JAIME PAULA PESSOA LINHARES FILHO
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- Dual platelet antiaggregation therapy after myocardial revascularization surgery(2019) FEITOSA, Mateus Paiva Marques; SOFFIATTI, Carla David; LINHARES FILHO, Jaime Paula Pessoa; BATISTA, Daniel Valente; LOBO FILHO, Heraldo Guedis; LIMA, Eduardo Gomes; SERRANO JUNIOR, Carlos VicenteCoronary artery bypass graft (CABG) is a consolidated treatment in patients with coronary artery disease (CAD) for both symptom control and improvement of prognosis. The patency of venous grafts is still the most vulnerable point of the surgical treatment since it presents a high prevalence of occlusion both in the immediate postoperative period and in the long-term follow-up. Aspirin plays a well-established role in this setting, and for a long time, clopidogrel use has been restricted to patients allergic to aspirin. Recently, subgroup analyses of studies with different anti-platelet therapies have shown reduced mortality and cardiovascular events in patients on dual anti-platelet antiplatelet therapy (DAPT) undergoing CABG, although such studies have not been designed to evaluate this patient profile. However, there is still an insufficient number of randomized studies using DAPT in this context, resulting in a disagreement between the European and American cardiology societies guidelines regarding their indication and generating doubts in clinical practice.
- Critical analysis of the classic indications for myocardial revascularization(2019) AZEVEDO, Diogo Freitas Cardoso de; LIMA, Eduardo Gomes; RIBEIRO, Matheus de Oliveira Laterza; LINHARES FILHO, Ijaime Paula Pessoa; SERRANO JUNIOR, Carlos VicenteTreatment of stable coronary artery disease (CAD) relies on improved prognosis and relief of symptoms. National and international guidelines on CAD support the indication of revascularization in patients with limiting symptoms and refractory to optimal medical treatment, as well as in clinical situations where there is a prognostic benefit of interventional treatment. Most of the studies that support the guidelines for indication of revascularization date back to the 1980s and 1990s of the last century. Recent studies have revisited the theme and brought a new breath. The present review provides a critical analysis of classic indications for revascularization, reviewing evidence from the studies of the 1970s to the recent controversial ORBITA study.
- CULPRIT-SHOCK study(2018) SOUZA JUNIOR, Jorge Mangabeira de; KULCHETSCKI, Rodrigo Melo; LINHARES FILHO, Jaime Paula Pessoa; LIMA, Eduardo Gomes; SERRANO JUNIOR, Carlos VicenteThe treatment of patients with ST-segment elevation myocardial infarction concomitant with the presence of multivessel disease has been studied in several recent studies with the purpose of defining the need, as well as the best moment to approach residual lesions. However, such studies included only stable patients. The best therapeutic approach to cardiogenic shock secondary to acute coronary syndrome, however, remains controversial, but there are recommendations from specialists for revascularization that include nonevent related injuries. Recently published, the CULPRIT-SHOCK study showed benefit of the initial approach only of the injury blamed for the acute event, in view of the multivessel percutaneous intervention, in the context of cardiogenic shock. In this perspective, the authors discuss the work in question, regarding methodological questions, limitations and clinical applicability.
- Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics(2017) LIMA, Eduardo Gomes; CARVALHO, Felipe Pereira Camara de; LINHARES FILHO, Jaime Paula Pessoa; PITTA, Fabio Grunspun; SERRANO JR., Carlos VicenteCoronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.