ANTONIO DE PADUA MANSUR
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
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- Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: A CORE64 multicenter trial substudy(2014) SARA, Leonardo; ROCHITTE, Carlos E.; LEMOS, Pedro A.; NIINUMA, Hiroyuki; DEWEY, Marc; SHAPIRO, Edward P.; GOTTLIEB, Ilan; MANSUR, Antonio P.; NICOLAU, Jose C.; LARDO, Albert C.; AZEVEDO, Clerio F.; KALIL-FILHO, Roberto; VAVERE, Andrea L.; COHN, Silvia; COX, Christopher; BRINKER, Jeffrey; MILLER, Julie M.; LIMA, Joao A. C.Background: Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS). Methods: Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories. Results: From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting >= 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P = 0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 +/- 449 in suspected ACS and 435 +/- 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients. Conclusions: The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.
- Long-term follow-up of a randomized, controlled clinical trial of three therapeutic strategies for multivessel stable coronary artery disease in women(2014) MANSUR, Antonio de Padua; HUEB, Whady Armino; TAKADA, Julio Yoshio; AVAKIAN, Solange Desiree; SOARES, Paulo Roberto; GARZILO, Cibele Larrosa; KALIL FILHO, Roberto; RAMIRES, Jose A. F.OBJECTIVES: Coronary artery disease is the leading cause of death in women. The proposed treatments for women are similar to those for men. However, in women with multivessel stable coronary artery disease and normal left ventricular function, the best treatment is unknown. METHODS: A post hoc analysis of the MASS II study with 10 years of follow-up, mean (standard deviation) 6.8 (3.7) years, enrolled between May 1995 and May 2000, evaluated 188 women with chronic stable multivessel coronary artery disease who underwent medical treatment, percutaneous coronary intervention or coronary artery bypass graft surgery. Primary end-points were incidence of total mortality, Q-wave myocardial infarction, or refractory angina. Data were analysed according to the intention-to-treat principle. RESULTS: Women treated with percutaneous coronary intervention and medical treatment had more primary events than those treated with coronary artery bypass graft surgery, respectively, of 34, 44 and 22% (P = 0.003). Survival rates at 10 years were 72% for coronary artery bypass graft surgery, 72% for percutaneous coronary intervention and 56% for medical treatment (P = 0.156). For the composite end-point, Cox regression analysis adjusted for age, diabetes, hypertension, treatment allocation, prior myocardial infarction, smoking, number of vessels affected and total cholesterol, had a higher incidence of primary events with medical treatment than with coronary artery bypass graft surgery [hazard ratio (HR) = 2.38 (95% confidence interval (CI): 1.40-4.05); P = 0.001], a lower incidence with percutaneous coronary intervention than with medical treatment [HR = 0.60 (95% CI: 0.38-0.95); P = 0.031] but no differences between coronary artery bypass graft surgery and percutaneous coronary intervention. Regarding death, a protective effect was observed with percutaneous coronary intervention compared with medical treatment [HR = 0.44 (95% CI: 0.21-0.90); P = 0.025]. CONCLUSIONS: Percutaneous coronary intervention and coronary artery bypass graft surgery compared with medical treatment had better results after 10 years of follow-up.
article 49 Citação(ões) na Scopus Diretriz de Doença Coronária Estável(2014) CESAR, LA; FERREIRA, JF; ARMAGANIJAN, D; GOWDAK, LH; MANSUR, AP; BODANESE, LC; SPOSITO, A; SOUSA, AC; CHAVES, AJ; MARKMAN, B; CARAMELLI, B.; VIANNA, CB; OLIVEIRA, CC; MENEGHETTI, C; ALBUQUERQUE, DC; STEFANINI, E; NAGIB, E; PINTO, IMF; CASTRO, I; SAAD, JA; SCHNEIDER, JC; TSUTSUI, JM; CARNEIRO, JKR; TORRES, K; PIEGAS, LS; DALLAN, LA; LISBOA, LAF; SAMPAIO, MF; MORETTI, MA; LOPES, NH; COELHO, OR; LEMOS, P; SANTOS, RD; BOTELHO, R; STAICO, R; MENEGHELLO, R; MONTENEGRO, ST; VAZ, VD