FERNANDO TEIICHI COSTA OIKAWA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Comparison between off-pump and on-pump coronary artery bypass grafting in patients with severe lesions at the circumflex artery territory: 5-year follow-up of the MASS III trial
    (2013) MELO, R. M. V.; HUEB, W.; REZENDE, P. C.; GARZILLO, C. L.; LIMA, E. G.; OIKAWA, F. T. C.; COSTA, L. M. A.; HUEB, T. O.; RAMIRES, J. A. F.; KALIL FILHO, R.
  • article 6 Citação(ões) na Scopus
    Comparison between off-pump and on-pump coronary artery bypass grafting in patients with severe lesions at the circumflex artery territory: 5-year follow-up of the MASS III trial
    (2015) MELO, Rodrigo Morel Vieira de; HUEB, Whady; REZENDE, Paulo Cury; COSTA, Leandro Menezes Alves da; OIKAWA, Fernando Teiichi Costa; LIMA, Eduardo Gomes; HUEB, Alexandre Ciappina; SCUDELER, Thiago Luis; KALIL FILHO, Roberto
    OBJECTIVES: The technical difficulty in the revascularization of the circumflex artery territory with off-pump surgery may compromise the outcome of this method in clinical follow-up. We aimed to evaluate cardiac events in patients with stable coronary artery disease and severe obstruction of the circumflex system, undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass. METHODS: MASS III was a single-centre study that evaluated 308 patients with multivessel coronary artery disease randomized to on-pump (153) or off-pump (155) CABG. Of this total, 260 (84.4%) patients had, on coronary angiography, at least one 70% obstruction in the circumflex territory (141 on-pump and 119 off-pump). The combined outcome was death, myocardial infarction, target vessel revascularization (angioplasty or surgery) or hospitalization for cardiac causes. Variables with possible associations (P < 0.1) were included in the multivariate analysis. RESULTS: The two groups were well matched for demographics and clinical and angiographic characteristics. After 5 years of follow-up, off-pump CABG had higher combined events than on-pump had: 25 (21%) vs 17 (12%), hazard ratio 1.88, 95% confidence interval 1.02-.48, P = 0.041. In the multivariate model with the inclusion of the following variables: age (P = 0.09) and complete revascularization (P = 0.68), off-pump surgery remained as a predictor of combined events in 5 years, P = 0.03. CONCLUSIONS: In patients with multivessel coronary artery disease and severe lesions in the circumflex territory, off-pump coronary artery bypass surgery resulted in a higher incidence of cardiac events at 5-year follow-up.
  • conferenceObject
    The Release of Cardiac Necrosis Biomarkers in Patients Without Myocardial Infarction After On-Pump Surgical Revascularization. A Study of Cardiac Magnetic Resonance Imaging
    (2016) OIKAWA, Fernando T.; HUEB, Whady; COSTA, Leandro M.; MELO, Rodrigo M. Vieira de; REZENDE, Paulo C.; GARZILLO, Cibele L.; LIMA, Eduardo G.; NOMURA, Cesar H.; VILLA, Alexandre V.; HUEB, Alexandre C.; RAMIRES, Jose A.; KALIL FILHO, Roberto
  • conferenceObject
    USE OF BIOMARKERS AND CARDIAC MAGNETIC RESONANCE FOR DETECTION OF MYOCARDIAL INFARCTION RELATED TO CORONARY REVASCULARIZATION PROCEDURES
    (2014) MELO, Rodrigo Vieira de; OIKAWA, Fernando Teiichi; COSTA, Leandro; REZENDE, Paulo; STRUNZ, Celia; NOMURA, Cesar; MARQUES FILHO, Ismar A.; VILLA, Alexandre; HUEB, Alexandre; HUEB, Whady; KALIL-FILHO, Roberto
  • 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.
  • bookPart
    Estratificação da doença arterial coronariana
    (2022) OIKAWA, Fernando Teiichi Costa; SCUDELER, Thiago Luis
  • conferenceObject
    COST-EFFECTIVENESS ANALYSIS OF ON-PUMP AND OFF-PUMP STABLE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTINGA angstrom MASS III 5-YEAR FOLLOW-UP
    (2016) SCUDELER, T. L.; HUEB, W.; SOAREZ, P. C. de; CAMPOLINA, A. G.; HUEB, A. C.; REZENDE, P. C.; LIMA, E. G.; GARZILLO, C. L.; COSTA, L. M.; OIKAWA, F. T.; RAMIRES, J. A.; KALIL FILHO, R.
  • 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
    BIOMARKERS AND CMR WITH LATE GADOLINIUM ENHANCEMENT FOR DIAGNOSIS OF PROCEDURE-RELATED MYOCARDIAL NECROSIS: A PROSPECTIVE TRIAL USING THE THIRD UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION
    (2013) HUEB, Whady; NOMURA, Cesar; VILLA, Alexandre V.; PARGA, Jose; COSTA, Leandro; MELO, Rodrigo M. V.; OIKAWA, Fernando T. C.; STRUNZ, Celia; REZENDE, Paulo; LIMA, Eduardo; GARZILLO, Cibele L.; RIBEIRO, Expedito E.; HUEB, Alexandre; SERRANO, Carlos; RAMIRES, Jose; KALIL-FILHO, Roberto
    Background: The elevation of cardiac biomarkers after percutaneous or surgical myocardial revascularization procedures is common. However, the correlation between the release and the diagnosis of procedure-related myocardial infarction (Ml) remains unknown. In this study we aim to compare the release of cardiac biomarkers after mechanical interventions with the presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). Methods: In this prospective study, we evaluated 64 stable multivessel coronary artery disease patients with preserved ventricular function and formal indication to revascularization. The release of troponin and CKMB for diagnosis of procedure-related Ml was defined as the third universal definition of Ml. CMR with LGE was performed in all patients before and after interventions. Measurements of cardiac biomarkers were performed before and after the procedure, every 6 hours until 48h after PCI and 72h after CABG. Results: Of 64 patients, 44 (68.8%) underwent CABG and 20 (31.2%) underwent PCI; 46 (72%) were male, 45 (70%) had 3-vessel disease, 33 (52%) had diabetes and 23 (36%) had class Ill/IV of angina. For CABG patients, injury occurred in 95.5% (troponin) and 25% (CKMB); for PCI patients injury occurred in 70% (troponin) and 5% (CKMB). From the initial 64 patients, 14 (21.9%) had new LGE on post-procedure CMR, 13 after CABG and 1 after PCI. From these 14 patients, 7 (50%) presented elevation of CKMB above the cutoffs and troponin was elevated in all patients. From the 50 patients with no new LGE on CMR, 5 (10%) presented CKMB elevation and 42 (84%) presented troponin elevation above the 99th percentile. Based on current cutoffs, troponin had a sensitivity of 100% and specificity of 16% (positive predictive value of 25% and negative predictive value of 100%). CKMB had a sensitivity of 50% and specificity of 90% (positive predictive value of 58% and negative predictive value of 87%). Conclusion: In this study, cardiac biomarkers had a low accuracy for the diagnosis of procedure-related myocardial infarction based on LGE CMR.
  • article 4 Citação(ões) na Scopus
    Hypotheses, rationale, design, and methods for evaluation of ischemic preconditioning assessed by sequential exercise tests in diabetic and non-diabetic patients with stable coronary artery disease - a prospective study
    (2013) REZENDE, Paulo Cury; GARCIA, Rosa Maria Rahmi; UCHIDA, Augusto Hiroshi; COSTA, Leandro Menezes Alves; SCUDELER, Thiago Luis; MELO, Rodrigo Morel Vieira; OIKAWA, Fernando Teiichi Costa; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; SEGRE, Carlos Alexandre Wainrober; FAVARATO, Desiderio; GIRARDI, Priscyla; TAKIUTI, Myrthes; STRUNZ, Celia Cassaro; HUEB, Whady; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
    Background: Ischemic preconditioning is a powerful mechanism of myocardial protection and in humans it can be evaluated by sequential exercise tests. Coronary Artery Disease in the presence of diabetes mellitus may be associated with worse outcomes. In addition, some studies have shown that diabetes interferes negatively with the development of ischemic preconditioning. However, it is still unknown whether diabetes may influence the expression of ischemic preconditioning in patients with stable multivessel coronary artery disease. Methods/Design: This study will include 140 diabetic and non-diabetic patients with chronic, stable coronary artery disease and preserved left ventricular systolic function. The patients will be submitted to two sequential exercise tests with 30-minutes interval between them. Ischemic parameters will be compared between diabetic and non-diabetic patients. Ischemic preconditioning will be considered present when time to 1.0 mm ST-segment deviation is greater in the second of two sequential exercise tests. Exercise tests will be analyzed by two independent cardiologists. Discussion: Ischemic preconditioning was first demonstrated by Murry et al. in dog's hearts. Its work was reproduced by other authors, clearly demonstrating that brief periods of myocardial ischemia followed by reperfusion triggers cardioprotective mechanisms against subsequent and severe ischemia. On the other hand, the demonstration of ischemic preconditioning in humans requires the presence of clinical symptoms or physiological changes difficult to be measured. One methodology largely accepted are the sequential exercise tests, in which, the improvement in the time to 1.0 mm ST depression in the second of two sequential tests is considered manifestation of ischemic preconditioning. Diabetes is an important and independent determinant of clinical prognosis. It's a major risk factor for coronary artery disease. Furthermore, the association of diabetes with stable coronary artery disease imposes worse prognosis, irrespective of treatment strategy. It's still not clearly known the mechanisms responsible by these worse outcomes. Impairment in the mechanisms of ischemic preconditioning may be one major cause of this worse prognosis, but, in the clinical setting, this is not known. The present study aims to evaluate how diabetes mellitus interferes with ischemic preconditioning in patients with stable, multivessel coronary artery disease and preserved systolic ventricular function.