RODRIGO MOREL VIEIRA DE MELO
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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.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, RobertoconferenceObject 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, RobertoconferenceObject 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, RobertoBackground: 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.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, RobertoBackground: 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.conferenceObject Biomarkers Release After Percutaneous Coronary Intervention in Patients Without Definitive Miocardial Infarction Assessed by Cardiac Magnetic Ressonance With Late Gadolinium Enhancement. a Prospective Trial Using the Third Universal Definition of Myocardial Infarction(2014) MELO, Rodrigo M. Vieira de; OIKAWA, Fernando T.; COSTA, Leandro M.; REZENDE, Paulo C.; SCUDELER, Thiago L.; NOMURA, Cesar H.; VILLA, Alexandre V.; HUEB, Alexandre C.; HUEB, Whady; KALIL FILHO, RobertoconferenceObject Five year follow-up of on-pump versus off pump coronary artery bypass surgery in elderly patients - the MASS III trial(2012) MELO, R. M. Vieira De; REZENDE, P. C.; GARZILLO, C. L.; LIMA, E. G.; SEGRE, C. A. W.; COSTA, L. M. A.; OIKAWA, F. T.; HUEB, W.; RAMIRES, J. A. F.; KALIL FILHO, R.Purpose: 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. Thus, off-pump surgery may have an increased benefit in elderly patients. We aim to evaluate cardiac events and long-term clinical outcomes in elderly patients with stable coronary artery disease and preserved left ventricular ejection fraction undergoing off-pump and on-pump CABG. Methods: The MASS III was a single-center randomized trial that evaluate 308 patients with stable coronary artery disease and preserved ventricular function assigned for off-pump (n=155) or on-pump (n=153) CABG. Of this, 176 (58,3%) patients had 60 years or older at the time of randomization (of-pump=90 and on-pump=86). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), 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. After 5-year follow-up, there were no significant differences between on- pump and off-pump groups in the composite end points: 27,9% vs 21,1% (hazard ratio 1.17, 95% CI 0.87 to 1.59; P=0.29) Figure 1. Six patients (7.0%) died in the on-pump group compared with 10 (11.1%) in the of-pump group (hazard ratio 0.78, 95% CI 0.47 to 1.29; p=0.33). On-pump patients had a higher incidence of postoperative stroke or myocardial infarction: 13 (15.1%) vs 5 (5,6%); p=0,036. Conclusions: Patients undergoing off-pump surgery had a lower incidence of in hospital stroke or myocardial infarction. This finding did not add benefit in clinical outcomes at 5-years follow-up.conferenceObject Five years follow-up of on-pump versus off pump coronary artery bypass surgery in diabetic patients of the MASS III Trial(2012) COSTA, L. M. A.; GARZILLO, C. L.; REZENDE, P. C.; LIMA, E. G.; FAVARATO, D.; MELO, R. M. Vieira De; OIKAWA, F. T.; HUEB, W.; RAMIRES, J. A. F.; KALIL FILHO, R.Purpose: Diabetic patients represent one-third of coronary artery disease (CAD) patients, many of whom are treated with revascularization procedures. They are at increased risk, including long-term mortality, compared with non-diabetic patients. Few data are available on the effects of off-pump coronary artery bypass graft surgery (OPCAB) on cardiac events and long-term clinical outcomes in this population. Methods: MASS III is a single-center randomized trial that evaluate 308 patients with stable coronary artery disease and preserved ventricular function assigned for off-pump (n=155) or on-pump (n=153) CABG. The subgroup of 110 diabetic patients were randomly assigned to off pump CAB (n=56) and on-pump CAB (n=54). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), or stroke. Results: The two randomized groups were well-matched for major baseline demographic, clinical, and angiographic characteristics. After 5-year follow-up, the primary composite end point was not different between groups (event-free survival 83.7% x 93.7%, p= 0.15). Conclusions:In this analysis, off pump diabetic patients presented the same incidence of composite end-points compared with on-pump CABG.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, RobertoconferenceObject Long-Term Outcomes of Patients With Coronary Artery Disease and Type 2 Diabetes Mellitus With Chronic Kidney Disease Undergoing Surgery, Angioplasty, or Medical Treatment(2013) LIMA, Eduardo G.; GARZILLO, Cibele L.; REZENDE, Paulo C.; MELO, Rodrigo M.; SCUDELER, Thiago; CESAR, Luiz A.; HUEB, Alexandre C.; HUEB, Whady; RAMIRES, Jose A.; KALIL FILHO, Roberto