RAFAEL CAVALCANTE E SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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article 29 Citação(ões) na Scopus Non-invasive Heart Team assessment of multivessel coronary disease with coronary computed tomography angiography based on SYNTAX score II treatment recommendations: design and rationale of the randomised SYNTAX III Revolution trial(2017) CAVALCANTE, Rafael; ONUMA, Yoshinobu; SOTOMI, Yohei; COLLET, Carlos; THOMSEN, Brian; ROGERS, Campbell; ZENG, Yaping; TENEKECIOGLU, Erhan; ASANO, Taku; MIYASAKI, Yosuke; ABDELGHANI, Mohammad; MOREL, Marie-Angele; SERRUYS, Patrick W.Aims: The aim of this study was to investigate whether a Heart Team decision-making process regarding the choice of revascularisation strategy based on non-invasive coronary multislice computed tomography angiography (MSCT) assessment of coronary artery disease (CAD) is equivalent to the standard-of-care invasive angiography-based assessment in patients with multivessel CAD. Methods and results: The SYNTAX III Revolution trial is a prospective, multicentre, all-comers randomised trial that will randomise two Heart Teams to select between surgical and percutaneous treatment according to either an invasive conventional angiography or a non-invasive MSCT angiography assessment in patients with multivessel CAL). The treatment selection by each Hean Team will be guided by the SYNTAX score II calculation. The primary endpoint is the level of agreement according to kappa of the initial decision by die Heart Teams on the modality of the rcvascularisation based on MSCT and angiography assessments. Secondary endpoints include agreement on the number of vessels requiring treatment and the coronary segments in need of revascularisation. Conclusions: The SYNTAX III Revolution trial will provide valuable information regarding the ability of a purely non-invasive coronary anatomy assessment to select accurately the most appropriate revascularisation strategy for patients with multivessel CAD.- Misogyny in Heart Disease?(2015) SILVA, Rafael C.; LEMOS, Pedro A.
- Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease(2016) CAVALCANTE, Rafael; SOTOMI, Yohei; LEE, Cheol W.; AHN, Jung-Min; FAROOQ, Vasim; TATEISHI, Hiroki; TENEKECIOGLU, Erhan; ZENG, Yaping; SUWANNASOM, Pannipa; COLLET, Carlos; ALBUQUERQUE, Felipe N.; ONUMA, Yoshinobu; PARK, Seung-Jung; SERRUYS, Patrick W.BACKGROUND Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. RESULTS Study population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. CONCLUSIONS In patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM _ 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG. (C) 2016 by the American College of Cardiology Foundation.
- Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound(2016) CAVALCANTE, Rafael; BITTENCOURT, Marcio S.; PINHEIRO, Thais L.; FALCAO, Breno A. A.; MORAIS, Gustavo R.; SOARES, Paulo; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.Aims: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. Methods and results: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 +/- 0.7 vessels, comprising 123.8 +/- 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. Conclusions: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.
- Periprocedural myocardial infarction in stent trials: how universal is the third universal definition?(2016) CAVALCANTE, Rafael; SERRUYS, Patrick W.
conferenceObject Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data(2014) SILVA, Rafael C.; LIMA, Thais P.; FALCAO, Breno A.; MORAIS, Gustavo R.; SPADARO, Andre G.; MARIANI, Jose; RIBEIRO, Expedito E.; KALIL, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.- Upstream Clopidogrel, Prasugrel, or Ticagrelor for Patients Treated With Primary Angioplasty: Results of an Angiographic Randomized Pilot Study(2016) MONT'ALVERNE-FILHO, Jose R.; RODRIGUES-SOBRINHO, Carlos R. M.; MEDEIROS, Fernando; FALCAO, Francisco C.; FALCAO, Joao L.; SILVA, Rafael C.; CROCE, Kevin J.; NICOLAU, Jose C.; VALGIMIGLI, Marco; SERRUYS, Patrick W.; LEMOS, Pedro A.Objetives: The main objective of the present randomized pilot study was to explore the effects of upstream prasugrel or ticagrelor or clopidogrel for patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Background: Administration of clopidogrel ""as soon as possible"" has been advocated for STEMI. Pretreatment with prasugrel and ticagrelor may improve reperfusion. Currently, the angiographic effects of upstream administration of these agents are poorly understood. Methods: A total of 132 patients with STEMI within the first 12 hr of chest pain referred to primary angioplasty were randomized to upstream clopidogrel (600 mg), prasugrel (60 mg), or ticagrelor (180 mg) while still in the emergency room. All patients underwent protocol-mandated thrombus aspiration. Results: Macroscopic thrombus material was retrieved in 79.5% of the clopidogrel group, 65.9% of the prasugrel group, and 54.3% of the ticagrelor group (P=0.041). At baseline angiography, large thrombus burden was 97.7% vs. 87.8% vs. 80.4% in the clopidogrel, prasugrel, and ticagrelor groups, respectively (P=0.036). Also, at baseline, 97.7% presented with an occluded target vessel in the clopidogrel group, 87.8% in the prasugrel group and 78.3% in the ticagrelor group (P=0.019). At the end of the procedure, the percentages of patients with combined TIMI grade III flow and myocardial blush grade III were 52.3% for clopidogrel, 80.5% for prasugrel, and 67.4% for ticagrelor (P=0.022). Conclusions: In patients with STEMI undergoing primary PCI within 12 hr, upstream clopidogrel, prasugrel or ticagrelor have varying angiographic findings, with a trend toward better results for the latter two agents. (C) 2015 Wiley Periodicals, Inc.
- Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials(2017) CAVALCANTE, Rafael; SOTOMI, Yohei; MANCONE, Massimo; LEE, Cheol Whan; AHN, Jung-Min; ONUMA, Yoshinobu; LEMOS, Pedro A.; GEUNS, Robert-Jan van; PARK, Seung-Jung; SERRUYS, PatrickW.Aims To assess the impact of the SYNTAX scores I and II in outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for patients with diabetes and multivessel disease (MVD). Methods and results We performed a patient-level pooled analysis of three large randomized trials of patients with MVD. The impact of coronary anatomic complexity as measured by the SYNTAX score in the differences in outcomes following PCI and CABG was assessed at a median follow-up of 5 years. We also assessed the performance of the SYNTAX II score model in patients with and without diabetes. From the 3280 patients enrolled in the three trials, a total of 1068 (32.6%) had diabetes. The rate of the composite of death, myocardial infarction (MI), or stroke was similar in the PCI and CABG arms in patients with low-intermediate (<= 32) SYNTAX scores (15.1% vs. 14.9%, respectively; P = 0.93) while it was significantly higher in the PCI arm in patients with high (>= 33) SYNTAX scores (24.5% vs. 13.2%, respectively; P = 0.018). The SYNTAX score II showed good calibration and moderate discrimination ability in patients with diabetes (c-index = 0.68) as well as in those without (c-index = 0.67). Conclusions Differences in 5 years outcomes following PCI and CABG for patients with MVD and diabetes were influenced by anatomic complexity as measured by the SYNTAX score. The SYNTAX score II mortality prediction model showed similar performance regardless of the diabetes status.
- A Novel Algorithm to Quantify Coronary Remodeling Using Inferred Normal Dimensions(2015) FALCAO, Breno A. A.; FALCAO, Joao Luiz A. A.; MORAIS, Gustavo R.; SILVA, Rafael C.; LOPES, Augusto C.; SOARES, Paulo R.; MARIANI JR., Jose; KALIL-FILHO, Roberto; EDELMAN, Elazer R.; LEMOS, Pedro A.Background: Vascular remodeling, the dynamic dimensional change in face of stress, can assume different directions as well as magnitudes in atherosclerotic disease. Classical measurements rely on reference to segments at a distance, risking inappropriate comparison between dislike vessel portions. Objective: to explore a new method for quantifying vessel remodeling, based on the comparison between a given target segment and its inferred normal dimensions. Methods: Geometric parameters and plaque composition were determined in 67 patients using three-vessel intravascular ultrasound with virtual histology (IVUS-VH). Coronary vessel remodeling at cross-section (n = 27.639) and lesion (n = 618) levels was assessed using classical metrics and a novel analytic algorithm based on the fractional vessel remodeling index (FVRI), which quantifies the total change in arterial wall dimensions related to the estimated normal dimension of the vessel. A prediction model was built to estimate the normal dimension of the vessel for calculation of FVRI. Results: According to the new algorithm, ""Ectatic"" remodeling pattern was least common, ""Complete compensatory"" remodeling was present in approximately half of the instances, and ""Negative"" and ""Incomplete compensatory"" remodeling types were detected in the remaining. Compared to a traditional diagnostic scheme, FVRI-based classification seemed to better discriminate plaque composition by IVUS-VH. Conclusions: Quantitative assessment of coronary remodeling using target segment dimensions offers a promising approach to evaluate the vessel response to plaque growth/regression.
conferenceObject Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data(2014) SILVA, Rafael C.; FALCAO, Breno A.; LIMA, Thais P.; MORAIS, Gustavo R.; ROCHITTE, Carlos E.; SPADARO, Andre G.; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; LEMOS, Pedro A.