LEANDRO MENEZES ALVES DA COSTA
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- 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, RobertoOBJECTIVES: 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.
- Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients(2015) REZENDE, Paulo Cury; RAHMI, Rosa Maria; UCHIDA, Augusto Hiroshi; COSTA, Leandro Menezes Alves da; SCUDELER, Thiago Luis; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; SEGRE, Carlos Alexandre Wainrober; GIRARDI, Priscyla; TAKIUTI, Myrthes; SILVA, Marcela Francisca; HUEB, Whady; RAMIRES, Jose Antonio Franchini; FILHO, Roberto KalilBackground: The influence of diabetes mellitus on myocardial ischemic preconditioning is not clearly defined. Experimental studies are conflicting and human studies are scarce and inconclusive. Objectives: Identify whether diabetes mellitus intervenes on ischemic preconditioning in symptomatic coronary artery disease patients. Methods: Symptomatic multivessel coronary artery disease patients with preserved systolic ventricular function and a positive exercise test underwent two sequential exercise tests to demonstrate ischemic preconditioning. Ischemic parameters were compared among patients with and without type 2 diabetes mellitus. Ischemic preconditioning was considered present when the time to 1.0 mm ST deviation and rate pressure-product were greater in the second of 2 exercise tests. Sequential exercise tests were analyzed by 2 independent cardiologists. Results: Of the 2,140 consecutive coronary artery disease patients screened, 361 met inclusion criteria, and 174 patients (64.2 +/- 7.6 years) completed the study protocol. Of these, 86 had the diagnosis of type 2 diabetes. Among diabetic patients, 62 (72%) manifested an improvement in ischemic parameters consistent with ischemic preconditioning, whereas among nondiabetic patients, 60 (68%) manifested ischemic preconditioning (p = 0.62). The analysis of patients who demonstrated ischemic preconditioning showed similar improvement in the time to 1.0 mm ST deviation between diabetic and nondiabetic groups (79.4 +/- 47.6 vs 65.5 +/- 36.4 s, respectively, p = 0.12). Regarding rate pressure-product, the improvement was greater in diabetic compared to nondiabetic patients (3011 +/- 2430 vs 2081 +/- 2139 bpm x mmHg, respectively, p = 0.01). Conclusions: In this study, diabetes mellitus was not associated with impairment in ischemic preconditioning in symptomatic coronary artery disease patients. Furthermore, diabetic patients experienced an improvement in this significant mechanism of myocardial protection.
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- Conservative strategy for treatment of stable coronary artery disease(2015) REZENDE, Paulo Cury; SCUDELER, Thiago Luis; COSTA, Leandro Menezes Alves da; HUEB, WhadyPatients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.
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 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 Usefullness of Early Release Peak of Cardiac Biomarkers for Detection of Myocardial Infarction Related to Coronary Revascularization Procedures. A Cardiac Magnetic Resonance Study(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 Prognostic Value of Exercise Stress Testing in Patients With Multivessel Coronary Disease Undergoing Medicine, Angioplasty or Surgery: 10-year Follow-Up of the Mass II Trial(2013) GARZILLO, Cibele L.; REZENDE, Paulo C.; LIMA, Eduardo G.; UCHIDA, Augusto H.; SANTOS, Cibelle D.; CESAR, Luiz A.; COSTA, Leandro M.; HUEB, Whady; RAMIRES, Jose A.; KALIL FILHO, RobertoconferenceObject Measurement of Myocardial Necrosis Biomarkers After Surgical or Percutaneous Intervention Assessed by Cardiac Magnetic Resonance for Diagnosis of Procedure-Related Myocardial Infarction. The MASS-5 Trial(2014) HUEB, Whady; REZENDE, Paulo C.; COSTA, Leandro M.; MELO, Rodrigo M. Vieira de; OIKAWA, Fernando T.; NOMURA, Cesar H.; VILLA, Alexandre V.; STRUNZ, Celia M.; HUEB, Alexandre C.; SILVA, Expedito E.; RAMIRES, Jose A.; KALIL FILHO, RobertoconferenceObject Elevation of Myocardial Necrosis Biomarkers After Surgical or Percutaneous Intervention Assessed by Cardiac Magnetic Resonance With Late Gadolinium Enhancement for Diagnostic of Procedure-Related Myocardial Injury. A Prospective Study Using the Third Definition of Myocardium Infarction(2013) HUEB, Whady; COSTA, Leandro M.; OIKAWA, Fernando T.; MELO, Rodrigo M.; REZENDE, Paulo C.; NOMURA, Cesar H.; MARQUES FILHO, Ismar; CESAR, Luiz A.; RAMIRES, Jose A.; KALIL FILHO, Roberto