study was performed based on the MASS Ill trial. Costs were estimated for all patients based on observed healthcare resource usage over a 5-year follow-up. Health state utilities were evaluated with the SF-6D questionnaire. Cost-effectiveness was assessed as cost per quality-adjusted life-year (QALY) gained using a Markov model. Probabilistic sensitivity analysis with the Monte-Carlo simulation and cost-effectiveness acceptability curve were used to address uncertainty. Results: Quality of life improved significantly in both groups during follow-up compared with baseline. At 5 years, when comparing on-pump and off-pump CABG groups, no differences were found in cumulative life-years (4.851 and 4.766 years, P = .319) and QALY gained (4.150 and 4.105 QALYs, P = .332). Mean cost in US dollars per patient during the trial did not differ significantly between the on-pump and off-pump groups ($5890.29 and $5674.75, respectively, P = .409). Over a lifetime horizon, the incremental cost-effectiveness ratio of on-pump versus off-pump CABG was $12,576 per QALY gained, which is above the suggested cost-effectiveness threshold range (from $3210 to 10,122). In the sensitivity analysis, the probability that on-pump CABG is cost-effective compared to off-pump surgery for a willingness-to-pay threshold of $3212 per QALY gained was <1%. For the $10,122 per QALY threshold, the same probability was 35%. Conclusion: This decision-analytic model suggests that on-pump CABG is not cost-effective when compared to off-pump CABG from a public health system perspective.