LEANDRO MENEZES ALVES DA COSTA

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Revista / Livro: Journal of the American College of Cardiology ×

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    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
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    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.
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    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.
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    COST-EFFECTIVENESS ANALYSIS AND QUALITY OF LIFE OF ON-PUMP AND OFF-PUMP STABLE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTING: MASS III TRIAL 5-YEAR FOLLOW-UP
    (2017) SCUDELER, Thiago; HUEB, Whady; SOAREZ, Patricia Coelho De; CAMPOLINA, Alessandro G.; REZENDE, Paulo; LIMA, Eduardo; GARZILLO, Cibele Larrosa; FREITAS, Diogo Freitas Cardoso; COSTA, Leandro; OIKAWA, Fernando Teiichi; RAMIRES, Jose; KALIL FILHO, Roberto